About the service:

Enhanced Elderly Care Service - Byker Hall Care Home is a residential care home that provided personal and nursing care for up to 95 people. At the time of the inspection, 87 people were living at the service.

People’s experience of using this service:

People told us they were safe living at the service and that rooms were kept clean and tidy. They told us staff were kind and liked; and were available when needed.

People were safeguarded from abuse by trained staff and any accidents or incidents were monitored and any lessons learnt were acted upon.

Medicines were administered in a timely manner and stored securely.

Systems and processes were in place and were monitored by the registered manager to ensure they remained suitable and identified any issues arising in the service, for example in the audits completed by the registered manager.

Recruitment was robust to ensure suitable staff were employed and there were enough staff to meet the needs of the people living at the service.

The service was well-led and the registered manager was visible throughout the service and was open and transparent in their approach.

More information is in the full report.

Rating at last inspection:

Good (Report published on 3 November 2017)

Why we inspected:

This focussed inspection looking at the ‘Safe’ and ‘Well-led’ key questions was brought forward in response to concerns we had received relating to the care provided at the service.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

The inspection took place on 21 and 25 August 2017 and was unannounced. At the last inspection on 21 April 2016, the service was rated requires improvement. We also found the provider had breached the regulations in relation to staffing.

The home provides residential accommodation with nursing care and support for up to 95 older people, some of whom live with dementia or a dementia related condition. At the time of this inspection 66 people were living at the home, 23 beds were intentionally closed in preparation for a new residential unit opening.

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.

Since our last inspection the provider had increased the staffing levels deployed in the home. There were sufficient staff deployed to meet people’s needs in a timely manner. This was confirmed from speaking with people using the service and staff, as well as our own observations during the inspection. We saw staff were visible around the home and responded to people’s needs quickly when needed. The provider had systems in place to monitor people’s dependency levels against the number of staff deployed.

Medicines were usually stored and administered safely. We noted some medicines records were not completed accurately. However, people confirmed they received their medicines when they were due. We have made a recommendation about medicines administration recording.

People told us they were well cared for by a team of kind and caring staff. They also said they felt safe living at the home.

Safeguarding matters were dealt with appropriately including making a referral to the local authority safeguarding team. Investigations had been completed to help keep people safe. Staff had been trained in safeguarding and had a good understanding of safeguarding principles.

There was a system of health and safety checks to help ensure the building and equipment was safe to use. This included checks of fire equipment, water systems, hoists, lifts and electrical items. Where required action had been taken to address any concerns identified. The provider had developed emergency plans to deal with unforeseen incidents. Personal emergency evacuation plans (PEEPs) described people’s support needs in an emergency situation.

Accidents and incidents were recorded and monitored. Reviews were carried out to identify patterns or trends.

The provider had effective recruitment procedures to ensure the safe recruitment of staff to the home.

Staff told us they received the support and training they needed. Records we viewed confirmed training, one to one supervisions and appraisals were up to date.

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 were supported to have enough to eat and drink. Where people required specific support or specialist advice and guidance this was provided. People gave mostly positive feedback about the meals provided. However, some people felt choices were limited.

People accessed external health care services in line with their assessed needs. This included GPs, community nurses, speech and language therapists and physiotherapists.

People’s needs had been assessed including identifying their preferences. This information was used to develop personalised care plans. These had been reviewed to keep them up to date with people’s changing needs.

There were opportunities for people to participate in activities if they wished. These included outings to places of personal interest, ball games and bingo.

People knew how to raise any concerns but told us they had none at pre

This was an unannounced inspection which we carried out on 21 April 2016. We inspected the service to follow up on the breaches and to carry out a comprehensive inspection.

We last inspected Byker Hall Care Home in January 2015. At that inspection we found the service was in breach of the legal requirements in force at the time with regard to Regulation 20 of the Health and Social Care Act 2008. (Regulated Activities) Regulations 2010. This was because records did not accurately reflect people’s care and support needs.

The home provides nursing care and support for up to 95 older people, some of whom live with dementia or a dementia related condition.

A manager was in place who was applying to become 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.

People said they felt safe. We had concerns however that there were not enough staff on duty to provide timely and individual care to people. Care was provided with kindness and people’s privacy and dignity were respected. However, we saw staff were busy and did not always have time to interact and talk with people except when they were carrying out care tasks.

