Archived: The Sycamores

The Sycamores is registered to care for up to 60 elderly people in one adapted building. On the day of the inspection there were 47 people accommodated at the home.

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

The provider used their safeguarding policies and procedures to protect people from harm. The administration of medicines was safe. Staff were robustly recruited and the provider undertook all required environmental checks. Any risks to people were assessed to protect their health and welfare. .

People were supported to live healthy lives because they had access to professionals, a well-trained staff team and a choice of a nutritious diet. The service worked with other organisations to provide effective and consistent care. 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.

Staff were trained in equality and diversity and they respected people’s choices. Where people wanted, they could follow their religion of choice or maintain their relationships. People were treated as individuals which helped protect their dignity. People praised the caring attitude of staff.

We saw that the service responded to the needs of people by providing meaningful activities, having regularly reviewed plans of care and any concerns acted upon. Staff training enabled them to care for people at the end of their lives.

The registered manager attended meetings to discuss best practice topics and liaise with other organisations to improve the service. People who used the service and staff said managers were available and approachable. People who used the service, staff and relatives were able to air their views about how the service was run.

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 06/09/2017).

Why we inspected

This was a planned inspection based on the previous rating.

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.

When we visited the service, although a manager was registered with the Care Quality Commission they were no longer in post and a new manager had been appointed. Their interview for registration with the Care Quality Commission took place in Manchester on the second day of our inspection. 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.

The Sycamores is a residential care home in the Tameside area of Greater Manchester. The home provides personal care to older people and people living with dementia type conditions. It is situated close to local amenities and transport links. The service was registered for 60 people and at the time of our inspection there were 35 people using the service.

At this inspection we found that the service had improved and the six regulatory requirements previously breached at the inspection conducted in October 2016 had been satisfactorily addressed.

We have made a recommendation however to replace the floor covering in three bedrooms identified to the manager and to replace the stained armchairs in the main lounge on Ash unit.

Staff spoken with understood their responsibilities in keeping people safe and the action to take should they become aware of any abuse or witness any poor practice by their colleagues. They were confident that the manager would take appropriate action if any issues about safeguarding concerns were raised.

Robust recruitment procedures were in place and the required pre-employment checks for new staff were carried out before they started working in the home. During the inspection we saw that there were sufficient numbers of staff available to assist and support people throughout the day and night.

Risk assessments were in place, which provided information and guidance to staff about how to support people and mitigate any known risks to their health, safety and wellbeing.

Records were available to demonstrate that the provider had made sure all equipment and utilities, such as electrical circuits, portable appliance testing (PAT), gas safety, hoists, fire alarm system and nurse call system were regularly maintained and serviced by an approved contractor.

We found that medicines were safely managed and only appropriately trained staff had the responsibility for administering medicines to people.

Records seen demonstrated that on-going staff training was taking place, along with formal staff supervision on a one-to-one basis.

Records were available to demonstrate that where appropriate mental capacity assessments and deprivation of liberty safeguards authorisations were in place. We saw records that indicated people and / or their representative had given their consent to their care and treatment.

People told us that they enjoyed the food provided and the choices of meals available to them. During the mealtime we observed that the meals served were nicely cooked and well-presented and staff continually monitored the dining room to provide support and assistance to people as requested and required.

We saw that the interactions of the staff with people were kind and they treated people in a respectful and dignified way and we saw that people were well dressed and cared for.

People had an individual personal hygiene record in a file which indicated the frequency of baths/showers people had or were offered.

Staff were carrying out activities whenever they had the opportunity and time to do so and we observed people enjoying participating in a sing-a-long session with a visiting entertainer.

We looked at the complaints file and the complaints being dealt with at the time of our inspection. We saw that appropriate details of each complaint had been recorded along with details of actions taken to date.

A new manager had been in post for seven weeks prior to our inspection taking place and was supported throughout their induction to the service by the relief manager.

We saw that improvements had been made in the auditing systems for the service and the manager provided us with copies of the latest audits conducted.

The Sycamores is a residential care home in the Tameside area of Manchester. The home provides personal care to older people and people with dementia type conditions. It is situated close to local amenities and transport links. The service was registered for 60 people and at the time of our inspection there were 45 people using the service.

The home had a registered manager employed to manage the service. 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 found that the service had issues with infection control and mal odours were present throughout the service, in corridors, in communal areas and peoples bedrooms.

Poor hygiene standards were evident within the service.

People’s personal care needs were not always met in accordance with their care plans.

People’s dignity and privacy was not always observed.

We spoke with a range of different team members; care, kitchen, maintenance, laundry, activities co-ordinators and domestic staff. They told us they felt well supported and that the manager was supportive and approachable. The manager was not present at the time of our inspection and was on annual leave so the inspection was carried out with the deputy manager. Throughout the day we saw that people who used the service and staff had a good rapport with the deputy manager.

Although the deputy manager was busy throughout the inspection the atmosphere within the home was sedate. We saw that some staff interacted with each other and the people who used the service in a friendly, supportive, positive manner. However we also observed some negative staff attitudes.

We observed how medicines were administered. We looked at how records were kept and spoke with the senior staff about how this was carried out and how staff were trained to administer medicines and we found that the medicine administering process was safe.

From looking at people’s detailed care plans we saw that they were written in the first person and contained some personal history information. The care plans did contain a one page profile however these were more task focussed than ‘person centred.’ Person centred is when the person receiving support is central to all decision making related to their support. Care plans were regularly reviewed and updated by the care staff and the registered manager.

Individual care plans contained risk assessments. These identified risks and described the measures and interventions to be taken to ensure people were protected from the risk of harm. The care records we viewed also showed us that people’s health was monitored and referrals were made to other health care professionals where necessary, for example: their doctor, optician or district nursing team.

