This inspection took place on 8 and 9 January 2019 and the first day was unannounced.

Byron Lodge was previously inspected in October 2017. We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to providing safe care and treatment and good governance. At this inspection we found sufficient improvements had been made and the service was meeting the regulations.

Byron Lodge is registered to provide accommodation for persons who require nursing or personal care for up to 14 people. There are 12 self-contained apartments and two en-suite bedrooms. At the time of the inspection 14 people were living at the service.

There was a registered manager was in post who was supported by two deputy managers. 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.

Byron Lodge provided care and support that was safe. During our inspection we found people were relaxed and settled in their surroundings. Risks to people were identified and measures implemented to mitigate these risks. The provider had made the required improvements since the last inspection to help ensure medicines were managed and stored safely.

There was sufficient and adequately trained staff to support people safely. All relevant pre-employment checks had been completed, to ensure they were appropriate to work with vulnerable people. The provider had suitable systems in place to protect people from abuse including accidents and incidents.

People were protected from the risk of infection because suitable arrangements were in place to ensure hygiene standards were maintained. The home was visibly clean and free from unpleasant smells. Staff were knowledgeable about and demonstrated good infection control practices.

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. The provider had submitted appropriate applications for the deprivation of liberty safeguards to the local authority.

Staff were competent and had adequate professional support to enable them to support people safely and effectively. Staff received an induction, training considered mandatory by the provider and shadowed experienced colleagues prior to working unsupervised. Staff had regular supervisions and annual appraisals. People could participate in giving feedback for staff’s appraisals.

People’s nutrition and hydration needs were met effectively. Where possible, people were supported to shop and prepare their own meals. The service acted proactively to ensure people maintained a balanced diet and that they received relevant health and medical attention as required. This helped to ensure people achieved a good quality of life and wellbeing.

People were supported in a friendly and respectful way. People, relatives and staff got on well and staff were aware of people’s personalities and behaviours. Staff responded promptly when people asked for help and were seen to support people in a patient and unhurried manner. People, relatives and visitors were complimentary about the staff and their caring attitude.

People and their relatives were involved in the decision-making regarding the care and support provided. Where required, people could use advocates to help them understand and be involved in their care and support.

The care home operated within a diverse and multicultural community and had systems in place to ensure people’s equality and diversity needs were recognised.

Care plans contained detailed and adequate person-centred information to guide staff to provide personalised care. These plans were reviewed regularly

This was the first inspection since the service was registered with the Care Quality Commission.

Byron Lodge is registered to provide accommodation for persons who require nursing or personal care for up to 14 people. There are 12 rooms that are bedsit style apartments and two bedrooms. At the time of the inspection 13 people were living at the service.

This inspection was unannounced and took place on 19 and 23 October 2017

A registered manager was 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.

Quality assurance systems were in place to assess, monitor and mitigate risks relating to the health, safety and welfare of people. However, concerns with rota management led to high turnover of staffing and agency staff being used.

Staff were aware of the signs and symptoms of abuse, how to report concerns and who they would report to. There was a whistle blowing policy in place and staff were aware of the policy and were also aware of the safeguarding policy.

People did receive their medicines as prescribed and a new system for the administration of medication had been introduced to reduce errors being made. Furthermore, we found the provider had not ensured the person who completed staff competencies had received the necessary training to perform this task.

There were robust policies, procedures and risk assessments in place in relation to health and safety and fire safety.

The principles of the Mental Capacity Act and Deprivation of Liberty Safeguards were being followed and referrals had been made in a timely manner.

Staff were kind and caring to people living at the service. They were knowledgeable about the person and their needs and followed agreed plans of care and strategies devised.

Staff received training in Acquired Brain Injury (ABI) and dealing with challenging behaviours. The provider needs to ensure that all staff receive fire safety training and training related to health conditions such as diabetes. Staff said they felt better supported since the interim deputy manager and interim senior care worker joined their service.

Complaints were addressed in a timely manner. We saw that feedback was sought from people, staff and professionals.

Recruitment processes were robust and safeguarded against unsuitable people obtaining employment at the service.

The staff team said there were improvements to the management of the rota which meant that staff were clear on their hours of working and people living at the home could be better supported

Care plans and risk assessments were detailed and gave good guidance for staff in supporting people and were regularly reviewed.

At this inspection we found three breaches of the Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to the management of medicines and good governance. You can see what action we have told the provider to take at the back of the full version of this report.