This inspection took place on 5 September 2018 and was unannounced.

Byron Lodge is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The home can accommodate a maximum of 61 older people. There were 31 people living at the home at the time of our inspection.

There was a manager in post at the time of our inspection. The manager had been appointed since our last inspection and their registration with CQC was in progress. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

At the last inspection on 25 June 2018, we found the previous provider was breaching regulations in relation to consent and governance. After the inspection, the previous provider sent us an action plan telling us how they planned to make improvements. Since that time a new provider had taken ownership of the home. At this inspection, we found the necessary improvements had been made to addresses the previous regulatory breaches. This has helped to improve the service's overall rating to 'Good.' The provider, manager and staff had all worked together to achieve these improvements.

The tools used to assess people's capacity had improved, which meant they were effective in identifying when people may need support to make decisions. People's care plans were personalised and reflected all aspects of their care. Staff had clear guidance to follow about how to provide the care and support people needed.

People and relatives were complimentary about the caring nature of staff and the positive atmosphere. People had developed positive relationships with the staff who cared for them and enjoyed their company. Many staff had worked at the home for some years and knew the people they cared for and their relatives well. Friends and families were encouraged to be involved in the home.

The provider and manager formed a strong leadership team and provided good support to staff. Staff were committed to providing high quality care and felt valued by the provider and manager for the work they did. Staff had the training and support they needed to perform their roles. They worked well as a team to ensure that people received good care.

People's care was regularly reviewed with them and staff were appropriately deployed throughout the home so that people received the timely support they needed. They were cared for by staff that knew what was expected of them and the staff carried out their duties effectively. Staff were friendly, kind and compassionate. They had insight into people's capabilities and support needs. They respected people's diversity and how they wished to receive their care.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People that needed support to manage their medicines received this. People were supported to eat and drink whenever this was part of their agreed plan of care. They were provided with a nutritious diet that took into account their tastes and preferences. Their dietary needs were assessed and monitored and appropriate external healthcare professionals, such as the dietician, were consulted when needed.

Staff treated people with respect and supported them to maintain their independence. People had access to a wide range of activities and outings and to be involved in their local community. Staff ensured that no one became socially isolated.

The service worked in partnership with other agencies to ensure quality of care acro

We inspected this service on 25 June 2018. The inspection was unannounced.

Byron Lodge is a 'care home'. People in care homes receive accommodation and nursing or personal care as single packages under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Byron Lodge is a nursing home that accommodates up to 61 older people with varying support needs, including nursing and people living with dementia. Accommodation is provided at the service over two floors. There were 30 people using the service at the time of our inspection.

At our last inspection on 18 and 19 October 2017, we identified significant failings and multiple breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches were in relation to safe care and treatment, staffing, medicines, infection control, need for consent, meeting nutritional and hydration needs, person-centred care and good governance.

Following the last inspection, the provider sent us an action plan to tell us what action they would take to meet these breaches in regulation.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection, the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

Since our last inspection, the registered manager had left the service. A new manager was in place and they were in the process of submitting their registered manager application. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered persons.' Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At this inspection, we found the provider was still not meeting the requirements of Regulation 17. Quality assurance systems and procedures were in place but had not enabled them to effectively identify and address the shortfalls we identified during our inspection. We also identified a breach of Regulations 11 of the Health and Social Care 2008 (Regulated Activities) Regulations 2014. The provider had not always sought people's consent and acted in accordance with the requirements of the Mental Capacity Act 2005.

Risks associated with people's needs had been assessed and planned for. Improvements had been made to how risks were managed. However, further time was required for improvements in documentation and monitoring to be embedded and sustained. Audits and checks in relation to risks associated with the environment had been monitored and equipment was safe and met people's needs.

Staff were aware of their responsibility to protect people from avoidable harm and safeguarding incidents had been acted upon. There were sufficient staff available to meet people's needs although the deployment of staff could be improved. Safe staff recruitment checks were in place and followed. Overall improvements had been made with the management of medicines and infection control; some shortfalls were identified that required further attention. Accidents and incident were recorded and analysed to consider lessons learnt.

We saw that staff obtained people's consent before providing care to them. Where people could not consent, assessments to ensure decisions were made in people's best interest had not been consistently completed. People's food and hydration needs were met and choices offered and respected. People's health care needs were assessed, planned for and monitored, but information available to staff to support these needs were not always clearly recorded.