Our observations during the inspection showed us that people who used the service were supported by sufficient numbers of staff to meet their individual needs and wishes. However we found different agency staff were used regularly who didn’t always know the people who used the service.

When we looked at the staff training records the information contained indicated staff were not always supported to maintain and develop their skills through training and development opportunities as some staff training was out of date or incomplete.

We saw that the physical environment throughout the home was not dementia friendly and did not always reflect best practice in dementia care or meet the standards set out in national guidelines.

Staff we spoke with told us they had regular supervisions and appraisals with the manager, where they had the opportunity to discuss their care practice and identify further mandatory and vocational training needs. However when we looked at records they indicated that some people were not receiving supervision and we found no recorded evidence of appraisals.

People also had access to advocacy when we inspected and there were services promoted if needed. Advocacy is support that is available for people to help them speak up and to exercise their rights.

We saw people were encouraged to eat and drink sufficient amounts to meet their needs. We observed people being offered a varied selection of drinks and snacks. The daily menu that we saw offered choices and it was not an issue if people wanted something different. People who had special dietary requirements for example diabetes; we found they were accommodated for appropriately.

We saw a complaints and compliments procedure was in place. This provided information on the action to take if someone wished to make a complaint and what they should expect to happen next.

People were encouraged to participate in activities that were organised including; arts and crafts, reminisce activities, bingo and dominoes. We saw activity co-coordinators spending their time positively engaging with people as a group and on a one to one basis in activities throughout out our inspection.

We found a quality assurance survey took place regularly and we looked at the results. However these audits were not consistent and results not always acted upon. These didn’t highlight the issues we identified during our inspection.

We found people who used the service and their representatives were regularly asked for their views at meetings and in an annual survey however we saw that no actions plans were in place to implement suggestions made from the surveys.

During the inspection we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

Below is a summary of what we found. The summary is based on our observations during the inspection; speaking with staff, people using the service, the manager and from looking at records.

Is the service safe?

Staff manage medicines consistently and safely. The service stores medicines correctly, disposes of them safely and keeps accurate records.

There are enough competent staff on duty who have the right mix of skills to make sure that practice is safe and they can respond to unforeseen events. The service regularly reviews staffing levels and adapts them to people's changing needs. Recruitment systems are robust and make sure that the right staff are recruited to keep people safe.

We considered the evidence collected under the outcomes and addressed the following questions: Is the service safe; is the service effective; is the service caring; is the service responsive; is the service well led?

Below is a summary of what we found. Please read the full report for the evidence supporting our summary.

Is the service safe?

We saw that people were treated with respect by staff. People we spoke with who used the service told us they felt safe living at The Sycamores and with the support they received. One person commented 'I'm quite happy with things, I wouldn't like to live on my own again'.

Policies and procedures were in place to support staff to manage people's medicines safely. Staff with the responsibility for administering medicines in the home had received relevant training. Although people were receiving their prescribed medicines and treatments these were not always administered safely and in accordance with the policies and procedures in place.

A compliance action has been set in relation to this. The provider must send us an action plan advising how they will ensure people's medicines will be administered safely at all times.

The staff team was skilled and experienced. However, staffing levels had been insufficient at times to meet people's needs. A compliance action has been set in relation to this. The provider must send us an action plan advising how they will ensure staffing levels will be maintained at all times to meet people's needs.

We saw that policies and procedures were in place to support staff in delivering safe and effective care. These policies and procedures included those in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards.

Is the service effective?

People's health and care needs were assessed with them, or with the support of their relatives or other healthcare professionals when required.

All staff we spoke with confirmed that there was always a written care plan available on each person's file.

The service had effective quality monitoring systems. These would help to identify if the service needed to review or amend any of its practices.

Is the service caring?

At the time of our visit people were being supported by kind and attentive staff. We observed care staff showing patience and giving general encouragement when supporting and assisting people. People using the service commented, 'I've no worries ' I just go from day to day' and 'The staff are alright ' they help me when I need it'.

The atmosphere in the home was calm, relaxed and friendly and staff we spoke with appeared to have a good knowledge and understanding of people's needs.

Is the service responsive?

Evidence was seen in records to demonstrate that other healthcare professionals were involved in meeting people's care and support needs where appropriate. For example, a visiting speech and language therapist, general practitioners and district nursing services. This meant that people using the service received co-ordinated care and support.

Is the service well led?

A new manager was in post that was yet to register with the Care Quality Commission.

We found that there were a number of systems in place to audit and monitor the quality of service and care being provided in The Sycamores. There were also independent audits by local commissioners of services to check the quality and standard of service delivery on a regular basis. Such monitoring of the service should help to ensure that people receive a high standard and quality of service at all times.

Relatives spoken with told us, 'They keep us fully informed of [relative] health and any changes. That gives us complete peace of mind" and "Knowing [relative] is safe, comfortable and well cared is all that matters."

Care plans and associated risk assessments were in place and were being reviewed on a regular basis.

We found that staffing levels were sufficient at the time of our visit and that service users dependency levels were being monitored by the manager on an ongoing basis.

Staff told us that they received supervision from their line manager and that appropriate training took place to support them in the jobs they are employed to carry out.

We found that the provider had systems in place to asses and monitor the quality of the service provided.

We spoke with four relatives of people using the service. They were very happy with the care their relative received. Comments included: 'The staff are so caring and the reports I have received from my other relatives visiting the home has always been very positive and reiterates my own feeling about the service' and 'Confidentiality is always maintained and I am always asked to sign paperwork, especially for financial matters'.