The inspection took place on 3 and 4 October 2016. The inspection was unannounced. This meant the service didn’t know we would be inspecting them.The Sycamores is a residential care home in the Tameside area of Manchester. The home provides personal care to older people and people with dementia type conditions. It is situated close to local amenities and transport links. The service was registered for 60 people and at the time of our inspection there were 45 people using the service.
The home had a registered manager employed to manage the service. 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 found that the service had issues with infection control and mal odours were present throughout the service, in corridors, in communal areas and peoples bedrooms.
Poor hygiene standards were evident within the service.
People’s personal care needs were not always met in accordance with their care plans.
People’s dignity and privacy was not always observed.
We spoke with a range of different team members; care, kitchen, maintenance, laundry, activities co-ordinators and domestic staff. They told us they felt well supported and that the manager was supportive and approachable. The manager was not present at the time of our inspection and was on annual leave so the inspection was carried out with the deputy manager. Throughout the day we saw that people who used the service and staff had a good rapport with the deputy manager.
Although the deputy manager was busy throughout the inspection the atmosphere within the home was sedate. We saw that some staff interacted with each other and the people who used the service in a friendly, supportive, positive manner. However we also observed some negative staff attitudes.
We observed how medicines were administered. We looked at how records were kept and spoke with the senior staff about how this was carried out and how staff were trained to administer medicines and we found that the medicine administering process was safe.
From looking at people’s detailed care plans we saw that they were written in the first person and contained some personal history information. The care plans did contain a one page profile however these were more task focussed than ‘person centred.’ Person centred is when the person receiving support is central to all decision making related to their support. Care plans were regularly reviewed and updated by the care staff and the registered manager.
Individual care plans contained risk assessments. These identified risks and described the measures and interventions to be taken to ensure people were protected from the risk of harm. The care records we viewed also showed us that people’s health was monitored and referrals were made to other health care professionals where necessary, for example: their doctor, optician or district nursing team.
Our observations during the inspection showed us that people who used the service were supported by sufficient numbers of staff to meet their individual needs and wishes. However we found different agency staff were used regularly who didn’t always know the people who used the service.
When we looked at the staff training records the information contained indicated staff were not always supported to maintain and develop their skills through training and development opportunities as some staff training was out of date or incomplete.
We saw that the physical environment throughout the home was not dementia friendly and did not always reflect best practice in dementia care or meet the standards set out in national guidelines.
Staff we spoke with told us they had regular supervisions and appraisals with the manager, where they had the opportunity to discuss their care practice and identify further mandatory and vocational training needs. However when we looked at records they indicated that some people were not receiving supervision and we found no recorded evidence of appraisals.
People also had access to advocacy when we inspected and there were services promoted if needed. Advocacy is support that is available for people to help them speak up and to exercise their rights.
We saw people were encouraged to eat and drink sufficient amounts to meet their needs. We observed people being offered a varied selection of drinks and snacks. The daily menu that we saw offered choices and it was not an issue if people wanted something different. People who had special dietary requirements for example diabetes; we found they were accommodated for appropriately.
We saw a complaints and compliments procedure was in place. This provided information on the action to take if someone wished to make a complaint and what they should expect to happen next.
People were encouraged to participate in activities that were organised including; arts and crafts, reminisce activities, bingo and dominoes. We saw activity co-coordinators spending their time positively engaging with people as a group and on a one to one basis in activities throughout out our inspection.
We found a quality assurance survey took place regularly and we looked at the results. However these audits were not consistent and results not always acted upon. These didn’t highlight the issues we identified during our inspection.
We found people who used the service and their representatives were regularly asked for their views at meetings and in an annual survey however we saw that no actions plans were in place to implement suggestions made from the surveys.
During the inspection we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
The overall rating for this service is 'Inadequate' and the service is therefore 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.