The inspection took place on 25 March 2018 and was unannounced.

Byways Residential care home 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.

Byways care home accommodates eight people in one adapted building. The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

There was a registered manager for the service. 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.

People were supported by enough staff to keep them safe. The staff levels helped reduce the risks of people experiencing harm. Staff had been trained in how to keep people safe. People were helped to stay safe because the provider had systems that helped reduce risks to them. The staff knew how to protect people if they had any concerns about their safety or wellbeing. People were helped by staff to manage and receive their medicines safely.

People were properly supported to stay healthy. They were supported to have positive relationships in their life. Each person had a detailed care plan in place. These had been planned and written with people and their relatives . Care plans set out how to meet each person’s’ care and support needs. Care plans were reviewed regularly. This was so that they were up to date and reflected people’s full range of care and support needs.

The staff supported people’s independence and encouraged them to take part in activities they valued. The staff were kind and caring. The engagement and communication we saw between people and staff was warm and positive. People went out often to see family and take part in a range of social events.

Staff felt they were supported in their work and they also felt the management were supportive. The quality of care and service that people received was checked and monitored. This was to make sure it was safe and suitable for them.

The staff felt positive about working as a team and they felt there was usually a good morale and team spirit among them. People were supported with their range of day to day needs by a team of staff who were well trained and properly supported and supervised in their work. The staff were able to go on regular training courses and felt developed and supported in their roles. This helped the staff to improve and develop their skills and competencies when they supported people at the home.

The visions and values of the organisation were understood by the team. Individual staff showed they understood these visions and values in their work. They included providing personalised care, treating people as unique individuals and supporting independence.

Byways provides accommodation and personal care for eight people. People who live at the home have a learning disability. There were seven people accommodated at the time of the inspection. This was an unannounced inspection, which meant the staff and provider did not know we would be visiting. This inspector took place on the 10 December 2015.

There was a manager in post. They had submitted an application to the Care Quality Commission to become registered. 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.

People were encouraged and supported to lead active lifestyles in their home and the local community. They had opportunities to take part in a variety of activities including going on an annual holiday. Two staff were employed with the specific role of supporting people with activities and they worked alongside the care staff.

People were protected from the risk of abuse because there were clear procedures in place to recognise and respond to abuse and staff had been trained in how to follow these procedures. Systems were in place to ensure people were safe. These included risk management, checks on the environment and safe recruitment processes.

People’s rights were upheld and they were involved in decisions about their care and support. Where decisions were more complex these had been discussed with relatives and other health care professionals to ensure it was in the person’s best interest. Staff were knowledgeable about legislation to protect people in relation to making decisions and safeguards in respect of deprivation of liberty.

Sufficient staff supported the people living at the service. Staff had received appropriate training to support the people living at Byways. Staff were supported in their role and received regular supervisions. Supervisions are where a member of staff meets with a senior manager to discuss their role, performance and training needs.

People had a care plan that described how they wanted to be supported. These were regularly reviewed. Care was effective and responsive to people’s changing needs. People had access to healthcare professionals when they became unwell or required specialist equipment. Feedback from health and social care professionals was positive in respect of the staff’s approach to people and delivery of care.

Systems were in place to ensure that any complaints were responded to. People’s views were sought through an annual survey that was completed by a representative from Milestones Trust. The new manager was exploring how people’s views could be sought more effectively and they recognised this was not always easy for people who communicate using non-verbal communication. Staff used a variety of methods to communicate with people including using visual aids such as objects and photographs.

The staff, the manager and a representative from Milestones Trust completed regular checks on the systems that were in operation in the home to ensure they were effective.

People were provided with a safe, effective, caring and responsive service that was well led. The organisation’s values and philosophy were clearly explained to staff.

Due to their learning disability people were unable to discuss their experiences of care so in order to understand their experiences we carried out observations in communal areas. We saw that people were relaxed and comfortable with staff. It was evident that staff knew people well and understood their different methods of communicating. We saw and heard that staff spoke to people kindly, respectfully and with warmth.

Staff understood the importance of consent and ensured that complex decisions were made legally and an independent advocate was involved.

People's care records were person-centred and contained clear information about their care needs. Where other professionals were involved, the home kept clear records and followed their recommendations.

The home was clean and well maintained and had the appropriate equipment to meet people's care needs.

Staff were recruited safely and checks were carried out to ensure they were of good character.

The provider regularly monitored the quality of the service and addressed any shortfalls identified.

People’s records were accurate and fit for purpose.

We visited Byways to check that improvements had been made. We found that the home was clean and bright. Communal areas, particularly bathrooms had been refurbished and the home had a new kitchen.

Due to limited communication of people who lived in the home they were not able to directly discuss their experiences with us. We spent time in communal areas observing staff supporting people in order to see how they interacted.

We saw that staff spoke with people in a kind and respectful way and supported people to be independent.

People's care records were in easy-read format and contained detailed information about people's likes, dislikes and care needs. They contained clear information to guide staff how to support people with physical health needs.

People were involved in planning the weekly menus at the home.

People received the medicines they needed in a safe way.

Staff received regular training and development.

We found that the home was not clean and that people were not being protected from the potential risks of acquiring infections

The person consulted about the home and the staff made positive comments. When asked about the staff meeting their needs and about living at the home, the response was ‘yes’.

We also gathered information from people that visit or do not have caring roles in the home. We spoke to the activities coordinator and visiting trainer about the way the care is delivered to the people at the home.

People were observed undertaking musical activities and we saw the activities coordinator using a variety of methods to engage with people. The activities coordinator told us that since employment at the home, activities have moved on from crafts and in-house activities to improving contact with the community. We understood that this approach is more holistic; it enables independence and gives people opportunities.

We spoke to the Moving and Handling trainer that regularly visits the home. These visits are to support staff to use techniques that ensure the safety of people living at the home and the staff. It was stated that staff are willing to put into practice recommendations made, they raise legitimate questions about techniques and there is no resistance to suggestions made.

When we watched staff interacting with people, we saw that they were level with the person, they enabled people to make choices and they spoke in a friendly manner.