The inspection took place on 14 and 16 March 2018 and was unannounced. Sycamore Lodge has been re- registered under the provider, Optivo since 26 October 2017. Optivo is a housing association and a registered society which also operates three other care homes in London. This was the first inspection of Sycamore Lodge under their ownership. Sycamore Lodge is a 'care home'. People in care homes receive accommodation and personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service is registered to provide personal care and nursing care for up to 77 people. There were 73 people living at the service at the time of our inspection.
The care home is purpose built and has three floors with lift access. Each person has their own bedroom with en suite facilities. The rooms are arranged into three ‘streets’ of 15 and two ‘streets’ of 16. Each ‘street’ has its own dining room, lounge and kitchen area along with an activities room. The service employed nursing staff on the first and second floor where people were living with the experience of dementia and required nursing care.
There was a registered manager in post at the time of our inspection who had worked at the service since May 2017 under both the previous owner and current owner. 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 provider did not have effective arrangements to protect people against the risks associated with the management of medicines.
The provider's systems for ensuring that only suitable staff were recruited were not always effective. Some personnel files were missing significant information to demonstrate that a robust recruitment process was in place. Some of the missing information was received after the inspection.
There were systems in place to assess and monitor the quality of the service, but these had not always been effective and had not identified the issues we found during our inspection.
We found breaches of the Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to Safe care and treatment, Fit and proper persons employed and Good governance. You can see what action we have told the provider to take at the back of the full version of this report.
There were systems and processes in place to protect people from the risk of harm. There were enough staff on duty to meet people's needs and there were contingency plans in the event of staff absence.
Care plans and risk assessments were reviewed and updated whenever people's needs changed. People and relatives told us they were involved in the planning and reviewing of their care and support and felt valued.
The risks to people's safety and wellbeing were assessed and regularly reviewed. People were protected whilst supported to remain as independent as they could be. The provider had processes for the recording and investigation of incidents and accidents.
The provider was acting in accordance with the Mental Capacity Act 2005. People's mental capacity was assessed when their care was planned. People had been asked to consent to their care and treatment and the staff understood their responsibilities under the Act. Processes had been followed to ensure that, when necessary, people were deprived of their liberty lawfully.
People were protected by the provider’s arrangements in relation to the prevention and control of infection. The environment was clean and free of hazards. The provider had a procedure regarding infection control and the staff had specific training in this area.
People's individual needs were met by the adaptation, design and decoration of the premises, and the provider was planning to further develop this.
People's health and nutritional needs had been assessed, recorded and were being monitored. People had access to healthcare professionals as they needed, and their visits were recorded in people’s care plans.
People were supported by staff who were sufficiently trained, supervised and appraised. The service liaised with other services to share ideas and good practice.
People's care plans were comprehensive and detailed people’s identified individual needs. They were personalised to reflect people’s wishes and what was important to them.
Staff had received training in end of life care and advanced care plans were put in place when a person was identified as needing end of life care.
A wide range of activities were arranged that met people’s individual interests and people were consulted about what they wanted to do.
Staff were caring and treated people with dignity, compassion and respect. Care plans were clear and comprehensive and included people's individual needs, detailed what was important to them and how they wanted their care to be provided.
Throughout the inspection, we observed staff supporting people in a way that took into account their diversity, values and human rights.
People's complaints and concerns were listened to and the provider responded appropriately to these.
There was a clear management structure at the service, and people and staff told us that the management team were supportive and approachable. There was a transparent and open culture within the service and people and staff were supported to raise concerns and make suggestions about where improvements could be made.