Archived: Sycamore House

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.

Sycamore House is a domiciliary care agency providing personal care for older people and younger adults in their own homes. At the time of the inspection, this included people living with a physical disability, dementia and/or other long-term health conditions.

Not everyone using the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene, mobility, health and nutrition. Where they do we also consider any wider social care provided. At this inspection there were over 100 people receiving care or other support from the service, including 68 receiving personal care.

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

The provider’s governance arrangements were not always effective to consistently ensure the quality and safety of people’s care in a timely, proactive manner, or to fully demonstrate ongoing, sustained service improvement.

A number of service improvements were evidenced in relation to people’s care and staffing arrangements but these were not always yet demonstrated as fully embedded or sustained ongoing.

The provider had not always notified us of important events when required, to help us check the quality and safety of people’s care until we asked them to

Staff knew how to respond in the event of a health incident or emergency and how to recognise and report the suspected or witnessed harm or abuse of any person receiving care.

Overall, staff understood people’ safety needs for their care. Not without delay, the provider had now acted to ensure staff testing arrangements for COVID-19 in accordance with Government guidance.

Staff were trained and mostly understood their role and responsibilities for people’s care but they did not always feel effectively informed or supported. Remedial actions were either implemented or in progress to fully ensure this.

Overall, people were supported to maintain their health and nutrition, in consultation with relevant external health professionals when needed. Not without delay, the provider acted to fully ensure timely information sharing with any visiting professionals for people’s care

People were mostly supported to have maximum choice and control of their lives. Staff supported people in the least restrictive way possible, in their best interests; the policies and systems in the service supported this practice.

People and relatives were often happy with the care they received and felt staff were overall kind and caring. People and relatives were involved to express their views and make decisions about care provision, but they did not always feel fully informed, confident or in control of their care.

Staff generally knew people well, had good relationships and knew how to communicate with them. The provider was meeting the accessible information standard, to make service information available for people, in a way they can understand.

People’s care was individualised but not always timely. The provider as able to demonstrate related improvements actions but these were not yet fully demonstrated as assured ongoing for people’s care.

People knew how to raise any concerns or complaints but they were not always confident that any improvements from these would be sustained ongoing. Complaints and feedback obtained from people, relatives and staff were often used to inform care improvements, but these were not always effected in a timely manner.

The provider regularly worked in partnership with relevant authorities, external professionals and educational bodies for people’s care and safety.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

This service was registered with us on 15/02/2016 and this is the first inspection.

Why we inspected

This was the first comprehensive ratings inspection of the service. The inspection was prompted in part due to concerns received about the service regarding the provider’s management and staffing arrangements. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see the Safe, Effective, Caring, Responsive and Well Led sections of this full report.

We have identified two breaches in relation to meeting legal requirements at this inspection. You can see what action we have asked the provider to take at the end of this full report.

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.