Sycamores

Sycamores is registered to provide accommodation and personal care for up to 36 people, including people living with dementia. At the time of our inspection visit there were 31 people living at the home. Care and support is provided across 3 floors. On each floor, people have use of a communal lounge and dining area, as well as occasional seating throughout corridors. People’s bedrooms are ensuite and there are further communal bathroom facilities located around the home. People can access outside spaces.

People's experience of using this service and what we found

Known risks relating to people’s health and welfare were not always managed safely and ineffective scrutiny of the quality of service, did not always identify issues. The provider’s quality assurance systems lacked effective scrutiny.

Where similar issues had been identified at inspections across some of the providers other homes, there was limited evidence lessons had been learnt.

Risks associated with people’s health and welfare were not always considered, reviewed, or reflected a person’s current needs. Records and actions that were required to be completed, were not always recorded, so we were not confident risks were managed safely. Oversight and scrutiny of those records through effective checks, went unchecked so staff did not always have up to date information to support people safely.

Safe moving and handling practices were not followed. Our observations showed staff did not always support people safely when transferring them in wheelchairs. Staff conversations showed us it was accepted practice for staff throughout the day, to move some people in wheelchairs or commodes. In 4 examples we saw, staff used wheeled appliances without footplates meaning people were put at unnecessary risk of injury.

People did not always receive their medicines safely and in line with national guidance. People’s own medicines were stored in their room, yet we found large stocks of medicines that was not necessary to be kept in people’s rooms. One person was not administered a medicine and staff had not identified this as an issue. Topical creams were applied, yet most topical creams we saw had no date of opening, so we could not be confident, those creams remained effective.

Communal areas were clean, however people’s individual rooms and equipment were not always clean and hygienic.

People told us they received support from staff when required. The provider had sufficiently trained and suitable staff on shift to meet people’s needs. When people rung their calls bells for assistance, staff were on hand to support them with limited delay.

People and relatives told us they felt safe living at Sycamores. People said it felt like home and those staff who supported them were kind and considerate. Relatives were able to attend relatives meetings which gave them an opportunity to be involved in how the care and support was provided.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 02 April 2020).

Why we inspected

We received concerns in relation to the standards of care provided and the quality of records. As a result, we undertook a focused inspection to review the key questions of safe and well led only.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to requires improvement based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Sycamores on our website at www.cqc.org.uk.

Enforcement

We have identified a breach in relation to Regulation 12 (Safe care and treatment) and Regulation 17 (Good governance).

We have found evidence that the provider needs to make improvements. You can see what action we have asked the provider to take at the end of this full report.

Following our visit, the provider sent us information telling us how they planned to immediately address the issues we raised.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

An outdoor visiting pod was available on an appointment basis. There was a cleaning regime and visits were coordinated by a visitor facilitator. This meant people could see their loved ones in a safe and comfortable environment.

People who were unable to socially distance were given extra support to minimise the risk of infection being spread. For example, a person who had difficulty self-isolating was supported to use a specific area of the lounge which was then cleaned. This helped to maintain the person’s wellbeing.

Staff wore Personal Protective Equipment (PPE) in line with current guidance and were observed to ensure continued good practice.

A two stage cleaning process was used throughout the home to ensure areas were cleaned and then sanitised. Separate cleaning equipment was stored on each floor to minimise the risk of cross contamination.

As part of staff training in hand hygiene, a special lotion was used to highlight any areas missed by inefficient hand washing techniques. This supported staff to improve their hand hygiene practice.

Sycamores is registered to provide residential accommodation and personal care for up to 36 older people, including people living with dementia. At the time of our inspection visit there were 31 people living at the home, however one person was in hospital. Bedrooms were across three floors with communal facilities and a main dining and lounge area on each floor. People had their own ensuite bedrooms and access to an outdoor area.

People’s experience of using this service and what we found

Safety for people continued to be maintained because enough staff protected people from known or poor practice. Staff knew what to do to minimise people’s exposure to known health risks and staff said they could respond to people’s request within accepted timescales. Staff followed safe principles for infection control which meant the potential for cross infection risk was minimised.

Staff knew people well, such as their individual preferences which helped staff tailor their approach to each person, especially those living with a cognitive impairment. Staff training was up to date and monitored by the provider.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. People’s records included decision specific mental capacity assessments. Staff knew how to support people in line with those choices to limit unnecessary restrictions.

