This inspection took place on 16 and 17 January 2019 and was unannounced.Sycamore Cottage Rest Home Limited (Sycamore Cottage) is a 'care home'. People in care homes receive accommodation and nursing or personal care, as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.
Sycamore Cottage provides care for up to 20 older people living with differing stages of dementia. There were 11 people living at the home on the first day of our inspection, with one person receiving treatment in hospital. On the second day another person was supported to move into the home. Accommodation was provided over two floors of a converted residential dwelling, with a stair lift that provided access to the second floor.
At our inspection in November 2017 we found that the provider had acted on the risks and shortfalls that had been previously identified, to ensure people were safe. Whilst we recognised that improvements had been made to the service’s systems and processes for maintaining standards and improving the service; many of the changes were still a work in progress and had not yet been sustained. At this inspection the provider demonstrated that the required improvements had been sustained and had become embedded in practice.
The home was consistently well-managed by the home manager who provided clear and direct leadership. Staff consistently told us the management team had created a supportive environment where their opinions and views were discussed and taken seriously, which made them feel their contributions were valued.
Quality assurance systems monitored the quality of service being delivered, which were effectively operated by the management team, to drive continual improvement in the service.
People experienced care that made them feel safe and were protected from avoidable harm and discrimination. When concerns had been raised, thorough investigations were carried out, in partnership with local safeguarding bodies.
Risks were assessed, monitored and managed effectively. Staff were aware of people’s individual risks and how to support them to remain safe.
There were sufficient staff to respond quickly and provide safe and effective care to people. The home manager operated a robust recruitment process, based on relevant pre-employment checks, which assessed the suitability of candidates to support older people and those living with dementia.
The provider proactively reviewed all accidents and incidents and acted to reduce the risk of a future recurrence.
People's dignity and human rights were protected, whilst keeping them and others safe. Staff supported people who experienced behaviour which may challenge others sensitively, in accordance with their positive behaviour support plans.
People received their prescribed medicines safely, from staff who had their competency to administer medicines assessed annually. People's medicines plans were reviewed regularly to ensure they still required the medicines they were prescribed.
High standards of cleanliness and hygiene were maintained throughout the home, which reduced the risk of infection. Staff followed the required standards of food safety and hygiene, when preparing, serving and handling food.
The operations manager and home manager ensured staff had an effective induction, ongoing training and support to maintain necessary skills and knowledge to support people effectively.
People were supported to eat and drink enough to protect them from the risk of malnutrition and dehydration. Risks to people with more complex nutritional needs were promptly referred to relevant dietetic specialists.
Each person had an individual health action plan which detailed the completion of important monthly health checks. People were promptly referred to external services when required, which maintained their health.
The home had not been originally designed to promote the independence and safety of people who live with dementia. However, the operations manager had developed a strategy to deliver environmental improvements to signage, decoration and lighting. At the time of inspection, improvements to signage had been made to enable people to find their own rooms more easily.
The management team had ensured people’s ability to make decisions was assessed in line with the Mental Capacity Act 2005 (MCA). People’s human rights were protected by staff who demonstrated a clear understanding of consent, mental capacity and Deprivation of Liberty Safeguards legislation and guidance.
Staff consistently treated people with compassion, kindness and respect. Staff spoke about people with pride and fondness, recognising people’s daily achievements, which demonstrated how they valued them as individuals. Relatives consistently reported that staff interaction with their loved ones had a positive impact on their well-being and happiness. People were supported to follow their interests and hobbies which enriched their lives.
People’s choices and independence were promoted by staff supporting and encouraging them to do things themselves. Staff supported people to develop friendships within the home and maintain close links with their loved ones. This protected them from the risk of social isolation and loneliness.
People actively contributed to their care planning. Care plans were personalised and contained information such as the person’s life history, preferences and interests. People living with dementia had assessments relating to memory, mood, interactions and behavioural tendencies.
There were regular opportunities for people and staff to feedback any concerns at review meetings, staff meetings and supervision meetings. People and their relatives knew how to complain. The registered manager used concerns and complaints to drive improvement within the home.
People were supported with care and compassion at the end of their life to have a comfortable, dignified and pain-free death. Staff were thoughtful and consistently treated relatives with kindness, which made them feel involved, listened to, and informed, in the last days of their loved one’s life.
The home manager collaborated effectively with key organisations and agencies to support care provision, service development and joined-up care, for example; local GPs and community mental health and nursing teams.