Archived: Sycamore Cottage Residential Home

Below is a summary of what we found. During our inspection we talked with five people who used the service, two visiting professionals, and four members of staff. Some of the people who lived at the home were not able to give their views due to their mental health needs so we spent time with them observing the support they received.

If you want to see the evidence that supports our summary please read the full report.

People told us they were satisfied with the care and support they experienced. One told us, 'We are very much looked after properly.' Another said, 'The staff have been fine and very good and everyone here is nice. I'm personally happy with things as they are.' A visiting professional commented, 'There is improvement here. The residents are happier and the environment is better.'

People said the amount of activities had increased since we last inspected. We observed one person playing cards with a volunteer and another playing a board game with a care worker. Other people were listening to a music channel they had chosen. Staff visited people on bed rest for a cup of tea and a chat. One person told us about the activities they had enjoyed and said, 'I'm happy and content here because of all the activities'

People told us the premises had improved. One person said, 'It looks brilliant now.' Another person commented, 'The owners have transformed the place. It is a hundred times better than it was before.' And a visiting professional told us, 'There has been a lot of improvement to the decoration.'

At our last inspection we found that some areas of the premises were unsafe and in a poor state of decoration and repair. We issued a warning notice telling the provider and then registered manager to remedy this. At this inspection we found that appropriate action had been taken and the environment was substantially improved.

However one issue concerning a hot unguarded radiator remained outstanding. And other areas in need of improvement were identified. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

People who were able to give their views told us they liked living at Sycamore Cottage. One person said, 'This is definitely home to me now, and the staff make sure we have everything we need.' A relative commented, 'The staff keep an eye on my (family member) to make sure they are safe.'

Prior to our inspection staffing levels had been increased and when we visited there were enough staff on duty to meet the needs of the people living at the home. The manager and other staff were available on call in case of emergencies.

At our previous inspection of the home on 6 June 2013 we found that the building was not adequately maintained and decor and furnishings were in need of improvement. At this inspection we found that although some improvements had been made, people were still not being protected against the risks associated with unsafe and unsuitable premises and grounds.

Due to our concerns about the safety of the premises we contacted the local authority during our inspection. The Senior Health and Safety Advisor (SHSA) arrived at the home while we were present. The SHSA identified further risks which they set out in a report sent to the providers and us following their inspection.

Is the service effective?

The care plans we reviewed were 'person-centred' in that they helped to ensure people received individualised care that promoted independence and choice. They included information about people's likes, dislikes and preferred routines. For example, one stated that a person liked to get up, 'When they wake up ' usually around 10am.' This demonstrated that people's views had been taken into account when care places were written.

We found that risks assessments were not always updated and followed to ensure people were safe. One person's risk assessments for leaving the home unaccompanied had not been updated following an incident when they went out via an unlocked door. This placed the person at further risk of harm. One person's risk assessment for falls was not being followed in that it specified that they needed 'adequate lighting' in their bedroom. This had not been provided placing the person at risk of further falls.

A compliance action has been set for these shortfalls and the provider must tell us how they plan to improve.

We looked at how the Mental Capacity Act Deprivation of Liberty Safeguards (MCA DoLS) were applied in the home. We found that one person appeared to have had their liberty restricted. However, the manager had not considered whether this should have been referred to the local authority for their review. We discussed this with the manager who agreed to refer this person to the local DoLS team. Following our inspection the manager told us she had done this.

Is the service caring?

People got on well with the staff who worked with them in a warm and supportive way. One person who used the service said, 'The staff are reliable, kind and thoughtful.' A relative told us, 'The staff care about everyone here and do a very good job.'

We observed lunch being served. Staff dined with the people who used the service so they could socialise with them and provide discreet assistance where necessary. Food was homemade and freshly prepared and served with plenty of choices and alternatives to suit people's wishes. One person told us, 'The meals are excellent ' the cook is as good as a top chef and I'd like to give them a special mention.'

Is the service responsive?

People told us that when they needed assistance staff were quick to provide it. One person said, 'If we need any help the staff come at once, they all come rushing over.' Another person told us, 'They are on the ball with medication. I take numerous tablets every day and they make sure I get them at the right time. They never forget.'

Both individual and group activities were provided, although the activity programme advertised in the entrance hall was out of date so it was difficult for people to tell what was going on without asking staff. Staff said group activities included exercise classes, music, board games and trips out. Individual activities depended people's particular hobbies and interests. For example, one person enjoyed sewing and records showed they done this with staff.

Is the service well-led?

People told us the manager was approachable and hard working. One person said, 'The manager is here a lot and always comes and talks to us. She is very easy to get on with.' A staff member told us, 'The manager wants everything done in a professional way and so do the staff, but it can be frustrating as we don't always have the resources we need.' We asked the provider to take note of this.

The local authority were providing the home with regular support and expertise to help improve standards. This was because over recent months there had been concerns about the quality of care and support people received at this home.

People's needs had been assessed and care plans put in place to explain how their support was to be delivered. These documents were up to date and reflected the views of people using the service. People who used the service told us that they were satisfied with the care and support they received. One told us, 'The staff here look after me, they are nice to me.'

Staff we spoke with understood their roles in helping to protect and keep safe the vulnerable people who used the service. People who used the service told us that they felt well looked after and safe. One told us, 'It is a nice home and I feel safe here. I don't worry about anything.'

There were no clear plans in place to explain how people's PRN (as required) medication was to be administered.

Maintenance and redecoration work needed to be undertaken to improve the standard of the building and to ensure it was suitable for the people who used the service.

The provider needed to ensure that all staff, including those newly employed, received proper training to support them in their job roles.

At the time of this follow up inspection the local authority was providing support to help make improvements at this home. This was in response to concerns that had been raised. Because of this we also used this follow up inspection to check that up to date assessments were in place and that people received care and support that was consistent with these assessments.

When we carried out this inspection there were nine people using the service and during our visit we spoke with five of these people to ask them for their views on the service they received. All those we spoke with told us that they were satisfied with the care and support they received. One told us, 'This place is good, I don't think there can be anywhere better.' Another said, I wouldn't stay here if I unless I was satisfied, and I am.'