The Care Quality Commission
  • Care Home
  • Care home

Archived: Sycamore Lodge

Overall: Requires improvement read more about inspection ratings

1 Edgecote Close, Acton, London, W3 8HP (020) 3202 0404

Provided and run by:
Viridian Housing

Important: The provider of this service changed. See new profile

All Inspections

31 May 2017

During a routine inspection

This inspection took place on 31 May and 1 June 2017. The visit on 31 May was unannounced and we arranged with the manager to return on I June to complete the inspection. The last comprehensive inspection of the service was in June 2016 when we rated the service as Requires Improvement for Safe and Well Led and Good for Effective, Caring and Responsive. We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 as the registered person did not assess, monitor and improve the quality and safety of the services provided. At this inspection we found the provider had improved the ways they monitored quality in the service.

We also carried out an unannounced, focused inspection in January 2017 after the Clinical Commissioning Group (CCG) passed us concerns they had identified with the management of people's medicines. A Care Quality Commission (CQC) pharmacist inspector carried out the inspection and found that the provider had taken action and improved the way they managed people's medicines.

Sycamore Lodge provides accommodation, care and nursing for up to 77 older people, some of whom were living with the experience of dementia. The home is divided into five separate units according to people's needs.

The registered manager left the service shortly before this inspection. The provider had appointed a new manager and they were in the process of applying to the Care Quality Commission for registration. 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 two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Health and safety checks did not identify possible risks to people using the service, including pull cords for the aid call system that people could not reach and fire doors were wedged open.

The provider did not always operate systems to monitor and mitigate possible risks in the service.

You can see what action we told the provider to take at the back of the full version of the report.

The provider had systems in place to keep people safe and although staff understood and followed these, some systems were not always effective.

There were enough staff to meet people’s needs and the provider carried out checks on new staff to make sure they were suitable to work with people using the service.

The provider assessed people’s health care needs, gave staff guidance on how to meet these and people received the medicines they needed safely.

Staff had the training and support they needed to care for and support people using the service.

The provider, manager, nurses and care staff had a good understanding of their responsibilities under the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. The provider did not deprive people of their liberty unlawfully.

People told us they enjoyed the food provided in the service. An observation we carried out at lunch time showed that staff supported people in a caring and patient way and people had a positive experience.

People using the service and their relatives told us the staff who looked after them were kind and caring.

We saw staff in the service were kind, caring and gentle with the people they supported, they allowed people time to make decisions and offered them choices.

People using the service told us that staff respected their privacy and said they enjoyed living in the service.

Each person had a care plan that included an assessment of their health and social care needs.

People and their relatives also told us the provider involved people in planning and reviewing the care and support they received.

Staff respected people’s choices and decisions about how they wanted to be supported with their personal care.

People told us they knew how to make a complaint and said they trusted the provider to investigate any concerns they had.

When the service’s registered manager left shortly before this inspection, the provider acted promptly to appoint a qualified and experienced manager. Staff told us they found the manager and senior staff in the service supportive.

The provider carried out regular monitoring visits to the service and developed an action plan to address issues they identified.

30 January 2017

During an inspection looking at part of the service

This inspection took place on 30 January 2017 and was unannounced. One pharmacist inspector carried out the inspection. We arranged the inspection after the Clinical Commissioning Group (CCG) passed us concerns they had identified with the management of people's medicines. At this inspection we checked the provider’s management of people's medicines, including their ordering, storage and administration. We found the provider had taken action and improved the way they managed people's medicines.

Sycamore Lodge provides accommodation, care and nursing for up to 77 older people, some of whom were living with the experience of dementia. The home is divided into five separate units according to people's needs.

The service had recently appointed a new manager who had applied to the Care Quality Commission for registration. 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.

During this inspection we found the provider had improved the way they managed medicines and people received the medicines they needed safely. While improvements had been made we have not revised the rating for this key question; to improve the rating to ‘Good’ would require a longer term track record of consistent good practice.

15 June 2016

During a routine inspection

This inspection took place on 15 and 16 June 2016. The visit on 15 June was unannounced and we told the provider we would return on 16 June to complete the inspection. We last inspected the service in June 2015 when we found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and awarded a quality rating of Requires Improvement. The provider sent us an action plan and said they would make the required improvements by the end of September 2015. At this inspection we found the provider had taken action to address the issues we raised at our last inspection but further improvements were needed.

