Archived: Sycamore Lodge

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.

Sycamore Lodge is registered to provide personal care and accommodation for up to four people living with mental health conditions. Sycamore Lodge is a detached house situated in a residential area of Ashford. There is a ground floor TV lounge/dining room, and kitchen and an upstairs quiet lounge, and bedrooms with ensuite bathrooms.

There is a large paddock and enclosed garden with a lawn to the rear of the building.

There were four people using the service during our inspection; who were living with a range of mental health needs. People required support and prompting from staff to help promote their independence and ensure their safety in their day to day activities.

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.

There were sufficient staff on duty to support the needs of people living in the service. The staff team was stable, most had worked at the service for several years, and worked well together as a team. Staff had received the training they needed to ensure people received the right support.

The procedure for recruiting new staff was done safely, with the proper employment checks being carried out.

The risks to people had been assessed and people’s care plans reflected the individual goals and interventions required to keep people safe. There were robust policies in place to protect people from the risk of harm and abuse. Accident and incidents were recorded and lessons learned from them helped to improve care practice.

Medicines were managed safely and people received their medicines as they were prescribed them.

People were encouraged to make healthy eating choices and were offered other meal options.

People were supported by staff to make choices in their day to day activities and encouraged to be involved in their own care and treatment decisions. Staff were kind and respectful when supporting people. A range of activities were on offer and the provider and staff knew people and their preferences well.

People’s physical and mental health needs were assessed regularly and referrals and appointments made with the relevant health professionals as needed.

Staff understood how to respond to people’s varying daily needs and to de-escalate behaviour that may affect the safety of people, while remaining kind and respectful.

The provider was supportive of staff and people and visited the service every day.

There were effective auditing and assurance processes in place to help identify any shortfalls in safety or quality. Staff enjoyed working in the service and felt able to raise any concerns or issues with the provider.

People were given opportunities to feed back about their experience of the service so that the service could constantly improve.

We looked at the answers to five questions: Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

Is the service safe?

We found that the provider had comprehensive procedures in place to check that people had consented to the care and treatment provided for them. People were appropriately supported by their family members or advocates, and by health and social care professionals, to help them with decision-making processes. The provider and staff showed that they understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). There were no DoLS authorisations in place, and no applications had been made. Some people had Community Treatment Orders in regards to their ongoing care and treatment in the home.

We found that people had risk assessments with their care plans which were specific to the person concerned. The risk assessments showed that the staff had assessed all aspects of risks for people living in the home, and suitable action was in place to minimise the risks concerned.

We found that the home was visibly clean in all areas and well maintained. Ongoing health and safety checks were carried out to ensure that the premises provided safe and suitable accommodation.

Is the service effective?

We found that care plans had been written according to people's individual needs, and showed the physical health, mental health and social care support that people needed. This meant that people were appropriately supported with their care needs.

The home had clear procedures in place in regards to obtaining and providing suitable food and drink. The provider and staff worked with people to provide a varied and healthy diet, in so far as people living in the home would agree with this.

Is the service caring?

Staff training records showed that all of the staff had completed mandatory training, which included subjects such as fire safety, first aid, infection control and food safety. They had also completed training in relevant subjects such as managing challenging behaviour, mental health illness and safeguarding vulnerable adults. This meant that people were supported by staff with sufficient training to enable them to provide safe and effective care.

We saw and heard that staff had a gentle manner with people, and allowed them to make their own decisions about their day to day lifestyles. The provider told us that staff were aware of the importance of providing people with structure to their lives, and preventing people from becoming socially isolated. Staff provided suitable strategies and encouragement to assist people to maintain their mental wellbeing.

Is the service responsive?

Some people had mental health difficulties which might lead them to refuse the support that they needed, such as medication. We found that there were clear directives in place to support the staff in referring people to the health and social care professionals involved in individual people's care. This showed that the service responded promptly to take suitable action if there were indications that someone's mental or physical health was deteriorating.

The staff made provision for people to share their views about the home through individual key worker meetings with staff. People's views were also sought using yearly questionnaires, and we saw that action was taken in response to people's comments. This showed that the service sought to obtain people's views and respond to them appropriately.

Is the service well-led?

The registered provider was also the manager, and was usually in the home every day, or was on call. This meant that she took direct responsibility for the day to day running of the home. We saw that she was accessible to the staff and people living in the home, and responded to any requests for support or advice.

The provider had systems in place to ensure there was ongoing monitoring of the home. This included care plan reviews, and checks for the environment, health and safety, fire safety, and staff training needs. The provider supported the staff through individual supervision sessions on a regular basis, and by following through with staff on their personal development plans. This showed that there were reliable systems in place to provide oversight for the service, and effective leadership by the provider.

People we spoke with said they liked living at the service and made choices about their daily lives. They told us they liked their rooms and rooms were comfortable. One person said 'It's a good room, I like it'.

People chose what to do each day and their individual routines were respected. People got up and went to bed when they chose to and were consulted about the menu. One person said 'I get up late as I am often tired' and 'I listen to the radio and watch television, and go ten pin bowling and to the gymnastics centre'.

People told us they liked the staff and they were satisfied with the support they received. People said they were asked what they thought about the service, one person gave us an example of changes having been made as a result.

A relative told us they were very satisfied with the service. A social care professional said they were very satisfied with the service overall and told us 'I have been very impressed by the place, my client has settled very well'.