Sycamore Lodge

Sycamore Lodge is a care home. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Sycamore Lodge is registered to support up to 78 people. At the time of this inspection 70 people were using the service.

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

Improvements were still required to the recording of people’s topical creams and repositioning charts. We recommend the provider implements a robust system for checking these records.

People were supported by enough staff who knew people well. People’s care plans contained important information relating to their medical conditions, life histories and any sensory requirements. Some care plans required improvement in relation to people’s individual needs, such as catheter and seizure care.

People were supported by staff who received training and who had a good understanding of the different types of abuse and who to report any concerns to. The provider monitored safeguarding concerns and incidents and accidents, including any outcomes or actions required.

People and relatives felt able to raise any issues or concerns with staff and the management. Complaints were logged, including any actions taken. People were supported to have maximum choice and control of their lives. Staff respected people’s choice and gave examples of how they promoted people’s independence and privacy. People, relatives and health professionals’ views had been sought and staff felt the management was approachable and accessible.

People were supported by staff to access health and social care professionals if the need arose. The provider and the registered manager were accessible and approachable and the provider’s senior management team visited the service at least weekly.

Rating at last inspection

The last rating for this service was requires improvement (published 11 June 2021)

The provider completed an action plan after the last inspection to show what they would do and when to improve.

At this inspection we found most improvements had been made and the provider was no longer in breach of regulations.

At our last inspection we made recommendations in relation to staffing and experienced staff to meet's people's care and treatment. At this inspection we found the provider had made some improvements to ensuring agency staff were regular and familiar with people’s individual needs.

Why we inspected

We carried out a comprehensive inspection to follow up on action we told the provider to take at the last inspection.

The overall rating for the service has changed from requires improvement to good based on the findings of this inspection.

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.

Sycamore Lodge is a care home. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Sycamore Lodge at this time provides care and support to 68 people, the service can support up to 78 people.

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

Records relating to people’s care, treatment and medicines were not always accurate and up to date. This included, care plans, pen portraits, nutrition and hydration charts, pressure care, times observation charts and handover sheets. People were not always supported by staff who were employed by the service and who knew them well. There was a high use of agency use in the service. The provider’s audits were not identifying shortfalls found during this inspection.

People felt safe and staff knew the different types of abuse and who to report any concerns to. Incidents and accidents were monitored, and records confirmed actions taken along with observations taken following an injury. The service appeared clean and odour free and Covid-19 guidance was being followed apart from management were not always wearing face masks as required. The service liaised with other agencies and health care professionals to achieve good outcomes for people. The provider was in the process of implementing a new electronic care planning system.

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 October 2018). The service at this inspection has deteriorated to requires improvement.

Why we inspected

We carried out an announced focussed inspection looking at Safe and Well-led including infection prevention and control measures.

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.

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.

We found the providers audits were not always identifying shortfalls found during this inspection and records were not always accurate, complete and contemporaneous. This is a breach of Regulation 17 HSCA RA Regulations 2014 Good governance

Sycamore Lodge provides personal and nursing care for up to 78 people, including people living with dementia. The home has three floors. The ground floor has offices and a separate unit and then there are two floors both having 30 beds each. At the time of the inspection there were 47 people living at the service.

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

At the time of the inspection, we were not assured the service was following current guidelines in relation to visits undertaken within the care home. Although arrangements were in place for testing visitors and providing them with personal protective equipment, social distancing was not being followed and there were no screens being used. The manager also confirmed people were receiving physical touch such as a hug. No individual risk assessment had been undertaken in relation to the risks this exposed people too and this was not in line with government guidance. We raised this with the manager and the nominated individual following our inspection. They confirmed actions taken to address this shortfall.

The providers visiting policy contained out of date information. Following the inspection, they provided us with a current up to date visiting policy that was in line with government guidelines.

Staff had access to personal protective equipment (PPE) and staff had received training in relation to infection control and procedures for donning and doffing their PPE. The manager undertook a daily walk around ensuring PPE was being used correctly.

There was a regular cleaning regime in place and increased cleaning to touch points within the service. The home was clean and odour free.

Staff were being supported with their well-being during the pandemic. The manager communicated regularly with family of people living in the home.

