All inspections: Sydmar Lodge - Care Quality Commission

We carried out an unannounced focussed inspection on the 17 May 2016. This meant the staff and provider did not know we would be visiting.

Sydmar Lodge provides accommodation for up to 57 people who require support with their personal care. The service provides support for older people and people living with dementia. At this inspection, the manager informed us there were 40 people using the service during the inspection. The premise is a purpose-built care home with passenger lift access to the first and second floor.

The provider recently employed a new manager who was in the process of applying to become the registered manager for the service. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law. 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 previously visited this service for an unannounced focussed inspection on 24 August 2015. During that visit, we found that people were not protected against the risk associated with the unsafe management of medicines, which was a breach of regulations.

At this focussed inspection, we checked to see that improvements had been implemented by the service in order to address the breach of regulations. This report only covers our findings in relation to that. Reports from our last comprehensive inspections are available on our website by selecting the “all reports” link for Sydmar Lodge at www.cqc.org.uk.

At this inspection on 17 May 2016 we looked at arrangements for the management of medicines and found that improvements had been made. We reviewed the provider’s action plan and saw evidence of the actions they had taken.

We looked at the management of medicines. There were concerns at the last inspection that people may not have been receiving their medicines as prescribed. We saw improvements had been made to the ordering process for repeat medicines to ensure people got their medicines on time and that regular stock checks were being carried out. We found no incidences on this inspection where people had not received their medicines as prescribed. This was an improvement in comparison with our previous visit.

We have, however, made a recommendation about the management of medicines. This is because some staff who administer medicines had not received appropriate training. There was also no documentation of regular pain assessment or the use of any pain assessment tools. This meant that people’s pain may not be appropriately managed, especially for those with dementia whose medicines were prescribed as ‘when required’.

We carried out an unannounced comprehensive inspection of this service on 4 June 2015. Breaches of legal requirements were found. This was because we found that people in the service may not have been receiving their medicines as prescribed. We also found that complaints processes were not responsive to people’s needs, and that the provider’s auditing processes were not fully effective at identifying some risks to people’s health, safety and welfare.

We served enforcement warning notices against the provider for two of the breaches because they were similar to concerns we found at our November 2014 inspection. We rated the service as ‘Requires Improvement’. After the June 2015 inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches.

We carried out this unannounced focused inspection on 24 August 2015 to check that the provider had followed their plan and to confirm that they now met legal requirements. The report only covers our findings in relation to these matters. You can read the report from our last comprehensive inspection by selecting the 'all reports' link for Sydmar Lodge on our website at www.cqc.org.uk .

Sydmar Lodge provides accommodation for up to 57 people who require support with their personal care. The service provides support for older people and people living with dementia. At this inspection, the registered manager informed us there were 44 people using the service and there was a maximum practical occupancy of 49 so that people were not sharing rooms. The premises is a purpose-built care home with passenger lift access to the first and second floor.

The registered manager was present throughout the inspection. 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.

At this inspection, people and their relatives told us about the caring nature of staff and the responsiveness of the service. We saw staff attending to people in a pleasant manner, and there was a warm and engaging atmosphere in the service.

We found that complaints processes were now responsive to people’s needs. People’s concerns were being addressed informally. Complaints processes were more accessible and advised complainants what they could do if they were unhappy with investigations. The provider took action to resolve people’s complaints.

The provider had made some of the necessary improvements with medicines. However, we still found some concerns with how medicines were managed safely, which put people at ongoing risk of unsafe care and treatment. In particular, one person had not received a pain-relief controlled drug for 21 days that was prescribed for administration at least every four days. A few other people may not have consistently received their medicines as prescribed, including eye-drops for glaucoma for one person. There were ineffective daily checks to ensure that medicines had been administered as prescribed, and had been recorded.

As a result of the above, we found that the provider’s auditing and governance processes were still not fully effective at identifying some risks to people’s health, safety and welfare.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We are taking enforcement action against the provider for the continuing breach in respect of safe and proper medicines management, and will report on that fully when completed. Details of these breaches are at the back of the full version of the report.

This unannounced inspection took place on 04 June 2015. Our previous inspection of 22 January and 02 February 2015 found that the provider had followed their plans in relation to addressing warning notices we issued following an earlier inspection of 18 November 2014 when we found a number of breaches relating to the care and welfare of people. However, we identified one area of further concern during the last inspection, in respect of accurate and up-to-date record keeping. We carried out this inspection on 04 June 2015 to check that the provider had addressed our previous concerns, and to provide a fresh rating for the service.

Sydmar Lodge provides accommodation for up to 57 people who require support with their personal care. Its services focus mainly on providing support for older people and people living with dementia. There were 39 people using the service at the time of our visit of 04 June 2015. The manager informed us that the maximum practical occupancy was 49 people.

