Sycamore Court

Sycamore Court is a residential care home providing nursing care and support for up to 40 people. People were living with a range of needs associated with the frailties of old age and some people were living with dementia or other mental health needs. 39 people were living at the service on the day of our inspection.

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

We saw the required improvements had been made since the last inspection in respect to the deployment of staff, the analysis of accidents and incidents and culture and staff morale. The provider had systems in place to monitor the quality of the service. However, we identified some further areas of practice that need improvement in relation to the management of the service.

People told us they felt safe and they received care that met their needs. A relative told us, “The home seems well managed, it’s all very calm. I haven’t got any complaints, they are all stars to me.” Another relative added, “I’m confident it’s well managed, it’s clean and very friendly.” Risks to people had been identified and assessed. Staff were recruited safely and there were enough staff to meet people’s needs. Medicines were managed safely. Infection prevention and control processes protected people from the risk of infections.

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.

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 requires improvement (published 25 July 2022) and there was a breach of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulation.

Why we inspected

The inspection was prompted in part due to concerns received about staffing levels and care delivery. 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 look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We carried out an unannounced comprehensive inspection of this service on 26, 27 & 30 May 2022. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve good governance.

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 Key Questions Safe and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Sycamore Court on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Sycamore Court is a residential care home providing nursing care and support for up to 40 people. People were living with a range of needs associated with the frailties of old age and some people were living with dementia or other mental health needs. 39 people were living at the service on the day of our inspection.

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

People told us that on the whole they were happy with their care and felt safe. However, we identified concerns in respect to the culture. We received mixed feedback from people and relatives in respect to the management of the service.

The provider had systems in place to monitor the quality of the service. However, staff with responsibility for monitoring these systems did not always have the operational knowledge to do so, and they were not being used effectively. For example, incidents and accidents had been recorded, but were not routinely monitored for any emerging trends or themes.

There were enough staff to keep people safe. However, we identified some issues in respect to the deployment of staff around the service.

People told us staff were kind and they had a good relationship with them. People received medicines safely. The service was clean, hygienic and a pleasant environment to spend time in. People’s care plans were up to date and accurately reflected their needs. People were able to receive visits from their relatives and there was a programme of activities to support their well-being.

Staff worked collaboratively with outside agencies such as the local authority and healthcare professionals. Complaints were handled appropriately, and people enjoyed the food and drinks on offer. People were protected from harm and abuse, as staff knew how to safeguard people and what procedures they should follow.

Staff had received relevant training to meet people’s needs. Complaints were responded to appropriately and people’s wishes at the end of their life were respected. People were able to express their views and had their dignity, independence and privacy promoted.

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.

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 25 January 2022).

Why we inspected

The inspection was prompted in part due to concerns received about staffing levels and care delivery. 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 look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

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

You can see what action we have asked the provider to take at the end of this full 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Sycamore Court is a residential care home providing nursing care and support for up to 40 people. People were living with a range of needs associated with the frailties of old age and some people were living with dementia or other mental health needs. 39 people were living at the service on the day of our inspection.

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

People received personalised care and support specific to their needs and preferences. People were protected from the risks of harm, abuse or discrimination because staff knew what actions to take if they identified concerns. There were enough staff working to provide the support people needed. Staff understood the risks associated with the people they supported. Risk assessments provided guidance for staff about individual and environmental risks. People received their medicines safely, when they needed them.

Care was person-centred and promoted people’s dignity, privacy and human rights. People’s individual needs and choices were recognised, and respected. People were supported to have 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.

As well as the need to keep people safe during the COVID-19 pandemic taking priority, the provider and staff had worked hard to develop good leadership. Quality monitoring systems had been embedded and morale was good amongst the staff team. We received positive feedback in relation to the care people received and how the service was run. A relative told us, “[My relatives] look incredibly well. I am never concerned they’re not well cared for.”