People had

The inspection took place on 18 and 19 October 2017 and was unannounced on the first day. The last comprehensive inspection took place in March 2017, when we identified breaches across all domains. The service was rated inadequate and placed in special measures. This inspection took place to check if improvements had been made. We found that the provider had failed to make or sustain sufficient improvements. You can read the report from our last inspections, by selecting the 'all reports' link for ‘Byron Lodge’ on our website at www.cqc.org.uk.

Byron Lodge is a care home providing accommodation for up to 61 people. It is situated in the area of West Melton, approximately six miles from Rotherham town centre. It provides accommodation on both the ground and the first floor and has parking to the front of the building and a secure accessible garden at the rear. The home is split up in to four units; Shakespeare and Ruskin providing nursing care and Wordsworth and Browning providing residential care. At the time of our inspection these were 44 people using the service.

At the time of our inspection there was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. 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 service is run.

Following the inspection Byron Lodge Care Home have notified the Care Quality Commission of a serious incident which is currently being investigated by the Safeguarding Authority.

The home had a dependency tool in place in care records which identified the level of support people who used the service required from staff. We observed staff interacting with people during our inspection and found there were times when the deployment of staff could have been managed more effectively. We spoke with people who used the service, relatives, visiting professionals and staff. They all felt there were not enough staff to meet people’s needs in a safe way.

Systems were in place to manage medicines safely. However, we found these were not always followed to ensure people received their medicines as prescribed.

Assessments identified risks to people and management plans to reduce the risks were in place to ensure people’s safety. However, we found these were not always followed.

The provider had a safeguarding procedure to ensure people were protected from abuse. However, some concerns had not been reported to the safeguarding authority.

Systems in place for infection prevention and control were not effective. The environment was not well maintained and therefore, could not be effectively cleaned.

We found that staff received training and support, but this was not always effective. For example staff had completed dementia training but lacked knowledge about assisting people who were living with dementia. Staff told us they did not feel supported by their managers and did not receive effective supervision.

We found the service was not always meeting the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). We found people’s best interests were not always clearly documented, did not always involve all relevant people and did not clearly detail the outcome. Decisions recorded were sometimes very general and not specific.

Mealtimes were relaxed and calm; however, staff did not always ensure people received adequate nutrition. Some people required a fortified diet to ensure they received adequate nutrition. There was little evidence to show that this need had been fulfilled. Some people’s food preferences were not respected.

We observed staff interacting with people and found they were kind and caring, but only interacted with people when carrying out a task. We also saw that staff had not recognised that some people were distressed

The inspection took place on 6 and 9 March, 2017 and was unannounced on the first day. The home was previously inspected in June 2016, when we identified a breach in Regulation 17, good governance. At the time the service was rated overall requires improvement. Previously the service had been rated inadequate. We brought this inspection forward due to concerns we had received about the service.

Byron Lodge is a care home providing accommodation for up to 61 people. The home has four units, Browning and Wordsworth which provide residential care and Ruskin and Shakespeare which provide nursing care. The home is situated in the West Melton area and is approximately six miles from Rotherham town centre.

The service did not have a registered manager in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service. 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 service is run. However, the deputy manager had been promoted to this position and was in the early stages of registering with the Care Quality Commission.

We found risks had been identified and measures put in pace to manage the risk. However, we found the risks were not always managed so people were at risk of harm. This showed the provider was not doing all that was reasonably practicable to mitigate risks associated with people’s care and treatment.

The provider did not have safe arrangements in place for managing medicines. We found that people did not always receive their medicines as prescribed. We found people were prescribed medication to be taken as and when required known as PRN (as required) medicine. However, there was a lack of protocols in place to guide staff in how these should be administered. The temperatures of the rooms used to store medicines was not always monitored or recorded to determine that they maintained the required temperatures. We also saw the fridge temperatures were not always recorded. It was therefore not evident if the required temperatures were maintained.

The premises and equipment used by people were not always clean and/or properly maintained. During our inspection we looked around the service. We found many areas were not kept clean and infection prevention and control policies were not adhered to. For example, store rooms were cluttered and not well organised. Many items were stored on the floor, which meant they were difficult to clean. We saw several dining chairs throughout the service which had ripped seats which could not be cleaned effectively. Other chairs were stained and marked.

We saw moving and handling slings were not labelled or stored appropriately. This meant the staff could not easily access them or know which size sling to use to ensure the correct sling was used for each person requiring moving with the mechanical hoist. Staff we spoke with were unsure of which sling was to be used for each person.

Overall, people we spoke with said there were enough staff on duty to meet people’s needs. However, some people felt that additional staff were needed. From our observations we found that there was enough staff around on the days we completed our inspection. However, we found staff lacked leadership, direction and were not deployed in an effective manner. This meant that people’s needs were not always met in a timely manner.

