All inspections: The Sycamores - Care Quality Commission

This inspection took place on 19 November 2015 and was unannounced.

We previously inspected the service on 18 October 2013 and at that time we found the registered provider was meeting the regulations we reviewed.

The Sycamores is registered to provide care for up to 40 older people. Accommodation is available on two floors accessed by a lift. All bedrooms are single occupancy with en-suite facilities. At the time of our inspection there were 40 people using the service.

The service is required to have 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.’ The service had not had a registered manager since 24 February 2014. A manager had been in place since that time and had left the service on 9 October 2015. The current manager was the registered manager at another location run by the same provider and had submitted their application to commence registration with CQC at this location. At the time of our inspection this was not finalised.

People who lived at The Sycamores told us they felt safe. Staff had a good understanding about safeguarding adults from abuse and who to contact if they suspected any abuse. However systems were not in place to immediately investigate evidence of abuse because a medicines error had not been reported to safeguarding or investigated. This was a breach of Regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014

Risk assessments minimised risk whilst promoting people’s independence. There were enough suitably trained staff to meet the assessed needs of people who used the service.

Medicines were managed in a safe way for people.

People’s capacity was considered when decisions needed to be made and support provided when necessary to support and enable people to air their views. This helped ensure people’s rights were protected when decisions needed to be made.

People were supported to eat a good balanced diet and people enjoyed the food served. A range of healthcare professionals were involved in people’s care as the need arose.

People’s individual needs were met by the adaptation, design and decoration of the service.

Staff were caring and supported people in a way that maintained their dignity and privacy and people were supported to be as independent as possible throughout their daily lives.

People’s needs were reviewed as soon as their situation and needs changed, however some records were not updated and contained minimal information. Accurate and secure records were not always maintained in relation to care that was being delivered. This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The new manager was addressing this and some improvements had been made.

People and their representatives were involved in care planning and reviews.

People told us they knew how to complain and told us staff were always approachable.

The culture of the organisation was open and transparent and the manager was visible in the service.

The manager held meetings with people who used the service, relatives and staff to gain feedback about the service they provided to people.

The registered provider had an overview of the service. They audited and monitored the service to ensure the needs of people were met and the service provided was to a high standard. However, this system had not addressed some of the problems we found with reporting and investigating safeguarding concerns and keeping accurate and secure records.

You can see what action we told the provider to take at the back of the full version of the report.

This was a follow up inspection to check that a concern raised at our previous visit had been addressed. During our last visit we witnessed an incident which indicated the home did not have an effective system in place to identify, assess and manage risks to the health, safety and welfare of people using the service and others. This was in relation to the assessment of people before they moved into the home to ensure the home could meet their needs appropriately and safely.

At this visit we spoke with the manager about what action the home had taken to address these concerns. The manager explained the process for pre-admission assessment had been improved. She described how initial information was obtained from people making enquiries about moving into the home to ensure the home would be able to meet the person's needs.

We reviewed the care records of two people who had recently moved in to the home. We saw pre-assessment visits had been carried out by the manager, who had also been accompanied by another senior member of staff. We saw evidence that people and their families had been actively involved in the assessment process. Assessment information from other health and social care professionals had also been taken into account. This showed the home had put an effective system in place to identify, assess and manage risks to the health, safety and welfare of people using the service and others.

During our visit we spoke with six people and four relatives to gain their views. People told us they were well looked after by staff. One person explained: 'The staff know what help and assistance I need.'

We saw people seemed relaxed and well cared for, and there was a good interaction between people who lived in the home and with staff. For example, we saw sitting talking to people about the music they enjoyed and reminiscing about dances they had enjoyed in the past.

We found that appropriate arrangements had been put in place to appropriately manage medicines.

We spoke with three members of care staff who told us they enjoyed working at the home. One member of staff commented: 'I like working here.' Staff spoken with told us there were regular staff meetings in the home as well as formal individual supervision meetings with senior staff. They said they could also request supervision meetings 'as and when needed' and had sufficient support from senior staff on a daily basis. Staff told us they received regular training in mandatory areas, such as moving and handling, safeguarding and fire safety.

We saw the home had effective systems in place to regularly assess and monitor the quality of service that people received. However, during our visit we saw an incident which indicated that an effective system was not in place to identify, assess and manage risks to the health, safety and welfare of people using the service and others.

We carried out this inspection in response to information of concern we received. The information alleged the following: a person missed hospital appointments because no proper transport was booked, there were issues regarding medication, lack of appropriate hand washing facilities and people were 'got up too early'.

We spoke with seven people who used the service. People made the following comments:

'I like it here, it meets my needs and I've made it my home.'

'I'm very happy living here. I have some good friends'.

'They [staff] work very hard and they meet my needs well'.

'Staff are patient and kind.'

We spoke with two relatives. One relative said; 'I'm very happy with the standard of care. [My relative] is looked after very well and the manager is approachable.' Another relative commented; 'The staff are good. [My relative] makes his own choices.'

During our visit we observed positive interactions between staff and people who used the service. We saw that staff spoke at a pace which met people's needs and engaged with people in a calm and patient way, which allowed people time to explain what they wanted or where they wanted to go.

We spoke with four members of staff who demonstrated a good understanding of the needs of the people who used the service.

We found that some improvements had been made following the last inspection; however we found there were some issues regarding the use and management of medicines.

People told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

The inspection team was led by a Care Quality Commission (CQC) inspector joined by an Expert by Experience who has personal experience of using or caring for someone who uses this type of service.

People we spoke with told us they liked living at the home. They said the staff were kind, considerate and friendly. One person told us 'The staff paint my nails and make them look beautiful, I like to look nice.'

People told us the food was very good and they liked having the option of having their meals in their bedroom. One person said 'I enjoy all of my meals, but I like the two roast dinners each week the best.'

People told us that they did not have many opportunities to join in activities. One person said, 'I even help with the dusting.' Another said,' We have our own sing-a-longs, but that's about it.'

These older reports are from our old approaches to inspection, including those from before CQC was created.

Archived: The Sycamores

All Inspections

19 November 2015

During a routine inspection

21 October 2013

During an inspection looking at part of the service

22, 23 May 2013

During a routine inspection

20 February 2013

During an inspection in response to concerns

10 July 2012

During a themed inspection looking at Dignity and Nutrition

Reports under our old system of regulation