Background to this inspection
Updated
23 March 2015
Comprehensive inspection 21 November 2014
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
This unannounced inspection took place on 20 November and was carried out by two inspectors.
Before the inspection we reviewed the information we held about the service and spoke with staff at the local authority. They raised concerns about care, staffing, and leadership at the service.
We used a number of different methods to help us understand the experiences of people living in the service. We spent time observing support in the lounge and dining room. We spoke with five people who used the service and one relative. We also spoke with the acting manager, four care workers, and two management consultants who were working with the provider at the time of our inspection.
We looked at six people’s care records, incident reports, medication records, menus, and policies and procedures. We also looked at staff records, duty rosters, and the provider’s statement of purpose. This is a document which includes a standard required set of information about a service.
Focused inspection 30 January 2015
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
This inspection took place on 30 January 2015 and was unannounced. It was carried out to check that action had been taken to address the breaches of regulations and meet the warning notice issued at a previous unannounced inspection on 21 November 2014.
This inspection was carried out by one inspector. Prior to the inspection we reviewed the provider’s statement of purpose and the notifications we had been sent. A statement of purpose is a document which includes a standard required set of information about a service. Notifications are changes, events or incidents that providers must tell us about.
We used a variety of methods to inspect the service. We met with all the people who used the service. Some people we met were unable to give their views due to their mental health needs so we spent time with them and observed the support they received.
We also spoke with the acting manager, provider, and two care workers. Prior to the inspection we exchanged information with the local authority responsible for commissioning services at this home.
We observed people being supported in the lounges and in the dining areas at lunch time. We looked at records relating to all aspects of the service including care, staffing and quality assurance. We also looked in detail at three people’s care records.
Updated
23 March 2015
We carried out an unannounced inspection of this service on 21 November 2014. Nine breaches of legal requirements were found and we issued a warning notice for one of these. We asked the provider to send us an action plan to state how and when these improvements would be made,
On 30 January 2015 we carried out a further unannounced inspecting of this service to check that action had been taken to address the breaches of regulations and meet the warning notice. We found that improvements had been made to meet the relevant requirements.
You can read a summary of our findings from both inspections below.
Comprehensive inspection 21 November 2014
This inspection took place on 20 November 2014 and was unannounced.
Sycamore Cottage provides residential care for up to 14 older people some of whom have mental health needs. Accommodation is on two floors with a stair lift for access. There is a communal lounge/dining room and a conservatory which opens onto a secure garden.
At our last inspection on 24 September 2014 we found that the people who used the service, staff and visitors were not protected against the risks of unsafe or unsuitable premises. We made a requirement under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 for the provider to put this right.
We told the provider to send us a report by 21 November 2014 telling us what action they were going to take to make improvements. The provider failed to do this.
At this inspection we found that not all the required work had been done to make the areas we identified safe and some of the risks remained.
Sycamore Cottage is required to have a registered manager. 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. At the time of our inspection a registered manager was not employed at the service.
People’s safety was being compromised in a number of areas. These included the management of moving and handling, pressure sore care, risk assessing, and the management of nutrition.
There were not enough staff to keep people safe and meet their needs and the provider did not operate an effective recruitment procedure. People were not protected against the risks associated with the unsafe use and management of medicines.
The provider was not always following the Mental Capacity Act 2005 for people who lacked capacity to make particular decisions. Consequently they had not made an application under the Mental Capacity Act Deprivation of Liberty Safeguards for two people, even though their liberty was being significantly restricted.
Care workers had completed a range of training relevant to their roles and responsibilities. However on one occasion they had not been able to put their training into practice due to not having the equipment they needed.
People’s privacy and dignity was not always respected and promoted. Although some staff cared for people in a respectful and dignified way, we saw that others did not. Sensitive personal information about the people who used the service and staff was sent by email to a person who had no reason to receive this information.
Some people were socially isolated in the home and did not have access to meaningful activities. This was because they were confined to their bedrooms or because activities weren’t being provided. Care workers said they did their best to help people follow their hobbies and interests but weren’t always able to do this due to lack of time.
The arrangements in place to assess and monitor the quality of the service were ineffective. As a result issues with plans of care, medication, and health and safety had not been identified or addressed.
We observed lunch being served and people told us they enjoyed their meal. The food was well-presented and nutritious and people had a choice as to what they ate.
During our inspection we found nine breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.
Focused inspection 30 January 2015
This inspection was unannounced. There were seven people living at the home at the time of this inspection.
Sycamore Cottage is required to have a registered manager. 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. At the time of our inspection an acting manager was in post who had not yet applied for registration with us.
Following our inspection on 21 November 2014 we issued a warning notice to the provider. This is a notice to providers informing them they are breaching a regulatory requirement. The warning notice told the provider to take proper steps to ensure that people wo used the service were protected against the risks of receiving care or treatment that was inappropriate or unsafe.The provider had until 29 December 2014 to meet this. At this inspection we found the warning notice had been met.
We also told the provider to make improvements to staffing numbers, recruitment procedures, the management of medication, consent to care, privacy and dignity, meeting people’s needs, unsafe premises, monitoring the service, and reporting serious incidents to us. At this inspection we found that action had been taken and improvements made in all these areas.
People who needed assistance to move about the home were being safely supported to do this. They had the equipment they needed and appropriately trained staff to help them. During the inspection we saw that care workers assisted people to move safely and in their own time.
People had up to date risk assessments and plans of care in place to help ensure they were cared for properly. Staff worked closely with local health care professionals to provide appropriate care. People had been re-assessed with regard to their eating and drinking needs and those who needed extra calories to build them up were provided with fortified food.
The providers had increased staffing levels. We saw that care staff had the time they needed to care for people safely. If people needed assistance this was provided promptly and at no time were people left unsupported. When people needed two care workers to assist them they were provided.
Recruitment policies and procedure had been reviewed and improved. The provider and the acting manager said these would always be followed, and staff would only work in the home if they had the necessary background checks. This will help to ensure that all staff employed are suitable to work with people receiving care.
People had their medicines safely and in the way they wanted it .Improvements had been made to the way medication was managed in the home. All medication records and documentation had been reviewed and updated, where necessary, by the acting manager.
Staff treated people with dignity and respect. People were wearing clean clothes they had chosen themselves. Staff encouraged people to be actively involved in making decisions about their care, treatment and support.
People told us staff had the time to support them with their hobbies and interests. During the inspection we observed staff playing cards with people, looking at books with them, and talking with them about their lives. The plans of care we looked at were personalised and included information on how staff could support people with their activities.
The acting manager and provider both checked all aspects of the service to make sure it was running safely and effectively. If any issues were found these were quickly dealt with. For example the acting manager told us one person’s room appeared ‘unloved’ so it was promptly re-decorated.
All the people we spoke with said the service had improved dramatically. Both people using the service and staff told us about the many changes for the better they had seen. All said they were happy to continue living and working in the home.