Bymead house is a residential and nursing home situated in Charmouth. It is registered to provide care for up to 30 people. The home is a detached property with rooms set out over two floors accessed by stairs or a passenger lift. There are lounge and dining areas on each floor of the home and a rear garden which is fully accessible. At the time of the inspection there were 26 people living at the service.

The home had not had a registered manager in position since February 2018. However a new manager had been appointed who was applying to Care Quality Commission to become the registered manager. 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 last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good.

There was no evidence or information from our inspection and on going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

People received care from a service which was very caring. Staff cared for people in a kind, compassionate manner. People had developed open and honest relationships with staff. One relative told us, “We chose Bymead as it struck us with a strong 'family' feel as soon as we walked in on our first visit.

There were enough staff to meet people’s care and support needs. Staff had been recruited safely including full employment history and disclosure and barring checks. Induction and on-going training provided staff with the skills needed to carry out their roles effectively.

People were involved in decisions about the care and support they received. People’s independence was respected and supported. People told us keeping their independence was important to them. The manager told us they were aware of their responsibility in ensuring people’s rights to choice and independence were fully respected and upheld

People were protected from abuse because staff understood how to keep them safe, including more senior staff understanding the processes they should follow if an allegation of abuse was made. All staff informed us concerns would be followed up if they were raised. People received their medicines safely. There were enough suitable staff to meet people’s needs. Risk assessments were carried out to enable people to retain their independence and receive care with minimum risk to themselves or others.

Staff received training to ensure they had the skills and knowledge required to effectively support people. People were supported to eat and drink according to their likes and dislikes. People who lacked capacity had decisions made in line with current legislation. People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

People were supported to engage in activity programmes. People knew how to complain and there were a range of opportunities for them to raise concerns with the manager and designated staff

Further information is in the detailed findings below.

The inspection took place on Monday 29 February 2016 and Tuesday 1 March 2016 and was unannounced. The inspection was carried out by a single inspector on both days.

Bymead house is a residential and nursing home situated in Charmouth. It is registered to provide care for up to 30 people and had no vacancies at the time of inspection. The home is a detached property with rooms set out over two floors accessed by stairs or a passenger lift. There are lounge and dining areas on each floor of the home and a rear garden which is fully accessible. 27 of the bedrooms have an ensuite bathroom and all have call bells.

The service had a registered manager. 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.

Medicines were stored safely at the home. Medicines were given appropriately according to the MAR (Medicine Administration Records). The MAR correlated with the medicines held at the home.

We looked at the creams which people used at the home. Each cream had a chart with written instructions and a body map indicating the area where the cream should be applied. We looked at creams for three people and found that in two cases, people had additional prescription creams in their rooms which they were no longer using. These should have been disposed of and we told the registered manager about this who immediately removed them. We spoke with staff who were able to tell us what creams were required and the charts in peoples rooms correlated with which creams should be used. We recommended that the creams for all people at the home should be reviewed to ensure that old stock was disposed of.

Staff were aware of how to keep people safe and had undertaken safeguarding training, they were able to explain the signs of abuse and knew how to report any safeguarding concerns

Although some of the staff and people we spoke to didn’t feel that there were enough staff, people’s care and support needs were met. We spoke with the registered manager about staffing and they explained that they use ratios to plan staffing and discuss with staff how to best use them to meet the needs of the people.

We saw evidence of group supervisions from January and February 2016 and the written documentation from these. We saw that each member of staff had scheduled individual supervision bi-monthly and we also saw evidence that the Registered Nurses(RN) had discussed and agreed a plan for managing these for other staff. The registered manager told us that they were in the process of rolling out the individual supervision plan.

The service was effective. Staff had detailed knowledge about the people they were supporting. We spoke to people about the support they received from staff and one told us that staff “support in the way I want”. Another said “If there is something you really wanted, they would get it for you”.

Staff told us that they communicate well and used staff meetings and staff handovers to discuss how to support people. A staff member said “we bring things we want to discuss and set an agenda beforehand”. Another told us that if staff are unable to attend, they “have input via a paper note and the issues are discussed”.

Staff were aware of the MCA and had received training. They were able to explain how they supported people with decision making. For example, one staff member told us that if a person “was confused or unable to make a decision, I would give space and reapproach” they also told us that they would tell the registered nurse(RN) in case the confusion evidenced a change to their health.

People, staff and visitors all told us that the food was good. One person said that the “catering is excellent”, another said that the “food is very nice, no pr

We spoke with seven people who told us they were happy at the home and that the staff met their needs.

People told us they felt they could express their views and that they were listened to by staff. People spoke positively about the care they received. One person told us, “It couldn’t be any better, anything I want they do it.”

People were cared for in a clean, hygienic environment. and there were systems in operation designed to prevent, detect and control the spread of health care associated infections.

People told us there were sufficient numbers of staff on duty to meet their needs.

The home had suitable systems to monitor the quality of service provided.

We spoke with people who use the service who spoke positively about the care they receive. People told us the food was “very good” and that “you get a good choice”. One person told us they were “perfectly happy” and another said “I can’t think of a thing” when asked if there was anything they would like to change about the home.

We found that people’s care needs were regularly assessed and reviewed and that their consent to treatment was obtained when required. Staff had appropriate recruitment and were supported through opportunities for their professional development.

The home had implemented effective systems to monitor the quality of the service provided and to assess and manage risks to the health, safety and welfare of people using the service and others.

People we spoke with told us “food is excellent”, “the staff are good, they look after me very well” and “the staff help me maintain my independence”.

We spoke with two people who told us “staff are lovely”, another said “can’t fault them, all the staff are so caring”.

The activities organiser told us there were activities scheduled every day of the week in the morning and afternoon.

We were told by one person that staff were kind and they felt safe in the home.

A person we spoke with who used a wheelchair told us that because of equipment in corridors it sometimes could be awkward moving around the home.

Three people we spoke with were able to tell us that they had attended the residents’ meeting which was held every three months. One person remarked they felt that the manager listened to what was said.