About the service

Sydney House is a care home that offers care and support to up 45 older people, some of whom are living with dementia. There were 38 people using the service at the time of our visit.

At our last inspection on 26 April 2016 we rated the service good. At this inspection we found the evidence continued to support the rating of good. There was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns.

People’s experience of using this service

• People were very happy living at Sydney House. They felt safe and liked the staff who supported them. Relatives were very satisfied with the service and they felt welcomed when they visited and said that staff contacted them when there were any changes. Staff were proud to be working at the home and enjoyed their job. Everyone said they would recommend the home.

• The provider had systems in place to keep people safe from avoidable harm. Staff supported people to raise any concerns they may have. Risk was assessed and managed while also respecting people’s human rights and freedom.

• Staff gave people their prescribed medicines safely. They followed good practice infection control guidelines to help prevent the spread of infection. Equipment was available so that staff could support people in a safe way and staff knew how to operate it in a safe way.

• The provider employed enough staff so that they could meet people’s needs in a timely way. Staff went through a thorough recruitment process so that the provider only employed suitable staff with the right skills and character.

• People had a choice of food and drinks which they enjoyed. Staff supported people to access healthcare professionals when they needed them and quickly recognised any changes to people’s health and wellbeing.

• Staff undertook training in a wide range of topics so they had the knowledge and skills to do their job well and effectively meet people’s needs.

• Staff were kind and compassionate. They knew each person well, including their likes and dislikes and their preferences about how they wanted staff to care for them. They ensured that people were as involved as they could be in making decisions about their care and support. People’s privacy, dignity and independence was protected and promoted.

• People could follow their interests and hobbies and maintain relationships with people who were important to them.

• Complaints were taken seriously and the staff team listened to people and took action to resolve complaints. Complaints were used as an opportunity to learn and improve.

• Everyone praised the registered manager who was approachable, helpful and provided strong leadership. The staff team enjoyed working together and supported each other and the registered manager.

• Staff knew they were responsible for giving people a high-quality service based on the provider’s ethos and values. Staff did everything to make people’s lives as comfortable and fulfilling as possible. The quality of the service provided was carefully monitored to check that people were safe and happy.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

At the last inspection we rated this service Good (report published on 3 June 2016).

Why we inspected

This was a planned inspection based on the previous rating.

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 26 April 2016 and was unannounced. The service provided accommodation for persons who require nursing or personal care for up to 40 people. There were 33 people living in the home when we inspected, some living with dementia.

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. There was a registered manager in post.

The home was safe and staff understood their responsibilities to protect people from harm or abuse and had received relevant safeguarding training. Staff were confident in reporting incidents and accidents should they occur.

There were effective processes in place to minimise and review risks to individuals. Assessments had taken place regarding people’s individual risks and clear guidance was in place for staff to follow in order to reduce risk. Recruitment processes were in place to ensure that staff employed in the service were suitable for the role. People were safely supported to take their medicines.

Staff had received training in areas specific to the people they were supporting and this helped to make sure that people received care individual to their needs. Staff understood the importance of gaining people’s consent to the care they were providing to enable people to be cared for in the way they wished.

Some people had applications in for the lawful deprivation of their liberty (Deprivation of Liberty Safeguards (DoLS)) and staff were able to explain how they promoted choice where people had variable capacity. The home complied with the requirements of the Mental Capacity Act 2005 (MCA).

People were supported to access healthcare wherever necessary and in a timely manner. People’s nutrition and hydration needs were met and drinks were available throughout the day.

People’s privacy and dignity were promoted and they had good relationships with staff who were kind and caring towards them. People were encouraged to be as independent as possible and make their own choices.

Staff had good knowledge about the people they cared for and understood how to meet their needs. People planned their care with staff and relatives, and activities were carried out in line with people’s preferences.

The management team was visible throughout the home and people found them approachable. They found the registered manager was responsive in addressing any concerns. People were encouraged to provide feedback on the service and, and regular meetings took place.

There were systems in place to monitor the quality of the service and these were used to develop and improve the service.

We reviewed the evidence we obtained during our inspection and used this to answer our five key questions: Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

This is a summary of our findings. If you would like to see further evidence supporting this summary please read the full report.

Is the service safe?

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to people residing in care homes. While no applications had needed to be submitted, proper policies and procedures were in place to protect people who could not make decisions for themselves. Relevant staff had been trained to understand when an application should be made, and how to submit one.

The registered manager advised us that currently no person living in Sydney House was subject to any restriction, as defined by the provider’s policy document.

There were detailed risk assessments in place that covered most aspects of people’s daily life and each of these had been completed specifically for the individual they referred to. The risk assessments we looked at were all up to date and had been regularly reviewed. These included mobilising, eating and drinking, falls prevention, diabetes management, the use of bed rails and care in respect of pressure sores.

From some of the records we looked at, it was evident that staff knew how to report incidents and there was evidence that learning from incidents took place and appropriate changes were implemented. For example, a ‘Significant Event Analysis’ was completed following certain incidents and an action plan was compiled to identify and address any learning needs and reduce the possibility of recurrences.

Is the service effective?

