This inspection took place on 20 and 22 September 2016 and was unannounced. The Byars Nursing Home provides accommodation and personal care for up to 30 older people, including people with dementia. On the day of our inspection 30 people were using the service.

The service had a registered manager in place at the time of our inspection. 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 and associated Regulations about how the service is run.

People were supported by staff who knew how to recognise abuse and how to respond to concerns. Risks in relation to people’s daily life were assessed and planned for to minimise the risk of harm.

People were supported by a team of staff who were skilled and given on-going training and opportunities to develop. People’s rights were protected because staff acted in accordance with the Mental Capacity Act 2005. The principles of the Deprivation of Liberty Safeguards were understood and applied correctly.

People received ongoing healthcare support from a range of external healthcare professionals and people’s health and nutrition were effectively monitored and responded to in line with nationally recognised practice. The registered manager took a pro-active approach to ensuring people who lived with a dementia related illness received care based on best practice.

People were supported with care and compassion and there was an ethos of care which was person-centred, valuing people as individuals. People received a personalised service which was responsive to their individual needs and there was an emphasis on each person’s identity and what was important to them from the moment they moved into the service.

The service was committed to ensuring strong links with the community and placed a strong emphasis on enhancing people’s lives through the provision of meaningful, imaginative activities and opportunities. Complaints were taken seriously, thoroughly investigated and lessons learnt from them.

The service was managed by an experienced, knowledgeable and motivated registered manager who worked in partnership with other organisations to develop new and best practice. There was a strong commitment to deliver a high standard of personalised care and continued improvement based on the views of people who used the service and the enhancement of their lives.

Prior to our visit we reviewed all the information we had received from the provider. During the visit we spoke with four people who used the service and asked them for their views. We also spoke with three care workers, a nurse, the business manager, service manager and the registered manager. We looked at some of the records held in the service including the care files for three people. We observed the support people who used the service received from staff and carried out a brief tour of the building.

We found people gave consent to their care and treatment and received care and support that met their needs. A person who used the service told us, “Staff talk to us so we can decide.” Another person told us, “I am very happy here and I am looked after very well.”

We found that suitable arrangements were in place to manage people’s medication and ensure they received any medication they needed. A person who used the service told us, “They make sure I take my medication when I should.”

We found there were sufficient staff to meet people’s needs. A person who used the service told us, “There are enough staff around, they come to me pretty quickly.” We also found the provider had an effective complaints procedure. People told us they felt they were listened to. A person told us, “I can speak up very clearly and loudly if necessary, I haven’t found it necessary.” Another person said, “I think I am listened to.”

Prior to our visit we reviewed all the information we had received from the provider. During the visit we spoke with five people who used the service and one relative and asked them for their views. We also spoke with four care staff, and the registered manager. We also looked at some of the records held in the service including the care files for three people.

We saw minutes of the service user forum meetings held throughout 2011. One example of a comment made was, “I always feel included in decisions about my life. I am given plenty of information and never left in the dark about things.”

A relative told us their relation was, “treated with respect and given lots of love.” A person who used the service told us, “I am definitely treated with respect, I would object if I wasn’t.”

We found people were supported in promoting their independence and community involvement. One person who used the service told us their walking frame was, “worth its weight in gold, it helps me get around.”

A relative told us how they thought their relation received very good care. A person who used the service said, “I am well looked after.”

We asked three people who used the service if they felt safe in the home and they all said they did. One person said, Oh yes I feel safe, it is free and easy.”

A person who used the service told us, “There are no faults here.” Another person said, “I am not saying anything wrong about the place, I cannot find any fault.”

This inspection took place on 15 and 17 October 2014 and was unannounced. The Byars Nursing Home provides accommodation and personal care for up to 30 older people, including people with dementia. On the day of our inspection 28 people were using the service.

The service had a registered manager in place at the time of our inspection. 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 and associated Regulations about how the service is run.

There were robust systems in place to protect people from abuse as all staff had been trained to recognise any form of abuse and knew how to do so. They knew how they should respond if any allegation or incident of abuse took place. They also knew the roles and responsibility of others in protecting people. This information was also shared with people who used the service and their relatives so they would know how to raise a concern about someone’s safety.

Medicines were managed safely and people received their medicines in an individual manner that best suited their needs. People were involved in reviewing their medicines. The registered manager implemented the best practices recommended by the providers of national guidance to improve health and social care.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The DoLS is part of the MCA, which is in place to protect people who lack capacity to make certain decisions because of illness or disability. DOLS protects the rights of such people by ensuring that if there are restrictions on their freedom these are assessed by professionals who are trained to decide if the restriction is needed. We found this legislation was being used correctly to protect people who were not able to make their own decisions about the care they received. We also found staff were aware of the principles within the MCA and had not deprived people of liberty without applying for the required authorisation. We found the provider was proactive in the way they met the requirements of the MCA and DoLS.

Effective methods were implemented to support people who had complex needs with their nutritional intake. People’s health was closely monitored and the service worked closely with healthcare professionals to provide people with an enhanced healthcare service. This was achieved through identifying and implementing best practices to meet and improve people’s care, treatment and support.

People valued their relationships with staff who treated them with compassion, dignity and respect. Staff knew and appreciated their individual needs and preferences. They were helped and encouraged to express their views and be involved in decisions about their care. People received the care they required in the manner they chose. People were supported to maintain their independence and encouraged to be involved in the local community and participate in community events.

There was strong management and leadership which put people at the heart of the service. Managers identified current best practices and achieved recognised quality accreditation schemes so that people received a service of the highest quality and continually strived to improve.