The home was open for admissions. When people were admitted they had to have a negative polymerase chain reaction (PCR) result and after admission to the home they had to isolate in their room for a 14-day period. There was a weekly testing programme for staff. Each week staff had a PCR test and two lateral flow tests. People living in Sycamore Lodge were tested monthly or sooner if they showed any COVID-19 symptoms. The majority of people and staff had received their first does of the vaccine.

Rating at last inspection; The last full comprehensive inspection rated the service as Good (published October 2018).

Why we inspected

We carried out an announced targeted Infection prevention control infection of this service on the 9 December 2020. A breach of legal requirements was found. The provider completed an action plan to show what they would do and by when to improve infection control procedures within the home.

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 previous breach relating to infection prevention control.

Follow up

Following our inspection, we requested the provider send us an urgent action plan on how they will improve the standards of visits being undertaken in the home. We will continue to monitor this action plan and work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

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

We inspected the service and were not assured the service was managing infection control procedures relating to the risks of coronavirus and other infection outbreaks effectively. For example, we found personal protective equipment (PPE) was not always being worn as required, PPE was being stored in some sluice rooms and staff and visitors had limited access to hand hygiene such as hand sanitiser.

We found the following examples of good practice.

• People had been supported to keep in touch with families. This had included outside visits and inside visits for those who were receiving end of life care. Risk assessments were completed, and there was signage and guidance for visitors to follow.

• There was a system in place to take people’s temperature on arrival and record contact details for test and tracing purposes.

• Additional cleaning regimes were in place to ensure a high standard of cleanliness, paying particular attention to high touch areas such as door handles. The service was clean and odour free.

• There was a designated area where people who tested negative for coronavirus were supported to isolate within. There were donning and doffing stations located outside people’s rooms so PPE could be disposed of safely.

• The movement of staff between different areas of the home was minimised. The provider was testing staff every week. This included testing agency staff.

Why we inspected

We received information raising concerns with us about the infection control procedures within the service. We announced our inspection and requested information relating to infection prevention control within the service. This included, policies relating to infection control procedures, the service contingency plans, staff training in infection control procedures and how the service was supporting visits safely. A decision was made for us to inspect and examine those risks.

We looked at infection prevention and control measures under the Safe key question.

We were 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 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.

We have identified a breach in relation to infection control procedures at this inspection.

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

Follow up

Following the inspection, we asked for an urgent action plan from the provider to understand what actions they were taking to improve the standards of quality and safety. We received a report from the provider that provided assurances in how they were going to address the shortfalls found during the inspection. We will continue to work alongside the provider and local authority to monitor progress.

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.

At the last comprehensive inspection of the service in October 2016 five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were identified and the service was rated as Requires Improvement.

After this inspection two warning notices were issued in regards to breaches of Regulation 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. A focused inspection was conducted in March 2017 to check the service was now meeting these regulations. The service was found to be compliant in these regulations.

We also conducted a focused inspection in August 2017. This was in relation to concerns we had received in regards to people’s safety in one area of the service called, Crofters Lodge. Crofters Lodge could provide treatment for up to 18 people detained under the Mental Health Act 1983. We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. After this inspection the service closed this aspect of the service in December 2017.

During this inspection we checked that the provider was meeting the legal requirements of the regulations they had breached. You can read the report from our last comprehensive inspection, by selecting the 'All reports' link for The Granary Care Centre, on our website at www.cqc.org.uk

The Granary Care Centre is a ‘care home’. 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 Granary Care Centre at this time provides care and support to 60 older people who are living with dementia. At the time of our inspection there were 45 people living at the service.

The service provides accommodation in a purpose built premises. The service is over two floors. The first floor provides residential care in three units. The second floor provides nursing care in three units. The ground floor has an atrium area where activities are held and is a space for people to socialise and utilise. There is access to a secure, level garden.

There was a registered manager in post. 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 service had met their action plan in regards to regulations they had previously breached. People, staff and relatives told us about the improvements made at the service.

At this inspection we found some areas that still required improvement in relation to accurate guidance, record keeping and reporting. Medicine documentation was not consistently safe as topical medicines records did not give clear guidance to staff and had not been consistently completed. Daily records had not been consistently completed to maintain an accurate record for people. We found some notifications in regards to Deprivation of Liberty Safeguards had not been submitted to the Commission.

Numbers of staff were kept at the assessed level deemed safe by the provider. The feedback we received was that staffing had improved. There was still a high use of agency staff acknowledged by the provider. However, steps were being taken in reducing the use of agency staff and systems had been implemented to ensure agency staff had the information they required to support people effectively.

