Archived: Sycamore House

Updated 30 September 2020

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

Two inspectors and an assistant inspector completed a site visit, whilst an Expert by Experience, made telephone call to relatives. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Sycamore House is a care home. People in care homes receive accommodation and nursing or personal care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

At the time of the inspection, there was not a manager registered with the Care Quality Commission. The provider was legally responsible for how the service is run and for the quality and safety of the care provided. A peripatetic manager was managing the service but was unavailable on the day of the inspection. The provider was in the process of recruiting an interim and registered manager. We will monitor this.

Notice of inspection

The inspection was announced. We gave the provider 10 minutes notice because we needed to check the current Covid-19 status for people and staff in the service.

What we did

Before our inspection, we reviewed our information we held about the service. This included information received from local health and social care organisations and statutory notifications. A statutory notification is information about important events, which the provider is required to send us by law, such as allegations of abuse and serious injuries. We reviewed the last inspection report. The provider did not complete the required Provider Information Return. This is information providers are required to send us with key information about the service, what it does well and improvements they plan to make. We took this into account in making our judgements in this report.

During the inspection we spoke to three people who used the service and the expert by experience spoke with nine relatives by telephone about their experience of the care provided. We also observed staff interacting with people. We spoke with the regional manager, business manager, two senior care workers, two agency senior care workers, four care workers and two cooks. We also spoke with two visiting health care professionals, a district nurse and a community nurse.

We reviewed a range of records. This included in part, eight people's care records. We looked at three staff files in relation to recruitment. A variety of records relating to the management of the service, including audits and checks on health and safety.

After the inspection we continued to seek clarification from the provider to validate evidence found. This included but was not limited to the provider's current action plan, training data, policies and procedures and meeting records.

Updated 30 September 2020

About the service

Sycamore House is registered for 42 beds and provides personal care and accommodation for older people. On the day of our visit 37 people were using the service. This included ten people living in Kenyon Lodge, this is a separate unit within Sycamore House for people living with advanced dementia.

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

Systems and processes had improved since the last inspection, but were not fully effective or embedded. We identified ineffective recording of people’s individual care needs. Information recorded was not consistent and therefore confusing to staff. People’s care plans and risk assessments did not consistently reflect people’s current needs.

Inconsistent management had impacted on the development of the service and staff felt that they were not always listened too or supported.

Plans were not always in place to ensure people’s safety. Some personal emergency evacuation plans were not readily available for staff in the event people needed to be evacuated.

Some concerns were raised about staffing levels. The management team were requested to follow up on the concerns received. Safe recruitment processes were used to ensure only staff suitable for their role were employed at the service.

People received their prescribed medicines safely. Some shortfalls were identified in the management of medicines, but this had a low impact on people.

Risks associated with people’s individual care needs had been assessed and were monitored. Improvements had been made to ensure people’s hydration needs were met.

Safeguarding concerns were reported to the local authority and CQC. The provider had introduced a more robust system of identifying and analysing incidents.

Infection prevention and control best practice guidance had been implemented by the provider and was being followed by staff. Covid 19 guidance was available to staff and people. Staff were observed wearing personal protective equipment correctly.

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 (Published on 12 April 2019) and there were two breaches of regulations. The provider completed an action plan after the last inspection, to show what they would do, and by when, to improve. At this inspection, enough improvement had been made to meet the regulation 12 breach, further work was required to meet the regulation 17 breach.

The overall rating for this focused inspection remains as Requires Improvement.

Why we Inspected

We received concerns in relation to the management of the service and care and treatment of people. As a result, we undertook a focused inspection to review the key questions of Safe and Well-led only. We also followed up on previous breaches.

We reviewed the information we held about the service. No areas of concern were identified in the other Key Questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those Key Questions were used in calculating the overall rating at this inspection.

We have found evidence that the provider needs to make improvement. Please see the safe and well led sections of this full report.

Enforcement

We have identified a breach in regulation in relation to the governance of the service. Please see the action we have told the provider to take at the end of this report

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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.