Sydenham House

Updated 13 January 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

Inspection team

Two inspectors and two Experts by Experience carried out the inspection. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service. One Expert by Experience spoke to people during the inspection site visit and the other Expert by Experience contacted people's relatives by telephone to request their feedback.

Service and service type

Sydenham House is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Sydenham House is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations. At the time of our inspection there was a registered manager in post, however they were not available during the inspection. There was a temporary acting manager in place, who had responsibility for the day to day running of the service.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with 16 people who used the service and 13 relatives. We spoke with 9 members of staff including the acting manager, associate area manager, quality support manager, care supervisors and care assistants. We undertook observations of people receiving care to help us understand their experiences. We reviewed a range of records. This included 7 people's care records and 6 people's medicines records. We looked at 4 staff files in relation to recruitment and records relating to staff induction, training and supervision. A variety of records relating to the management of the service and quality assurance were reviewed including accident and incident records and audits. We sought feedback from professionals who work with the service.

Updated 13 January 2023

About the service

Sydenham House is a residential service providing personal care for up to 49 people, some of whom are living with dementia. The service consists of one purpose-built building, which includes individual bedrooms and communal spaces spread over two floors and an accessible garden. At the time of our inspection there were 40 people using the service.

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

We found significant concerns with staffing levels, management of medicines and risks to people, Mental Capacity assessments, staff support and management oversight which placed people at increased risk of harm.

The service did not have a robust system in place to monitor the quality and safety of the service. Management oversight did not identify or address the issues we found during the inspection.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

The provider did not always promote a positive culture at the service. We received negative feedback from people and staff about the pressures of low staff numbers. We found this impacted the quality care people received.

Staff followed infection prevention and control measures.

Appropriate recruitment procedures were in place for staff employed by the service to ensure they had been assessed as safe to work with vulnerable adults.

People and relatives told us people felt safe with the care and support they or their relative received. Policies and procedures were in place to protect people from abuse.

People had access to a balanced and healthy diet and were satisfied with the food on offer.

Relatives told us communication was good with the service and they felt satisfied with the support their relatives received.

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 requires improvement (published 30 December 2019) and there were breaches of regulation. At this inspection we found the provider remained in breach of regulations. The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 10 December 2019. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions safe, effective and Well-led which contain those requirements.

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 remained requires improvement. This is based on the findings at this inspection.

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

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We made a recommendation about transition arrangements when people start living at the service.

We found several breaches of regulation and issued the registered manager and provider with warning notices in relation to safe care and treatment and good governance.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.