Archived: The Sycamores Nursing Home

The Sycamores is a care home providing personal and nursing care for up to 84 younger and older people who may live with dementia, a learning disability, or physical disability. At the time of the inspection there were 61 people who lived at the home.

The home was purpose built and people live on three units over three floors, two which are predominately nursing care and one for people living with dementia without nursing needs.

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

Quality monitoring systems were being developed but there was scope to further improve these in some areas, for example in improving the consistency and accuracy of people’s records and to ensure good practice was considered within medicine audits.

People's care plans and risk assessments, on most occasions, reflected people’s needs and preferences although there were some inconsistencies found. However, staff were able to explain how they provided appropriate, safe care that reflected people’s needs and preferences. People also expressed overall satisfaction with the care they received.

People were safe, and staff knew what to do to minimise risks to people as far as this was possible without infringing their rights. There were enough staff available to keep people safe and staffing levels were reviewed and changed to reflect changes in people’s needs.

People were supported by care staff who had the skills and knowledge to meet their needs, although some staff did identify further training or guidance in specific health conditions would be helpful. People expressed confidence in staff skills and knowledge and staff understood, felt confident and well supported in their role. Peoples health care needs were met as staff worked effectively with health care professionals

People were supported to have maximum choice and control of their lives and staff understood they should support them in the least restrictive way possible; the policies and systems in the service supported this practice.

People had access to food and drink, with most people enjoying their meals, and the service offered specialist or culturally appropriate diets when needed.

People were supported by staff that were caring and expressed interest in them. People and the support they provided them. People received person centred care and support based on their individual needs and preferences. Staff were knowledgeable about people, their needs and preferences and used this to develop good relationships. People’s privacy, dignity and independence was respected by staff.

The service was responsive to information from people and relatives. People could complain, and concerns were listened and responded to by the staff. Complaints and comments were used as a tool to drive improvement of the service.

People, relatives and staff were able to share their views with staff and were involved in planning their care. People said they enjoyed their life at The Sycamores and said their care usually reflected their needs and preferences. People were able to follow their chosen routines and had access to a range of activities.

People said the registered manager and staff were approachable, listened and responded to them and acted on feedback they shared with them. The registered manager had demonstrated they were not complacent and had improved the service since our previous inspection.

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 (report published 11 December 2018).

Why we inspected

This was a planned inspection based on the previous rating.

The home is registered to provide accommodation and personal care, for a maximum of 84 people. There were 60 people living at the home on the day of the inspection. The home is split across three floors comprising a nursing unit, a unit for people living with dementia and a residential unit.

We last inspected The Sycamores Nursing Home in October 2017, when we rated the service as 'requires improvement' in all the areas we inspected. We found the provider was in breach of the regulations regarding the safe care and treatment of people; protecting people from the risk of harm; and governance systems. We asked the provider to take action to ensure there were arrangements in place to address the issues we found. When we carried out this inspection we found improvements had been made and the provider had met the regulations, however, further improvements in two key questions were needed, therefore the overall service remained as ‘requires improvement.’

People felt safe living at the home. Staff were available to people and demonstrated good knowledge about people living at the home. People were supported by staff to have their medicines and records were maintained of medicines administered.

People were cared for by staff who were trained in recognising and understanding how to report potential abuse. Staff knew how to raise any concerns about people’s safety and shared information so that people’s safety needs were met. Staff maintained good hygiene and used protective clothing when appropriate.

Staff told us training helped them meet the specific needs of the people living at the home and they attended regular training to ensure they kept their knowledge updated.

Staff understood the importance of ensuring people agreed to the care and support they provided and when to involve others to help people make important decisions. The registered manager was aware of their responsibilities in regard to the Deprivation of Liberty Safeguards (DoLS) and had submitted the appropriate applications where they had assessed that people were potentially receiving care that restricted their liberty.

Some people felt the choice of meals could be improved and this was agreed by the management team who were taking action to improve the menus. People were supported to access professional healthcare outside of the home, for example, they had regular visits with their GP and any changes to their care needs were recognised and supported by staff.

People said staff were caring and treated them with respect. We saw people were relaxed around the staff supporting them and saw positive communication with staff. We saw that staff ensured they were respectful of people’s choices and decisions. People and relatives knew how to raise concerns and were confident that action would be taken in response.

People’s access to activities and support varied across the homes three units. We found improvements were needed to support people living with dementia. Relatives said they would like more dementia appropriate activities as there was little for their family members to do and our observations supported this. The design of the unit for people living with dementia did not meet their needs.

The provider had systems in place to check and improve the quality of the service provided. However, we found that further improvements were needed to ensure that checks and audits were robust enough to identify all areas for improvement and that action was taken in a prompt way.

People, relatives and staff were positive about the overall service. Staff all complimented the registered manager and the improvements made under the new management. The registered manager demonstrated clear leadership and staff were supported to carry out their roles and responsibilities effectively, so that people received care and support in-line with their needs and wishes.

The home is registered to provide accommodation and personal care, and the treatment of disease, disorder or injury for a maximum of 84 people. There were 78 people living at the home on the day of the inspection. The home is split across three floors comprising a nursing unit, a unit for people living with dementia and a residential unit.

The registered manager left the home in March 2017 and a new manager was appointed. The new manager has applied to CQC to become the registered manager. 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 that people’s medicines were not always available and administered to them as prescribed to meet their health needs. Medicines for four people had been out of stock for a period of four days and action had not been taken to seek advice from a GP or make observations to assess the potential risk to the people concerned.

People told us that they felt safe and they were supported by staff who knew how to keep people safe from harm but they sometimes had to wait for support. Staffing arrangements need to ensure there were enough staff who were organised in the right way to meet people’s needs effectively.

