Sycamore Rise Residential Care Home

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

Medicines were not always managed safely. Systems and process were not robust enough to ensure medications were administered and disposed of safely. Risks were not always being identified and managed in the environment and some people did not have risk assessments in place. Recruitment processes were not always safe as appropriate checks were not always being completed. The service was staffing at safe levels, however, due to recruitment issues and sickness, agency was being relied on. We have made a recommendation around maintaining recruitment and staffing tools. Infection prevention and control practices were not robust. People and families told us they felt the service was safe.

Staff were consistently receiving training in key areas and had good levels of compliance. We have made a recommendation the service includes training around learning disabilities and increased non mandatory courses. Supervisions were occurring. Pre-admission assessments were being completed and care plans covered key areas, although some plans required updating. People were having their diet and nutritional needs met and told us they enjoyed the meals. The provider worked in partnership with other agencies to maintain people’s health and wellbeing.

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 were being treated with dignity and respect. People and relatives told us staff were caring. People could have visitors without restrictions and people and families were being encouraged to express their views on their care. People’s independence was being supported.

An activities coordinator had been recruited and activities in the home were taking place, although they were limited due to staffing issues. Records showed care was person centred and people were able to make everyday choices. People had communication care plans in place to ensure the support they need to communicate and receive information was in a way they understand. No one in the service was at end of life at the start of our inspection. The service was supporting people and families to plan end of life care. A complaints procedure was in place and the information was made accessible to people. People and families told us they felt able to complain.

Systems and processes were not always effective to oversee and manage the service. The provider did not record or provide structured support and oversight to the registered manager. The views of people, families, staff and professionals were regularly being sought and analysed. Staff and residents’ meetings were regularly occurring. People, families and visiting professionals spoke positively around the management and service. Staff told us they did not always feel heard. The provider was aware of duty of candour and was making appropriate notifications.

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 29 October 2019).

At our last inspection we recommended that the provider considered improving activities and the provider put in a formal process for overseeing the home and providing management support. At this inspection we found some improvements have been made in relation to activities however, not enough improvements have been made in relation to provider oversight.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

We have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

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

Enforcement and Recommendations

We have identified breaches in relation to safe management of medicines, assessing and managing risk, infection control practices, safe recruitment, and oversight of the service at this inspection. We made recommendations around recruitment and staffing tools and additional training.

Please see the action we have told the provider to take at the end of this report.

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.

Sycamore Rise Residential Care Home is a residential care home providing personal care to 28 people aged 65 and over at the time of the inspection. The service can support up to 32 people. The home is located in a rural area near the centre of Colne.

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

The manager had implemented infection prevention and control procedures which were understood and followed by the staff. All staff had completed training on the use of personal protective equipment (PPE) and participated in the weekly testing programme. The service had plentiful supplies of PPE and stocks were carefully monitored. We observed all staff were wearing appropriate PPE. The home had a satisfactory standard of cleanliness in all areas seen.

There were sufficient numbers of staff deployed to meet people's needs and ensure their safety. Appropriate recruitment procedures ensured prospective staff were suitable to work in the home. The manager agreed to implement a health questionnaire for all future appropriate applicants. Risk assessments were carried out to enable people to retain their independence and receive care with minimum risk to themselves or others.

The manager carried out a monthly analysis of accidents and incidents and discussed any lessons learned with the staff team. They intended to record future discussions at staff handover and general meetings.

The manager understood how to safeguard people from abuse and report any concerns. During our visit, the home was calm, and staff were well organised. We observed staff responded promptly to people’s needs.

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 30 October 2018).

Why we inspected

We undertook this targeted inspection to check whether the provider had met the requirements of the Health and Social Care Act 2008 (Regulated Activities). The overall rating for the service has not changed following this targeted inspection and remains good.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

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 coronavirus and other infection outbreaks effectively.

Follow up

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

At the last inspection on 15 and 16 February 2016 the service was rated as ‘Good’ across all domains. At this inspection we found that although the service remained ‘Good’ overall, in the domain of “Well-Led’ we have judged that it requires improvement because there had been insufficient provider input following the building of an extension to the home and increase in the number of people who used the home.

