This inspection took place on 23 & 31 August 2017.

Bybrook House Nursing Home provides accommodation, nursing and personal care for up to 24 older people. At the time of our inspection there were 13 people living in the home.

There is a registered manager for this 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.

Our last inspection in February 2016 found areas which required improvement in relation to the administering and management of medicines. We had received an action plan setting out how the provider would address these areas. These areas included administering of PRN or "As Required" medicines, recording of medicines changes and maintaining the effectiveness of medicines through checking of environment temperatures. The provider had made the required improvements to ensure the safe storage and management of medicines.

At this inspection the arrangements for supporting people with their medicines were good and people received their prescribed medicines at the times required and people's health and welfare were protected.

The arrangements for the monitoring of pressure mattresses which are used where people are at risk of skin breakdown were not effective. There were a number which were not at the correct setting. People who were in bed and needed to be re-positioned to protect their skin integrity were not always re-positioned at the time intervals recorded in their care records.

People told us they felt safe and staff recognised and were confident about reporting any concerns about the safety and welfare of people. One person told us "I feel safe because I trust the staff, they know what they doing." A relative told us they felt confident their relative was safe and said, "When I leave the home after visiting I know (name) is safe and well looked after I do not worry about them."

The service was responsive to people's changing care needs and had good arrangements for getting support from outside professionals such as tissue viability nurses and dieticians. There were regular reviews of people care needs and people or their representatives had an opportunity to discuss their care needs so care plans accurately reflected their health and social care needs.

People and relatives told us staffing arrangements were good and staff were available at a time they were needed. Staff responded promptly to requests for help and support. One person told us "The staff are there when I need them."

There was a welcoming environment where people were able to maintain their relationships with family and friends. People and relatives told us there were no restrictions on visiting.

People felt able to voice their views or concerns about the service. There were regular meetings where people living in the home could give feedback about the quality of care provided in the home.

People spoke of staff being caring and kind. This was confirmed by relatives we spoke with. One told us "Staff are so caring and friendly." We observed staff supporting people in a sensitive and caring manner.

People had the opportunity to take part in activities of their choice. There was a varied menu, offering a number of daily choices and people were very positive about the quality of meals. One person said, "The food is very good I always enjoy my meal and we always get a choice."

People, relatives and staff spoke highly about the registered manager and senior staff. They were described as "Approachable and always there to listen." The registered manager and provider continually monitored the quality of the service and made improvements in accordance with people’s changing needs. When concerns were raised during the inspection the registered manager was r

Bybrook house nursing home provides accommodation which includes nursing and personal care for up to 24 older people. At the time of our visit, 17 people were using the service. The inspection took place on 23 February 2016. This was an unannounced inspection. The home was last inspected on 24 June 2013, this was a focused inspection where we found the provider had made the necessary changes identified from the previous inspection.

There was a registered manager in post when we inspected 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.

The registered manager was accessible and approachable throughout our inspection. Staff, relatives and people who used the service told us the registered manager was available if they needed to speak with her and had confidence in her abilities to manage the service.

Risks to individuals and the service were not always managed effectively and assessments put in place were not being followed correctly. This meant there was the potential for harm to come to people.

The home’s medicine management systems required improvement in order to fully protect people.

Staff understood their responsibilities in reporting any safeguarding concerns and had confidence in the registered manager that these would be fully investigated to keep people safe.

Not all staff had received regular training, suitable for their position which meant they potentially lacked the knowledge and skills to effectively fulfil their role.

Staff were receiving regular supervisions, which the registered manager had put in place so staff could be supported in their development.

People and relatives were very complimentary about the food and choices available. Mealtimes were an enjoyable experience and menus were tailored to meet individual’s preferences.

Staff were knowledgeable about people’s needs and people’s privacy and dignity was always respected. Staff explained the importance of supporting people to make choices about their daily lives. People told us they were involved in decisions about their care and systems were in place to monitor and review people’s changing needs.

Care plans were in an accessible format and contained information about the person which enabled person centred care to be provided. However the recording of information was not always completed, meaning people’s needs were not monitored effectively for changes to be identified in a timely manner.

The registered manager had created a positive and open culture in the time they had been in post. Relatives spoke about the changes they had seen and felt reassured the home was moving in the right direction.

Quality audits were undertaken; but some findings indicated that action was not always taken in response to these audits and some recordings were not an accurate reflection of events in the home. We saw that an event that is notifiable to CQC, concerning a pressure wound had not been reported.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

It was a positive visit and we could see that people were well cared for, supported and respected.

During the day we spoke with five people who lived in the home, a volunteer and eight members of staff. People told us that staff were dedicated and caring and we observed this to be the case. It was evident through observation and discussions with staff that they enjoyed working in the home and supporting people.

The visiting professionals we spoke with had high praise for the quality of the care people who lived in the home received.

Part of this inspection was to follow up three outcome areas where we required the provider to make improvements. We found that the necessary improvements had been made to, the recording of communications, staff supervision and auditing of supervision and appraisals.

Throughout the day we talked with many people who lived in the home. One person said, "I'm very happy living here, it's a wonderful place". When we asked people about their experiences of living in the home everyone had positive comments to make about the care they received. People looked well cared for and at ease in the company of staff. The home smelt fresh and was clean throughout and care was given to the décor and maintenance.

We observed that staff worked hard but were primarily task focused. Staff did not often engage in social interaction with people, for example sitting and talking with people. Staff told us they would like to have the time to be able to sit and talk with people, hold their hand or offer emotional support as they considered this was part of their caring role.

People told us they felt Bybrook House was a safe place to live and that staff treated them with respect. People told us they liked the staff and were well looked after. One person said, "the staff are lovely, so kind and do their job really well".

We found that the home did not have an overview of staff supervision or appraisal. We could not be assured therefore, that staff were being adequately supported in their roles.

People told us they were happy with the quality of care and support that they received from the service. We were told that the staff were professional and competent and treated people with dignity and respect. Staff were also described as friendly and caring. People said they felt safe living in the home.

People are involved in planning and reviewing their care if they choose. Relatives told us the staff communicated well and kept them informed of any ongoing issues and that they were always made to feel welcome in the home.

Bybrook House provides a homely and comfortable environment and people enjoy the variety of activities that are arranged for their enjoyment. The individual rooms are well maintained and people can personalise them with their own belongings if they wish.

People said they enjoyed the food and were provided with a good range of choices and the option of eating in their rooms or communally if they preferred.