On the day of our inspection 17 older people were living at Sycamore Cottage. We spoke with four people who used the service and the relatives of eight people. Most of the people who used the service were not able to communicate verbally with us. However, we were able to find out about their experiences of living at the service by observing care and talking to their families. We also spoke with the registered manager, the deputy manager, three senior care staff, three care staff, the cook and a general assistant.We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;
' Is the service safe?
' Is the service caring?
' Is the service effective?
' Is the service well led?
' Is the service responsive?
This is a summary of what we found.
Is the service safe?
People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. The manager told us that each person had a nominated key worker, which we saw reflected in the ten care records we examined. The support plans were detailed and included appropriate risk assessments to reduce the risk of harm for people. Care practices we observed demonstrated that staff knew the needs of people and how to deliver the necessary support.
We found that the provider had protected people who used the service from the risk of abuse because they had taken reasonable steps to identify the possibility of abuse and to prevent it from happening. A visiting health professional had raised concerns regarding unexplained bruising and a general increase in the number of pressure sores experienced by different people. We saw the manager had arranged further training for all staff in relation to moving and handling to ensure that people were moved safely.
During our inspection we observed a senior care worker administer medicines safely, in the way people preferred. We found that the provider had an effective process to manage the ordering, receipt, storage, handling and recording of medication. Since the last inspection there had been no medication errors reported.
People were cared for by suitably qualified, skilled and experienced staff because the provider had an effective recruitment and selection process.
The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS )which applies to care homes. The DoLS are a legal process supported by a code of practice to ensure that people who lacked mental capacity to make decisions were not deprived of their liberty, other than in accordance with the law. We found that people who lived At Sycamore Cottage were only deprived of their liberty when this had been appropriately authorised.
Is the service caring?
We saw that staff communicated effectively with people who responded positively to them. Staff ensured that everyone was included in activities and immediately provided support when necessary. When people wished to move staff were attentive but ensured people were given time to get up and walk unaided whenever possible.
We found that staff promoted people's independence, whilst they ensured their safety. This included discreetly assisting people with personal needs, helping them to retain their dignity. We spoke with two senior care workers who were passionate about creating a homely environment, where people could come and go as they pleased. During the lunch service we saw that people had a choice of menus. We observed that two people did not want to eat the meals they had chosen. We saw staff speak with them in a compassionate way to see if they were unwell and then offered them other options.
People who used the service told us that the staff were always 'kind and helpful'. One person said, 'This is my home and the staff are like an additional family.' Another person said, 'The staff are always cheerful and brighten up my day, even if I'm not feeling well.' A relative of one person said, 'The care is excellent and the staff are so understanding when people are confused or worried.'
Is the service effective?
Where people did not have the capacity to consent the provider had not acted in accordance with legal requirements. We looked at ten care records and found that no mental capacity assessments had been completed. We have asked the provider to make improvements in relation to how they obtain valid consent from people. We have asked them to provide a report detailing how they plan to achieve the improvements.
We found that staff had not received appropriate training, professional development, supervision or appraisal. This meant that people had not been cared for by staff who had been supported to deliver care and treatment to an appropriate standard. We have asked the provider to make improvements in relation to how they support workers. We have asked them to provide a report detailing how they plan to achieve the improvements.
Is the service responsive?
The service had a system for recording falls which demonstrated that the provider took action quickly to eliminate or reduce identified risks. Where required some care plans contained specific moving and handling assessments, together with instructions for use of relevant equipment. We read the provider's policy regarding pressure area relief and initial assessments of people who had been suffering with pressure ulcers. We saw how people had been properly assessed and treated, including guidance from the district and tissue viability nurse where required.
Is the service well-led?
The provider had not protected people against the risk of inappropriate or unsafe care by effectively assessing and monitoring the quality of the service provided. We found that the provider did not have systems in place to ensure that care reviews, staff training and supervisions were completed when due. The provider did not have an effective system to learn from complaints, accidents or near misses. We have asked the provider to make improvements and tell us how they intend to implement them.