Archived: Sycamore Lodge

Updated 18 August 2017

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, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 5 and 6 April 2017 and was unannounced. The inspection was carried out by two inspectors and an expert by experience. The expert had personal experience of supporting people living with mental health conditions. We did not ask the provider to complete a Provider Information Return (PIR), because the inspection was brought forward due to concerns received from the local safeguarding authority. A PIR is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We considered the information which had been shared with us by the local authority and other people, looked at safeguarding alerts which had been made and notifications which had been submitted. A notification is information about important events which the provider is required to tell us about by law.

We met with all four of the people who lived at Sycamore Lodge. Not everyone wished to share with us their experiences of life in the service. We therefore spent time observing their support. We inspected the home, including the bathrooms and some people’s bedrooms. We spoke with three of the care workers and the provider.

We ‘pathway tracked’ all four of the people living at the home. This is when we looked at people’s care documentation in depth, obtained their views on how they found living at the home where possible and made observations of the support they were given. This allowed us to capture information about a sample of people receiving care.

During the inspection we reviewed other records. These included three staff training and supervision records, three staff recruitment records, medicines records, risk assessments, accidents and incident records, quality audits and policies and procedures.

Updated 18 August 2017

This inspection took place on 5 and 6 April 2017, was unannounced and carried out in response to concerns raised with us by the local safeguarding authority.

Sycamore Lodge is registered to provide personal care and accommodation for up to four people with mental health conditions. There were four people using the service during our inspection; who were living with a range of mental health needs such as schizophrenia and bi-polar.

Sycamore Lodge is a detached house situated in a residential area of Ashford. There was a small lounge available with comfortable seating and a TV for people. There was also a kitchen and utility room, but no dining room. There was a large enclosed garden to the rear of the building.

This service is not required to have a registered manager in post. The provider has registered with the Care Quality Commission to manage the service and is therefore a ‘registered person’. 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.

Sycamore Lodge was last inspected in June 2016, when it was rated as good. At this inspection we found inappropriately restrictive practices and culture which led to a number of breaches of Regulation.

People told us they did not always feel safe and that staff were not always supportive to them.

Assessments about some risks to people had not been carried out, so there were no actions in place to reduce them. Other assessments, for example of evacuation in a fire, had not been properly completed and therefore did not fully document the risk or how it could be minimised. Environmental risks and those associated with medicines had not been consistently addressed and some risks remained unchecked.

People were unfairly and inappropriately restricted in what they could do and where they could go. All people were adults and had capacity to make their own decisions but staff did not appreciate that the regime within the service amounted to a form of abuse.

There were not enough staff to meet people’s needs and specialist training about mental health conditions had been ineffective. Recruitment practices were not robust enough to ensure that suitable staff were employed to work with people.

People were given limited choice of food, and meals were only available at set times. People had to spend their own money to buy meals out four times each week and purchase their own snacks if they did not want the limited choice provided in the service. Tea was available but people could not have coffee.

Consent had not been sought from people in some areas of their care and support. Decisions were made for them even though the provider told us that people all had capacity to make their own choices.

People were not treated with dignity or respect and their independence was not promoted. There had been no formal complaints but feedback people provided in surveys and at resident meetings was not acted upon to improve their experiences.

Support was not delivered in a person-centred way and some restrictions were applied in a ‘blanket’ manner to all people, without considering them as individuals. Activity choices were limited and repetitive and did not take account of preferences.

The service was not well-led. There were no effective auditing and assurance processes in place to help identify any shortfalls in safety or quality. Management oversight had been wholly ineffective because the provider/manager was unaware that their own practice was inappropriate.

We identified a number of breaches of Regulations. The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.