About the service: Sycamore House is a residential care home that was providing personal care and support to people with mental health needs. They were registered to provide care for 28 people and there were 27 living at the home when we visited. The accommodation consists of two floors with shared communal areas on the ground floor.

People’s experience of using this service:

• The risks to people’s health and wellbeing were assessed and action taken to reduce them. People were supported by staff who understood how to protect them from avoidable harm. There were enough staff deployed to keep people safe. People’s medicines were well managed and staff understood how to reduce the risk of the spread of infection. There were systems to learn from mistakes including the detailed analysis of accidents and incidents.

• Staff received training to enable them to do their jobs well. People were provided with care and support which protected them from discrimination. They were supported to maintain a healthy diet and had access to other health and social care agencies when needed. 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. The environment was adapted to meet people's needs.

• There were kind and caring relationships between people and staff which were based on dignity and respect. People felt involved with decisions and that staff respected their wishes. Staff had a good understanding of cultural and religious differences and provided support to meet these. Families were welcomed at any time.

• People had care and support provided which met their preferences. Complaints were handled appropriately and in line with the provider’s complaints policy. People did not currently receive end of life care but people had discussed their wishes with staff.

• Staff enjoyed working at the service and felt respected and valued. People could give their views about how the service could develop and improve. The provider’s quality assurance processes were effective in identifying potential risks to people’s safety. There was a continued focus on learning, development and improvement.

The home continued to meet the characteristics of a rating of good in all areas. For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection: The service was last inspected on 17 March 2016 and was rated good.

Why we inspected: This was a scheduled inspection based on the rating at the last inspection.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

The inspection took place on 17 March 2016 and was unannounced. At the last inspection on 22 May 2014, we found that the provider was meeting the Regulations we inspected.

Sycamore House provides accommodation and support for up to 28 adults with mental health needs. At the time of our inspection 27 people were living there.

There was a registered manager in post. 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.

People who lived at the home felt secure and safe in the knowledge that staff were available to support them, when they needed to be supported. The provider had systems in place to keep people safe and protected them from the risk of harm and ensured people received their medicines as prescribed.

There was sufficient numbers of staff to meet people’s identified needs. The provider ensured staff were safely recruited and they received the necessary training to meet the support needs of people.

Staff sought people’s consent before providing support. Staff understood the circumstances when the legal requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLS) should be followed.

People were encouraged to consider healthy food and drink options and had good access to health care professionals to ensure their health care needs were met.

People were supported by caring and respectful staff that encouraged people to be as independent as much as possible.

People’s health care and support needs were assessed and regularly reviewed. There were no complaints about the service.

The provider had established management systems in place to assess and monitor the quality of the service to ensure it remained consistent and to an acceptable standard.

On the day of our inspection we talked with the owner and the deputy manager. The registered manager was not available. We looked in detail at the records for three people. We observed how people were being cared for and talked with four people who lived in the home. We visited on a weekday and of the 25 current residents, one person was in hospital, and other people at home. We observed people in the lounge area and at lunch time in the dining area. We talked with two staff members and one professional. We also spoke with three relatives. One relative commented, “The home is alright, it’s OK”

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask.

This is a summary of what we found;

Is the service safe?

We saw that people had been cared for in an environment that was safe and clean. There were enough staff on duty to meet the needs of the people who lived at the home and a member of the management team was available on call in case of emergencies. Safeguarding procedures were available and staff had received training so that they understood their role in safeguarding the people they supported.The staff had a good understanding of whistle blowing policy.

The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. One application had been made in accordance with these safeguards, proper policies and procedures were in place, and the owner understood the managers’ responsibilities in relation to the law.

There were policies and procedures in place to make sure that unsafe practice was identified and people were protected. This included the correct administration of medication. One relative told us, “The staff are excellent they seem to want to help.”

Is the service effective?

All the people we spoke with told us that they were happy with the care that had been delivered and their needs had been met. It was clear from our observations and from speaking with staff that they had a good understanding of people’s care and support needs and that they knew them well.

We found that staff provided person centred care and were aware of peoples’ choices, preferences and support needs. Care plans had been written to reflect this person centered approach. There was a comprehensive training programme including mental capacity awareness for the staff team so that they had the skills they needed to meet people's needs. One relative told us “They do the best they can. I find them quite reasonable to deal with.”

Is the service caring?

People were supported by kind and attentive staff. We saw that all staff showed patience and gave encouragement when they supported people. All the people we spoke with told us that they were happy with the care that had been delivered and that their needs had been met. People appeared calm and relaxed and we observed four people ask for drinks and snacks and received them in a timely and appropriate manner. One person said about a member of staff, “He’s lovely.”

Is the service responsive?

People’s needs had been assessed before they moved into the home. Care plans and risk assessments provided staff with up to date information which was regularly reviewed.The senior staff set the staff rotas so that there was enough staff on duty, and the owner told us that only staff known to the residents are used to cover any emergencies. The service worked well with other agencies and services to make sure people received their care safely and effectively.

Is the service well-led?

All the staff we spoke with told us they were clear about their roles and responsibilities. There were clear processes in place to keep people safe and the owner knew what to do if there was a problem or concern.

The service has a basic quality assurance system and they used their resident meetings and staff handover meetings to assure the quality of service delivery to people. One relative told us, “The home are good at communicating with us.”

There were twenty seven people living at the home at the time of our visit. We spoke with eleven of these people, three relatives and the staff that were supporting them. We spent time sitting in the lounge and dining room. We saw that staff supported people in a respectful manner and offered them choices of how and where they wanted to spend their time.

