We reviewed the evidence we obtained during our inspection and used this to answer our five key questions: Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?This is a summary of our findings. If you would like to see further evidence supporting this summary please read the full report.
Is the service safe?
CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to people residing in care homes. While no applications had needed to be submitted, proper policies and procedures were in place to protect people who could not make decisions for themselves. Relevant staff had been trained to understand when an application should be made, and how to submit one.
The registered manager advised us that currently no person living in Sydney House was subject to any restriction, as defined by the provider's policy document.
There were detailed risk assessments in place that covered most aspects of people's daily life and each of these had been completed specifically for the individual they referred to. The risk assessments we looked at were all up to date and had been regularly reviewed. These included mobilising, eating and drinking, falls prevention, diabetes management, the use of bed rails and care in respect of pressure sores.
From some of the records we looked at, it was evident that staff knew how to report incidents and there was evidence that learning from incidents took place and appropriate changes were implemented. For example, a 'Significant Event Analysis' was completed following certain incidents and an action plan was compiled to identify and address any learning needs and reduce the possibility of recurrences.
Is the service effective?
We asked people for their opinions with regard to how they spent their time in the home. People told us that they could choose whether they joined in with the group activities or entertainment. One person said: 'There's always plenty to do; it's our own fault if we get bored! I like joining in with some things but not everything. We can read or watch television - it's nice to have this area with no TV.' Another person told us, 'I like to read my book but we've had a game of ball this morning.'
All six people we spoke with told us that they liked the meals. Some of the comments included: 'The food is marvellous here. There are always plenty of choices.' 'very nice' 'excellent'
We noted that the lunch period was a cheerful, unhurried and sociable occasion. Where people required assistance with their meals, we observed that this was done in a dignified manner.
We asked one person if they always had enough to eat and drink and they replied: 'Always.' We also asked how they managed to have drinks whenever they wanted and they told us that they could use their pendant call-bell and 'just ask the staff'
Is the service caring?
We met and spoke with six people at length during this inspection. All six people had full mental capacity and varying degrees of support requirements. All six people we spoke with told us that they were able to choose to do as they wished and that they were always asked for their consent before receiving any care or support.
One person we spoke with was sitting in the garden reading a magazine. We noted that they had very limited mobility and were currently reliant on staff to move them from place to place in their wheelchair. We asked this person about the care and support they received from staff and whether they were able to go where they wanted, when they wanted.
This person told us: 'The staff are very kind and they never do anything for me without my consent. If I want anything I just use this (pendant call bell) and the staff come.' The person confirmed that this applied to having snacks or drinks, being taken different areas within the home or being supported with any personal care.
Some of the responses we received when we asked how the staff treated people included: 'They're all wonderful', 'all very kind and always cheerful', 'always respectful and very professional - but still friendly' 'Oh, the staff are all lovely; can't fault the staff at all'
We saw that the manager and staff had received numerous 'thank you' letters and cards from people living in the home or using the service, as well as some people's relatives. All of these were very complimentary and praising of the staff and the levels of care provided.
Is the service responsive?
We saw some very positive comments and constructive feedback from people, with regard to activities and entertainment, in the minutes from the residents' meetings that had been held in December 2013, February and April 2014.
We met and spoke with six people and looked at the care records for eight people who had varying degrees of support requirements. One person had been identified as being at high risk of developing pressure sores. Some people needed support with managing their diabetes and some needed high support with mobilising. In addition, we looked at the records for people who had swallowing problems (dysphagia) and one person for whom bed rails were required.
All the information we saw was clear, detailed and personalised. It was also easily accessible by staff, providing clear guidance with regard to how each person required support, in accordance with their needs and wishes.
We noted that regular advice and intervention was sought, as necessary from relevant professionals such as the district nurse, GP, physiotherapist, occupational therapist, speech and language therapist and dietician, to ensure people's health was maintained.
Is the service well led?
We looked at two staff files and saw that these contained evidence that appraisals were carried out annually. With regard to support and supervision, we noted these were generally comprised of two observations by a senior, with input from someone receiving care, of care practice and the delivery of person centred care. In addition, staff were supported by way of at least two group meetings per year. The manager confirmed that if any staff needed more one-to-one time for support, these were accommodated as required.
Six people we spoke with who lived in the home told us that they believed that the staff were all very well trained and professional.
We saw that there were a number of systems in place to assess and monitor the quality of service provided. For example, we saw that meetings were held regularly with the people living in the home.
We also looked at the results from the Quality Assurance survey that had been carried out in October 2013. We saw that the responses from people using the service and their relatives were mostly very positive, with the majority of scores being above average.
We noted that the manager had an 'open door policy' and actively encouraged comments, suggestions and feedback from the people living in the home, their friends and family and relevant professionals.