About the service: The Sycamores is a residential care home that was providing personal care to 35 people aged 65 and over at the time of the inspection.

People’s experience of using this service:

• The service had improved since the last inspection and was no longer in breach of any regulations.

• People, relatives and staff spoke positively about the improvements that had been made. One person said, “The managers and senior staff are all on our side. They share values and want what's best for the people that live here and the staff."

• People told us they were happy living at The Sycamores. Comments included, "I like it here. This is my home" and "I wouldn't want to live anywhere else.”

• Staff were kind and caring, treating people with respect and maintaining their dignity.

• People were able to make choices and were involved in decisions about their care. Staff asked people for consent before providing care. However, improvements were needed in how capacity assessments and best interest decisions were recorded.

• People received personalised care which met their needs and risks were well managed. Care records had improved and many had been transferred to the electronic care recording system. The registered manager recognised further improvements were needed to make sure all the care records were accurate and on the electronic system.

• People enjoyed the food and their dietary needs were met.

• People’s health care needs were met although arrangments needed to be made for people to be registered with a dentist. Medicines were managed safely.

• People told us they felt safe in the home and systems were in place to manage any allegations of abuse.People and relatives knew how to raise any concerns and had confidence in the complaints process.

• Most people felt there were enough staff to meet their needs, although some thought there should be more. Many people chose to stay in their rooms which we saw had an impact on staff availability in communal areas. The registered manager agreed to take this into consideration when reviewing the staffing levels.

• Activities for people were limited; some enjoyed one-to-one time with a staff member, however, other people told us there was little for them to do. This was due to improve as a new activity organiser was starting in post the week after the inspection.

• Recruitment processes ensured staff were suitable to work in the care service. Staff were well trained and supported by the registered manager.

• The home was clean and well maintained and people’s rooms were highly personalised. However, improvements were needed in the environment to help people living with dementia find their way around the home.

• People, relatives and staff praised the management of the home and spoke highly of the registered manager who they said was approachable and always available. Quality audits and checks had improved. The provider had an ongoing action plan to ensure improvements were maintained and developed further.

Rating at last inspection: At the last inspection the service was rated Inadequate (report published 1 October 2018). This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as Inadequate overall or in any of the key questions. Therefore this service is now out of Special Measures.

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

Follow up: We will continue to monitor this service. We will check improvements have been made by completing a further inspection in line with our re-inspection schedule for those services rated requires improvement.

The inspection took place on 14 and 15 August 2018 and was unannounced. This was the first inspection of The Sycamores sine the change of provider in February 2018.

The Sycamores provides care for up to 40 older people. At the time of the inspection 39 people were using the service. The Sycamores is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a 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 had a registered manager although they were spending some of their time managing another of the provider’s sister services. 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 service was not safe because risks to people were not assessed or well managed. Staffing arrangements were not appropriate and new members of staff were not supervised and trained. Medicines were not managed safely. Safe recruitment practices were followed.

People were comfortable in their environment and had access to spacious communal areas and an enclosed garden. All bedrooms were single occupancy with en-suite toilets. However, there was a lack of bathing facilities and people told us they did not receive regular baths and showers.

People’s care records contained very little information about what was important to them and their needs were not identified through the care planning process. People did not receive appropriate support with oral care. Staff did not have guidance around how to deliver personalised care. We have made a recommendation about improving accessible information to meet people's communication needs.

People’s capacity to make decisions was not always assessed when needed, and were not always supported to have maximum choice and control of their lives; the policies and systems in the service did not support this practice

In-house and community activities were very limited although an activity worker had recently been appointed and the management team were confident this would improve people’s social and leisure opportunities. People enjoyed the meals, and were offered regular drinks and snacks.

People told us they felt safe and well cared for. They were complimentary about the management and staff team. Our observations confirmed staff were caring. Health professionals told us people’s health needs were met, and staff followed guidance and advice. Visiting relatives and friends were welcomed, and, where appropriate, staff and management provided information and updates.

The provider did not have effective systems to assess, monitor and manage the service. The provider had a system for investigating complaints and people told us they would raise concerns with staff and the management team, which included the registered manager.

We found five breaches of the Health and Social Care Act 2008 (Regulated Activities) regulations 2014, which related to safe care and treatment, staffing, person centred care, governance arrangements and consent to care.

The overall rating for this service is ‘Inadequate’ and the service therefore has been place in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement proce