About the service:

Sycamore House is registered for 42 beds and provides personal care and accommodation for older people. On the day of our visit 37 people were using the service. Eleven people were living in Kenyon Lodge, this is a separate unit within Sycamore House for people living with advanced dementia. 26 people were living in the main service – Sycamore House.

People’s experience of using this service:

People’s medicines were not managed following national best practice guidance. This put people at greater risk of not receiving their prescribed medicines safely. Risk assessments lacked guidance for staff about the action required to manage known risk and people’s care plans lacked detail for staff to provide person centred care.

The deployment of staff did not consistently ensure people’s safety. Whilst permanent staff had been safely recruited, profiles for agency staff (who worked at the service only when required) were not readily available for staff to review to verify their identity.

People’s hydration needs were not fully assessed, provided for or monitored, putting people at greater risk of becoming dehydrated and unwell. Where people were unable to make specific decisions regarding their care; there was inconsistencies in how the Mental Capacity Act 2005 principles were applied. This meant people were not consistently supported to have maximum choice and control of their lives and may not have been supported in the least restrictive way possible.

Improvements were required in end of life care. We have made a recommendation about staff training about end of life care.

The manager had introduced a system that analysed accidents and incidents for patterns and trends and these confirmed, there had recently been a decline in the falls people had experienced. Safeguarding concerns were reported to the local authority safeguarding team and CQC. Some shortfalls were identified with the measures in place for the prevention and control of infections.

People’s health needs were monitored and staff made referrals to external healthcare professionals when people’s health needs changed. Staff were kind and caring and respected people’s privacy and dignity.

Activities and opportunities were limited and may not have met people’s interests, hobbies and pastimes. People’s diverse needs were known and understood. People had access to the provider’s complaint procedure. People received opportunities to be involved in the development of the service.

The manager was introducing many improvements at the service. This included improved opportunities in how people, relatives and advocates were involved in their care. How information was shared between staff. Staff training and support was also being improved. An action plan was in place to drive forward the improvements the manager and regional manager had identified.

The service met the characteristics for a rating of "Requires Improvement" in all key questions.

Please see the ‘action we have told the provider to take’ section towards the end of the report.

Rating at last inspection:

Good (report published 12 January 2016)

Why we inspected:

This was a planned inspection based on the rating at the last inspection.

Follow up:

We have requested the provider for an action plan to advise us how and when they will make the required improvements. We will also continue to monitor intelligence we receive about the service until we return to visit at the next scheduled inspection. If any concerning information is received we may inspect sooner.

We inspected the service on 8 December 2015. The inspection was unannounced. Sycamore House is registered to accommodate up to 43 people, including people living in a separate annex for people living with a dementia related illness called Kenyon Lodge. On the day of our inspection 40 people were using the service.

The service had a registered manager in place at the time of our inspection. 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 registered managers are also the registered providers of the service.

People felt safe in the service and staff knew how to protect people from the risk of harm. Medicines were managed safely and people received their medicines as prescribed. There were enough staff deployed in the service to meet the needs of people and to ensure they received care and support when they needed it.

People were supported by staff who had the knowledge and skills to provide safe and appropriate care and support. People felt staff were knowledgeable about the work they were doing and our observations supported this. People were supported to maintain their nutrition and hydration and staff ensured healthcare advice was sought when people’s health needs changed.

The Care Quality Commission (CQC) monitors the use of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). We found people who were not able to make their own decisions about the care they received were protected under this legislation.

People lived in a service where they were valued as individuals. People and their relations praised the staff for the way they went the extra mile to make them happy. People were treated with dignity and respect staff were kind and caring and compassionate when supporting people.

People were supported to have a varied and fulfilling social life in a service which used creative and imaginative ways to engage with people. People enjoyed the activities and social stimulation and this had a positive impact on their lives. People were given support to live their lives as independently as possible. People were very happy in the service but knew who to speak with if they had any concerns they wished to raise and they felt these would be taken seriously and acted on.

The registered manager led from the top to ensure staff were striving to achieve high quality care. People were involved in giving their views on how the service was run through the systems used to monitor the quality of the service. Systems were in place which effectively assessed the quality of the service and identified any improvements which could be made.

We spoke with 12 people using the service and two groups of relatives. We received many positive comments from all of the people we spoke with including, “Hugely delighted”, “Very happy and well cared for”, “I am very happy here, the care is good” and “It’s much better here than other places I have been.” People we spoke with were all happy with the care they were receiving.

People were protected from abuse or the risk of abuse because the manager responded appropriately to incidents or allegations.

Records showed that any incidents which were of a safeguarding nature were being reported to the Nottingham City Council safeguarding vulnerable adults team. They were also logged on the system used by the manager so that they could be monitored centrally by the provider.

People spoken with gave positive feedback about the care staff were delivering. They said things like, “They are a good group of people” and “They (the staff) know what they are doing. They are kind and they listen to me.” Records showed that staff were receiving regular training to enable them to do their job safely and supervision to ensure they were supported to do their job.

People knew how to raise concerns and complaints and we saw these were acted on within a specified timescale. One person told us they had discussed some issues with the manager and that she had, “sorted everything out straight away.” None of the people we spoke with had any concerns about the service.

Observations and discussions with people using the service showed people were supported to be independent and have choices in relation to how they were cared for.

We observed several people enjoying a walk in the garden which was designed in a way which supported people to do this independently. We saw there was lot’s of banter and humour exchanged. We chatted to the people who were in the garden and they told us, “I love the garden, I get out here whenever the weather is dry” and “we are lucky to have such a beautiful garden to spend time in. I like to smell the flowers and have some time to myself outside.”

People felt they were well cared for by staff. We received comments like, “I can’t praise the place enough. I love it here and think the staff do a good job”, “I am very happy here, you can see for yourself how lovely it is”, “very pleased I found this place, me and my family looked at a lot of places and none were as good as this one” and “in my opinion this is the best care home in Nottingham.”

From looking at records and speaking with staff and people using the service we were able to judge people felt safe in the home and staff knew how to keep them safe.

People felt they were involved in the way the service was run and their views were listened to and acted on. People said things like, “I think staff and the manager value what I say”, I have been to the meetings they have here and I have had a chance to make choices about what we do” and “they do listen to me, the manager is always around if I want to talk to her.”

One person using the service told us, “I go to bed and get up when I feel like it” and another said, “I like it here as there are no rules and regulations with people telling you what you can and can’t do. The staff listen to you and value your opinion”

We observed staff interactions with people using the service and we saw that they were kind, polite and respectful. We saw that people were given choices about where they went, what they did and were made to feel included in their care.

We spoke with six people using the service and they all told us that they were very happy with the care they were given. They said things like, “you couldn’t get a better place”, “This is my home and it feels like it”, “if I am ill the staff get the doctor very quickly and they always keep my family up to date with how I am doing” and “staff are lovely, they are very kind.”

We observed people using the service at lunch and we saw that it was a pleasant experience with a relaxed atmosphere and people using the service chatted with each other and with staff, who were available to give support.