We undertook an unannounced focused inspection of Sycamore Lodge on 24 July 2018. This inspection was done to check that improvements to meet legal requirements planned by the provider after our comprehensive inspection of 14 and 16 March 2018 had been made. The team inspected the service against two of the five questions we ask about services: is the service safe and is the service well led? This is because the service was not meeting some legal requirements.

No risks, concerns or significant improvement were identified in the remaining Key Questions through our ongoing monitoring or during our inspection activity so we did not inspect them. The ratings from the previous comprehensive inspection for these Key Questions were included in calculating the overall rating in this inspection.

Sycamore Lodge is a ‘care home’. People in care homes receive accommodation and nursing or 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.

Sycamore Lodge accommodates up to 75 older people across five separate units, each of which has separate adapted facilities. The service provides care to people who need nursing care, people living with the experience of dementia and people who are receiving care at the end of their lives. When we carried out this inspection, 65 people were using the service.

The service has a manager who is registered with the Care Quality Commission. 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 acted to address issues we identified at our last inspection. People received their medicines safely and as prescribed. There were systems in place for the prevention and control of infection.

The provider carried out checks to make sure staff were suitable to work with people using the service.

There were arrangements in place to keep people safe from abuse. Staff knew about the provider’s policies and procedures and had completed training.

The provider had systems to monitor quality in the service and make improvements. When their audits identified areas for improvement, the provider acted.

The service had a qualified and experienced manager who was supported by a team of experienced senior staff. Staff told us the registered manager and senior staff team were approachable, supportive and knowledgeable.

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, desig