CQC report explained · a residential care home
What the CQC found at Byron Lodge
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- People received medicines safely and as prescribed, and there were enough staff to support people safely. Inspectors noted that recording the use of as-needed creams could be more consistent.
- Effective?
- Good
- Staff had completed induction and relevant training, and people received appropriate health and nutritional support. Inspectors said instructions for rotating one person's feeding tube could be more specific.
- Caring?
- Good
- Staff knew people's personalities and needs and supported them in a patient, respectful way. People were involved in decisions and were supported to develop and maintain independence.
- Responsive?
- Good
- Care plans were detailed, personalised and reviewed regularly. People took part in activities they chose, maintained relationships and had a clear complaints process.
- Well-led?
- Good
- The management team used audits, meetings and feedback to monitor the service. Inspectors said these systems had improved, although the medication audits had not identified the inconsistent recording of creams.
What inspectors found, February 2019
Byron Lodge was rated Good in all five areas; inspectors found safe, kind and personalised care, with a few records needing improvement.
Inspectors visited on 8 and 9 January 2019. The first day was unannounced. They spoke with people living at the home, staff, managers and a health professional, and reviewed care plans, medicines records, staff files and quality checks.
The home was meeting the legal requirements at this inspection. People were supported safely, treated with respect and involved in decisions. Staff were trained, there were enough staff, and people received support with food, activities, health care and maintaining independence.
The home had improved since the October 2017 inspection. Earlier problems with medicines, staffing arrangements and quality monitoring had been addressed. Inspectors still found some smaller recording issues, including records for as-needed creams and instructions about rotating a feeding tube.
Kind and respectful staff
People said staff were easy to speak to and kind. Inspectors observed patient and respectful support, with staff understanding people's personalities and communication needs.
“People were treated with dignity and respect.” from the report
Personalised support
Care plans contained detailed information about people's needs, preferences and ways of reducing anxiety. Plans were reviewed monthly or when circumstances changed.
“Care plans were detailed and personalised to people's needs.” from the report
Improved safety
The home had improved how it managed medicines, staffing and risks since the previous inspection. Inspectors found medicines were stored and given safely and staffing levels were adequate.
“The provider had made the required improvements since the last inspection to help ensure medicines were managed and stored safely.” from the report
Independence and activities
People were supported to make choices, prepare food, manage tasks and take part in activities inside and outside the home. Activities were linked to their interests and goals.
“People were engaged in meaningful activities and recreation within and outside of the home, which they had been involved in planning.” from the report
Open management
People, relatives and staff described the management as approachable. Families had opportunities to give feedback through questionnaires and a family forum.
“The culture at Byron Lodge was open and transparent.” from the report
As-needed cream records
needs fixingRecords showing when as-needed creams were applied were not always consistent. Inspectors discussed this with the manager, who said advice would be sought about a better recording method.
“However, we found the recording of 'as required' creams could be more consistent.” from the report
Feeding tube instructions
needs fixingThe instruction about rotating one person's feeding tube was not specific enough to ensure staff followed it consistently. The records showed the rotation had been completed and there was no sign of infection.
“We found however the requirement for rotating the PEG each day could be more specific to help ensure staff did this consistently.” from the report
Covert medicine instruction
needs fixingInspectors found that one medicine should not be crushed, but the written instruction did not explain clearly how it would be given covertly. They asked the home to review this with the pharmacist and GP.
“However, we asked the registered manager to review this issue with the pharmacist and the GP.” from the report
- 01How do you now record when as-needed creams are applied, and who checks these records?
- 02What advice did you receive from the pharmacist and GP about giving the medicine that should not be crushed?
- 03How do you make sure feeding tube rotation instructions are clear and followed consistently?
- 04How are staffing levels and the mix of staff skills checked when people's needs change?
- 05How will my relative and our family be involved in care reviews, activities and feedback?