Since the last inspection in February 2016, the registered provider had built an extension to the home and the CQC was kept informed of this development. As a consequence the allowance for the maximum number of people who could reside at the home had increased from 25 to 32.

Sycamore Rise Residential Care Home is a 'care home' in Colne in the county of Lancashire. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided and both were looked at during this inspection.

The home is registered to provide accommodation and support for up to 32 people and cares for older people, including those living with dementia. At the time of our inspection 28 people were using the service.

There was a registered manager in place who had been registered since 1 October 2010. 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.

People using the service said they felt safe and that staff treated them well. There were enough staff on duty and deployed throughout the home to meet people’s care and support needs. Safeguarding adult’s procedures were robust and staff understood how to safeguard people they supported. There was a whistle-blowing procedure available and staff said they would use it if they needed to.

Appropriate recruitment checks took place before staff started work.

People were receiving their medicines as prescribed by health care professionals.

We found that people and their relatives, where appropriate, had been involved in planning for their care needs. Care plans and risk assessments provided clear information and guidance for staff on how to support people using the service with their needs.

There was a range of activities available for people to enjoy but relatives felt that since the home had been extended, staff did not have enough time to engage with people meaningfully. We have made a recommendation around this in the 'Responsive' section of this report.

People and their relatives knew about the home’s complaint’s procedure and said they were confident their complaints would be fully investigated and action taken if necessary.

We found that people were not being deprived of their liberty inappropriately and, where appropriate, DoLS applications were being made. The registered manager and staff were aware of the need to seek consent in line with the MCA.

Proper assessments were being made around ways of protecting people and action had been taken to support people with sufficient numbers of well-trained staff.

People were supported to maintain a balanced diet and had access to a range of healthcare professionals when required. People received appropriate end of life care and support.

The registered manager conducted regular checks to make sure people were receiving appropriate care and support. The registered manager took into account the views of people using the service, their relatives and staff through meetings and surveys. The results were analysed and action was taken to make improvements at the home. Staff said they enjoyed working at the home and received appropriate training and good support from the registered manager but further support and input was required from the provider.

We had concerns about the provision of checks to ensure that the service operated effectively and found that the provider was not completing any audits and was leaving responsibility for all checks with the registered manager. This has resulted in making a formal recommendation around this issue that you can see in the ‘Well-Led’ section of the report.

Sycamore Rise care home is registered to provide accommodation, personal care and support for 23 people. Sycamore Rise is located in a rural location on the outskirts of Colne in Lancashire. The accommodation consists of 21 single and two twin-bedded rooms.

The service was last inspected in September 2013 and was found compliant in all areas inspected. At the time of this inspection there was a registered manager employed. 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.

Throughout this inspection we received positive feedback from people who used the service, visitors and community professionals. People expressed satisfaction with the service provided and spoke very highly of the staff that supported them. Comments included, “Staff are really good. Their interaction with people living here is great. They know my [relatives] needs well” and “Staff are very pleasant. What they are doing is invaluable and they make me very feel safe”.

We noted the service had robust processes and procedures in place to maintain a safe environment for people accessing the service and for staff and visitors. The service had detailed and up to date health and safety checks which covered areas such as water safety, fire safety, maintenance and a walk through inspection of the service to look for any obvious hazards. We noted ‘building risk assessments were also in place. These considered risks associated with ‘trips and falls’, in the kitchen area, bathroom, stairway and corridors.

We noted audits on equipment and furnishings were done on a monthly basis. These audits included bedrooms, lounge, stairs, lift and hoists. We saw the service had fire risk procedures in place and detailed annual fire risk assessments were followed. These risk assessment covered areas such as testing all call points, emergency lighting and fire extinguishers.

People using the service told us they felt safe living at the home. Visitors were also confident that their relatives were in a safe place. We noted robust safeguarding procedures were in place and staff showed a good understanding around recognising the signs of abuse. Staff had also undertaken safeguarding training.

