We carried out an unannounced comprehensive inspection of Byrnhill Grove on the 19 & 25 January 2017.

Byrnhill Grove is a care home situated in a sheltered accommodation complex in Ventnor on the Isle of Wight and is registered to provide accommodation with personal care for up to 17 people who have needs associated with advanced age and early stage dementia. At the time of our inspection there were 11 people living in the home.

There was a registered manager in place at the home. A registered manager is a person who has registered with the Care Quality Commission to manage the home. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the home is run.

People and their families told us they felt the home was safe. Staff and the management team had received safeguarding training and were able to demonstrate an understanding of the provider’s safeguarding policy and explain the action they would take if they identified any concerns.

The risks relating to people’s health and welfare were assessed and these were recorded along with actions identified to reduce those risks while promoting choice and independence.

There were systems in place to monitor the quality of the care provided and the safety of the environment. Accidents and incidents were monitored and analysed and remedial actions identified to reduce the risk of reoccurrence.

People were supported by staff who had received an induction into the home and appropriate training, professional development and supervision to enable them to meet people’s individual needs. There were enough staff to meet people’s needs and the staffing levels in the home provided an opportunity for staff to interact with the people they were supporting in a relaxed and unhurried manner.

There were suitable systems in place to ensure the safe storage and administration of medicines. Medicines were administered by staff who had received appropriate training and assessments. Healthcare professionals, such as chiropodists, opticians, GPs and dentists were involved in people’s care when necessary.

Staff sought verbal consent from people before providing care and followed legislation designed to protect people’s rights.

Staff developed caring and positive relationships with people. Staff were sensitive to people’s individual choices and treated them with dignity and respect. People were encouraged to be as independent as possible.

People were supported to have enough to eat and drink. Mealtimes were a social event and staff supported people, when necessary in a patient and friendly manner while promoting their independence.

People were provided with appropriate mental and physical stimulation and had access to activities that were important to them. Staff were knowledgeable about people’s right to choose the types of activities they liked to do, and respected their choice.

There was an opportunity for people and their families to become involved in developing the service and they were encouraged to provide feedback on the service both informally and formally.

People and relatives were able to complain or raise issues on a formal and informal basis with the registered manager and were confident these would be resolved. This contributed to an open culture within the home. Visitors were welcomed and there were good working relationships with external professionals.

People and their families told us they felt the home was well-led and were positive about the registered manager who understood the responsibilities of their role.

An adult social care inspector carried out this inspection. We considered all the evidence we had gathered under the outcome we inspected. We spoke with three people using the service. We also spoke with a senior member of staff and three other staff. We used the information to answer the question we always ask;

Is the service safe?

This is a summary of what we found-

Is it safe?

At our last inspection in July 2014, we found some risks associated with the security of the building and hazards in the surrounding grounds had not been assessed or mitigated. We asked the provider to tell us what they were going to do to meet the requirements of the law in relation to the safety and security of the premises.

At this inspection we found security arrangements at the home had been improved. Visitors were required to use an intercom system to gain access to the building. Staff we spoke with were aware of the need to always ask visitors for identification before allowing them into the home, and we saw this in practice during our inspection.

Risk assessments had been produced to ensure that people living in the home were safe. These covered a range of risks including trailing wires from television equipment and security in hot weather when doors to the outside area would be left open for ventilation. Further measures to increase security had been requested from the provider and we saw these were in progress.

An emergency plan had been prepared which staff were familiar with, and all staff we spoke with knew what to do in the event that the fire alarm sounded. We spoke with three people using the service. All of them said they felt safe and secure in the home. One person said, “I feel very safe here. I am very glad I am here”.

We considered all the evidence we had gathered under the outcomes we inspected. We spoke with 14 people using the service and a visitor. We also spoke with three staff, the registered manager and a representative of the provider. During this inspection we looked at outcomes relating to people’s care and welfare, the safeguarding of vulnerable adults and the safety and suitability of the premises. We also looked at staff training and support and the home’s quality assurance processes. We used the information to answer the five questions we always ask;

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led?

This is a summary of what we found-

Is it safe?

People were cared for in a safe manner. Care plans were clear and informative. The premises had been designed to ensure enough light, heat and space were available to people. Individual risks to people’s health and welfare had been assessed and actions put in place to mitigate the risks. However, some risks, such as those associated with the security of the building and hazards in the grounds of the building, had not been assessed or mitigated.