This was a comprehensive inspection covering Safe, Effective, Caring, Responsive and Well-led, and included checks of care, medicines, staffing, records and management systems. This explanation was written from the published report of 2 February 2019 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, January 2018
Byron Lodge was rated Requires Improvement; inspectors found kind, personalised care, but medicines, stoma care and management checks were not reliable enough.
This was the first inspection since the home was registered. It was unannounced and took place on 19 and 23 October 2017. Inspectors observed care, spoke with people, relatives and staff, and checked care records, medicines records, rotas, training and management audits.
People were treated with dignity and respect. Care plans were detailed and personalised. Staff understood people's needs, supported their independence and responded to complaints in a timely way. The home was clean, and people said they felt safe.
Inspectors found problems with medicines records and the safe supply of stoma care. Some staff training was incomplete. High staff turnover and agency use affected continuity of care. Management audits had not found some of these problems, so the overall rating and the Safe and Well-led ratings were Requires Improvement. Effective, Caring and Responsive were rated Good.
Kind and respectful care
Inspectors saw positive interactions. People were offered choices about their daily routines and were treated with dignity and respect.
“We observed positive and kind interactions throughout the day.” from the report
Personalised support
Care plans described people's needs, preferences, routines and ways to reduce anxiety. They also supported personal goals and independence.
“Support plans were individualised and were regularly reviewed.” from the report
Supporting independence
People were supported with activities, family visits and community access. Risk assessments were used to help some people go out independently.
“This meant that the service encouraged and supported people to remain independent whilst managing risks and maintaining peoples safety.” from the report
Good complaint handling
The complaints reviewed by inspectors had been dealt with appropriately and promptly.
“Complaints were responded to in a timely manner and positive outcomes sought” from the report
Recruitment checks
The staff files checked contained the required background checks, references and employment history.
“From the three staff personnel files we viewed, we saw the required checks had been made including a Disclosure and Barring Service Check (DBS) and two references” from the report
Medicines were not always safely managed
seriousRecords for creams and 'when required' medicines were incomplete. The person assessing medicines competence had not received formal training, and recent administration mistakes had occurred.
“Medicines were not managed safely and the provider did not assure themselves that the staff they deployed to carry out this task was competent to do so.” from the report
Stoma care supply failure
seriousThe home ran out of stoma bags, causing a one-day delay in changing one person's stoma. Inspectors said this could adversely affect the person's physical and mental health.
“The provider did not ensure this person's stoma care was safely managed.” from the report
Management checks missed problems
seriousLocal audits had not identified the medicines and training issues found by inspectors. The report also questioned whether improvements made by temporary managers could continue.
“The internal audits had not identified the issues we found at this inspection with regards to medicines management and staff training.” from the report
Incomplete staff training
needs fixingOnly five of 24 staff had received fire safety training, and only one had received diabetes training, although people living at the home had diabetes.
“We found however that five staff from 24 staff members had received fire training and one staff member had received training in the management of diabetes.” from the report
Staffing instability
needs fixingHigh staff turnover and agency use meant people did not always have continuity of care. The rota had improved by the inspection, but permanent management posts still needed to be filled.
“A high turnover of staff and high agency usage had meant the service didn't always offer continuity of care to people living at Byron Lodge.” from the report
- 01How are 'when required' medicines and creams now recorded and audited?
- 02What checks make sure every staff member giving medicines has been trained and had their competence observed?
- 03How do you make sure stoma bags and other essential supplies are ordered in time?
- 04How many staff have now completed fire safety and diabetes training?
- 05What is the current level of agency staffing, and how are you maintaining continuity of care?
This was an unannounced first inspection covering all five CQC questions and the overall quality of the home. This explanation was written from the published report of 17 January 2018 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Byron Lodge
2 rated inspections over a year: the service has improved, from Requires improvement to Good.
- February 2019Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- January 2018Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- September 2015
Registered with the Care Quality Commission on 30 September 2015.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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