The inspection took place on 11 May 2017 and was unannounced.

This was a comprehensive inspection carried out at Byway House. At the last inspection on 13 January 2015, the service was rated ‘Good’. At this inspection, we found the service was now ‘Outstanding’.

Byway House is registered to provide accommodation and care for up to 16 people with a variety of healthcare needs, including frailty of old age. At the time of our inspection, 15 people were living at the home. Byway House is a large, detached house situated on the corner of a private road and close to the local shops and coastline of Middleton on Sea. All bedrooms have en-suite facilities comprising a sink and toilet; bathrooms are separate. Communal areas include a lounge and dining area. A passenger lift operates between the ground and second floors and one of the staircases has a stair lift. Accessible gardens provide people with places to sit and have recently been refurbished to provide a pleasant, relaxing outside space.

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.

Staff were totally committed to providing an exceptional standard of care for people at the home and genuinely cared about people’s wellbeing. One person said, “I have been living in this home for a few years and I really do like living here so much. It really feels like home. Everyone here is so kind and helpful”. Nothing was too much trouble for staff and warm, caring relationships were evident. People were supported in their spiritual beliefs. People, if they wished, were involved in making decisions relating to their care and felt that their views were listened to and acted upon. This helped to ensure people lived their lives in the way they wished and in a way that made them feel valued. People were treated with dignity and respect by staff at all times; their independence was promoted which helped people to maintain their dignity. Staff had signed up to the Dignity in Care initiative which was about improving the quality of care and experiences of people using services. Staff put what they had learned into practice and had been provided with information about becoming Dignity Champions. The atmosphere at Byway House was conducive to ensuring people were happy and contented.

People were involved in developing the service and felt their views were listened to and that they mattered. There were opportunities for people to assist in interviewing new staff, to join staff in training and to attend residents’ meetings. People felt their views and opinions were listened to and the registered manager met people individually every day to see whether they needed anything and to obtain their feedback about living at Byway House. Staff felt supported by management and were passionate about caring for people and their employment at the home. Relatives and visitors spoke highly of the care people received and of the management of the home. The culture was one of openness and transparency and it was clear that people were at the heart of the home. The registered manager was committed to ensuring people received a high quality of care and was an excellent role model for staff. A range of audits had been put in place to maintain the high standards at Byway House and to drive continuous improvement. People spoke highly of the home. One person said, “I would recommend this place to anybody and anyone. It is a great place to live, especially in your latter years”.

People felt safe living at Byway House. Staff had been trained to recognise the signs of potential abuse and knew how to report any concerns relating to people’s safety and wellbeing. People’s ris

We spoke with six people during our visit. They told us that they were very satisfied with the care that they received. They told us that it was a good home and that they enjoyed delicious food. One told us, “I’ve been very happy, the staff are wonderful”. Another said, “I’m very comfortable, the home is well run”.

We spoke with three relatives. They also told us that they were pleased with the home. One said, “I don’t think I could have found a better place”. Another told us, “I can’t speak highly enough”. We saw two thank you cards that had been sent to the home. One of these read, ‘I am so grateful (to the home) as it enabled me to relax and not worry about X’. People and their relatives spoke highly of the staff.

We spoke with three members of staff and the manager. Staff told us that it was a good place to work. One said, “There is good morale among staff and we have a stable team”.

We found that people looked well cared for and observed that they had a good rapport with the staff. People's rights with regard to consent were being promoted by the service and staff understood how people's capacity should be considered. Staff were welcoming and we saw that they supported people with kindness and respect. People told us that they could approach staff or the manager if they were unhappy or had ideas to discuss. While staff demonstrated a good knowledge of how to support people, we found that this information was not always accurately or sufficiently recorded.

We spoke with ten of the 14 people who were living at the service. All said they were treated with respect, that their privacy was promoted by staff and that the choices they expressed were respected. For example, one person told us, “You can sit out in the garden if you want, it’s beautiful. We have free will here and I’m happy with that. It would make me feel like a child if they told me what to do”.

