We inspected the service on 13 February 2017 and the visit was unannounced.

Sycamore Cottage Residential Home is a care home and provides care and support for up to 14 people. There were 12 people using the service when we visited and many were living with dementia.

There was a registered manager in place. It is a requirement that the service has a registered manager. 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 had safely recruited a suitable number of staff to provide care and support to people. People were supported safely and staff knew their responsibilities to protect them from abuse and avoidable harm. The provider took action following an incident or accident including gaining the specialist support of health care professionals to help reduce the likelihood of a reoccurrence. Risks to people’s health and well-being were assessed and reviewed. For example, where a person could display behaviour that challenged themselves and others, there was guidance for staff which they followed.

People received their medicines when they required them. Staff knew what action to take should they have concerns about a person’s medicines including what to do in the event of an error. Staff received training and guidance for handling medicines to make sure people were supported safely.

People were asked for their consent before care and support was undertaken. Staff knew the importance of doing this and spent time with people so that they understood what they were being asked.

People were not always supported in line with the Mental Capacity Act 2005. For example, the provider had not always completed mental capacity assessment to determine people’s ability to make decisions. Staff did not always understand the requirements of the Act. The registered manager told us they would make improvements including arranging additional training for staff. The registered manager had made applications to the appropriate body where they had sought to deprive some people using the service of their liberties to make sure this was acceptable.

Staff mainly had the necessary skills and knowledge to offer good care to people. Staff had received training in areas such as dementia and dignity and respect. Staff had language skills that benefitted the people they were supporting. Staff received an induction when they started working for the provider so that they were aware of their responsibilities. Staff also received guidance and feedback from the registered manager to make sure they were offering support that met people’s care requirements.

People had mixed views about the food offered to them. The registered manager told us that the menu was being reviewed. Staff recorded what some people ate and drank. We found that the records occasionally contained gaps. We saw that people had enough to eat and drink. The registered manager told us they would review the need to record this as they did not have current concerns about people’s eating and drinking.

People were supported to maintain their health. This included having access to healthcare services such as to their doctor, chiropodist and optician.

Staff knew about the people they were supporting. They involved them in decisions about their care where people were able to be part of this. People received care that was based on things that mattered to them. For example, routines that were important to them were respected by staff.

People were supported to be as independent as they wanted to be to retain their skills. Staff were kind and compassionate although we saw an occasion where a staff member could have caused offence to a person. The registered manager told us they were taking action about the