Due to the COVID-19 pandemic, the provider had ensured that appropriate infection control procedures were in place to keep people safe. This included increased cleaning and ensuring adequate supplies of personal protective equipment (PPE) were available. Staff completed training in relation to COVID-19. We were assured the provider managed infection prevention and control through the COVID-19 pandemic.

We observed a kind and caring culture. People and professionals spoke positively about the support staff gave to people. We observed positive interactions between people and staff throughout the inspection. A visiting professional told us, “The staff here are very proactive at recognising when people’s needs change and if they need to contact a healthcare professional.” A relative added, “I would describe them as kind and compassionate. People think that care work is an easy job, it really isn't, these people are just so special.”

People’s care plans were personalised and gave staff the information they needed to support people. We saw people were supported with their communication needs and their preferred activities in accordance with their care plans.

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

Rating at last inspection

At the last inspection, the service was rated as Requires Improvement. The overall rating for the service has now improved to Good. This is based on the findings at this inspection.

Why we inspected

We had received concerns in relation to care delivery at the service. As a result, we undertook a focused inspection to review the key questions of safe, caring, responsive and well-led only. We found no evidence during this inspection that people were at risk of harm from these concerns.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

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.

Sycamore Court is a care home with nursing registered to provide accommodation for up to 40 people with various health conditions, including dementia, frailty and sensory impairment. There were 31 people living at the service on the day of our inspection.

People’s experience of using this service

People were happy with the care they received, felt relaxed with staff and told us they were treated with kindness. They said they felt safe, were well supported and there were sufficient staff to care for them.

Our own observations supported this, and we saw friendly relationships had developed between people and staff. One person told us, “I’ve got no problems, I’m very happy.”

People told us their choices and needs were met. They enjoyed the food, drink and activities that took place daily. People thought the service was well managed and they enjoyed living there. A relative told us, “This home is very well run. I can’t fault them. We’re happy with the care and I know [my relative] is.”

Staff had received training considered essential by the provider. It was clear from observing the care delivered and the feedback people and staff gave us, that they knew the best way to care for people in line with their needs and preferences. A member of staff told us, “I would be happy for any of my relatives to live here.”

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.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

The provider had systems of quality assurance to measure and monitor the standard of the service and drive improvement. These systems also supported people to stay safe by assessing and mitigating risks, ensuring that people were cared for in a person-centred way and that the provider learned from any mistakes. Our own observations and the feedback we received supported this. People received good care that met their needs and improved their wellbeing from dedicated and enthusiastic staff.

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 11 August 2020).

Why we inspected

The inspection was prompted in part by notification of a specific incident, following which a person using the service died. The information CQC received about the incident indicated concerns about the management of choking and staffing levels. This inspection examined those risks.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe, effective and well-led sections of this full report.

We reviewed the information we held about the service. No areas of concern were identified in the key questions of caring and responsive. We therefore did not inspect these. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has remained as Requires Improvement. This is based on the findings at this inspection.

Follow up

We will continue to monitor the intelligence we receive about this home and plan to inspect in line with our re-inspection schedule for those services rated Requires Improvement. If we receive any concerning information we may inspect sooner.

We found the following examples of good practice

The service was clean and tidy and specific processes were followed to ensure all cleaning tasks were consistently completed. This included frequent disinfection of areas which were regularly touched, for example, door handles and hand rails.

Hand-washing facilities were available, and visitors had their temperatures taken and completed either a questionnaire, or signed in to an online track and trace service before entering the service. Personal protective equipment (PPE) was available throughout the service.

The registered manager and staff completed detailed risk assessments for both people living at the service and staff to ensure their safety. In depth analysis of COVID-19 testing was in place and the registered manager worked closely with other stakeholders, such as the Local Authority and Public Health.

Staff were wearing appropriate PPE in-line with government guidelines. Staff had completed infection prevention and control (IPC) training. The registered manager had undertaken additional IPC training to support staff with best practice.