The service operated safe recruitment procedures. Assessment identified risks to people. Guidance was in place to direct staff in how to manage risks to people whilst enabling people to remain independent. Regular checks of the environment, equipment and fire systems were completed. Staff were knowledgeable about identifying and reporting safeguarding concerns, which were reported to the appropriate agencies.

Staff received an induction and on-going training. Supervision was held regularly. The service was meeting the requirements of the Deprivation of Liberty Safeguards. Consent to care and treatment was sought in line with guidance. Where needed best interest decisions had been made in consultation with appropriate people. People were supported with their nutrition and hydration. Feedback was sought from people in order to continue to develop people’s experiences in regards to food and drink.

Staff were kind and caring. People and relatives were positive about the care and support people received from staff. The service consulted and engaged with people’s, relatives and staff. Meetings were held regularly and people’s feedback sought. There was a calm and friendly atmosphere at the service.

Care records were person centred. Records showed people’s preferences and how they wished to be supported. People and relatives spoke positively about the about activities facilitated. We observed people engaging and enjoying the activities provided. The environment had been considered in relation to people’s care needs. People’s independence was encouraged and supported.

Positive feedback was received about the changes to the services and the registered manager’s leadership. People, relatives and staff spoke of the improvements made. Systems were in place to monitor and review the quality of the service. Actions were taken in identified areas.

We have made a recommendation about staff training on the subject of the Mental Capacity Act 2005.

At the last comprehensive inspection on 10, 11 and 13 October 2016, the service was rated Requires Improvement.

This responsive focused unannounced inspection on 21 August 2017 was prompted by information of concern. We had received information about people’s safety within Crofters Lodge. This included information relating to staff training, staffing levels, record keeping, risk assessments and care planning. This inspection focused only on Crofters Lodge. This report only covers our findings in relation to this area. You can read the report from our last comprehensive and focused inspections, by selecting the 'All reports' link for ‘The Granary Care Centre’ on our website at www.cqc.org.uk

There was a registered manager in post. 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. Each manager was responsible for a number of services.

At this inspection we found the service remained Requires Improvement.

Staffing levels at the service were not always adequate and fell below what the provider had deemed safe. People were also supported by agency staff who could be unfamiliar with people’s individual needs.

Personal evacuation plans were in place but were not always accurate and up to date. These records which could be used in the event of an emergency contained different information and duplicate copies.

Risk assessments were completed and were being updated by the provider to ensure they were reflective of people’s assessed needs. The environment and equipment viewed during the inspection was safe.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of this report.

Further information is in the detailed findings below.

The Granary Care Centre is a care home providing care for up to 78 people living with dementia. Within the home there is a unit called Crofter’s Lodge for people with complex needs. Crofter’s Lodge can provide treatment for people detained under the Mental Health Act 1983. The Granary comprises two floors, the first floor is for residential care and the second floor is for nursing care.

The home is purpose built and all bedrooms are for single occupancy. During our inspection there were 14 people living on the first floor and 21 people living on the second floor in The Granary and seven people living in Crofter’s Lodge.

There was not a registered manager in post. 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. There was a temporary manager in post and they were managing the service until a permanent manager was recruited. The director of residential and nursing services told us they were in the process of recruiting a manager for The Granary and they had recruited a new manager for Crofter’s Lodge.

We carried out an unannounced comprehensive inspection of this service on 10, 11 and 13 October 2016. Breaches of legal requirements were found because the service was failing to assess some risks to the health and safety of service users who were receiving care or treatment. Authorisation was not always sought around changing medicines where this was a legal requirement. Complete and contemporaneous records were not kept in respect of each service user, systems and processes were not operated effectively to assess, monitor and mitigate risks.

After the comprehensive inspection, we used our enforcement powers and served two Warning Notices on the provider. These are formal notices which confirmed the provider had to meet the legal requirements by 28 February 2017.

We undertook this focused inspection to check they now met these legal requirements. This report only covers our findings in relation to these requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link on our website at www.cqc.org.uk

We found action had been taken to improve people’s safety although some areas of the service required some improvement.

The correct procedures were being followed where people who were detained under the Mental Health Act 1983 (MHA) had changes to their medicines and the correct authorisation for the changes were in place.

Risks to people were identified and measures were put in place to reduce the risks. There were effective systems in place to ensure pressure relieving mattresses were set at the correct pressure.