People told us that they were happy with how their care and support needs were being met. They told us that staff were available at the times they needed them. People using the service told us “Whatever I want the staff will help me,” and “I get good care here.”

People told us about the quality and choice of food and drink available. They told us that, overall they were satisfied about the choice and quality of meals. A person using the service told us “We have some lovely food here.”

People told us that they felt safe living at the home and that they would speak to the manager or staff if they had any concerns.

People had some opportunities to participate in activities both within and outside of the home. However, some people told us that they often were bored as there wasn’t much for them to do throughout the day.

Systems were in place to monitor the quality of service provided at the home. People using the service and their relatives were involved in this.

We last inspected Sycamore House in May 2012. We found that the provider had not been compliant with regulations regarding the care and welfare of people who use services, cleanliness and infection control and quality checking systems. The provider sent us an action plan following the last inspection. This detailed the actions taken to ensure compliance was reached. The findings of our inspection identified that improvements had been made in these areas and that compliance had been achieved.

During this inspection of Sycamore House we used a number of different methods to help us understand the experiences of people who lived there. We spent time with most of the people who lived at the home, spoke with all of the members of staff on duty and spoke with a health professional who was visiting the home.

There were twenty seven people living at the home at the time of our inspection and two of these people were in hospital. People told us that they were happy with how their care and support needs were being met at the home. A person that was living at the home told us “I am comfortable here, I have no complaints.”

We saw that people were relaxed and at ease with staff and within their home environment. We saw that staff interacted with people in a friendly, courteous and respectful manner. We found that people were treated with respect and that their dignity and choices had been considered by staff.

Prior to our inspection we received a concern regarding people’s limited choice of food at mealtimes. The outcome of our inspection identified that people were provided with a choice of food in order for their nutritional needs to be met. People told us “I can’t grumble about the food;” and “I am happy with the food and choice of food.”

Prior to our inspection we received a concern that people had limited opportunities to join in with activities arranged by the home. The outcome of our inspection identified that people had the opportunity to put forward suggestions for activities and that, overall, they were satisfied with the activities provided. People told us “I don’t get bored. I’m going shopping with staff at the weekend. I’m going to buy some new clothes;” and “Sometimes we get balls and have a kick around or a game of bingo. I enjoy painting pictures too.”

We requested information about the quality of the service provided at the home from local authority staff involved in monitoring the home. They told us that they did not have any additional information to give us at this time.

This visit was undertaken as part of our scheduled plan of inspections. However we also used the visit to follow up on improvements that were needed at the time of our last visit to the home. These were improvements needed regarding outcomes 1, 4, 8 and 16. There were twenty seven people living at the home at the time of our visit and one person was in hospital.

There were no visitors at the home during or visit. Therefore, following our visit, we had telephone conversations with three relatives of people who were living at the home. This was in order to obtain their views about the service being provided. They told us that overall they were happy with the care provided at the home.

All of the people that we spoke with during our visit told us that they were happy living at the home and that they were happy with how their care needs were being met. People told us “It is fine living here, I do enjoy it”, “I am comfortable. It is very nice living here.” and “I am really pleased with the home. My relative has a wash every day and he has put on weight since he came to live here. It makes a huge difference.” However, other evidence from our visit did not always support this.

People told us that they enjoyed the food provided at the home and that they were offered a choice at meal times. People told us “The food is good” and “I get a choice of what food I want. If I ask the cook for something different he will get it for me.”

People told us that they had opportunities to express their views about what it was like to live at the home. One person told us “We have residents meetings here. I go to them depending on how I feel that day.”

People told us that staff were available at the times that they needed them and that staff supported them in an understanding manner. People told us “Usually there is enough staff on.” and “The care staff can’t do enough to help. They never know when I will be visiting and they are always welcoming.”

People we spoke with were confident that they could raise concerns if they were not happy with the care being received and that they would be listened to. The relative of a person that was living at the home told us “I would be more than happy to speak to the manager if I had any concerns. I had to raise one issue in the past and this was dealt with well.”

During our inspection, we discussed the quality of the service provided at the home with local authority colleagues involved in monitoring the home. They said they had not got any concerns about the service being provided.

People told us that they were happy living at the home and that their health and personal care needs were being met. People told us “I have an en suite shower so I can shower myself. It is lovely” and “My mother looks well cared for when I come”.

People told us that they had enjoyed a recent trip outside of the home but overall there were limited opportunities for them to take part in recreational activities. People told us “I enjoyed the botanical gardens. I spoke to a peacock”. “I have lived at the home for a long time and there are not many activities” and “We have a few activities here but a lot of people don’t want to join in. The men like snooker”.

People told us that they were generally happy with the meals provided at the home. People told us: “We have hot drinks, meals and snacks in the day and we have supper at 5pm” and “The staff can access toast, soup, biscuits and hot drinks for us at any time”.

People told us that they were happy with the levels of cleanliness at the home however we found that improvements were needed regarding this. People told us “It is always nice and clean here” and “I come here twice a week and everything seems to be clean when I visit”.

People told us that staff were available at the times that they needed them. People told us “We have enough staff on duty” and I’ve got no complaints about the staff. They look after me”.

People told us that they felt confident to raise any concerns that they may have about the service and that actions are taken in response to these. People told us “I would tell the managers if I wasn’t happy about something but I haven’t got any complaints” and “If I am not happy about anything I tell the staff”.

We spent some time sitting with people that lived at the home. We were observing what was happening to see what it was like to live there. This enabled us to have a look at the support provided to people that live at the home and how care workers interacted with them. These observations were used alongside other information gathered to assess the quality of care.

As part of our review, we spoke with the local authority who pay for people to use the service. They told us that they have not received any concerns or complaints about the service in the past twelve months.