Staff assisted people to move around the home safely. Changes to people’s health and welfare were recorded and appropriate action was taken to ensure people received medical attention where necessary.

Staff had received training in the safeguarding of vulnerable adults and were aware of the signs to look for if they suspected a person had been abused. Staff knew how to report suspected abuse. People told us they felt safe in the home and with staff. One person said, “There is no reason to not feel safe”.

The manager was aware of their responsibilities under the Mental Capacity Act (MCA). No applications had been made under the Deprivation of Liberty Safeguards (DoLS) however, the manager knew the procedures to follow should this be necessary.

Is it effective?

Daily records of care showed people were cared for according to their care plan and assessed needs. Staff we spoke with were fully aware of people’s care requirements and how to meet them. Staff training needs had been identified and these had been provided to enable staff to deliver individualised care.

People told us they received the care they required. One person said, “They really take care of you here”. Another person said, “I wouldn’t change a thing”.

Is it caring?

We observed staff to be caring and kind to people living in the home. Communication with people was friendly and a jovial atmosphere was present in the home. Provision of sun protection, such as sun screen and hats, was available to people so they could enjoy the outside space safely during the recent hot weather. Activities were planned, with the input of people living in the home, and adapted games had been purchased to enable everyone to be involved should they wish. For example, large sized playing cards and board games meant people with poor eyesight could participate.

People told us staff were caring. One person said, “They are very caring girls”. Another person told us, “The staff couldn’t do more for you”.

Is it responsive?

Systems were in place to ensure people’s complaints and comments were acted on. Feedback was sought from staff, people using the service, and their relatives. This was acted on. For example, items for the garden had been purchased, and activities planned, in response to feedback from people. Staff told us the manager and deputy manager were open to suggestions for improvement, and support was always available to them. Comments and complaints were responded to according to the home’s complaints policy, although the majority of people said they had no complaints at all.

An effective system was in place to ensure the prompt involvement of medical professionals in people’s care when this was required.

Is it well-led?

Quality assurance systems were in place and these were used to ensure improvements were made to the service. These included a monthly inspection report which was sent to the provider. Actions were recorded and we saw these were completed in a timely manner. Staff were clear about the management structure. Staff supervisions were carried out regularly and staff told us they felt supported by the management.

We spoke with five of the 16 people living at Byrnhill Grove and met three other people living there. Everyone we spoke with was happy with the care they received. One person said “it’s lovely here”. Another told us “I couldn’t be happier”. We also spoke with two relatives. One told us “the care is fantastic”.

We observed care in the communal areas of the home. We saw staff were respectful to people and promoted a friendly and jovial atmosphere. People had access to drinks throughout the day and the meal served at lunchtime looked appetising. People we spoke with said they enjoyed the food.

We spoke with three care staff. They were fully aware of people’s needs and how to support them. We observed staff offering people choices and gaining informal consent from people before providing support. All parts of the home we viewed were clean and infection prevention and control measures were in place.

We viewed two staff records. These contained all the relevant information and checks carried out before employment commenced. Feedback from staff, people using the service and their relatives was sought regularly and action was taken following this to improve the service.

We spoke with three people who used the service. They told us staff always checked they were happy to receive care before it was delivered. One said, “They never force me to do anything I don’t want to do”.

People’s needs were assessed and care was planned and delivered in line with their individual care plan. We looked at three care plans and saw they contained detailed information about each person, including their preferences and interests. People told us their needs were met, and they had full control over their daily routines. One person told us, “They look after me very well”. A visiting family member said, “They are excellent here”.

Appropriate arrangements were in place for obtaining and recording medicines. We checked seven medicines and found all but one had been administered as prescribed and correctly recorded. Medication was stored securely. Staff who administered medicines were trained, and had been assessed as competent.

Staff were supported to deliver care and treatment to an appropriate standard. We spoke to three members of staff and saw records which showed they received regular supervision and appraisal. Staff were also encouraged to gain further qualifications.

The provider regularly assessed and monitored the quality of service delivered. We looked at records of residents’ surveys and meetings, and saw improvements made as a result of people’s comments. A range of audits were also conducted, which had led to the purchase of new equipment.