Byfield Court

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question requires improvement. At this assessment, the rating has changed to Good. This meant that people were safe and protected from avoidable harm.

Risks to people were assessed and measure put in place to ensure they were managed appropriately. People were safeguarded from abuse. There were enough staff who were trained and supported to meet people's needs. People received their medicines safely, however, records of medicine administered were not always up to date. Lessons were learnt from incidents and accidents.

This service scored 72 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Lessons were learnt from incidents and when things went wrong. There were systems and processes in place for reporting incidents and accidents, and staff knew about the systems. Staff told us they completed the incident forms and informed the registered manager about incidents. The registered manager told us they reviewed incidents and took actions as appropriate to address them to reduce the chances of them happening again. People’s care plans and risk assessments were reviewed and updated after incidents.

Handover and team meetings were used to discuss incidents and to share learning from them. We saw minutes of staff meetings where learning was shared following an incident about people’s safety. Staff participated in discussing the risk and agreeing measures to be put in place. For example, a copy of the speech and language therapist (SALT) guideline which contained information of safe food textures and fluids for each individual was kept in the kitchen where staff preparing food could easily see it. professionals told us that the service learned from incidents and put measures in place to reduce recurrence of incidents.

The service collaborated with people, their representatives and relevant healthcare professionals to maintain safe systems and pathways for people when they moved between services.

Each person had a hospital passport which contained information about people’s medical conditions, communication needs, preferences and how their needs would be met. A hospital passport copy was provided to individuals during their hospital visits to facilitate a seamless transition.

Staff told us they also accompanied people to hospital so they could support them and give a handover to the hospital team looking after them.

People’s relatives told us staff ensured people took important things with them when they went on home visits or on holidays, such as medications and their hospital passports. One relative told us the service had supported them and ensured appropriate equipment had been put in place to enable their loved one to return home safely.

Staff told us and records showed that people had been referred to services when needed to maintain their health and well-being. Staff told us referrals for the input of the multidisciplinary team were done through the GP. Professionals we contacted confirmed that staff were knowledgeable and knew when to refer people. One professional commented, “Yes, Staff let us know of any problems at the earliest opportunity.When out of hours, 111 is contacted for advice if needed, but appropriately so.”

People told us they felt safe living at the service. One person said, “I feel safe. I’m very happy here.” A relative told us, “[My loved one] is very happy there. If they were not happy or safe, I would have found out. I have no concerns about the home.”

The service had a safeguarding policy and procedure in place and staff knew how to report abuse or concerns. They described the various forms of abuse and signs to recognise them. Staff told us they believed if they raised concerns with the registered manager their concerns would be investigated appropriately. Staff knew their right to ‘whistle-blow’ and how to do so if necessary to safeguard people.

The registered manager showed they understood their responsibilities to safeguard people from abuse. They had acted in accordance with their procedures to ensure concerns raised were appropriately investigated and actions taken to safeguard people. They involved the local authority safeguarding team and CQC as required.

We spent time observing people and staff. People felt comfortable with staff and spoke to people in a kind and respectful way.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. In care homes, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DOLs). Staff had received training on MCA and understood their role and responsibility in promoting the principles of MCA.

People’s rights and freedom were promoted in the home. People had valid DOLs in place except for one person who did not need one. The registered manager understood their responsibility to promote people’s right and to notify CQC of any approved DOLs.

The service worked with people to manage risks to their health, safety and well-being. People and their relatives were involved in discussing risks to people and looking at measures to manage them. One relative told us, “Staff contact me to discuss anything they are concerned about. They suggest ways to manage it and asked if I was okay with the plan.”

The service conducted assessments to identify risks to people’s health conditions, behaviours, relationships and activities that may put people at risk of harm. We reviewed one person’s choking risk assessment and saw that the SALT team had been involved in assessing the risk and developing the management plan. It contained information to help support the person safely, such as food texture and positioning. The plan also included actions to take if the person started to choke. We also reviewed a risk assessment for supporting one person at risk of constipation and another person at risk of having epileptic seizures. There were clear with detailed guidance for staff to follow to reduce the risks of becoming unwell.

Staff understood the risks associated with people and how to support them appropriately. We observed people were supported to eat and drink safely as detailed in their risk assessment. One professional commented, “The support workers know the residents very well and are aware of their care needs, and any risks.”

The environment and equipment were kept in good condition, ensuring health and safety standards were consistently maintained. There was an up-to-date fire assessment for the service, and the recommendation had been actioned. Each person had a Personal Emergency Evacuation Plan (PEEP) which sets out detailed instructions about the level of support a person would require to evacuate the building in the event of an emergency. The fire alarm system was tested weekly. Regular fire drills took place so staff could practice evacuation procedures. We saw valid certificates for legionella, gas safety, electrical safety and portable appliance tests.

Staff received training, in health and safety, fire, first aid and moving and handling, and fire evacuations.

There were enough staff available to support people safely. One person told us, “Staff help me, and they are nice.” A relative commented, “I think they are enough staff, at least from what I see when we visit.”

Staff told us there were enough on each shift to support people safely. One staff member mentioned, “I’m happy with the number of staff on duty.” We observed that people were given the support they required promptly. Individuals who needed one-on-one support received it from staff, and tasks like moving and handling, which required two staff members for safety, were completed by two staff members. The registered manager explained they planned staffing levels using a dependency rating tool which considered people’s needs and risks. The registered manager told us that they provided additional staff if required based on the needs of people, activities or if people had appointments.

The provider followed safe recruitment procedures to ensure people were supported by staff who were fit and safe to support them. Recruitment records included satisfactory references, right to work in the UK, employment history, and criminal records checks.

Staff were supported to be effective in their roles. One staff member said “I feel very supported. I get supervisions every 6-8 weeks. I can bring any concerns I have for discussion, and we address them.” Supervision records showed that staff were able to discuss concerns about the people they supported, team issues, performance and learning and developmental needs. Training records confirmed that staff had completed training relevant to their job roles and specific to the needs of the people they supported. This included dysphagia, epilepsy and mental health awareness.

Record showed that all staff had completed a period of induction when they started working at the service which included shadowing experienced staff members.

The home was clean and free from an unpleasant smell. The provider had an infection control procedure in place which covered best practice guidelines. Staff had received training in infection control and food hygiene. We saw staff use personal protective equipment (PPE), such as gloves and aprons where required. Staff told us they promoted good hand hygiene and supported people to do the same.

Staff did not always maintain records to show when medicines had been administered to people. We reviewed the Medicines Administration Records (MARs) for 11 people living at the service, and we found gaps on three people’s MARs on two different occasions. We counted the balance of the medicines for the people affected to ascertain whether staff had administered the medicines. We spoke to the registered manager who explained they had completed an audit and found that the medicines were administered, but staff had failed to sign the MARs.

Where people’s medicines were administered covertly, there was a risk assessment, care plan and best interest decision in place to support this. We saw protocols for the use of ‘as when required’ (PRN) medicine. Staff told us they only administered medicines prescribed to reduce agitation as a last resort and they kept records to explain why they had administered them.

Medicines were safely stored in a locked medicine room which only staff had access to. Controlled Drugs (CDs) were kept in a locked cabinet. The medicine room temperature was monitored regularly. There were systems in place for receiving medicines into the home and for disposing unused medicines. Monthly medicine audits took place to identify discrepancies. Training records showed staff had completed training on medicine administration and had their competency assessed regularly.