This inspection took place on 1 May 2018 and was unannounced. At the time the CQC had received a notification of an incident involving the use of oxygen. The inspection did not examine the circumstances of the incident, but examined those risks and other potential risks to people.Sycamore Court is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Sycamore Court is purpose built, and was taken over in 2015 by Tradstir Limited. This is the second inspection since the service was taken over by the new provider. Residential and nursing care is provided, across three units, for up to 40 older people with increasing physical frailty, many living with dementia or other mental health needs. Long term care and respite care is provided. There were 34 people resident at the time of the inspection.
At the last inspection on 7 March 2017 the service was rated overall Requires Improvement. At this inspection we found the service remained overall Requires Improvement. At the last inspection we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because we found robust audit systems maintained and embedded in the running of the service to ensure the quality of the service had not been completed. An external company had also been used to audit in the service. However, action plans to address the issues highlighted had not been developed. We could not identify how the provider monitored or analysed the information received to look for any emerging trends or make improvements to the service provided. Regular health and safety checks of the building had not been maintained and not all risk assessments had been completed. Records were not fully accessible for senior staff to refer to and ensure essential checks of the building and services had been carried out. We also found areas in need of improvement. Training records were not fully up-to-date, so it was not possible evidence all staff had completed the essential training to support them in their roles. Staff told us they felt well supported by the senior staff who were accessible. However, feedback and records showed us that not all the staff had received regular individual supervision or appraisal. A new electronic care planning system had been introduced into the service, and people's care plans were in the process of being reviewed and transferred from the paper records onto the new system. This process had not been fully completed and care plans were between both systems, and some reviews had fallen behind. It was not possible to fully evidence peoples current care and support needs and any risks that had been identified were being met. People's nutritional needs were assessed and recorded. However, where people were being supported with their fluid intake, records had not been fully completed to inform care staff. Activities for people particularly for those people who stayed mainly in their own rooms were still in need of development. The provider sent us an action plan as to how these issues would be addressed. At this inspection we found significant improvements had been made to address all the issues raised. However, not all the issues had not been fully addressed, or had time to be fully embedded in the practice of the service and were still in need of improvement.
There was a new registered manager for the service. 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. The registered manager was also the registered manager for another of the provider’s services located nearby. They had a good understanding the of the provider’s systems and processes to be followed which they had introduced into Sycamore Court. They had divided their time between both the services, and they were supported at both services by a deputy manager/clinical lead and a team of senior staff.
The registered manager told us the service had been through a significant period of change since they had commenced working in the service. With a new registered manager and deputy manager, and several staff changes particularly to the senior staff team who had taken time to be inducted into the service. They told us this had meant the implementation of processes and systems had been delayed and had not in all instances been fully developed and embedded as quickly as they had planned. Senior staff were working closely together following and working to the services action plan to address any outstanding issues. This was evident from the feedback and records we viewed. The provider and their personal assistant were now based in the service for part of the week to support senior staff with the necessary changes, and had received regular updates on the progress from the registered manager. Staff spoke positively of the changes and improvements which had been implemented since the new management team had started. They felt better supported and told us they liked working in the service. A member of staff told us, “The management are now very approachable, and staff are a lot happier.”
Although feedback from staff indicated a robust recruitment process was followed for new staff working in the service, supporting documentation did not always evidence the receipt of all the recruitment checks prior to staff coming work in the service. This was a requirement of the services own policies and procedures. To ensure all the information required to safeguard people had been available for a decision to be made as to the suitability of a person to work with adults. Staff told us they were supported to develop their skills and knowledge by receiving essential training which helped them to carry out their roles and responsibilities effectively. Senior staff told us they had audited and identified staffs training needs and were working to provide this. They acknowledged this was still an area of improvement and they were monitoring and ensuring the completion of staff training in supervision. Training records were up-to-date, so it was possible to evidence staffs progress and the improvement in the numbers of staff who had up-to-date training. Feedback and records showed us a system of supervision had just started. Annual appraisals were still to be completed. Senior staff had been given guidance and support to provide staff with supervision and appraisal. However, despite the improvements made training, supervision and appraisal were still an area in need of improvement and not fully embedded in the practice of the service.
People told us they had felt involved in making decisions about their care and treatment and felt listened to. People's individual care and support needs were assessed before they moved into the service. The electronic care planning system had been fully introduced into the service. Senior staff told us the detail of the recording was still being developed. Support had been given and training had been booked to support care staff to ensure records were more person centred. People’s care and support needs had been reviewed as the information had been transferred. A system of ongoing regular reviews was in place. It was not possible to fully evidence this had been embedded into the practice of the service. Care staff demonstrated a good knowledge of people’s care and support needs. However, not all the care plans reflected changes to people’s current care needs. Risk assessments completed did not always detail what actions needed to be followed to mitigate any risks identified.
Medicines were stored correctly and there were systems to manage medicine safely. However, we identified some improvements needed to the recording of medicines.
People told us they felt safe with the care provided. One person told us, “I feel safe and secure here. I can lock my door.” People were protected from the risk of abuse because staff understood how to identify and report it. People were cared for by kind and caring staff. One person told us, “I like it in the home, I’m happy here. The staff are very nice. I’m happy and settled here. I don’t know how they could improve it.” Another person told us, “I like it in the home and the staff are very nice. I can’t grumble about anything.” The selection of activities people could join in were still being developed. The selection of activities available for people to join in were still being developed. In particular for people living with dementia. One person told us staff were, “Good at encouraging people to do activities which is good as that is good for them.” Another person told us, “I take part in activities when I can. I like the singing.” A member of staff told us, “I enjoy the company of the people I care for. I like to keep them chatting and debating. It’s my job to inspire them.”
Senior staff monitored people’s dependency in relation to the level of staffing needed to ensure people’s care and support needs were met. Feedback from people and staff was that there was usually enough staff to meet people’s care and support needs. One person told us they were, “Very happy in the home. The home is so friendly. Not pressurised to do anything. Enough staff in the home. They come quickly if I use the call bell.” A member of staff told us, “Not short staffed very often. Usually the same night staff and most staff are happy to do overtime.”
People’s nutritional needs were assessed and recorded. People told us they enjoyed the food provided. One person told us, “Oh yes I like the food. Empty plates where I’m concerned. Plenty of drinks and