Sycamore Court is a residential care home providing nursing care and support for 29 people. The service can support up to 40 people. People were living with a range of needs associated with the frailties of old age and some people were living with dementia or other mental health needs.

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

At the last inspection in September 2019, we identified seven breaches of regulations. These were in relation to Regulation 9 (Person Centred Care), Regulation 10 (Dignity and Respect), Regulation 11 (Need for consent), Regulation 12 (Safe Care and Treatment), Regulation 15 (Premises and equipment), Regulation 17 (Good Governance) and Regulation 18 (Staffing) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Following this inspection, the provider sent us an action plan. This included information about the steps they had taken to make improvements at the service. However, due to COVID-19 and the subsequent lockdown on visitors, their priorities had to change. The provider and staff worked hard to ensure the appropriate infection control procedures for the pandemic were in place to keep people safe. This included increased cleaning and ensuring adequate supplies of personal protective equipment (PPE) were available. Staff completed training in relation to COVID-19. The impact of COVID-19 meant that some improvements will need further time to be fully introduced and embedded into every day practice.

People were protected from the risks of harm, abuse or discrimination because staff knew what actions to take if they identified concerns. There were enough staff working to provide the support people needed. Staff understood the risks associated with the people they supported. Risk assessments provided some guidance for staff about individual and environmental risks. People received their medicines safely, when they needed them.

Quality assurance systems had been introduced and were continuing to be developed and improved. This included audits of medicines, care plans, and health and safety. Further systems of quality monitoring had been implemented, but at the time of inspection had not started.

The provider and staff team had worked hard to address the areas for improvement following the last inspection. Further time was needed to fully embed these changes into day to day practice.

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 Inadequate (published 27 January 2020). There were multiple breaches of regulation. At this inspection we found improvements had been made.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 11 and 12 September 2019. Breaches of legal requirements were found. We imposed a condition on the provider’s registration. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

We undertook this focused inspection in light of concerns we had received in respect to the care people were receiving. Concerns included staffing levels, assessments of risk, and the management of pressure care and medicines. Therefore, this report covers our findings in relation to the Key Questions Is it Safe? and Is it Well-led?

For those key questions not looked at on this occasion, the ratings from the previous comprehensive inspection were used in calculating the overall rating at this inspection. The overall rating for the service has changed from inadequate to requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Sycamore Court on our website at www.cqc.org.uk.

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.

Sycamore Court is purpose built and accommodates up to 40 people with increasing physical frailty, people living with dementia or other mental health needs. The home also provides respite care. At the time of inspection 34 people were living at the home.

Sycamore Court was located over three floors which were accessible via stairs or lifts. The home had a large communal area and smaller lounges on each floor for people and relatives to use.

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

People did not always have access to enough staff to meet their care and support needs. Risk to people’s safety were not always identified or assessed. People and relatives told us on many occasions that there weren’t enough staff to support people safely.

The management of medicines was not always safe, improvements were needed to help staff identify when people required medicines on an ‘as and when basis’.

People living with dementia, did not always receive respectful or dignified care. There was a lack of person-centred practices to ensure that people’s needs, preferences and wishes were respected and met. There was a lack of meaningful and stimulating interactions with staff to occupy people’s time. The environment and information had not always been adapted to meet people’s needs. People were at risk of social isolation.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests. People’s needs were not fully identified and assessed to enable staff to deliver care that met people’s preferences or requirements. People’s dietary needs and nutritional requirements were not assessed and accurately recorded to help people maintain a balanced diet. People had access to external health care professionals when they were unwell.

Interactions between staff and people was task-focused and staff had little time to spend with people. People’s care plans were not person centred and staff did not always know people well to enable them to deliver person-centred care.

The service was not well-led. The registered manager lacked oversight of the service and there had been significant shortfalls in the leadership of the service. Quality assurance processes were not always effective at identifying issues and improving the quality of care people received. Systems did not always check staff competency and staff told us they did not feel supported.