Some staff had not received appropriate support, supervision and appraisal necessary for them to carry out their duties. Staff were not always knowledgeable about people’s needs and there were some gaps in the training record.

Decisions made where people lacked capacity did not follow best practice and did not evidence decisions were made in a person’s best interest. We identified people’s conditions in relation to the authorised Deprivation of Lib

The inspection took place on 14 June 2016 and was unannounced. Our last comprehensive inspection at this service took place in October 2015 when breaches of legal requirements were identified. We asked the provider to send us an action plan outlining how they would meet these breaches. You can read the report from our last inspections, by selecting the 'all reports' link for ‘Byron Lodge’ on our website at www.cqc.org.uk.

Byron Lodge is a care home providing accommodation for up to 61 people. It is situated in the area of West Melton, approximately six miles from Rotherham town centre. It provides accommodation on both the ground and the first floor and has parking to the front of the building and a secure accessible garden at the rear. The home is split up in to four units; Shakespeare and Ruskin providing nursing care and Wordsworth and Browning providing residential care. At the time of the inspection there were 49 people using the service.

The service did not have a registered manager in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service. 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 service is run. The provider had employed a manager who was in the process of registering with the Care Quality Commission.

Following our last inspection of the service in October 2015, the home was rated inadequate and placed in special measures. The provider sent us an action plan explaining how they would address this and sent regular updates showing the progress they were making. We continued to liaise with the local authority and monitored intelligence we received about the home. At our inspection of 14 June 2016, we saw that a new management team was in place and improvements had been made.

Systems were in place to ensure people received their medications in a safe and timely way from staff who had been trained to carry out this role. However, we identified these had not always been followed.

The staff we spoke with were very knowledgeable on safeguarding and whistle blowing policies and procedures.

We looked at people’s records and found they identified risks associated with people’s care and treatment. However, these were not always reviewed to ensure they were a current reflection of the person’s needs.

The provider had a safe recruitment procedure in place which involved pre-employment checks being made prior to the person commencing employment.

People were supported to eat and drink sufficient to maintain a balanced diet and snacks were available in-between. People we spoke with who used the service told us they liked the food and were given choice. We observed meal times and found people had different experiences depending on which unit they lived on. Some staff interacted well and recognised needs whilst some units were less organised.

We found there was enough staff with the right skills, knowledge and experience to meet people’s needs. However, staff told us at certain times they could do with more staff to ensure people’s needs were met in a timely way.

We looked at care records and found they contained a care plan entitled, ‘my decision making.’ This stated the level of capacity the person had and what, if anything restricted their capacity. We saw best interest decisions had been made in relation to areas where people lacked capacity.

We observed staff working with people and found they were kind and caring in their nature. Staff we spoke with were knowledgeable about respecting privacy and dignity and gave examples of how they would do this.

We checked people’s care records that were using the service at the time of the inspection. They told staff how to support and care for people to ensure that they received care in the way they had been assessed. Ho

We carried out this focused inspection on 15 July 2015 following concerns raised by whistle blowers and by the local council.

Byron Lodge is a care home providing accommodation for up to 61 people. It is situated in the area of West Melton, approximately six miles from Rotherham town centre. It provides accommodation on both the ground and the first floor and has parking to the front of the building and a secure accessible garden at the rear.

The service did not have a registered manager in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service. 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 service is run.

We spoke with the deputy manager, who was covering the manager role at the time of our inspection, supported by the service manager. We were told that a new manager had been employed and would be commencing their role in August 2015.

At this inspection we found, while most people said they were happy with the home, we identified a number of concerns. Our observations and the records we looked at did not always match the positive descriptions some people gave us. We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in that risks associated with people’s care were not always monitored, people’s privacy, dignity and preferences were not always respected and the management of medicines was not appropriate. You can see what action we told the provider to take at the back of the full version of this report.

The provider did not have appropriate arrangements in place to manage medicines. The provider’s medication policy and procedure did not include instruction for the medication system that was in place at the home.

People were not protected against the risks associated with the unsafe use and management of medicines. Appropriate arrangements for the obtaining, recording, handling, using, safe keeping, dispensing, safe administration or disposal of medicines used were not always in place and/or followed.

Care and support was not always planned and delivered in a way that ensured people were safe. We saw support plans included areas of risk. However they were not always monitored and applied effectively and therefore did not always prevent risks from occurring.

