The Sycamores

The Sycamores is a residential care home providing support and accommodation for older people who require nursing or personal care for up to 56 people. At the time of our inspection there were 49 people using the service. The care home provides accommodation across two floors.

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

Systems were in place to safeguard people from the risk of abuse. Staff understood their responsibilities to protect people from avoidable harm. People we spoke with told us they felt safe. Risks to people were assessed and up to date. However, records did not always clearly indicate how staff should use hoist slings appropriately. Staff were recruited safely and there were sufficient staff to meet people’s needs. Medicines were managed safely. Infection prevention and control measures were in place. The registered manager monitored incidents in the service and took action to reduce risks to people.

Staff were knowledgeable about people’s needs and how these should be met. Staff received regular appraisals and supervisions to support them in their role. People were supported to make choices for their meals and where they would like to eat. The service had strong links with local healthcare services and weekly GP visits were facilitated to meet people’s healthcare needs.

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 treated people with compassion and kindness. People told us they felt cared for and well looked after. The registered manager promoted dignity and respect in the service. People’s views were obtained to drive improvements. Relatives told us staff were friendly and people’s wishes were met.

Individualised assessments and care plans detailed how to meet people’s day to day needs. People were involved in choosing daily activities, which were meaningful to them. Complaints and concerns were recorded and fully Investigated with lessons learned and action taken appropriately. End of life care plans were individualised and respected the wishes of people.

The registered manager had systems in place to improve quality in the service. Staff felt supported in their roles and relatives told us they felt able to speak to the registered manager if they had any concerns. Complaints were dealt with effectively and lessons learned when things went wrong.

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 23 June 2021). 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.

The Sycamores can accommodate up to 56 people who require support with personal care needs. At the time of our visit, 39 people were living at the service. The Sycamores is situated in Wakefield.

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

The registered provider did not always have effective governance in place to maintain and improve the quality and safety of the service. Quality assurance audits were not always effective in identifying and addressing areas requiring improvement such as, care records and infection control.

People told us they felt safe living at The Sycamores and were supported by kind staff who knew how to support them. Enough staff were deployed to support people safely. Staff were knowledgeable about how to identify and report safeguarding concerns. Accidents, incidents and falls had been documented and reviewed to look for trends and help prevent a reoccurrence. Medicines were managed safely.

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 19 March 2020).

Why we inspected

The inspection was prompted in part due to concerns received. A decision was made for us to undertake a focussed inspection to review the key questions of safe and well-led only. 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 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.

The overall rating for the service remains requires improvement. This is based on the findings 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.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for The Sycamores on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified a breach in relation to good governance at this inspection.

Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality. 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.

The Sycamores is a residential care home providing personal and nursing care to 39 people aged 65 and over at the time of the inspection. The service can support up to 40 people.

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

There were insufficient numbers of effectively deployed staff to ensure people’s needs were met in a timely manner. Although staff were caring in their approach and support of people, they did not have time to spend with people other than as part of a task related activity.

Staff were recruited safely. Staff had received safeguarding training and understood their responsibility in keeping people safe. The premises and equipment were maintained, the home was clean.

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 were respectful and treated people with dignity however, personal information was not always stored securely .People were happy with the quality of their meals. There was a programme of induction and training in place for staff. People were able to access other health care professionals as needed.

The home employed an activities organiser, although in their absence there was limited opportunites for people to enagage in social activities. We have made a recommendation about the quality of records relating to the use of hoists and provision of activities. Care plans were person centred and contained sufficient information for staff. There was a system in place to manage complaints.

A range of audits were regularly completed by the registered manager and regional manager. There were systems in place to gain feedback from people, relatives and staff. This included meetings, surveys and staff supervision. The methods used had been ineffective in identifying, escalating or addressing concerns regarding the numbers or deployment of staff. We have made a recommendation regarding effective engagement.

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 1 October 2018). There was also an inspection on 5 February 2019 however, the report following that inspection was withdrawn as there was an issue with some of the information that we gathered.

Why we inspected

This is a planned re-inspection because of the issue highlighted above.

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.

Enforcement

We have identified a breach in relation to staffing at this inspection.

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 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.

The Sycamores provides care for up to 40 older people. At the time of the inspection 39 people were using the service. The Sycamores 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.

The service had a registered manager although they were spending some of their time managing another of the provider’s sister services. 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 service was not safe because risks to people were not assessed or well managed. Staffing arrangements were not appropriate and new members of staff were not supervised and trained. Medicines were not managed safely. Safe recruitment practices were followed.

People were comfortable in their environment and had access to spacious communal areas and an enclosed garden. All bedrooms were single occupancy with en-suite toilets. However, there was a lack of bathing facilities and people told us they did not receive regular baths and showers.

People’s care records contained very little information about what was important to them and their needs were not identified through the care planning process. People did not receive appropriate support with oral care. Staff did not have guidance around how to deliver personalised care. We have made a recommendation about improving accessible information to meet people's communication needs.

People’s capacity to make decisions was not always assessed when needed, and were not always supported to have maximum choice and control of their lives; the policies and systems in the service did not support this practice

In-house and community activities were very limited although an activity worker had recently been appointed and the management team were confident this would improve people’s social and leisure opportunities. People enjoyed the meals, and were offered regular drinks and snacks.

People told us they felt safe and well cared for. They were complimentary about the management and staff team. Our observations confirmed staff were caring. Health professionals told us people’s health needs were met, and staff followed guidance and advice. Visiting relatives and friends were welcomed, and, where appropriate, staff and management provided information and updates.

The provider did not have effective systems to assess, monitor and manage the service. The provider had a system for investigating complaints and people told us they would raise concerns with staff and the management team, which included the registered manager.

We found five breaches of the Health and Social Care Act 2008 (Regulated Activities) regulations 2014, which related to safe care and treatment, staffing, person centred care, governance arrangements and consent to care.

The overall rating for this service is ‘Inadequate’ and the service therefore has been place 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.