Staff received training and supervision. However, as the home provided care and support to a number of people who lived with severe dementia and associated mental health conditions we considered some of the nursing staff needed a background in mental health and dementia care. This was to ensure people’s specialist needs were met and to complement the general nursing care that was provided. We have made a recommendation about staff training on the subject of dementia.

Staff had received training and had an understanding of the Mental Capacity Act 2005 and best interest decision making, when people were unable to make decisions themselves. We have made a recommendation about medicines management where medicines were given in a person’s best interest. People received their medicines in a safe and timely way.

People were protected as staff had received training about safeguarding and knew how to respond to any allegation of abuse. When new staff were appointed, thorough vetting checks were carried out to make sure they were suitable to work with people who needed care and support.

Menus were varied and a choice was offered at each mealtime. Staff supported people who required help to eat and drink and special diets were catered for. Some activities were available for people and the activities and entertainment programme was to be developed to ensure it met people’s interests.

A complaints procedure was available. People told us they would feel confident to speak to staff about any concerns if they needed to. People had the opportunity to give their views about the service. There was regular consultation with people or family members and their views were used to improve the service. The provider undertook a range of audits to check on the quality of care provided.

The environment was well-maintained and a programme of refurbishment was taking place as the service expanded. The environment was not yet equipped to meet the needs of people who lived with dementia. This would help people remain orientated and be aware of the environment they lived in and help people to retain some independence. We have made a recommendation about the service following best practice for equipping the environment for people who live with dementia.

Communication was effective, ensuring people, their relatives and other relevant agencies were kept up to date about any changes in people’s care and support needs and the running of the service.

You can see what action we told the provider to take at the back of the

This was an unannounced inspection, we carried out on 22 January 2015.

This was the first inspection of Byker Hall since changed registered provider. It was registered on 27 February 2014.

Byker Hall provides nursing care and support for up to 48 older people, some of whom may be living with dementia. All bedrooms have an en-suite shower and toilet.

A registered manager is in place. ‘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 said they felt safe and they could speak to staff as they were approachable. Comments included; “I do feel safe living here.” And; “I feel safe here, I’m a home bird.” “A relative said; “My Mum is safe, we’ve never had any cause for concern.” We found there were enough staff on duty to provide individual care and support to people and to keep them safe.

People were protected as staff had received training about safeguarding and knew how to respond to any allegation of abuse. When new staff were appointed, thorough vetting checks were carried out to make sure they were suitable to work with people who needed care and support.

People received their medicines in a safe and timely way.

The necessary checks were carried out to ensure the building was safe and fit for purpose.

Staff undertook risk assessments where required and people were routinely assessed against a range of potential risks, such as falls, mobility, skin damage and nutrition.

Staff knew people’s care and support needs, but detailed care plans were not all in place to help staff provide care to people in the way they wanted. Information was available for people with regard to their individual preferences, likes and dislikes.

Communication was not always effective to ensure the well-being of people who used the service.

People said staff were kind and caring. Comments included; “The staff are very helpful, nothing is a trouble.” And; “Staff are very respectful, they talk to me and explain what they want to do, they will do anything for me.” Another person said; “I think the staff are lovely.”

Menus were varied and a choice was offered at each mealtime. Staff were sensitive when assisting people with their meals and the catering staff provided special diets which some people required.

Byker Hall was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS). Staff had received training and had a good understanding of the Mental Capacity Act 2005 (MCA) and best interest decision making, when people were unable to make decisions themselves.

Staff were provided with training to give them some knowledge and insight into the specialist conditions of people in order to meet their care and support needs.

People had access to health care professionals to make sure they received appropriate care and treatment. Staff followed advice given by professionals to make sure people received the treatment they needed.

Activities and entertainment were available for people.

People had the opportunity to give their views about the service. A complaints procedure was available. People told us they would feel confident to speak to staff about any concerns if they needed to. The provider undertook a range of audits to check on the quality of care provided.

The registered manager was introducing changes to improve the quality of care and to ensure the service was well-led for the benefit of people who used the service.

We found one breach of the Health and Social Care Act 2008(Regulated Activities) Regulations 2010 in relation to records.

You can see what action we told the provider to take at the back of the full version of the report.