Sycamore Lodge provides accommodation, care and nursing for up to 77 older people, some of whom were living with the experience of dementia. The home is divided into five separate units according to people's needs. When we inspected, 76 people were using the service.

The service’s registered manager had not worked at the home for some time, after taking up another post with the provider. The provider had appointed a manager in March 2016 and they told us they were applying to register with the Care Quality Commission. 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 one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider did not always take action to address issues identified in audits and checks they carried out to monitor quality in the service and make improvements. You can see what action we told the provider to take at the back of the full version of the report.

The provider had not always taken action after they had identified risks although we also found evidence of the provider reviewing and updating risk assessments and care plans when people’s needs changed

There were enough staff on duty to support people and the provider carried out pre-employment checks to make sure staff were suitable to work in the service.

The provider had assessed people's capacity to make decisions and taken appropriate action where restrictions were in place. They worked with the local authority to make sure any restrictions were agreed.

People using the service were supported and cared for by staff who were appropriately trained and supported.

People's nutritional needs were met and most told us they enjoyed the choice of food provided in the service. Staff supported people living with the experience of dementia to have a positive experience at meal times.

Staff supported people to stay healthy and arranged for them to see other healthcare professionals as needed.

People using the service and their relatives and visitors told us staff were caring and that they always treated people with respect. Throughout the inspection we saw interactions between staff and people using the service that were caring and kind. Staff made sure people were comfortable and responded promptly when they asked for support.

Staff supported people to take part in meaningful activities to meet their social and emotional needs.

Managers and staff assessed people's care needs and recorded these in care plans which they reviewed and updated regularly.

People knew how to make a complaint and felt confident that these would be responded to.

The provider, managers and staff carried out other audits and checks to monitor quality in the service and we saw these were up to date.

The service had a new manager and Head of Nursing and together with the Head of Care, this meant the service had a permanent management team in place. Staff told us they felt well supported by their managers.

15 and 16 June 2015

During a routine inspection

This inspection took place on 15 and 16 June 2015. The visit on 15 June was unannounced and we told the provider we would return the next day to complete the inspection. At our last inspection in July 2014, we found a number of breaches of regulations. At this inspection, we found the provider had taken action to address the issues we identified and standards of care for people using the service had improved.

Sycamore Lodge is a service that provides accommodation, nursing and personal care for up to 77 older people, including people living with dementia. At the time of this inspection, 74 people were using the service.

The provider appointed a new manager in January 2015 and the manger has applied to the Care Quality Commission for registration. 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 three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The provider needed to improve risk management, especially for people who smoked in their rooms. There were gaps in the staff training records and the provider needed to make sure all staff were up to date with the training they needed to look after people safely and effectively. The provider also needed to make sure they were following procedures to comply with the Deprivation of Liberty Safeguards (DoLS).

You can see what action we told the provider to take at the back of the full version of the report.

Most people using the service told us they were happy with the care they received. We also received positive feedback from people’s relatives and visiting healthcare professionals, who felt the service was well run and people’s changing needs were identified and met.

Staff recruitment procedures were in place and were being followed to ensure suitable staff were being employed at the service.

Staff supported people in a caring way, respecting their privacy and dignity.

Staff understood safeguarding and whistleblowing procedures and were clear about the process to follow to report concerns. Complaints procedures were in place and people and relatives said they would feel able to raise any issues so they could be addressed.

Medicines were being well managed at the service and people were receiving their medicines as prescribed.

Care records reflected people’s needs and interests and were kept up to date. Communication between the manager and staff was effective and staff understood people’s changing care and support needs.

Systems were in place for monitoring the service but these were not always effective so action was not always taken promptly to address any issues identified.

19 December 2014

During an inspection looking at part of the service

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.

Sycamore Lodge provides care and nursing support for up to 77 older people. The service is split into five units over three floors. Two of the units provide nursing care and the service also provides care for people with dementia care needs.

We carried out an unannounced comprehensive inspection of this service on 29 and 30 July 2014. After that inspection we received anonymous concerns in relation to the care and welfare of people using the service. As a result we undertook a focused inspection on 19 December 2014 to look into those concerns. This report only covers our findings in relation to these concerns. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Sycamore Lodge on our website at www.cqc.org.uk.

There were sufficient numbers of staff to provide people with the care and support they needed.

People's care needs were assessed and recorded but we found some conflicting evidence about people's end of life care wishes.

