This inspection took place on 07 October 2014 and was unannounced. We visited again on 09 October 2014 and the provider knew we would re-visit on that date.
Sycamore Care Centre is a 113 bed care home. The service provides personal and nursing care to older people with mental health and general care needs. The service is set in its own ground and is a detached converted building with extensions to the rear and side. It is placed in a mainly residential area but has access to amenities and services.
The home has a registered manager in place.
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.
We saw records that showed staff had been trained in recognising and responding to suspicions of abuse. Staff could articulate their understanding well.
People’s needs were assessed and good plans were in place showing their needs. We saw that staff knew what those needs were and were effective in meeting people’s needs.
People were encouraged to live healthy lifestyles within the home. Special provisions were made for those people who had special dietary requirements such as limitations due to diabetes, specially prepared food because of difficulties swallowing, or supplements to help them sustain or gain weight.
Day to day people were given choices about the things they wanted and the things they needed. Records and observations showed that staff supported people to make choices for themselves where they could. When people were not able to make choices for themselves, the home was careful to ensure their rights were protected by ensuring other important people such as family or health care professionals were involved in decisions made for them. We saw assessments of peoples mental capacity were undertaken and where required they involved peoples families, GPs, other health professionals and the local authority.
The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. These safeguards exist to ensure people are only deprived of their rights if it is within their best interests. The registered manager understood the home’s responsibilities under the Mental Capacity Act 2005 (MCA) and we saw records in the care files that showed the home had followed this requirement and received confirmation that it was appropriate from the authority
We examined the medication records and observed the processes for giving medication and saw that the staff used safe methods to ensure people received the medicines they should when they needed them.
The home smelled and looked clean and the home had effective systems in place to manage infection controls.
We saw records relating to staff training. They were comprehensive and showed clearly what training staff had undertaken and what needed renewing. We staff putting some of that training into effect. For example we saw several instances where staff used hoists to move people. The seemed capable and confident in using the equipment.
We saw that people were consulted about their care We saw records showing how they had been involved what they said and what they wanted from the home. We saw staff putting that information into practice such as preferences about the food they ate. We saw in day to day interactions that staff were courteous and always asked people before performing a task for them.
We saw good records showing where people were at risk from dehydration and malnourishment. We saw that the home monitored those high risk areas. In one case we saw that the person was not always achieving their required daily fluid intake. We asked staff about that and they said they were seeking guidance from a dietician to look at ways of improving the situation.
We saw good assessments and care plans in relation to people’s health needs. There were corresponding day to day records that showed how staff were helping people meet those needs by seeking guidance from other health care professionals, the local authority or main stream services such opticians and dentists.
People living there and their families spoke highly of the care given by the nurses and care staff.
People felt the home was well run and staff checked that people and their relatives felt this way through group meetings and surveys of people living in the home, their families and other professionals involved with the home.
Staff received the support and guidance they needed to meet people’s needs. Records showed that staff had suitable training to care for the people who lived there.
People thought that staff were active in getting the support people needed. We were told, “The nurses here are tenacious to pursue care and get results. They persist until they get answers for us.”
When talking about the changes that staff within the home had made on one person’s life a relative said, “My [relative] is now like a different person I have my [relative] back.”
Apart from leaving some medicine records on top of medicine trolleys unattended we staff were careful to protect people’s privacy and dignity. We saw that they were careful to ensure people were covered appropriately, we saw them shutting doors behind them when they delivered personal care. We saw them speaking quietly so they could not be overheard when asking a personal question.
One relative told us, “The staff are really good at ringing us to tell us things that have happened and ask our opinion about things,” Another said, “I get phone calls all of the time. I was fully involved in the decision to get a DoLS (Deprivation of Liberty Safeguards) authorisation in place for my relative and fully agreed with it.”
We saw records of various surveys the home undertook to gain the opinions of people who lived there, their relatives and the staff who worked in the home. These showed various suggestions about changes and we saw that the manager included these in plans to develop the service.
We saw good evidence that people’s plans and assessments were changed over time as their needs changed. Relatives felt they participated in the care planning processes. One relative told us, “The nurses here are tenacious to pursue care and get results. They persist until they get answers for us.”
We examined training records and saw that staff had received training relative to the roles they undertook. We looked at the records for staffing and saw that the home had sufficient staff with the right training to provide the care needed. There were two people who provided a range of activities for people who lived in the home. We saw group activities such as ball games to improve suppleness and coordination, we saw games being played and we saw individuals getting personal attention in one to one situations.
Staff felt they were well managed and had access to the registered manager when they needed it. The spoke about supervisions (one to one personal guidance about their roles) and training and they felt they had sufficient training to do their jobs well.
The registered manager and the provider had systems in place to check how the home was performing. They gathered information from people who lived there their relatives and the staff. The results of those surveys were readily available in each area of the centre. The manager had systems that gathered information about care plans and if they had been reviewed following changes in need. We saw evidence of that updating process in both paper and electronic records.
The manager informed us the home had a system in place [the daily report] where they gathered information daily from each unit. That information was passed around all of the senior management team who shared any queries or concerns amongst the staff team. This included actions that needed to be taken within a given time frames.
The daily report and reports from staff who worked nights formed part of the agenda for the homes Monday morning head of department/ senior staff meetings. The provider had systems in place that checked that day to day management tasks were being undertaken There were systems to check that staff had supervision, training and annual reviews of their work. There were systems to capture information about falls, complaints and other incidents that were then included in plans of Monday morning senior meetings.