We asked people for their opinions with regard to how they spent their time in the home. People told us that they could choose whether they joined in with the group activities or entertainment. One person said: “There’s always plenty to do; it’s our own fault if we get bored! I like joining in with some things but not everything. We can read or watch television - it’s nice to have this area with no TV.” Another person told us, “I like to read my book but we’ve had a game of ball this morning.”

All six people we spoke with told us that they liked the meals. Some of the comments included: “The food is marvellous here. There are always plenty of choices.” “…very nice…” “…excellent…”

We noted that the lunch period was a cheerful, unhurried and sociable occasion. Where people required assistance with their meals, we observed that this was done in a dignified manner.

We asked one person if they always had enough to eat and drink and they replied: “Always.” We also asked how they managed to have drinks whenever they wanted and they told us that they could use their pendant call-bell and “…just ask the staff…”

Is the service caring?

We met and spoke with six people at length during this inspection. All six people had full mental capacity and varying degrees of support requirements. All six people we spoke with told us that they were able to choose to do as they wished and that they were always asked for their consent before receiving any care or support.

One person we spoke with was sitting in the garden reading a magazine. We noted that they had very limited mobility and were currently reliant on staff to move them from place to place in their wheelchair. We asked this person about the care and support they received from staff and whether they were able to go where they wanted, when they wanted.

This person told us: “The staff are very kind and they never do anything for me without my consent. If I want anything I just use this (pendant call bell) and the staff come.” The person confirmed that this applied to having snacks or drinks, being taken different areas within the home or being supported with any personal care.

Some of the responses we received when we asked how the staff treated people included: “They’re all wonderful…”, “…all very kind and always cheerful…”, “…always respectful and very professional - but still friendly…” “Oh, the staff are all lovely; can‘t fault the staff at all…”

We saw that the manager and staff had received numerous ‘thank you’ letters and cards from people living in the home or using the service, as well as some people’s relatives. All of these were very complimentary and praising of the staff and the levels of care provided.

Is the service responsive?

We saw some very positive comments and constructive feedback from people, with regard to activities and entertainment, in the minutes from the residents’ meetings that had been held in December 2013, February and April 2014.

We met and spoke with six people and looked at the care records for eight people who had varying degrees of support requirements. One person had been identified as being at high risk of developing pressure sores. Some people needed support with managing their diabetes and some needed high support with mobilising. In addition, we looked at the records for people who had swallowing problems (dysphagia) and one person for whom bed rails were required.

All the information we saw was clear, detailed and personalised. It was also easily accessible by staff, providing clear guidance with regard to how each person required support, in accordance with their needs and wishes.

We noted that regular advice and intervention was sought, as necessary from relevant professionals such as the district nurse, GP, physiotherapist, occupational therapist, speech and language therapist and dietician, to ensure people’s health was maintained.

Is the service well led?

We looked at two staff files and saw that these contained evidence that appraisals were carried out annually. With regard to support and supervision, we noted these were generally comprised of two observations by a senior, with input from someone receiving care, of care practice and the delivery of person centred care. In addition, staff were supported by way of at least two group meetings per year. The manager confirmed that if any staff needed more one-to-one time for support, these were accommodated as required.

Six people we spoke with who lived in the home told us that they believed that the staff were all very well trained and professional.

We saw that there were a number of systems in place to assess and monitor the quality of service provided. For example, we saw that meetings were held regularly with the people living in the home.

We also looked at the results from the Quality Assurance survey that had been carried out in October 2013. We saw that the responses from people using the service and their relatives were mostly very positive, with the majority of scores being above average.

We noted that the manager had an 'open door policy' and actively encouraged comments, suggestions and feedback from the people living in the home, their friends and family and relevant professionals.

One person we spoke with told us: “I like to sit here by the window and read or just watch the world go by.” And, “I like to have my meals with other people in the dining room, except for my tea, as I just like to have a piece of cake then”.

Some of the people we spoke with in the garden said: “It’s lovely sitting out here, especially when the weather’s as nice as this.”

Another person told us: “I’m just here for a holiday but I think it’s wonderful. I’m coming back again in September, so that should tell you something shouldn’t it!”

We saw that daily activities were available for people to join in with if they wished. One person told us: “I always know what’s on and when because there are posters on the notice board and the staff remind us of what’s happening.”

All of the people we spoke with told us that they felt safe using the service and had no concerns regarding the way they were supported by staff.

We saw that there were enough staff available to spend time with people, talking or supporting them with various tasks.

One person we spoke with said: "I don’t have any complaints but I would talk to the manager or any of the staff if I did.”

Another person told us: “I can talk to the manager or any of the staff if I’m not happy about anything.”

People we spoke with said they liked living at this home. One person said, “I can’t grumble about anything.” Other comments included, “Staff are always kind,” and “There are enough staff, I don’t have to wait.” People spoke warmly about staff and the interaction between staff and people at the home was appropriate, friendly and supportive.

People said they felt safe and if they had any worries or complaints that they would speak with staff or the manager. One person told us, “I would speak to the manager, I have no complaints.” People said they could spend their time as they wished and one person said, “I like to read in the lounge.” Another person had enjoyed spending time in the garden, tidying the flowerbeds.

We were told that people could have visitors whenever they wished. A person said, “My family can visit me when they want, they are always welcome.”