At the time of our inspection there was no registered manager in post. A registered manager is a person who has registered with CQC to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

29 and 30 July 2014

During a routine inspection

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 and to pilot a new inspection process being introduced by the Care Quality Commission (CQC) which looks at the overall quality of the service.

Sycamore Lodge provides care and nursing support for up to 77 older people. At the time of our inspection there were 76 people using the service. The service is split into five units over three floors. Two of the units provide nursing care and the service also provides care for people with dementia care needs.

The last inspection of this service took place on 18 June 2013. During this inspection we found that the service was meeting regulations related to respect and involvement, care and welfare, nutrition, supporting workers and complaints.

This inspection was an unannounced inspection. At the time of our inspection there was not a registered manager in post.  A registered manager is a person who has registered with CQC to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

People were not kept safe at the service. Not all staff were aware of their responsibilities or felt confident raising concerns about the welfare of people using the service. In addition there were not always enough staff to meet people’s needs. Staff recruitment processes did not protect people from staff unsuitable to work with vulnerable adults and there were inadequate plans in place to manage risks to people’s welfare.

We found the service did not fully consider people’s mental capacity, their right to make decisions for themselves or the impact of any restrictive practices to ensure that people’s rights were respected.

People’s health and wellbeing were not suitably monitored and taken care of. For example, people’s individual needs were not fully assessed and care plans did not always consider people’s preference, likes or dislikes. Staff did not always adequately monitor people’s weight or ensure that general eye, foot and dental care needs were addressed. In addition people had mixed views about the food provided and people were not always offered foods that met their individual dietary needs, including their religious and cultural needs.

Staff received an induction to the service and mandatory training, however, they did not always receive training to equip them with the skills to meet people’s individual needs.

People using the service and their relatives gave varied accounts about the staff and how caring they found the service. We saw some positive interactions between staff and people using the service but we also saw staff acting in ways that were not respectful.

People’s spiritual needs were met. An activities co-ordinator organised activities for people and some people were supported to go out into the community. However, there was limited one to one interaction with people on a day to day basis or activities that supported people to maintain their interests and hobbies.

We found that the home was not managed in a way that ensured people’s safety and there were not systems in place that encouraged openness and learning from incidents. The operation of the service was not adequately monitored to ensure that any issues were addressed and improvements made.

Following our inspection we spoke with a local authority representative who stated that they had identified similar concerns to those found during our inspection.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.

18 June 2013

During a routine inspection

We spoke with the manager of the service, eight other members of staff, four relatives and 10 people who were using the service. The people we spoke with made positive comments about staff such as, "I'm exceedingly well looked after" and "no question about it, they are very good, all I have to do is ask and they'll do it, they are very kind."

People's needs were assessed and care plans developed taking account of their likes, dislikes and preferences. People were supported to maintain their independence and risks to their health and welfare were assessed to ensure that staff took action to minimise these risks and keep people safe.

The people we spoke with made positive comments about the food such as, "the food is very nice, we have cake and sandwiches in the evening" and "the food is very nice, we get quite a variety". One person told us they were given "a nice cup of tea and biscuits before breakfast because I like to get up early". People's individual dietary needs were met, however, there was limited consideration of people's cultural needs in relation to their diet.

Staff received training in a range of topics to support them in their role. Staff had received an annual appraisal but had not received regular supervision sessions to ensure they received adequate support.

People and their relatives told us they raised concerns when they arose and felt listened to by staff. One person said, "I complained about the food and they made it better."

10 April 2012

During a routine inspection

We spoke with 15 people using the service, 8 visitors and 16 staff. People said staff listened to what they had to say and treated them with respect. Some people said they had been involved in their plan of care, and others could not recall this. People told us they were able to make choices, for example, menu choices, activities and when they wanted to get up and retire to bed. They said these choices were respected.

People said staff were 'very good' and confirmed there was always someone available for them to speak with. People told us they were being 'well cared for' and staff answered their call bells when they needed help. Three visitors on the dementia care nursing unit felt that there was regularly a shortage of staff. Some staff on this unit identified that there were times when the staffing team on duty were not able to fully meet each person's needs. Staff working on the general nursing and residential units said the staff teams on duty enabled them to meet people's needs effectively.

People said they felt 'safe' at the home and would report any concerns. Visitors said they knew to report any concerns to the senior staff or the manager. People and their visitors told us they were asked their opinions about aspects of the home and they had seen improvements made in response to their suggestions.