Archived: Sycamore House

Sycamore House is registered for 42 beds and provides personal care and accommodation for older people. On the day of our visit 37 people were using the service. This included ten people living in Kenyon Lodge, this is a separate unit within Sycamore House for people living with advanced dementia.

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

Systems and processes had improved since the last inspection, but were not fully effective or embedded. We identified ineffective recording of people’s individual care needs. Information recorded was not consistent and therefore confusing to staff. People’s care plans and risk assessments did not consistently reflect people’s current needs.

Inconsistent management had impacted on the development of the service and staff felt that they were not always listened too or supported.

Plans were not always in place to ensure people’s safety. Some personal emergency evacuation plans were not readily available for staff in the event people needed to be evacuated.

Some concerns were raised about staffing levels. The management team were requested to follow up on the concerns received. Safe recruitment processes were used to ensure only staff suitable for their role were employed at the service.

People received their prescribed medicines safely. Some shortfalls were identified in the management of medicines, but this had a low impact on people.

Risks associated with people’s individual care needs had been assessed and were monitored. Improvements had been made to ensure people’s hydration needs were met.

Safeguarding concerns were reported to the local authority and CQC. The provider had introduced a more robust system of identifying and analysing incidents.

Infection prevention and control best practice guidance had been implemented by the provider and was being followed by staff. Covid 19 guidance was available to staff and people. Staff were observed wearing personal protective equipment correctly.

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 Requires Improvement (Published on 12 April 2019) and there were two breaches of regulations. The provider completed an action plan after the last inspection, to show what they would do, and by when, to improve. At this inspection, enough improvement had been made to meet the regulation 12 breach, further work was required to meet the regulation 17 breach.

The overall rating for this focused inspection remains as Requires Improvement.

Why we Inspected

We received concerns in relation to the management of the service and care and treatment of people. As a result, we undertook a focused inspection to review the key questions of Safe and Well-led only. We also followed up on previous breaches.

We reviewed the information we held about the service. No areas of concern were identified in the other Key Questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those Key Questions were used in calculating the overall rating at this inspection.

We have found evidence that the provider needs to make improvement. Please see the safe and well led sections of this full report.

Enforcement

We have identified a breach in regulation in relation to the governance of the service. Please see the action we have told the provider to take at the end of this report

Follow up

We will request an action plan from the provider, to understand what they will do to improve the standards of quality and safety. We will 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.

Sycamore House is registered for 42 beds and provides personal care and accommodation for older people. On the day of our visit 37 people were using the service. Eleven people were living in Kenyon Lodge, this is a separate unit within Sycamore House for people living with advanced dementia. 26 people were living in the main service – Sycamore House.

People’s experience of using this service:

People’s medicines were not managed following national best practice guidance. This put people at greater risk of not receiving their prescribed medicines safely. Risk assessments lacked guidance for staff about the action required to manage known risk and people’s care plans lacked detail for staff to provide person centred care.

The deployment of staff did not consistently ensure people’s safety. Whilst permanent staff had been safely recruited, profiles for agency staff (who worked at the service only when required) were not readily available for staff to review to verify their identity.

People’s hydration needs were not fully assessed, provided for or monitored, putting people at greater risk of becoming dehydrated and unwell. Where people were unable to make specific decisions regarding their care; there was inconsistencies in how the Mental Capacity Act 2005 principles were applied. This meant people were not consistently supported to have maximum choice and control of their lives and may not have been supported in the least restrictive way possible.

Improvements were required in end of life care. We have made a recommendation about staff training about end of life care.

The manager had introduced a system that analysed accidents and incidents for patterns and trends and these confirmed, there had recently been a decline in the falls people had experienced. Safeguarding concerns were reported to the local authority safeguarding team and CQC. Some shortfalls were identified with the measures in place for the prevention and control of infections.

People’s health needs were monitored and staff made referrals to external healthcare professionals when people’s health needs changed. Staff were kind and caring and respected people’s privacy and dignity.

Activities and opportunities were limited and may not have met people’s interests, hobbies and pastimes. People’s diverse needs were known and understood. People had access to the provider’s complaint procedure. People received opportunities to be involved in the development of the service.

The manager was introducing many improvements at the service. This included improved opportunities in how people, relatives and advocates were involved in their care. How information was shared between staff. Staff training and support was also being improved. An action plan was in place to drive forward the improvements the manager and regional manager had identified.

The service met the characteristics for a rating of "Requires Improvement" in all key questions.

Please see the ‘action we have told the provider to take’ section towards the end of the report.

Rating at last inspection:

Good (report published 12 January 2016)

Why we inspected:

This was a planned inspection based on the rating at the last inspection.

Follow up:

We have requested the provider for an action plan to advise us how and when they will make the required improvements. We will also continue to monitor intelligence we receive about the service until we return to visit at the next scheduled inspection. If any concerning information is received we may inspect sooner.

People were protected from abuse or the risk of abuse because the manager responded appropriately to incidents or allegations.

Records showed that any incidents which were of a safeguarding nature were being reported to the Nottingham City Council safeguarding vulnerable adults team. They were also logged on the system used by the manager so that they could be monitored centrally by the provider.

People spoken with gave positive feedback about the care staff were delivering. They said things like, 'They are a good group of people' and 'They (the staff) know what they are doing. They are kind and they listen to me.' Records showed that staff were receiving regular training to enable them to do their job safely and supervision to ensure they were supported to do their job.

People knew how to raise concerns and complaints and we saw these were acted on within a specified timescale. One person told us they had discussed some issues with the manager and that she had, 'sorted everything out straight away.' None of the people we spoke with had any concerns about the service.