Archived: Sycamore Lodge

Updated 28 June 2017

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 31 May and 1 June 2017. The visit on 31 May was unannounced and we arranged with the manager to return on I June to complete the inspection. The inspection team consisted of one 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. The Expert by Experience for this inspection was the family carer of a person living with the experience of dementia.

Before the inspection we reviewed the information we held about the service. This included previous inspection reports and notifications the provider is required to send us of significant incidents that affected people using the service. We also contacted the local authority’s safeguarding adults and commissioning teams for their views of the service.

During the inspection we spoke with 29 people using the service, five relatives and visitors and 10 members of staff, including nurses, health care assistants, domestic, catering and maintenance staff. We also spoke with the manager and the provider’s training and quality assurance manager. We looked at the care records for 10 people using the service and staff recruitment and training records for four members of staff. We reviewed other records including the medicines records for 25 people using the service and checks and audits the provider carried out to monitor quality in the service and make improvements.

During lunch on one unit for people living with the experience of dementia, we carried out a Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us. We saw all communal parts of the service and some people’s bedrooms, with their permission. We also spent time observing activities that staff organised for people on both days of the inspection.

Updated 28 June 2017

This inspection took place on 31 May and 1 June 2017. The visit on 31 May was unannounced and we arranged with the manager to return on I June to complete the inspection. The last comprehensive inspection of the service was in June 2016 when we rated the service as Requires Improvement for Safe and Well Led and Good for Effective, Caring and Responsive. We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 as the registered person did not assess, monitor and improve the quality and safety of the services provided. At this inspection we found the provider had improved the ways they monitored quality in the service.

We also carried out an unannounced, focused inspection in January 2017 after the Clinical Commissioning Group (CCG) passed us concerns they had identified with the management of people's medicines. A Care Quality Commission (CQC) pharmacist inspector carried out the inspection and found that the provider had taken action and improved the way they managed people's medicines.

Sycamore Lodge provides accommodation, care and nursing for up to 77 older people, some of whom were living with the experience of dementia. The home is divided into five separate units according to people's needs.

The registered manager left the service shortly before this inspection. The provider had appointed a new manager and they were in the process of applying to the Care Quality Commission for registration. 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.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Health and safety checks did not identify possible risks to people using the service, including pull cords for the aid call system that people could not reach and fire doors were wedged open.

The provider did not always operate systems to monitor and mitigate possible risks in the service.

You can see what action we told the provider to take at the back of the full version of the report.

The provider had systems in place to keep people safe and although staff understood and followed these, some systems were not always effective.

There were enough staff to meet people’s needs and the provider carried out checks on new staff to make sure they were suitable to work with people using the service.

The provider assessed people’s health care needs, gave staff guidance on how to meet these and people received the medicines they needed safely.

Staff had the training and support they needed to care for and support people using the service.

The provider, manager, nurses and care staff had a good understanding of their responsibilities under the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. The provider did not deprive people of their liberty unlawfully.

People told us they enjoyed the food provided in the service. An observation we carried out at lunch time showed that staff supported people in a caring and patient way and people had a positive experience.

People using the service and their relatives told us the staff who looked after them were kind and caring.

We saw staff in the service were kind, caring and gentle with the people they supported, they allowed people time to make decisions and offered them choices.

People using the service told us that staff respected their privacy and said they enjoyed living in the service.

Each person had a care plan that included an assessment of their health and social care needs.

People and their relatives also told us the provider involved people in planning and reviewing the care and support they received.

Staff respected people’s choices and decisions about how they wanted to be supported with their personal care.

People told us they knew how to make a complaint and said they trusted the provider to investigate any concerns they had.

When the service’s registered manager left shortly before this inspection, the provider acted promptly to appoint a qualified and experienced manager. Staff told us they found the manager and senior staff in the service supportive.

The provider carried out regular monitoring visits to the service and developed an action plan to address issues they identified.