Everyone that we spoke with confirmed they felt safe from harm because of the staff that supported them. They also expressed satisfaction with the choice of meals and the care they received.

All ten people that we spoke with expressed satisfaction with the staff who worked at the service. For example, one person told us, “I can’t praise the girls enough. One girl said to me that if she can make me happy then she was doing her job correctly. I got quiet emotional when she said this to me. I think her comment sums up how we are treated here”.

This inspection took place on the 13 January 2015 and was unannounced.

Byway House provides accommodation and care for up to 16 older people. There were 16 people living at the home at the time of our inspection. People living at the home had a range of needs related to their health and mobility and required differing levels of care and support from staff. Accommodation is provided over two floors with lift access. Rooms are en-suite and there are additional bathrooms and toilets on each floor. There is a ground floor dining room, connected to a sitting room and a ground floor kitchen. There is a level garden accessed from the main entrance or sitting room, with a raised flower bed and pond.

The service had a registered manager but this person was no longer managing the service. Prior to the inspection the provider informed us a new manager had been appointed. Our records showed that the provider had taken steps to remove the previous manager’s name from our records and to register the new manager with the CQC. 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.

At our previous inspection on 14 October 2013 we asked the provider to take action to make improvements in relation to records. The provider sent us an action plan to tell us the improvements they were going to make. At this inspection we saw that these actions had been completed.

People were positive about the home. One person told us, “You couldn’t have a better place to be”. People were cared for by kind and caring staff. A person told us, “Staff are marvellous, a lot of them are my friends” and another said, “They look after us very well”. We observed staff offered reassurance to people when needed and laughed and chatted with people throughout our visit whilst they carried out their roles in a professional manner.

People felt safe living at the home. The provider had good systems and processes in place to keep people safe. Assessments of risk had been undertaken and were regularly reviewed to ensure that information was up to date. There were clear instructions for staff on what action to take in order to mitigate risks to people. Staff knew what action to take if they suspected abuse and had received training in keeping people safe. Arrangements were in place to keep people safe in the event of an emergency. The service employed sufficient staff with the skills, competence and experience to meet people’s individual needs. Staff felt supported and were positive about their roles and the home. One staff member told us, “It’s lovely; I would be happy for my relatives to be here if they needed care”.

The provider had arrangements in place for the safe ordering, administration, storage and disposal of medicines. People were supported to get the medicine they needed when they needed it. The home was clean and measures in place for the prevention and control of infection. People had sufficient to eat and drink throughout the day and had access to the healthcare services they required.

Staff followed the requirements of the Mental Capacity Act 2005 (MCA). People’s capacity to make decisions in different areas of their life had been assessed. Staff observed the key principles of the MCA in their day to day work checking with people that they were happy for them to undertake care tasks before they proceeded. The manager actively supported people to consult with their representatives or advocates.

Staff knew the people they were supporting well and the choices they made about their care and their lives. The needs and choices of people had been clearly documented in their care records. People were supported to undertake activities of interest to them, for example one person had a wood working bench and tools in their room and produced craft items. Another person showed us the Chinese brush paintings they had painted and were preparing to display as the home was having a theme day to celebrate the Chinese New Year. Further activities took place within the home in line with people’s interests. People were supported to maintain contact with family and friends. We observed people received visitors throughout our inspection.

Though there had been a change in manager the provider ensured that continuity of service had been maintained. The manager had a proactive approach and had quickly established positive relationships with both staff and people living at the home. We observed they spent time talking and listening to people who lived at the home and monitored the day to day standards of care and support that were provided. Staff, the manager and owner had a shared understanding of the values of the home. They described their approach as maintaining, “Hotel standards’ whilst providing additional person centred care.

The provider sought feedback on the care and support provided and took steps to ensure that care and treatment was provided in a safe and effective way and where necessary improvements were made. Any complaints received were recorded along with the actions taken in response.