Staff had a good understanding of protecting people from the risk of abuse and harm and knew their responsibility to report any concerns.

The principles of the MCA had not been consistently applied. Staff spoken to had limited knowledge of the MCA and how this impacted on the care provided to people. Systems for reviewing DoLS applications had not identified actions required.

Staff understood people’s individual care needs and had received training so they would be able to care for people living in the home. There were good links with health and social care professionals and staff sought and acted upon advice received, so people’s needs were met.

People’s nutritional needs were met. People were given a choice of meals, however they felt the quality of the food they received could be improved. The manager was working with staff to improve people’s dining experience.

People liked some of the staff who cared for them, however care was not provided in a person centred way. Care provided was task focussed and people were not always treated with dignity and respect.

People’s access to activities and support varied across the homes three units. We found improvements were needed to support people living with dementia. Relatives said they would like more dementia appropriate activities as there was little for their family members to do and our observations supported this.

Relatives told us communication was good and they were updated on any changes in their family member’s health. The manager had introduced new meetings and records which staff told us had improved communication within the staff group. People felt able to raise concerns; however they did not feel actions were always taken in response.

The provider had systems in place to check and improve the quality of the service but these had not been effective in identifying the concerns that we found at our inspection. Audits need to be developed further to ensure that actions had been applied in practice to improve standards of people’s care.

The new manager had made some improvements, for example, daily management meetings and a new handover process, but further action was required to ensure that changes were embedded and also further improvements made in a timely way.

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

This report only covers our findings in relation to the concerns raised with us about people’s daily routines, the call bells not been answered in a timely manner and there being an unpleasant odour in the home. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘The Sycamores Nursing Home’ on our website at www.cqc.org.uk’

The Sycamores Nursing Home is a purpose built home providing personal and nursing care for up to 84 people. The home is in three discrete units on separate floors and supports people with learning and/or physical disabilities, people with nursing needs and people needing care because of mental health needs such as dementia. At the time of our inspection there were 73 people living in the home.

At the time of our inspection there was not a registered manager in post. 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.

People received support that was safe, met their needs and promoted choices. People were able to make the choice when they got up and when they wanted to go back to bed, this included returning to bed in the afternoon if they chose. People were able to choose where they ate their meals and people were supported to eat meals which met their nutritional needs and preferences

Staff responded to the call bell in a timely manner but we saw that on some occasions staff did not always attend people’s bedrooms when they accepted the call. People told us that the staff were excellent and responded to their requests for help in a timely manner but understood that on occasions they may have to wait a short while.

The home was clean and there were no unpleasant odours evident.

The Sycamores is a purpose built home providing personal and nursing care for up to 84 people. The home is in three distinct units on separate floors. Oak, the ground floor unit accommodates people with learning and/or physical disabilities. Ash and Elm, the middle and top floor units accommodate older people, Elm catering for older people living with dementia. People that need nursing care are accommodated on Oak and Ash units.

There was a registered manager in post at the time of our inspection. 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.

People felt safe and well treated by staff. There was sufficient staff available to keep people safe. Staff were able to identify signs of abuse and knew when and how to raise concerns. People had their medicines when needed. Appropriate checks on staff ensured they were safe to work at the service. Individual risks to people were identified and staff were knowledgeable about these.

People’s rights were promoted, and their best interests considered. People had confidence in staff who they felt were skilled and competent. People had a choice of, and enjoyed the food and drinks that were available to them. People’s health care needs were promoted.

People felt staff were kind and caring. Staff showed people respect and ensured their privacy was maintained. People’s choices were recognised and promoted by staff who supported them to make these choices. People were supported to be independent by staff.

People were involved in the care and support they received. Staff demonstrated a good awareness of people’s individual needs and preferences. People were able to have involvement in daily pastimes they enjoyed and were supported by staff with these. People were able to complain and were confident issues raised would be addressed.

People and staff were able to approach managers, who listened to what people said. There were systems in place to capture and respond to people’s views so as to monitor and improve the quality of the service. Staff felt well supported, enjoyed their work and supported the provider’s improvement agenda.

People expressed conflicting views about how they were involved in planning their care and treatment, and how their dignity was promoted. One person told us, 'Most of what I want, I get. It suits me. There are little gripes, nothing much, just the odd thing'. Another person said, 'Staff do not always tell me, I wanted to know about activities'.

We found that care and support was planned and delivered in a way that was intended to ensure people's safety and welfare. Most people we spoke with expressed satisfaction with the care provided, although some people said the care they received may vary dependent on the staff providing it.

We found that people who used the service were protected from the risk of abuse, because the provider had systems in place to identify the possibility of abuse and ensure it was reported.

There were enough qualified, skilled and experienced staff to meet people's needs although people had differing views about whether there was sufficient staff available. One person told us, "I use my buzzer a lot if I want anything. Sometimes they come, other times if busy they take a bit longer'.

We saw the provider had systems in place to assess and monitor the quality of service.

At this inspection we found that care people received was well reflected in their care records and staff we spoke with were aware of what people's needs were. This meant that the risk of people receiving unsafe care that did not meet their needs was reduced.

We spoke with one person who told us that they 'get choice' and if 'don't get the care I tell them and its sorted'. Another said 'they (the staff) care for us'.

We found that more choice of Jamaican meals were available. One person told us 'the food is very tasty'. Another person told us they were also happier now Jamaican meals were available. We saw that people with swallowing difficulties had been assessed by speech therapists and their advice was followed by staff. This meant that people received support they needed.

We found that people were protected against the risks associated with medicines. We saw there was an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who use the service.