We inspected Byron House on 1 and 6 December 2016. This was an unannounced inspection. The service provides care and support for up to 23 people. When we undertook our inspection there were 22 people living at the home.

People living at the home were of mixed ages. Some people required more assistance either because of mental health needs or because they were experiencing difficulties coping with everyday tasks.

There was a manager in post, who had been interviewed by CQC for the registered manager’s post and was waiting for her certificate to arrive. 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.

CQC is required by law to monitor the operation of the Mental Capacity Act 2005 Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves. At the time of our inspection there was no one subject to such an authorisation.

We found that people’s health care needs were assessed and care was planned and delivered in a consistent way through the use of their care plans. People were involved in the planning of their care. The information and guidance provided to staff in the care plans was clear. Risks associated with people’s care needs were assessed and plans were put in place to minimise risk in order to keep people safe.

We found that there were sufficient staff to meet the needs of people using the service. The provider had taken into consideration the complex needs of each person to ensure their needs could be met through a 24 hour period.

People were treated with kindness and respect. Staff in the home took time to speak with the people they were supporting. We saw many positive interactions and people enjoyed talking to the staff in the home. The staff on duty knew the people they were supporting and the choices they had made about their care and their lives. People were supported to maintain their independence and control over their lives.

People had a choice of meals, snacks and drinks. Meals could be taken in dining rooms, sitting rooms or people’s own bedrooms. Staff encouraged people to eat their meals and gave assistance to those that required it. There were menus on display so people could remind themselves of the choices they had made.

The provider used safe systems when new staff were recruited. All new staff completed training before working in the home. On-going training was available for all staff.

People had been consulted about the development of the home and quality checks had been completed to ensure the home could meet people’s requirements. This included environmental checks both in and outside the building and there was a maintenance plan in place. There was an analysis of quality checks and lessons learnt were passed on to staff.

We talked with four people who used the service and they told us that they were very happy with the care and support provided at the home. One said, “We are looked after very well.” Another said, “I know the staff very well and have a good relationship with them.” We saw that peoples’ privacy and dignity were respected and they were involved in decisions about their care and treatment.

We found that risk assessments were completed to ensure the safety of people who used the service and there were effective systems in place for the safe administration and management of medicines.

We saw that staff knew the people they cared for very well and they had been supported to develop the appropriate skills and knowledge to deliver good standards of care.

Systems were in place to assess and improve the quality of care provided and learn from incidents.

At our last inspection on 23 November 2012 we looked in several people's rooms. We observed a poor standard of cleanliness in each.

At this inspection we saw the home had employed a member of staff with responsibility for cleaning who worked 30 hours each week. We observed a high standard of cleanliness in people’s rooms. One member of staff told us, “Having the cleaner has made a massive difference to us, we can concentrate on care now; the home has improved so much.”

At our last inspection we looked in the lounge used by people who smoked. We saw the floor and furniture was badly stained from cigarette stubs. The sofa was covered in cigarette ash. The extractor fan did not work and was clogged up with dust and dirt. The smell of smoke from this room affected many other parts of the home.

At this inspection we were told the company had decided to close the smoking room and it was to be refurbished in due course to become a general lounge. We saw the room had signs on the door to this effect, re-directing smokers to a courtyard area outside.

We saw many areas of the home had been completely refurbished including lounge areas and people’s rooms. The acting manager told us, “I sat down with people and chose the wall papers and paint colours, people really like it.”

Care and treatment was planned and delivered in such a way that was intended to ensure people’s safety and welfare. We looked at four care plans for people who used the service. These were personalised and provided detailed guidance about how people’s needs should be met.

Staff were attentive to people and spent time sitting and talking with them

We saw people ate appetising and fresh meals. People had access to sandwiches and drinks throughout the day. One person said, “The meals are good and they listen to us about things we want.”

We observed a poor standard of cleanliness throughout the home. We looked in all the communal bathrooms and found dirty toilets, sinks and showers.

We were told the home had not had a cleaner or cook for over a year. The cooking was undertaken by the laundry assistant and the cleaning was provided by the care staff.

Staff we spoke with told us they did not have enough time to meet people’s needs adequately as well as clean.

One person we spoke with told us, “I really like living here. I come and go as I please and feel very independent. The staff are very good and I get on really well with all of them and with the other people who live here. My bedroom is very big and it’s my private space. No-one goes in there without asking me.”

Another person told us, “I have lived here for many years. It’s perfect for me. I can be independent but help is there whenever I need it. I make all my own choices, sometimes after discussing things with the staff and sometimes on my own. Whichever, they always respect what I have to say.”

People all told us the food was very good and there was plenty of choice. One person said “I love salad and can have it whenever I want. It’s always fresh.”