Background to this inspection
Updated
7 October 2021
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
Inspection team
The inspection was carried out by one inspector, an assistant inspector, and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Service and service type
This service is a domiciliary care agency. It provides personal care to people living in their own homes.
The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
This inspection was announced. We gave notice of the inspection to give time for the registered manager to obtain peoples and relatives’ consent for us to contact them, and to make sure the registered manager would be in the office to support the inspection visit.
Inspection activity started on 27 July 2021 and ended on 2 August 2021. We carried out telephone calls on 27 July 2021 to people and relatives to gain their experience of the service they received. We made calls to care staff on 27 and 28 July 2021. We visited the office location on 2 August 2021.
What we did before the inspection
We reviewed all the information we held about the service since the last inspection. We sought feedback from local authority care commissioners and professionals who work with the service. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report. We used all of this information to plan our inspection.
During the inspection
We spoke with five people who used the service, one relative and six care staff by telephone prior to the office visit. At the office visit we spoke with the registered manager, the provider and new nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We looked at seven people's care records, reviewed four staff files and reviewed a range of management records.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We reviewed a range of key service documents, which we had asked the registered manager to send us. This included information such as policies and procedures, meeting records, staff training, the provider’s action plan and additional care plans, risk assessments and care call logs. We received further feedback from two care staff.
Updated
7 October 2021
About the service
Sycamore House is a domiciliary care agency providing personal care for older people and younger adults in their own homes. This included people living with a physical disability, dementia and/or other long-term health conditions. At the time of our inspection 25 people were receiving the regulated activity of Personal Care.
People’s experience of using this service and what we found
Continued shortfalls were identified in the systems and processes that assessed, monitored, and mitigated risks and quality. There was a lack of effective oversight and leadership of the service.
Incident and risk management, including analysis and learning lessons when thing went wrong were not fully effective. People were not sufficiently protected from the risk of abuse.
The provider had failed to notify the Care Quality Commission of all reportable incidents they are legally required to do.
Since the last inspection, there had been a significant number of missed and late calls affecting a high number of people. People assessed as requiring two care staff to support them had received calls from one care staff.
The provider had received a high number of complaints from people, relatives, external professionals, and staff raising concerns about the quality and safety of the care provided.
Staffing issues meant people’s individual care and support needs were not met safety. A high number of staff had left the service since the last inspection impacting on the safe delivery of care.
Best practice guidance in the management of medicines was not followed. New staff did not receive probationary meetings to monitor their performance. Staff did not feel supported or valued and raised concerns about the quality of training, communication and organisation.
People’s care plans and risk assessments were not consistently detailed with guidance for staff, of how to meet people’s care needs and mitigate risks.
Infection prevention and control best practice guidance was followed.
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 17 April 2021). The service has deteriorated to Inadequate.
Why we inspected
We received ongoing concerns about the safe care and treatment of people. This included concerns about missed and late calls and people not being protected from abuse. As a result, we undertook a focused 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 inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.
We reviewed the information we held about the service. No new concerns 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.
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 Sycamore House 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 two continued breaches of regulation in relation to governance systems and procedures, oversight and leadership, and the provider had not informed the Care Quality Commission of all reportable incidents.
Three new breaches in regulation were identified, people had received unsafe care and treatment and had not been fully protected from abuse and avoidable harm. Staff deployment was not sufficient to meet people's needs, staff had not had probationary meetings or were supervised effectively.
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.
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 provider’s registration, we will re-inspect the service.
If the provider has not made enough improvement and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.