Sycamores

Updated 21 June 2023

The inspection

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.

As part of this inspection, we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection visit was completed by 2 inspectors and an Expert by Experience. An Expert by Experience is someone who has experience of this type of service.

Service and service type

Sycamores is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. Sycamores is a care home without nursing care. Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. 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.

At the time of our inspection there was no registered manager in post. A new manager had taken up this post from 01 May 2023 and was in the process of registering with us.

Notice of inspection

This inspection visit was unannounced.

Inspection activity started on 24 May 2023 and ended on 30 May 2023.

Following our visit, we requested further information from the provider to help us inform our judgements.

What we did before inspection

We reviewed the information we held about the service, such as feedback from people and their relatives and statutory notifications. The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with 5 people who received a service to get their experiences about the quality of care received. We spoke with 2 care coordinators, 4 members of care staff and a maintenance person. We spoke with the manager, a services manager and a director of quality and compliance. During our visit we spoke with 3 visiting health professionals.

We reviewed a range of records. This included examples of 6 people’s care records, samples of medicine records and associated records of people’s care. We looked at records that related to the management and quality assurance of the service and risk management, and policies related to safe recruitment practices.

Updated 21 June 2023

About the service

Sycamores is registered to provide accommodation and personal care for up to 36 people, including people living with dementia. At the time of our inspection visit there were 31 people living at the home. Care and support is provided across 3 floors. On each floor, people have use of a communal lounge and dining area, as well as occasional seating throughout corridors. People’s bedrooms are ensuite and there are further communal bathroom facilities located around the home. People can access outside spaces.

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

Known risks relating to people’s health and welfare were not always managed safely and ineffective scrutiny of the quality of service, did not always identify issues. The provider’s quality assurance systems lacked effective scrutiny.

Where similar issues had been identified at inspections across some of the providers other homes, there was limited evidence lessons had been learnt.

Risks associated with people’s health and welfare were not always considered, reviewed, or reflected a person’s current needs. Records and actions that were required to be completed, were not always recorded, so we were not confident risks were managed safely. Oversight and scrutiny of those records through effective checks, went unchecked so staff did not always have up to date information to support people safely.

Safe moving and handling practices were not followed. Our observations showed staff did not always support people safely when transferring them in wheelchairs. Staff conversations showed us it was accepted practice for staff throughout the day, to move some people in wheelchairs or commodes. In 4 examples we saw, staff used wheeled appliances without footplates meaning people were put at unnecessary risk of injury.

People did not always receive their medicines safely and in line with national guidance. People’s own medicines were stored in their room, yet we found large stocks of medicines that was not necessary to be kept in people’s rooms. One person was not administered a medicine and staff had not identified this as an issue. Topical creams were applied, yet most topical creams we saw had no date of opening, so we could not be confident, those creams remained effective.

Communal areas were clean, however people’s individual rooms and equipment were not always clean and hygienic.

People told us they received support from staff when required. The provider had sufficiently trained and suitable staff on shift to meet people’s needs. When people rung their calls bells for assistance, staff were on hand to support them with limited delay.

People and relatives told us they felt safe living at Sycamores. People said it felt like home and those staff who supported them were kind and considerate. Relatives were able to attend relatives meetings which gave them an opportunity to be involved in how the care and support was provided.

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.

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 good (published 02 April 2020).

Why we inspected

We received concerns in relation to the standards of care provided and the quality of records. 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 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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to requires improvement based on the findings at this inspection.

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

Enforcement

We have identified a breach in relation to Regulation 12 (Safe care and treatment) and Regulation 17 (Good governance).

We have found evidence that the provider needs to make improvements. You can see what action we have asked the provider to take at the end of this full report.

Following our visit, the provider sent us information telling us how they planned to immediately address the issues we raised.

Follow up

We will request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.