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 (report published 12 September 2018). At this inspection we found the service had deteriorated to Inadequate.

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

Enforcement:

We have identified breaches of seven regulations. These were in relation to Regulation 9 (Person Centred Care), Regulation 10 (Dignity and Respect), Regulation 11 (Need for consent), Regulation 12 (Safe Care and Treatment), Regulation 15 (Premises and equipment), Regulation 17 (Good Governance) and Regulation 18 (Staffing).

Full information about The Care Quality Commission's (CQC) regulatory response to more serious concerns found in inspections and appeals is added to reports after any representation and appeals have been concluded.

Follow up:

The overall rating for this service is Inadequate and the service is therefore in 'special measures'. This means we will keep the service under review and, if we do not propose to cancel the providers registration, we will re-inspect within six months to check for significant improvements.

Sycamore Court 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 Court is purpose built, and was taken over in 2015 by Tradstir Limited. This is the second inspection since the service was taken over by the new provider. Residential and nursing care is provided, across three units, for up to 40 older people with increasing physical frailty, many living with dementia or other mental health needs. Long term care and respite care is provided. There were 34 people resident at the time of the inspection.

At the last inspection on 7 March 2017 the service was rated overall Requires Improvement. At this inspection we found the service remained overall Requires Improvement. At the last inspection we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because we found robust audit systems maintained and embedded in the running of the service to ensure the quality of the service had not been completed. An external company had also been used to audit in the service. However, action plans to address the issues highlighted had not been developed. We could not identify how the provider monitored or analysed the information received to look for any emerging trends or make improvements to the service provided. Regular health and safety checks of the building had not been maintained and not all risk assessments had been completed. Records were not fully accessible for senior staff to refer to and ensure essential checks of the building and services had been carried out. We also found areas in need of improvement. Training records were not fully up-to-date, so it was not possible evidence all staff had completed the essential training to support them in their roles. Staff told us they felt well supported by the senior staff who were accessible. However, feedback and records showed us that not all the staff had received regular individual supervision or appraisal. A new electronic care planning system had been introduced into the service, and people's care plans were in the process of being reviewed and transferred from the paper records onto the new system. This process had not been fully completed and care plans were between both systems, and some reviews had fallen behind. It was not possible to fully evidence peoples current care and support needs and any risks that had been identified were being met. People's nutritional needs were assessed and recorded. However, where people were being supported with their fluid intake, records had not been fully completed to inform care staff. Activities for people particularly for those people who stayed mainly in their own rooms were still in need of development. The provider sent us an action plan as to how these issues would be addressed. At this inspection we found significant improvements had been made to address all the issues raised. However, not all the issues had not been fully addressed, or had time to be fully embedded in the practice of the service and were still in need of improvement.

There was a new registered manager for 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. The registered manager was also the registered manager for another of the provider’s services located nearby. They had a good understanding the of the provider’s systems and processes to be followed which they had introduced into Sycamore Court. They had divided their time between both the services, and they were supported at both services by a deputy manager/clinical lead and a team of senior staff.

The registered manager told us the service had been through a significant period of change since they had commenced working in the service. With a new registered manager and deputy manager, and several staff changes particularly to the senior staff team who had taken time to be inducted into the service. They told us this had meant the implementation of processes and systems had been delayed and had not in all instances been fully developed and embedded as quickly as they had planned. Senior staff were working closely together following and working to the services action plan to address any outstanding issues. This was evident from the feedback and records we viewed. The provider and their personal assistant were now based in the service for part of the week to support senior staff with the necessary changes, and had received regular updates on the progress from the registered manager. Staff spoke positively of the changes and improvements which had been implemented since the new management team had started. They felt better supported and told us they liked working in the service. A member of staff told us, “The management are now very approachable, and staff are a lot happier.”