At the time of inspection we found the service had adequate staffing levels. Staff told us they had time to undertake the caring role effectively. People told us their needs were met appropriately and staff had time to sit with them. We observed a good level of staff interaction to support this.

We found the service had a good recruitment system in place. We found appropriate documentation in people’s recruitment files. We noted the service required all new staff to undertake a thorough induction process. This required them to familiarise themselves with the people using the service, read the service’s policies and procedures and shadow experienced members of staff.

The service had processes in place for the appropriate administration of medicines. Staff were adequately trained in medicines management. Medicines were stored safely and in line with current guidance.

We saw the service had created detailed individual risk assessments for all people using the service. These risk assessments included behaviours which challenge, skin integrity, mobility and nutritional needs.

We saw detailed care plans which gave clear information about people's needs, wishes, feelings and health conditions. These were reviewed monthly by senior care staff with oversight of the registered manager when required.

We saw evidence of detailed training programmes for staff. All carers had a Level 2 or above NVQ (National Vocational Qualification) or above or were working towards this. All people spoken with were very positive about staff knowledge and skills and felt their needs were being met appropriately.

Staff spoken with were aware of the principles of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). These provided legal safeguards for people who may be unable to make their own decisions. The manager also demonstrated their knowledge about the process to follow should it be necessary to place any restrictions on a person who used the service in their best interests. At the time of inspection we found that no person using the service was subject to a DoLS.

We noted that people's nutritional requirements were being met and choice was offered at every meal time. We saw the food was freshly prepared and served at a suitable temperature.

We saw appropriate referrals had been made to dieticians and instructions were strictly followed in cases where people had known dietary requirements. Health care professionals we spoke with told us the service was pro-active with health referrals.

Over the two days of the inspection we noted positive staff interaction and engagement with people using the service. Staff addressed people in a respectful and caring manner. The service had a calm and warm atmosphere. We observed people enjoying each other’s company, conversing, laughing and helping each other with crosswords and puzzles.

We had positive feedback from people using the service, relatives and staff about the registered manager. People told us they were happy to approach management with any concerns or questions.

We found systems had been implemented to assess, identify, detect the control and spread of healthcare associated infections.

Policies and procedures had been updated and infection control training had been arranged for all staff.

Improvements had been made to the environment and plans had also been made to update and maintain the patient bedroom areas.

We also spoke with two people's relatives who lived in the home. They told us you could not fault the care and staff at the home. One relative told us that if they had any concerns or comments they had raised them with the manager who listened to them and addressed the issues.

We found there were processes in place to ensure, where people may not have had the capacity to make particular decisions, staff had the necessary information, training, policies and procedures to be able to act in their best interest.

We reviewed the care files of three people who lived in the home. We saw that care plans identified their needs and how to prevent any risks identified. Records we looked at included information on how they wished their care to be delivered and this was reviewed on a monthly basis.

The recruitment and selection of new staff included an interview and appropriate checks to ensure suitable people were employed in the home.

We found the home had no systems in place to assess, prevent, and detect health care associated infections and action was required to address this area. Part of the home we looked at had strong urine odours and checks were not in place to address these issues.

We found that some systems were in place to assess and monitor the quality of the service provided.

People's needs were assessed and care plans were personalised and reviewed regularly.

All of the people we spoke to told us that they liked the food and were always provided with an alternative if they didn't like the choice of food on the menu. One person told us, 'The food is always good here, we always get a choice'.

Two people spoken with told us they were able to voice any concerns about their care to a member of staff or the manager.

People who used the service told us they had no concerns or worries about the service they received. One person told us, "I feel safe here and they look after me well".

People we spoke to told us that staff always responded to call alarms in a timely manner. One person we spoke with thought there were always enough staff on duty to help the different people living and staying at the home. We found that there were sufficient numbers of suitably qualified staff to meet the needs of people who used the service.

The home had suitable and effective arrangements in place in relation to complaints and feedback about the home.