We observed staff interacting with people to ascertain if there were enough staff to meet the needs of people living at the home. On the day of our inspection there were more staff on duty due to staff working extra shifts to ensure they worked their contracted hours. Therefore it was difficult to gain a clear picture of what the staffing situation would be on a usual day. We will look at this further when we visit the home again.

We spoke with staff about their understanding of safeguarding people from abuse and what action they would take if they suspected abuse. Staff we spoke with were knowledgeable in this area and told us they would report anything they needed to straight away.

We observed staff interacting with people and we spoke with people who used the service and their relatives. Relatives felt the staff were very caring and kind. However one person who used the service felt their choices and preferences were not respected. We also observed staff to be task focused and did not always check out people’s preferences.

The inspection took place on 29, 30 October and 5 November 2015 and was unannounced. The service was registered with the CQC in March 2015. We completed a focused inspection of the service in July 2015, following concerns raised. We looked at whether the service was safe and caring and breaches of legal requirements were found. We issued a warning notice because people were not protected against the risks associated with the unsafe use and management of medicines. Other breaches were that people did not receive care or treatment in accordance with their wishes, and their privacy and dignity were not always respected.

After the focused inspection, the provider wrote to us to say what they would do to meet the legal requirements in relation to the breaches.

We began the inspection on the 29, 30 October and 5 November 2015 by checking that they had made the improvements in regard to the warning notices issued and the breaches found at our last inspection. We found that no action had been taken to address the issues relating to medication and limited action had been taken to resolve the breaches.

Byron Lodge is a care home providing accommodation for up to 61 people. It is situated in the area of West Melton, approximately six miles from Rotherham town centre. It provides accommodation on both the ground and the first floor and has parking to the front of the building and a secure accessible garden at the rear.

The home was split up in to four units; Shakespeare and Ruskin providing nursing care and Wordsworth and Browning providing residential care. At the time of our inspection there were 53 people using the service.

The service had a manager in post at the time of our inspection, who had worked at the home for approximately ten weeks. However, they were not registered with the Care Quality Commission. A registered manager is a person who has registered with the Care Quality Commission to manage the service. 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 service is run.

During this inspection we looked to see if improvements had been made since our last inspection in July 2015. We saw no improvement in the areas previously identified and we found further breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These included that records did not always reflect that medicines were given correctly, and as prescribed. Medicines records were not always clearly completed to show the treatment people had received. We found a number of gaps in the records we reviewed, and there was evidence to suggest people had not been given their medicine, but no reason had been recorded as why these medicines had not been given.

We looked at six support plans and found they contained risk assessments. These were documents which outlined any risk associated with the person’s care. They explained the risk presented, but guidance on how to minimise the risk was limited, and the care we saw being offered by staff was not in line with these assessments.

During our inspection we observed staff working with people and found there were not enough staff, with the right skills and experience available to meet people’s needs.

We looked at the training record provided to us by the manager. It showed that a number of staff had not received mandatory training. This meant they may not be able to safely deliver care to people who used the service.

We observed lunch on the first day of inspection on Ruskin unit. Lunch was soup, sandwiches and cakes. Staff put food down in front of people; and did not provide any choice.

We found the service was not always meeting the requirements of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). One person we met wanted to leave and had restrictions placed upon them. We saw no DoLS was in place for this person and no evidence that an application had been made.

There was a lack of social interaction with people living at the home. We saw that people were not always involved in decisions about their care, or given choice.

People’s support plans were not always clear and precise. Care delivered was not always in line with people’s care plans.

The service had a complaints procedure and people felt able to raise concerns, but they were not sure if anything was actioned.

Staff did not know their responsibilities and there was a lack of leadership within the home.

We saw some systems in place to assess and monitor the quality of the service. However these had not been developed and actions raised had not been addressed.

We saw no evidence that people were routinely asked for their views about the service. People told us they had not been asked to give feedback about the service.

We raised our concerns with the nominated individual of the service and visited the home on 5 November 2015 to conclude our inspection and to see if they had taken any immediate action to address the issues we found on the 29 and 30 October 2015. We found that a regional manager had been employed and was based at the home offering leadership and guidance to staff about actions they needed to take to meet acceptable standards. The staff numbers had been raised by one on the Shakespeare unit and also the Ruskin unit. Two nurses had also been recruited to work at the service.

We found seven breaches of The Health and social care Act 2008 (Regulated Activities) Regulations 2014, and continued breach of Regulation 12(1), (2) (f) (g) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We are taking action against the provider, and will report on this at a later date.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures.’

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.