Although feedback from staff indicated a robust recruitment process was followed for new staff working in the service, supporting documentation did not always evidence the receipt of all the recruitment checks prior to staff coming work in the service. This was a requirement of the services own policies and procedures. To ensure all the information required to safeguard people had been available for a decision to be made as to the suitability of a person to work with adults. Staff told us they were supported to develop their skills and knowledge by receiving essential training which helped them to carry out their roles and responsibilities effectively. Senior staff told us they had audited and identified staffs training needs and were working to provide this. They acknowledged this was still an area of improvement and they were monitoring and ensuring the completion of staff training in supervision. Training records were up-to-date, so it was possible to evidence staffs progress and the improvement in the numbers of staff who had up-to-date training. Feedback and records showed us a system of supervision had just started. Annual appraisals were still to be completed. Senior staff had been given guidance and support to provide staff with supervision and appraisal. However, despite the improvements made training, supervision and appraisal were still an area in need of improvement and not fully embedded in the practice of the service.

People told us they had felt involved in making decisions about their care and treatment and felt listened to. People's individual care and support needs were assessed before they moved into the service. The electronic care planning system had been fully introduced into the service. Senior staff told us the detail of the recording was still being developed. Support had been given and training had been booked to support care staff to ensure records were more person centred. People’s care and support needs had been reviewed as the information had been transferred. A system of ongoing regular reviews was in place. It was not possible to fully evidence this had been embedded into the practice of the service. Care staff demonstrated a good knowledge of people’s care and support needs. However, not all the care plans reflected changes to people’s current care needs. Risk assessments completed did not always detail what actions needed to be followed to mitigate any risks identified.

Medicines were stored correctly and there were systems to manage medicine safely. However, we identified some improvements needed to the recording of medicines.

People told us they felt safe with the care provided. One person told us, “I feel safe and secure here. I can lock my door.” People were protected from the risk of abuse because staff understood how to identify and report it. People were cared for by kind and caring staff. One person told us, “I like it in the home, I’m happy here. The staff are very nice. I’m happy and settled here. I don’t know how they could improve it.” Another person told us, “I like it in the home and the staff are very nice. I can’t grumble about anything.” The selection of activities people could join in were still being developed. The selection of activities available for people to join in were still being developed. In particular for people living with dementia. One person told us staff were, “Good at encouraging people to do activities which is good as that is good for them.” Another person told us, “I take part in activities when I can. I like the singing.” A member of staff told us, “I enjoy the company of the people I care for. I like to keep them chatting and debating. It’s my job to inspire them.”

Senior staff monitored people’s dependency in relation to the level of staffing needed to ensure people’s care and support needs were met. Feedback from people and staff was that there was usually enough staff to meet people’s care and support needs. One person told us they were, “Very happy in the home. The home is so friendly. Not pressurised to do anything. Enough staff in the home. They come quickly if I use the call bell.” A member of staff told us, “Not short staffed very often. Usually the same night staff and most staff are happy to do overtime.”

People’s nutritional needs were assessed and recorded. People told us they enjoyed the food provided. One person told us, “Oh yes I like the food. Empty plates where I’m concerned. Plenty of drinks and

Sycamore Court is purpose built, and was taken over in 2015 by Tradstir Limited. This is the first inspection since the service was taken over by the new provider. The service provides residential and nursing care, across three units, for up to 40 older people with increasing physical frailty, many living with dementia or other mental health needs. Long term care and respite care is provided. There were 20 people resident at the time of the inspection.

There was a registered manager for 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.

Staff told us it had been a significant period of change with a new provider taking over the service, difficulties in recruiting staff and a number of staff changes. The registered manager told us for a long period they had been without a deputy manager and clinical lead for the service. This had meant process and systems had not been fully developed and embedded in the service as quickly as they had planned. However, one had recently been recruited and work had already commenced to start to address this. Staff also spoke of changes and improvements which were now starting to be implemented since the deputy manager had started to work in the service. There were also a lot of refurbishment works being carried out to the building, which had led to areas of the building not in use and people being moved out of their rooms for a period whilst the work was being completed. This was due to be completed shortly. Staff spoke of the passenger lift had been out of action for a significant period of time which had been difficult to manage and had restricted the movement of people around the service. One the day of the inspection one unit was closed for refurbishment and only half the beds were filled.

