Sycamore Cottage Residential Home

Sycamore Cottage is residential care home providing accommodation for people requiring personal or nursing care for up to 14 people. The service provides support to older people and younger adults. At the time of our inspection there were 13 people using the service.

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

Expected food hygiene standards could not always be met because the kitchen was old and required replacement. The provider had ordered a replacement kitchen and was waiting for dates for delivery and installation.

Safety checks and routine maintenance was carried out to ensure the premises and any equipment were safe to use. The provider was in the process of refurbishing and redecorating the building.

We made a recommendation about protocols for medicines prescribed on an ‘as required' basis. Staff managed people’s medicine in as safe way. There were enough staff to meet people’s needs and keep them safe. Staff were recruited in a safe way.

People were safe because staff had training about protecting people from abuse. People had confidence in staff and managers. Risks were assessed and staff knew how to reduce risk and how to provide reassurance if people became distressed.

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.

People and staff were involved and consulted about the day to day running of the service. People had choices and their feedback was used to improve care and support. Care and support was person centred and achieved good outcomes for people. Staff and managers knew people well and understood the things which were important to them.

Checks and audits were carried out and areas for improvement were identified and implemented. The provider and managers had a very hands on approach and were supportive to people and staff.

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 10 October 2019).

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 regulations.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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, which will help inform when we next inspect.

Sycamore Cottage is a residential care home providing personal and nursing care to 10 people aged 65 and over at the time of the inspection.

The home accommodates up to 14 people in one adapted building.

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

There was not enough staff employed to meet people’s needs in a safe and timely way. Care staffs role was to provide care, maintain the cleanliness of the home and cook. This meant that people sometimes had to wait to have the support they required and did not always receive the level of supervision they required.

There were systems in place to monitor the quality and standard of care but where shortfalls had been identified the action to address them lacked the resource to complete work in a timely way. People could not always be assured they were cared for in a clean and tidy environment and were unable to independently access the garden when they wished to.

People’s care needs were assessed before they went to live at the service, to ensure their needs could be fully met. Staff received an induction when they first commenced work at the service and ongoing training that enabled them to have the skills and knowledge to provide effective care.

People were supported to eat and drink enough and staff supported people to live healthier lives and access healthcare services.

The service had a welcoming atmosphere where visitors were welcomed and encouraged. The premises were adapted to meet the needs of people using the service.

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.

Staff provided care and support in a caring and meaningful way. They knew the people who used the service well and had built up kind and compassionate relationships with them. People and relatives, where appropriate, were involved in the planning of their care and support. People’s privacy and dignity was generally maintained.

Care plans were detailed and supported staff to provide personalised care. There was a complaints procedure in place and systems in place to deal with complaints effectively. The service provided appropriate end of life care to people.

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 good (published 07 April 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified a breach in regulation to staffing. There was not enough staff employed to provide the care and support people required in a safe and timely way.

Please see the action we have asked the provider to take at the end of this report.

Follow up

We will request an action plan for 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 Cottage Residential Home is a care home and provides care and support for up to 14 people. There were 12 people using the service when we visited and many were living with dementia.

There was a registered manager in place. It is a requirement that the service has a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The provider had safely recruited a suitable number of staff to provide care and support to people. People were supported safely and staff knew their responsibilities to protect them from abuse and avoidable harm. The provider took action following an incident or accident including gaining the specialist support of health care professionals to help reduce the likelihood of a reoccurrence. Risks to people’s health and well-being were assessed and reviewed. For example, where a person could display behaviour that challenged themselves and others, there was guidance for staff which they followed.

People received their medicines when they required them. Staff knew what action to take should they have concerns about a person’s medicines including what to do in the event of an error. Staff received training and guidance for handling medicines to make sure people were supported safely.

People were asked for their consent before care and support was undertaken. Staff knew the importance of doing this and spent time with people so that they understood what they were being asked.

People were not always supported in line with the Mental Capacity Act 2005. For example, the provider had not always completed mental capacity assessment to determine people’s ability to make decisions. Staff did not always understand the requirements of the Act. The registered manager told us they would make improvements including arranging additional training for staff. The registered manager had made applications to the appropriate body where they had sought to deprive some people using the service of their liberties to make sure this was acceptable.

Staff mainly had the necessary skills and knowledge to offer good care to people. Staff had received training in areas such as dementia and dignity and respect. Staff had language skills that benefitted the people they were supporting. Staff received an induction when they started working for the provider so that they were aware of their responsibilities. Staff also received guidance and feedback from the registered manager to make sure they were offering support that met people’s care requirements.

People had mixed views about the food offered to them. The registered manager told us that the menu was being reviewed. Staff recorded what some people ate and drank. We found that the records occasionally contained gaps. We saw that people had enough to eat and drink. The registered manager told us they would review the need to record this as they did not have current concerns about people’s eating and drinking.

People were supported to maintain their health. This included having access to healthcare services such as to their doctor, chiropodist and optician.

Staff knew about the people they were supporting. They involved them in decisions about their care where people were able to be part of this. People received care that was based on things that mattered to them. For example, routines that were important to them were respected by staff.

People were supported to be as independent as they wanted to be to retain their skills. Staff were kind and compassionate although we saw an occasion where a staff member could have caused offence to a person. The registered manager told us they were taking action about the staff members' performance and we saw this to be the case.

People’s dignity and privacy was mainly protected although their care records were not always stored securely. The registered manager told us they would remind staff to keep people’s care records secure. People’s relatives and friends could visit without undue restriction.

People or their representatives contributed to the planning and review of their care although this was not always recorded. The provider told us they would take action to make improvements.

People took part in interests and hobbies that they enjoyed. For example, people accessed facilities in their local area.

People knew how to make a complaint as the provider had made information available to them. The registered manager responded to concerns where they were raised and took action.

Sycamore Cottage Residential Home was well-led and staff were supported by the registered manager. Staff, people and their relatives had opportunities to give feedback to the provider. The provider listened to the feedback received and took action where this was required.

Staff knew what was expected of them. This included how to report the inappropriate or unsafe practice of their colleagues should they have needed to.

The registered manager was aware of their responsibilities and carried out quality checks of the service to make sure that it was of a high standard. For example, checks on people’s medicines and the health and safety of the building occurred. The registered manager told us they would make improvements to recording when actions were completed.