This inspection was carried out on 22 February 2018 and 05 March 2018. The first day of the inspection was unannounced.

Byron Lodge Care Home Ltd is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. People received nursing and personal care.

Byron Lodge Care Home Ltd accommodates up to 28 people in one three storey building. There were 25 people living at the service when we inspected. A number of people received their care in bed. Some people lived with dementia.

There was a registered manager 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.

Not all risks had been managed safely. Risk assessments within the service had not been reviewed and updated following accidents and incidents to ensure that that accident did not happen again. Other risks to people such as risks of a person falling, sustaining injuries when taking medicines which thin the blood, moving and handling, diet and nutrition and developing pressure areas had been well managed.

The provider had not followed effective recruitment procedures to check that potential staff employed were suitable for their roles and had the skills and experience needed to carry out their roles. Appropriate numbers of staff had been deployed to meet people's needs. However, it was not clear how staffing levels had been determined as people’s dependency information was not used to calculate the staffing required. We made a recommendation about this.

Medicines had not been managed in a consistently safe way. Medicines were stored safely and securely within a temperature controlled environment. We observed a medicines round and observed the trained nurse explaining to people what medicines they were being administered and why. There was inconsistent practice in relation to records relating to medicines that were classed as controlled drugs (CDs) under the Misuse of Drugs Act 1971. We checked the stock of CDs and found that the number in stock did not match the expected number recorded in the CD book. We made a recommendation about this.

There was inconsistent monitoring and oversight of people’s nutrition and hydration needs. Records did not show that all people had been supported to eat and drink enough to maintain a balanced diet. People told us that they liked the food and we observed staff supporting people to drink regularly.

We observed that people made decisions about their care and treatment. Where people lacked capacity to make particular decisions, mental capacity assessments had taken place.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The registered manager had a system in place to track and monitor applications and authorisations, which was not always effective. We made a recommendation about this.

Care plans were person centred and provided details about how people preferred to receive their personal care. People had access to a small range of activities. The registered manager planned to improve activities and enable more people to utilise the communal areas.

People had been asked for their feedback about the service, it was not always evident that they had been listened to. We made a recommendation about this.

A programme of quality audits were in place but had not been effective in highlighting the issues we found at this inspection.

Registered person’s had not always informed CQC about serious injuries that had occurred. We made a recommendation about this.

The service had a friendly an