We found regular auditing by senior staff in the service to ensure the quality of the service had not been completed or regularly maintained and embedded in the running of the service. People had been able to feedback on the care and support they had received. An external company had also been used to audit in the service. However, action plans to address the issues had either not been drawn up or actions had not been taken to address the issues highlighted. We could not identify how the provider monitored or analysed the information received to look for any emerging trends or make improvements to the service provided. This is an area which requires improvement.

People received care in an environment that was clean and tidy. However, regular health and safety checks of the building had not been maintained and not all risk assessments had been completed. Records were not fully accessible for senior staff to refer to and ensure essential checks of the building and services had been carried out. This is an area which requires improvement.

Senior staff monitored people’s dependency in relation to the level of staffing needed to ensure people’s care and support needs were met. Feedback from people and staff was that there was usually enough staff to meet people’s care and support needs. One member of staff told us, “This is generally a good place to work, we pick up lots of skills here. The place has potential and is designed for a certain type of care. We all sing from the same hymn sheet with similar aspirations and expectations.” Another member of staff told us “It’s really good I’m quite happy the staff are doing a very good job.” Staff told us they were supported to develop their skills and knowledge by receiving training which helped them to carry out their roles and responsibilities effectively. However, training records were not fully up-to-date so it was not possible to evidence this. This is an area in need of improvement. The registered manager told us all care staff were now being taken through the care certificate. Senior staff were monitoring this with staff to ensure its completion. Staff told us they felt well supported by the senior staff who were accessible, however, feedback and records showed us that not all the staff had received regular individual supervision or appraisal. Senior staff told us of the work which had commenced to address this. This is an area in need of improvement.

People told us they had felt involved in making decisions about their care and treatment and felt listened to. People's individual care and support needs were assessed before they moved into the service. A new electronic care planning system had been introduced into the service. Senior staff acknowledged that some reviews had fallen behind and it was not possible to fully evidence people current care and support needs and any risks that had been identified as people’s care plans were in the process of being reviewed and transferred onto the new system. People’s nutritional needs were assessed and recorded. People told us they enjoyed the food provided. However, where people were being supported with their fluid intake, records had not been fully completed for care staff to refer to. These are areas in need of improvement.

People were able to join in a range of meaningful activities. Staff told us there were two part-time activities co-ordinators who were trying out new ideas for activities and were receiving support and guidance on providing activities for people living with dementia. However, feedback we received was that activities for people who stayed in their own rooms had not been fully developed. This is an area in need of improvement.

Medicines were stored correctly and there were systems to manage medicine safely.

Consent was sought from people with regard to the care that was delivered. Staff understood about people’s capacity to consent to care and had a good understanding of the Mental Capacity Act 2005 (MCA) and associated legislation, which they put into practice. Where people were unable to make decisions for themselves staff were aware of the appropriate action to arrange meetings to make a decision within their best interests. People told us they felt safe. One person told us, “I am safe and happy and will give them ‘thumbs up’.” Another person told us, “I feel safe here. They take me to the balcony to smoke and watch me and bring me in.” We observed staff speaking with people in a kind and respectful manner and saw many examples of good natured but professional interaction. Staff were aware of the values of the service and understood the importance of respecting people’s privacy and dignity. A compliment received by the service detailed, ‘It was clear to us that mum felt safe and well cared for during her short stay at Sycamore Court. This was important and reassuring.’

Procedures were in place for people and their relatives and their representatives to raise any concerns. No one we spoke with had raised any concerns, but they felt it was an environment where they could raise issues and they would be listened to.

We found 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 the full version of the report.