Improvements had been made which ensured records of the care delivered were completed. Some of the care plans needed to include clearer instructions for staff on how to support people with specific aspects of care. Staff were aware of how to support people and the manager had an action plan in place to update all of the care plans.

The systems for assessing, monitoring and improving the quality and safety of the service provided had improved.

We found the provider had made the improvements required to meet the legal requirements.

The home is purpose built and all bedrooms are for single occupancy. During our inspection there were 14 people living on the first floor and 22 people living on the second floor in The Granary and eight people living in Crofter’s Lodge.

We inspected The Granary Care Centre in August 2015. At that Inspection we found the provider to be in breach of three regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The regulations included; safe care and treatment, need for consent and receiving and acting on complaints. We also completed a Mental Health Act visit inspection in Crofters Lodge on 6th January 2016.

The provider wrote to us with an action plan of improvements that would be made. They told us they would make the necessary improvements by March 2016. During this inspection we saw the improvements identified had been made. However we found further breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and the Care Quality Commission (Registration) Regulations 2009.

The inspection took place on 10, 11 and 13 October 2016 and was unannounced.

There was a manager in post but they were not registered with us. 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 manager was in the process of completing their registration application with us.

Risks to people were not always identified. Where risk assessments were in place they did not always contain accurate and up to date information. The home was not regularly assessing risks relating to people when they were granted leave from Crofters Lodge which put the safety of people at risk.

There was some information missing from records relating to how people took their medicines. Authorisation was not always sought around changing medicines where this was a legal requirement. Medicines were stored securely.

People were supported by staff who were not directly employed by the service. Relatives and staff raised concerns about the number of agency staff the home used at times to cover their vacant posts. There were times when night shifts were covered predominantly with agency staff. We saw the same agency staff were requested to work at the home to provide consistency.

There were some gaps in staff training and the manager had plans in place to address this. New members of staff received an induction which included shadowing experienced staff; they told us this prepared them for the role.

Staff did not always feel supported, listened to and valued. Staff did not always receive regular one to one supervision with their line manager. Where improvements were identified with staff performance, this was monitored and reviewed by their manager.

Care plans did not always include accurate and up to date information. Records were not always fully completed by staff.

The provider had a system in place to audit the service, whilst the audit identified some of the concerns we identified during our inspection there were areas of concern that were not covered in the audits.

The provider was not notifying us of all incidents in line with their legal responsibility.

Relatives said the home was a safe place. Systems were in place to protect people from harm and abuse and staff knew how to follow them.

A recruitment procedure was in place and staff received pre-employment checks before starting work with the service.

Relatives told us their family members were happy with the food provided.

Relatives told us they were confident they could raise concerns or complaints with the staff and they would be listened to.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) ¿Regulations 2014 and the Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take at the back of the full version of this report.

We spoke with staff and relatives and made observations of the care that people were receiving. Relatives that we spoke with were happy with the care provided at the home and we observed interactions where staff were kind and caring. Staff appeared knowledgeable about the kinds of activities that people enjoyed and engaged in and we saw that some recordings were made about the activities undertaken.

We viewed information relating to training for staff and saw that all staff had completed basic dementia training. Staff were positive about the course and told us about the things they had learnt from it. Senior staff were due to attend further in depth training. We viewed a sample of supervision records and saw that these were used to discuss staff development needs.

Not everyone using the service was able to provide us with feedback about the service they received. However, we made observations, including a formal observation called a SOFI (Short Observational Framework for Inspection). This is a tool that we use to help us understand the experiences of people that are not able to speak with us. This observation was carried out on the first floor at the home and showed some positive relationships between staff and people using the service. People received appropriate support to help them with their meals.

We found that there were systems in place to monitor the quality of the service provided and these included gathering feedback from people using the service and their representatives. A programme of audits was in place to help identify particular issues of concern.

People using the service were protected from the risks of abuse because staff received training and demonstrated relevant knowledge in this area.

We judged that the staffing arrangements were a significant factor in relation to these concerns. There were not enough staff to ensure that people's needs were consistently met. The training plan for the staff team did not reflect the specialist nature of the service. This meant that people were at risk of receiving care from staff who lacked the skills and support that they needed to do their jobs well.

Some systems were in place for quality assurance. However we found that these were not effective in ensuring that good standards were maintained throughout the service.