This inspection was unannounced and took place on 19 April 2017.

Sydenham House provides personal care and accommodation to up to 49 people. The home specialises in the care of older people including a small group of people living with dementia. At the time of this inspection there were 36 people living at the home.

There is 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.

The last inspection of this service was carried out in February 2016. At that inspection we rated the service ‘Requires Improvement.’ We found that improvements needed to be made to make sure people received their meals in a timely manner. We also found that although the provider’s quality assurance systems had highlighted areas for improvement these had not always been acted upon to make sure people received an improved service. Following the inspection the provider produced an action plan which had resulted in improvements to the service provided to people.

At this inspection we found there were enough staff at meal times to make sure people did not have to wait for an excessive amount of time for their meals. People who needed help to eat their meal received this in a timely and discreet manner.

The provider and registered manager were using their quality assurance systems effectively to make improvements to the service offered to people and to their safety. These included changes to staff deployment at night and responding to satisfaction surveys.

People felt safe at the home and with the staff who supported them. People told us staff were always kind and caring towards them. One person told us “I definitely feel safe and I sleep well because I have no worries.”

People told us they were able to make choices about their day to day lives and staff supported them when they requested help. People felt there were enough staff to meet their needs and said staff responded to them promptly when they needed assistance. Staff received training which enabled them to provide safe and effective care to people.

There were opportunities for people to take part in activities or to pursue their own hobbies and interests. People’s privacy was respected and they could choose how and where they spent their time. One person told us “You can do what you like within reason. They seem able to accommodate most things.”

Staff monitored people’s health and supported them to access healthcare professionals to meet their individual needs. People received their medicines safely from staff who had received specific training.

The registered manager involved people in the running of the home by arranging meetings and giving people opportunities to be part of the recruitment process for new staff. People felt confident that if they raised any concerns these would be listened to. One person told us “I have said when things don’t suit and they have always listened and done something about it.”

This inspection was unannounced and took place on 10th February 2016.

Sydenham House provides care and accommodation for up to 50 people. The home specialises in the care of older people. One part of the home, Daisy Way, had been developed as a dementia friendly unit where people could enjoy a quieter environment. At the time of this inspection there were 45 people living at the home.

The last inspection was carried out on 18 February 2014. No concerns were identified with the care being provided to people at that inspection.

There is 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.

Most people were satisfied with the choice and quality of food provided. Some aspects of the service of food required improvement as people waited too long and this affected their enjoyment of their meal.

The home had a quality assurance system in place designed to gather information from people who lived in the home and the staff who supported them. Some aspects of this process needed to be improved.

People felt safe at the home and praised the staff who supported them One person said “If I had any worries I would talk to the manager. I have a key worker who is very helpful. And the staff are very nice. I am definitely safe. No worries at all.”

There were sufficient numbers of staff available at all times to keep people safe and to meet their needs. People said “They come pretty quickly when you ring the bell. I have always got one by my bed.”

Risks of abuse to people were minimised because the service’s recruitment procedures included checks to ensure new staff were suitable. Staff received training to enable them to recognise and report any possible abuse. Staff felt confident that any concerns reported would be dealt with to make sure people were protected. People received medicines safely and at the prescribed times.

People told us they were well cared for. They felt staff showed kindness towards them and were always polite. “Staff are nice people. Very gentle.” “It is lovely. They can’t do too much for you. The first thing they say when a visitor arrives is do you want a cup of tea. We couldn’t be better looked after. Really lovely.”

People received care and support that met their needs and took account of their individual wishes. People had access to the healthcare professionals they needed. Staff were prompt in seeking advice from appropriate professionals if they had concerns about a person’s health. A small number of people’s health needs were not followed up appropriately.

People were involved in decisions about any care and treatment and were able to make choices about their day to day routines. Care plans contained risks assessments which outlined measures in place to enable people to take part in activities with minimum risk to themselves and others.

People knew how to make a complaint if they were unhappy with any aspect of their care. People were confident that any complaints made would be taken seriously and action would be taken to address any issues.

There were 45 people who use the service on the day of our visit; a total of 16 staff were on duty. We spoke with four people who use the service, two relatives, two members of staff and a visiting district nurse. The manager was not due to be working on the day of our visit; however once staff notified them of our presence they arrived to provide assistance throughout the inspection.

People we spoke with said “staff ask if we need anything” and “staff offer to help”. Other comments included “it’s lovely here” and “they’re caring”. One person said “you ask them anything and they’ll do it”. Staff we spoke with said “we know people’s needs quite well”.

Care plans were seen to contain detailed information about activities of daily living and staff told us that the support plans gave them the information they needed to be able to provide appropriate care.

We observed lunch in the dining room. Whilst most people enjoyed their meals we saw that one person did not have a pleasant dining experience.

People staying in The Willows, which was a ‘step up, step down’ unit for people not well enough to go home but who didn’t need to be in hospital, were encouraged to self-medicate for the last week of their stay to ensure they were able to manage.

We saw that there was a comprehensive quality assurance system in place which linked to the essential standards of quality and safety.

People living at the home told us that they were able to make choices about their day to day lives. One person told us "You can choose what you do more or less. They get to know what you like". Another person said "I have nothing at all to complain about. I can chose when I get up and I have my books to read and my radio.”

We spoke to fourteen people in the home. Everyone asked was happy with the care and support that they received. People said "We couldn’t be better looked after. Staff are good. Really good.”

We saw that the home was clean and there was evidence of infection control measures in place in people’s rooms and throughout the service.

We saw that the home operated a system of recruitment that was designed to employ staff who were suitable for their post and safe to care for people in the home.

The provider Somerset Care Ltd had developed a quality assurance programme which was in line with the essential standards of quality and safety. The programme combines themed interviews with people who live in the home, direct observation of staff and a comprehensive system of audits.

People living at the home told us that they were able to make choices about their day to day lives. Comments included “You can more or less do what you like” and “I get up when I like and go to bed when I like, what I do during the day is up to me.”

Everyone asked was very happy with the care and support that they received. People said “We are well looked after, they always find time for you,” “I’m really happy, I wouldn’t changed a thing” and “It’s a lovely place, they will do anything for you.”

Some people asked were fully aware of what was in their care plan and others said that they knew about the care plan but did not get fully involved. One person said “I have a care plan and they check it with me regularly” another person said “They have discussed the care I need with me.” One person commented “I sign the care plan every month but they don’t really go though it with me.”

Everyone felt that staff respected their privacy and always treated them with care and consideration. We observed that interactions between people living and working at the home were kind and polite. We saw that staff knocked on bedroom doors and waited to be invited in before entering.

One person told us “Living here is good it has exceeded my expectations.”

People asked were very happy with the medical support provided by the home and said that they always arranged visits from outside professionals to ensure that they had the “right type of help.” One relative said how impressed they had been by the homes’ “pro active approach” to their relatives needs.

During the visit we observed that staff appeared competent in their roles and demonstrated a good knowledge of the needs and likes of individuals. One person said “Staff are very nice and know what they are doing.”

Everyone said that staff were kept busy throughout the day but always responded quickly if they rang for assistance. Throughout our visit we noted that bells were answered very quickly meaning that people received assistance promptly when needed.

All those asked said that they would not hesitate to speak with a member of the management team if they had any worries or concerns.