There was no registered manager in post at the time of our inspection visit. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider. However, a new manager had been working at the service for five months. They had submitted their application to become the registered manager and had been interviewed by us for that role.

At this inspection, there was good feedback about the caring nature of staff. We saw staff attending to people in a pleasant manner, and people were responded to in good time. There were enough staff working at the service to meet people’s needs. Care reflected people’s individual needs and preferences. There was also much positive feedback about the increased and improved range of activities provided by the service.

People received meals that were appetising and freshly prepared. People’s nutritional needs were kept under regular review, and actions were taken to address any concerns identified. People received good support with healthcare matters.

New staff underwent appropriate recruitment checks before they were allowed to work with people at the service. Staff received support to deliver care to people appropriately, including through regular training and supervision.

The quality and consistency of record keeping had improved, which helped to demonstrate that appropriate care took place.

The new manager knew the service and people using it well. There were systems of auditing quality and risk at the service, and action was taken to address shortfalls that this process identified. However, we found some risks to people’s health, safety and welfare that the auditing processes had not identified, which showed that the auditing process was not fully effective. ,

Whilst there were improvements in working within the principles of the Mental Capacity Act 2005, we found that this was not being consistently applied for everyone using the service.

Whilst the service had systems of managing people’s medicines, we found a number of discrepancies between medicines records and the remaining stock. We also found that health professional advice for one person’s as-required medicines had not been updated on their records and use of the medicine was not being kept under review within the service. This meant that people in the service may not have been receiving their medicines as prescribed.

Whilst people’s concerns and complaints were responded to, complainants were not advised of what they could do if they were unhappy with the provider’s investigations into their complaint. Complaints processes were not fully accessible to everyone, and there was little analysis of complaint outcomes so as to establish trends and determine lessons to be learnt.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We are taking enforcement action against the provider for two of these breaches because they are similar to concerns we found at our November 2014 inspection. Details of these breaches are at the back of the full version of the report.

We carried out an unannounced comprehensive inspection of this service on 18 November 2014. Breaches of legal requirements were found. We served enforcement warning notices on the provider in respect of three breaches that had the greatest impact on people, in the areas of care and welfare of people, meeting nutritional needs, and management of medicines. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to all the breaches.

We undertook this unannounced focused inspection on 22 January and 02 February 2015 to check that the provider had followed their plan in respect of the warning notices and to confirm that they now met legal requirements in those areas. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Sydmar Lodge on our website at www.cqc.org.uk

Sydmar Lodge provides accommodation for up to 57 people who require support with their personal care. Its services focus mainly on providing support for older people and people living with dementia. There were 37 people using the service at the time of our visit of 02 February 2015.

At our focused inspection of 22 January and 02 February 2015, we found that the provider had followed their plan in relation to the warning notices, however, we identified one area of further concern during our visit, in respect of accurate and up-to-date record keeping.

We found that people were being better protected against the risks associated with the unsafe use and management of medicines. Systems had been improved to ensure that people were offered their medicines as prescribed.

We found that, where people needed support with eating and drinking, they were better protected from the risks of malnutrition and dehydration. The monitoring of people’s weight was taking place regularly, and action was taken to address health concerns arising from this. A new catering provider was operating at the service. This enabled care staff to have more time to support people with eating and drinking where this was needed.

A number of care plans had been reviewed and updated to ensure that they reflected the individual needs and preferences of people, and we saw that this process was being kept under review to ensure completion for everyone. There was also less use of agency staff due to the provider’s ongoing recruitment at the service, meaning people were more likely to receive safe and consistent care from staff who knew their needs and preferences well.

A new call-bell system had been installed. It enabled better monitoring of staff response times. There had also been further reviews of staffing levels so that more staff were working with people, which enabled a better quality of service. We found that people were no longer having to wait for support when they requested it. People and staff fedback positively about this.

There continued to be no registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider. However, a new manager had been appointed since our last inspection, whom we met during this inspection. They had submitted their application to become the registered manager. The provider had kept us informed of changes to the management of the service.

We identified one area of further concern during our visits. We found that some care delivery records were not consistently accurate and kept up-to-date. For example, although charts were in place for three people assessed as in need of repositioning during the night due to high risks of developing pressure sores, these had not been consistently filled out to demonstrate that people had been offered the appropriate support. Records of people’s food and fluid intake, and of having creams and ointments applied, were also inconsistently filled out. This compromised the accuracy of the records, which failed to protect people from the risks of inappropriate or unsafe care.

Overall, we found that the provider had addressed the three breaches of regulations that had resulted in us sending warning notices, but there was one further breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 in relation to records. You can see what action we told the provider to take at the back of the full version of the report.

We will undertake another unannounced inspection to check on all outstanding legal breaches identified for this service.