People found staff were respectful, kind and caring. People had individual care plans and assessments that met their health and social needs and they were supported by other health professionals.

People were involved in pursing their interests and hobbies. People’s life history information was used to inform staff about their hobbies and interests. Care plans were clear and they provided staff with the information and guidance they needed to support people in line with their individual care needs. Staff could support people who were at end of life and people’s advanced wishes and preferences were discussed and followed.

People and relatives were provided opportunities for feedback on the service. The registered manager had an open-door policy. They and the deputy manager worked ‘on the floor’, providing frequent opportunities for people and staff to share any feedback or opinions.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was good (published 30 August 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor intelligence we receive about the service until we return to visit as per our inspection programme. If any concerning information is received, we may inspect sooner.

The Sycamores provides accommodation and personal care for up to 36 older people who may also have a diagnosis of dementia, over three floors. At the time of our inspection visit there were 34 people living at the home.

At the last inspection, the service was rated Good overall. At this inspection we found the service has maintained an overall Good rating, but has been rated ‘Requires Improvement’ in ‘Safe’.

There was an experienced registered manager at the home. 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. We refer to the registered manager as the manager in the body of this report.

Staff understood their responsibilities to protect people from the risk of abuse. The manager checked staff’s suitability for their role before they started working at the home and made sure there were enough staff to support people safely. Medicines were stored, administered and managed safely.

The manager and provider identified risks to people’s environment, and management plans were in place to protect people from those risks. However, risks to people’s individual health and wellbeing were not always consistently managed to minimise risks to people’s health.

People we spoke with told us they were happy at the home. They told us the staff were kind and caring. People were involved in planning their care with the support of their relatives and staff, to make sure their care plans met their individual needs, abilities and preferences. Care plans were regularly reviewed and staff asked other health professionals for advice and support when people’s health needs changed.

People were cared for and supported by staff who had the skills and training to meet their needs. The registered manager and staff understood their responsibilities in relation to the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards.

People were supported to eat and drink enough to maintain a balanced diet that met their individual dietary needs and preferences.

People who lived at the home and staff had confidence in the registered manager, who was supported by a hands-on management team. The provider had implemented systems that ensured staff and management had access to the most up-to-date information at the press of a button and enabled relatives to be fully informed and involved in their relations’ care.

The provider employed a lifestyle coach, whose time was dedicated to supporting people to make the most of each day through physical and mental stimulation.

People, their relatives and healthcare professionals were encouraged to share their opinions about the quality of the service, to ensure planned improvements focused on people’s experiences. The provider listened and acted on people’s views to improve the service.

We spoke with two relatives of people that used the service, they were both happy with the service that their relative received. One relative told us 'I can't fault the place, the staff have really taken the time to get to know my (relative)'.

We spoke with five staff members who told us that they felt well supported in their roles and that there were enough staff on duty to meet the people's needs. We observed staff responding promptly to call bells throughout our visit.

We found that people's needs were assessed and care plans were put in place to ensure that people's needs were met. We found that people's likes, dislikes and preferences were recorded in their care plans and we observed staff carrying out care and support and communicating with people as described in their care plans. We found that risks associated with people's care were identified and control measures had been put in place to ensure people's safety.

We found that there were appropriate arrangements in place to protect people from the risks associated with medicines and that staff supported people appropriately with their medication.

However, we identified there were some gaps in the records that were kept of people's care and support which meant that there was not an accurate record of the care and support that they received. We also found that there were inconsistencies in some people's care records.

We asked relatives about the care provided to their family and they each told us that the care delivered to people was good. They told us, 'Very good personal care is given by staff' and 'I am perfectly happy with XX's care, they are always clean and smart.'

We saw people's bedrooms were clean, warm and well furnished. People had brought some personal items with them into the care home and this made their rooms "homely".

We saw that mealtimes were a relaxed and social occasion and that people had a choice about what they wanted to eat and drink.

Staff told us they had sufficient information about how to support the needs of the people who used the service. Records we looked at showed that staff communicated people's changed needs to managers so that health and medical care could be sought promptly.

We found the provider recruited staff to work in the care home only after checks had taken place to show people who used the service would be safe and not at risk of harm from the staff delivering care to them.