Byfield Court

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

At our last assessment we rated this key question requires improvement. At this assessment, the rating has changed to Good.

Good: This meant the service was consistently managed and well-led. Leaders and the culture they created promoted high-quality, person-centred care.

The service was well led. People and staff told us that the registered manager was approachable and open to new ideas. There were systems in place to monitor and assess the quality of service provided. The service worked in partnership with other agencies and community services to provide an effective service to people.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

There was a shared vision and strategy in which the service operated. People’s relatives told us the staff team worked well together and delivered effective care to people. One relative commented, “The home is amazing! I have nothing but good words and praises for the home. It is so refreshing to see staff who actually know what they are doing.”

The provider used various ways to engage with staff and people to share its strategy. They shared regular updates, newsletters and organised events. All the staff we spoke with demonstrated they understood their roles and responsibilities, and the aims and objectives of the service. They talked enthusiastically about their roles in ensuring people were safe and their well-being promoted. One member of staff commented, “The organization reminds us of our roles and responsibilities and how to make sure we deliver good care.” The registered manager held regular team meetings with staff where they discussed various matters including the standard of care delivered to people. Staff told us that they were able to discuss matters freely and as a team they found solutions together.

The provider had policies and procedures which guided the running of the service and sets out the standard of service expected. Staff confirmed they had completed training to enable them to deliver their jobs as required.

There was visible leadership in the service. The registered manager listened and supported people where they needed support. One relative told us, “I know the registered manager. They are very open, approachable and they listen. I can go to them if I have any concerns. They are good.” Professionals we spoke with also told us that the service was well managed. One professional commented, “I feel this is a very well-run home, with experienced, knowledgeable and consistent staff.”

Staff told us that they felt supported by the registered manager, and they felt they were part of the service. One staff member mentioned, “[The registered manager] is great. She is very supportive inside of work and personal life. She is very understanding. I can trust her.” The registered manager was available and accessible to staff. We observe the registered manager interacting with people and staff in an open and supportive manner.

The registered manager understood their roles and responsibilities to deliver an effective service to people and to act in accordance with the duty of candour. They complied with the requirements of their registration and had notified us (CQC) of significant events as required.

The registered manager told us they felt supported by the regional support manager who visited the home regularly. They had completed training relevant to their role and could request additional training if they needed it to improve their effectiveness. They told us they also attended meetings with other registered managers where they listened, shared ideas and supported each other.

The service promoted a culture where staff could raise their concerns about the service. Staff told us they knew how to raise their concerns both internally and externally, and they felt empowered to do so if this was needed. One staff member told us, “I can raise my concerns if I'm not happy with anything with the registered manager. If the registered manager is not around, I can take it to the next senior person in the organisation.” Another member of staff mentioned, “The staff team speak up if something has gone wrong. They talk about it and want it resolved. I’m not afraid to whistle-blow because I have a duty to protect people.”

The registered manager told us they were always open and accessible to staff and made staff comfortable to raise concerns freely. They also used staff meetings to encourage staff to speak up if they had concerns.

The provider had a 'Speaking Up' policy. There was a poster displayed in the office which provided details on how to raise concerns within and outside the organisation.

The service promoted equality and diversity in the team. The provider had an equality and diversity policy in place, and staff had completed equality and diversity training.

Staff told us they worked as a team and supported each other irrespective of their differences. One member of staff commented, “I'm treated fairly. All the staff work as a team, and we respect one another.” Another member of staff told us their duties had been adjusted recently due to changes in their personal circumstances.

There was a diverse workforce at the service from various cultures and backgrounds. We saw that they interacted well and shared jokes together. The registered manager explained that they encouraged staff to share their cultural food during team events. They supported staff to practice their religious beliefs by giving them opportunity to say their prayers and attend their places of worship.

The service had systems in place to regularly assess and monitor the quality of service provided. The registered manager conducted various audits and checks including health and safety, medicine audits, infection control, care records and review of the service. They shared their reports with regional manager and developed an action plan to address areas requiring improvement. We saw action plan had been developed to address the concern regarding staff not always signing the medication administration records. Medication refresher training had been booked for staff and daily shift handover now included checking MAR records.

Staff meetings were used to discuss the quality of the service and staff were given opportunities to feedback on areas requiring improvement. Staff told us they reviewed various aspects of the service including people’s care, health and safety and team issues. Staff told us the team all had some responsibility in identifying gaps in the service and reporting them accordingly. Staff knew systems to report repairs and maintenance issues in the home.

The service worked in partnership with various organisations and agencies to meet people’s needs. Relatives we spoke with confirmed that staff supported their loved one to access the community facilities and services. One relative commented, “[Loved one] likes to go out often and staff support them when they are out in the community to stay safe.”

Staff told us they worked closely with families, various health, and social care professionals to ensure people’s needs were met. They told us they communicated openly with them, shared relevant information, and followed up on actions agreed to enable a positive working relationship. On the day of our visit, a professional visited to review the service they were providing to one person. They were complimentary of the progress the person had made and the support from staff. Professionals we contacted also confirmed that staff and the registered manager worked closely and professionally with them.

The service arranged a several activities aimed at bringing people, their families, staff members, and the wider community together. These gatherings fostered collaboration and strengthened connections. Among the events hosted were summer and Christmas fairs, along with carol performances by the local school choir.

There were processes in place to ensure continuous learning in the service. Staff meetings were used to seek staff feedback about the service and discuss areas for improvement. We reviewed staff meeting minutes and noted staff made suggestions openly on areas requiring improvement. For example, they had discussed ways to improve the health and safety of the environment. Staff meetings were also used as an opportunity to gain experience and improve practice. The registered manager had shared feedback from a professional with the staff team, which had been discussed and learning shared.

The service also sought feedback from people, their relatives and other professionals involved in the service. We found that the menu for people had recently been adapted to meet people's needs based on feedback received. One relative commented, “They [the service] are always looking for ways to make the home better for the residents and to improve the care for residents. They always ask if we were happy and what they can do.” One professional stated, “They [staff] always come to us if they are not sure about anything. They ask for our opinions, and they use it to improve the care.”