This unannounced inspection took place on 18 November 2014. Sydmar Lodge provides accommodation and personal care services for up to 57 people. Its services focus mainly on caring for older people including people with dementia. There were 42 people living in the service at the time of our inspection.

We last inspected this service in May 2014 at which we found no breaches of regulations. However, we decided to inspect the service again as a result of information we received since then. This included changes of manager at the service and outcomes of safeguarding investigations.

There was no registered manager in post at the time of our visit, however, a new manager was working at the service and had started the process of applying for registration with us. 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.

At this inspection, we found seven breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and one breach of the Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take at the back of the full version of this report.

We found that people were not being protected against the risks associated with the unsafe use and management of medicines. This was because we found occasions when people had not been given their medicines as prescribed.

We found that, where people needed support with eating and drinking, they were not protected from the risks of malnutrition and dehydration. The monitoring of people’s weight was not taking place regularly. Whilst we saw some people enjoying lunch, sufficient attention was not paid to those with greater support needs.

We found that the planning and delivery of care was not consistently meeting people’s needs and ensuring their welfare and safety. We found instances where care plans did not reflect the changed needs of some people, which put them at risk of receiving inappropriate or unsafe care, particularly because of ineffective communication between staff and the use of a number of different agency staff.

We found that two people’s call-bells were not set up to call for staff assistance. One had been identified for repair six weeks earlier but this had not occurred at the time of our visit, which was compromising their safety and welfare.

We found occasions when there were not as many care staff working as the provider planned for. This affected the delivery of care and support to people. We saw instances where people had to wait, such as for support to use the toilet. We were not assured that there were enough staff available at all times, to keep people safe. However, people’s feedback and our observations of how staff interacted with people showed that staff were patient, kind and caring towards them.

Concerns around people sometimes having to wait for staff support had been raised in meetings for people using the service and their representatives three months before our visit, however, we found that these concerns had not been responded to effectively and that people still experienced waiting for staff support.

The provider did not give us specific details of recent complaints and responses when requested, and the complaints procedure was not on display in the service, which did not assure us of an effective and well-organised complaints system.

The provider’s quality team had recently identified a number of concerns about how the service was protecting people against the risks of inappropriate or unsafe care, however, actions arising from this had not addressed concerns effectively. We also identified shortfalls in the effectiveness of other quality auditing processes used by the provider, including for complaints processes.

We found that the provider’s systems of ensuring that the service enabled people to consent to care and treatment in line with legislation and guidance had not been effectively implemented.

We found that whilst staff were given training to help ensure that they had the skills and knowledge to provided effective care, there had been little staff supervision in recent months. This did not assure us that systems of supporting and guiding staff on how to meet people’s needs were effective.

The provider did not keep us informed of changes to the management of the service, which did not assure us that when there were significant changes to the service, the quality and safety of the service would be maintained, which our overall findings confirmed.

Sydmar Lodge provides accommodation for up to 57 people who require nursing, personal care and support on a daily basis. The focus is on caring for adults over 65 years of age including those with dementia. When we visited, 37 people were living in the home.

People told us they were happy with the care and support they received. They told us they enjoyed the activities provided in the home. Comments from people included, “The activities are great, I can choose to take part, I really like the activities co-ordinator. They also told us care staff were “very good” and “its fantastic here, staff treat us well and like individuals. They will discuss my health issues with me and listen to my thoughts and wishes.”

People received the support they needed at lunch time and they were encouraged to make choices about what they ate and drank. However people told us that the food was not always appropriate to the Jewish culture.

The care staff we spoke with demonstrated a good knowledge of people’s care needs, significant people and events in their lives and their daily routines and preferences. They also understood the provider’s safeguarding procedures and could explain how they would protect people if they had any concerns.

The home’s manager had been in post for one month and was not registered with the Care Quality Commission.

We found the provider to be meeting the requirements of the Deprivation of Liberty Safeguards.

We carried out this unannounced inspection to check whether the provider had addressed the compliance actions arising from our last inspection of 16 April 2013. At that time, some aspects of the service's care planning and delivery processes were not protecting people who use the service against the risks of receiving care that was inappropriate or unsafe. Additionally, staff were not supervised frequently, and most care staff had not received dementia or wound-care training.

At this inspection, we found that matters had been addressed. Care records indicated that people received appropriate support in respect of nutrition and pressure care management. In particular, food, fluid and turning charts were up-to-date and being consistently recorded for anyone with high needs in these areas.

The provider had introduced an on-line training package for staff since our last inspection. Many staff had now completed the dementia training course, and wound-care training was ongoing. All the staff we spoke with told us they felt supported by the manager and senior staff, and there was sufficient evidence of individual staff supervision meetings taking place since the April inspection.

We also spent time talking with five people who use the service and one visitor. People praised the service and the care provided. Comments included, 'I'm very satisfied here' and 'all the staff are very pleasant.' We saw that staff worked as a team and attended to people in a pleasant manner.

