This inspection took place on 21 February 2018 and was unannounced. A second day of inspection took place on 23 February 2018 and was announced.

Sycamore Care Centre 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 Care Centre provides personal care for up to 113 people. At the time of our inspection there were 102 people living at the home who received nursing and personal care, some of whom were living with a dementia. The service is set in its own grounds and consists of four units: the Lodge, the Mews (which is split into four smaller sub units called Cedar, Hawthorn, Maple and Willow), the Villa and the Cottage.

A registered manager was in place at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

We last inspected this service in November 2015 when it was rated ‘Good’ overall, although we found the provider had breached Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to safe care and treatment. This was because medicines were not managed effectively. We returned to the service in August 2016 to check whether improvements had been made in this area. In August 2016 we found improvements in medicines management. The rating for the key question ‘is this service safe?’ remained ‘Requires Improvement’ as we needed to be sure consistent good practice could be sustained over time. During this inspection, we found improvements in medicines management had mostly been sustained. Overall, the service remained ‘Good.’

Staff had completed training in safeguarding vulnerable adults and understood their responsibilities to report any concerns. Thorough recruitment and selection procedures ensured suitable staff were employed. Risk assessments relating to people's individual care needs and the environment were reviewed regularly.

Staff received appropriate training and support. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People were supported to have enough to eat and drink and attend appointments with healthcare professionals.

There was a welcoming and homely atmosphere at the service. People were at ease with staff and people and relatives said staff were caring. Staff treated people with kindness and compassion.

Staff had a clear understanding of people's needs and how they liked to be supported. People's independence was encouraged without unnecessary risks to their safety. Support plans were well written and specific to people's individual needs.

Relatives and staff felt the service was well managed. Staff described the registered manager as approachable and said there was an open culture. There was an effective quality assurance system in place to ensure the quality of the service and drive improvement.

Further information is in the detailed findings below.

At the last inspection on 19 and 20 November 2015 we found a breach of regulation. Following the inspection the provider wrote to us to say what they would do to meet

legal requirements in relation to medicines.

We undertook this focused inspection to check that they had met legal requirements and to confirm that they had followed their action plan and made improvements to the service. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Sycamore Care Centre on our website at www.cqc.org.uk.

Sycamore Care Centre is registered to provide personal and nursing care for up to 113 older people with general care and mental health needs. At the time of this visit 103 people were using the service. The service is set in its own grounds and consists of four units (the Lodge, the Mews, the Villa and the Cottage).

The current manager has been in post since the beginning of August 2015. They are in the process of applying to the Care Quality Commission (CQC) to become the registered manager. A registered manager is a person who has registered with the CQC 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.

At our focused inspection on 10 August 2016, we found medicines were managed safely. The provider had followed their plan and legal requirements had been met.

We used different methods to help us understand peoples experiences of the service, as some had complex needs which meant they could not tell us. We spoke with a number of people individually and in groups. The people we spoke with said they were happy with the service and the staff were "really nice” and “excellent, always patient".

A relative told us they were confident their family member was being looked after; they said “we couldn’t ask for more”, and that their relative was “really well since she came here". Another person said, “We're always really happy with the care she gets” and another “We are confident when we leave her that she will be alright.”. We saw staff speaking to people in a kind and respectful way. We also observed that people were clean and well groomed.

We saw effective recruitment and selection processes for the staff to make sure people using the service were being supported by staff who were fit, appropriately qualified and physically and mentally able to do their job. The system for recruiting was robust and checks were carried out to ensure people were able to carry out their role safely.

People’s records were detailed, up to date and gave staff information on how to meet their needs. They were written in a way that described how a person wanted to have their needs met and focused on them as individuals. Records of how the building, facilities and equipment were maintained and checked for safety were well organised and up to date.

We, the Care Quality Commission, have undertaken two compliance reviews to Sycamore Care Home. The visit for the first review was carried out on 11 July 2011, and we found that improvements were needed. The provider gave us a plan which identified what action they were going to take to make sure the service was compliant. The visit for the second review was carried out on 19 April 2012 and this report describes our findings.

Due to the physical and mental health needs of the people living in the home it was not possible to get some peoples views. However we were able to speak to a number of the people living there and we spoke to visiting relatives and representatives and visiting professionals.

All of the people living in the home who were spoken to said that they were happy with the service provided by the staff. A person living in the service told us that the staff were “brilliant” and another said that “things couldn’t be better and another said “ you cant get any better than this”. When we asked people about the food, one person said that they thought it was “excellent”.

One visiting relative told us that they were confident that their family member was being looked after and another, when asked about the care being given to their relative, said “you couldn’t fault it”.

Another visiting relative told us they chose Sycamore Care Home from a recommendation from a family friend. When asked about the Sycamore Care Home being provided they said “We have peace of mind. We know our … is safe and well cared for.”

The people living here, and their relatives told us there were too few staff.

They told us the regular sounding of bells was intrusive.

We were told, things could be better, but nothing will change.

The inspection took place on 19 and 20 November 2015 and was unannounced. At the previous inspection in October 2014 the service was given an overall rating of ‘good’.

Sycamore Care Centre is registered to provide personal and nursing care for up to 113 older people with general care and mental health needs. At the time of this visit 106 people were using the service. The service is set in its own grounds and consists of four units (the Lodge, the Mews, the Villa and the Cottage).

At the time of our inspection the registered manager had been absent since the end of July 2015. An acting manager was appointed at the beginning of August 2015. 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 service had notified us about this and an acting manager had been in post since the beginning of August 2015.

We found the provider had breached Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the service did not have accurate records to support and evidence the safe administration of medicines. Medicine records were not always completed correctly or in a timely manner, which placed people at risk of medicine errors.

You can see what action we told the provider to take at the back of the full version of this report.

People told us they felt safe because they were well looked after. The provider made sure only suitable staff were employed. Thorough background checks were carried out before staff started to work with people who used the service.

Staff completed safeguarding training as part of their induction and then at regular intervals. Staff we spoke with said they would raise any concerns immediately. This meant they knew how to deal with any concerns about people’s safety.

Accidents and incidents were recorded accurately and analysed by the manager. Measures were put in place which significantly reduced the number of falls people had. Risks to people’s health and safety were assessed and reviewed regularly.

Staff received appropriate training and regular supervisions and appraisals. Staff understood the Mental Capacity Act 2005 for those people who lacked capacity to make a decision, and Deprivation of Liberty Safeguards to make sure people were not restricted unnecessarily.

People’s health needs were assessed and monitored. People were supported to maintain a balanced diet. Staff knew people’s likes and dislikes well. Care records were personalised to each individual and were reviewed regularly.

People and relatives spoke positively about the caring and friendly attitude of staff. One person told us, “The best thing about the place is the staff – they’re lovely. You can’t help but bond with them because they are so nice.”

The people, relatives and staff members we spoke with felt the service was well-run. The provider had an effective quality assurance system and people’s views about the service were frequently sought to check where any improvements could be made. People and their relatives had several opportunities to raise suggestions and comments about the service.

People felt the atmosphere in the home was very good. Staff members we spoke with said staff morale was good and they felt valued.