We spoke with ten people who use the service and three visitors. People praised the service and the care provided. Comments included, 'this is the best home in the area.' Everyone talked positively about the staff. 'They are very helpful,' one person said.

We found that people were treated with respect and dignity, and were supported in promoting their independence. People said they were asked before being provided care. Some people told us of being encouraged to walk, to regain some independence. People told us there were different activities provided every day, and that they were kept informed and involved with this.

We found there were systems to assess and monitor quality and risk at the service. These included consideration of people's views. 'We have meetings where we can bring anything up and we are listened to,' one person told us.

People said that they were happy with the care they received. Comments included, 'I am well cared for.' Staff worked as a team and attended to people in an unhurried and pleasant manner. However, we found that systems of planning and delivering care in respect of weight and nutrition, and for delivering pressure care management, were not always meeting people's individual needs and ensuring their welfare and safety.

We also found that arrangements for staff supervision and the training of care staff on dementia were not suitable. This put people at risk of receiving care that was not safe or at an appropriate standard.

We spoke with seven people who use the service, and one relative, during this inspection. Most people spoke positively about the standard of care provided, with comments such as, 'We're well looked after here.'

We watched how staff interacted with people, which we saw to be respectful and friendly. Most people feedback positively about the staff, with comments including that staff were helpful and treated people well. A relative we spoke with also described the staff as 'kind and attentive.'

One person who uses the service told us that the curtains in one lounge had not been improved on, despite wear and tear, and matters having been previously raised with the provider. Although not a risk to people using the service, the outcome of adequate maintenance of the environment was not being fully experienced by them.

The overall purpose of this visit was to review the improvements that the home had made in response to Warning Notices which had previously been issued by the Care Quality Commission (CQC). The Warning Notices identified failures with ensuring that people were protected by accurately maintained records, and with the effectiveness of systems designed to enable the provider to assess and monitor the quality of the services and to identify, assess and manage risks relating to people at the service. At this visit, we found that Sydmar Lodge had met the requirements of the Warning Notices.

The majority of people who use the service spoke positively about it. Comments such as, 'Everything's nice here. I'm pleased I'm here,' were reasonably typical.

The majority of people spoke positively about standards of care, and said that staff knew them well. People generally told us that staff listened to them and acted on their wishes. As one person put it, 'Staff are obliging and friendly.' Some people had reservations however about the approach of some staff. As one person put it, 'You feel they're doing you a big favour.'

We found that appropriate records in respect of each person were not accurately maintained and in some cases were poorly completed. Care plans did not always clearly specify people's current needs and did not always include appropriate information in relation to the care and treatment provided to each person. This meant that people were not always protected against the risk of unsafe or inappropriate care and treatment.

We also found that the registered provider was not effectively operating systems to both regularly assess and monitor the quality of the services, and to identify, assess and manage risks relating to the health, welfare and safety of people who use the service. This meant that people were not sufficiently protected against the risks of inappropriate or unsafe care and treatment.

There were a range of comments overall about Sydmar Lodge. A majority of people were happy with the services provided, with comments such as 'It's a very good service. I've no grumbles' and 'I am happy here. If I have to be in a home then this suits me fine'. However most people also felt that there were not enough staff working. We heard comments such as, 'Staff haven't got time to talk.' Some people explained how insufficient staffing numbers meant that had to wait for things and so not receive timely care, which for one person for instance meant that they were left feeling cold.

People were generally happy with the quality of staffing. Comments such as, 'They are lovely carers who treat everyone the same' meant that the service was recruiting staff that people liked. People said that were generally treated respectfully and they felt that they were living in a safe, warm and friendly environment. They also told us that they could access health professionals such as doctors when needed.

There were mixed responses about the food provided, ranging from 'very good' to 'plain.' People felt they had food choices however, and we were told, 'The cook would do me anything I wanted if asked.' There was also praise for the activities provided, with comments such as 'There's always something to do, especially in the afternoon.'

Overall, people tended to praise the service more often than not, with some people very happy about standard of care provided. It was only staffing levels that people consistently raised concerns about. Our overall findings however raised concerns in some other outcome areas, as detailed below.

Archived: Sydmar Lodge

All Inspections

17 May 2016

During an inspection looking at part of the service

24/08/2015

During an inspection looking at part of the service

04/06/2015

During a routine inspection

22/01/2015 and 02/02/2015

During an inspection looking at part of the service

18/11/2014

During a routine inspection

01/05/2014

During a routine inspection

30 August 2013

During an inspection looking at part of the service

16 April 2013

During a routine inspection

5 April 2012

During an inspection looking at part of the service

27 January 2012

During an inspection looking at part of the service

15 June 2011

During a routine inspection