Sycamore Court

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question good. At this assessment the rating has remained good. This meant people were safe and protected from avoidable harm.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice. Staff told us that the registered manager and their colleagues helped them learn and improve practice when things went wrong. For example, lessons learnt were discussed in staff meetings, supervisions and daily handovers. The registered manager told us they investigated accidents/incidents events and had learnt from these. They gave an example of improvements they had made around people who experienced repeated falls, such as, using a ‘sensor eye’, that identified that a person was moving and at risk. This had also involved communication with family members and staff to ensure that restrictions were not unduly excessive. Processes for investigating, analysing, and responding to accidents, incidents, complaints, and safeguarding alerts were in place, with systems for families, people and staff to raise concerns or share their views. The service had a service improvement plan in place which detailed plans for ongoing improvements.

Not everyone could share their experience of moving in to Sycamore Court but one person said, ”Very good at keeping on top of all my appointments.” families told us "Everything is very organised, they always have the special equipment to support when they have appointments they arrange everything", and "I know my relative see’s a doctor, and a chiropodist, a hairdresser does their hair," and "They arrange hospital appointments and ensure they attend them, they keep us informed about health appointments, so we can go along if we can." Staff and leaders demonstrated good knowledge of referring to external professionals when needed. Referrals to the multidisciplinary team had been requested via the GP, these included requests for support from Speech and Language therapists (SALT), the community nurses and the community mental health team. They also explained how they worked closely with the community rehabilitation team to prevent risk of people falling. Visiting professionals spoke of a positive relationship with the home and we saw that community nurses were informed of all new admissions and a GP visit arranged as soon as possible

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately. Staff were knowledgeable and confident about safeguarding processes. They understood their safeguarding responsibilities to keep people safe, how to challenge discrimination and report any concerns. They knew how to recognise the signs of potential abuse and knew how to raise alerts and report concerns, by whistleblowing if necessary. The management team explained that people’s capacity was assessed in accordance with the Mental Capacity Act (MCA) and assessments were stored within people’s records. People were supported with kindness and respect by staff who knew them well. There was a safeguarding and whistleblowing policy in place, and staff confirmed they had read the policies as part of their induction and training. We saw that procedures had been correctly followed, and the provider had made referrals as required to the local authority and notified CQC appropriately. There was a file kept by the registered manager of all the DoLS submitted and their status. The service worked within the principles of the Mental Capacity Act (MCA) and if needed, appropriate legal authorisations were in place to deprive a person of their liberty (DoLS). Records reflected MCA assessments had been undertaken to consider people’s capacity to make decisions about their care. Care plans contained information about where decisions were being made in people’s best interests, and the reasons for this. DoLS applications and authorisations were in place for people around any restrictions within their lives that they did not have capacity to consent to. Systems to review these were seen.

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them. Staff were able to tell us about people and the risks associated with their care. They told us how they supported them safely. This included pressure area management, safe mobility and what to do when people become distressed. Staff told us, “We read the care plans and risk assessments; we get to know people and so pick up when people are not well.” We discussed with staff, certain people who had either bruising or dressings on and they were able to discuss their treatment plans and any potential risks. Staff told us that additional checks were in place for people at risk of falls. These included sensor mats, location checks, appropriate footwear checks, and if necessary 1-1 support. People who were at risk from pressure damage had air flow mattresses and these were set correctly as per manufacturers guidance against peoples’ weight. People who were at risk from falls, had sensors that alerted staff the person was up and at risk. Call bells were in peoples' rooms, and there were risk assessments in place for those who couldn't use a call bell and we saw that staff checked them regularly. People were moved with the correct equipment and assisted by staff in a safe way. corridors were free from obstruction, allowing people to walk safely if they choose to. Systems and procedures were in place for unusual events, such as fire, loss of power, and other emergencies. Staff received training in areas of potential risk such as moving and handling, first aid and health and safety. Personal Emergency Evacuation Plans (PEEPS) had been completed for each person. PEEPS give staff or the emergency services detailed instructions about the level of support a person would require in an emergency such as a fire evacuation.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. Not everyone was able to talk to us, but those that could, told us, “I like it, my room is as I want it, I have a call bell I use when I need anything, I feel very safe," and “I have all I need, my bits are here and staff are very good at checking that everything is working.” Relatives told us "It’s a warm and pleasant home, no concerns at all. They have the necessary equipment, no concerns at all -always looks fine, they are decorating at the moment.” Staff told us, "We get training, in health and safety, fire, first aid and moving and handling, we do fire evacuations and tests, it’s mandatory.” The environment was safe and generally well cared for. There were areas that required attention and this had been identified through audits and had been included on the maintenance plan. There was a dedicated maintenance person who took responsibility for the day to day maintenance of the building and checking of equipment. This included arranging fire drills. Care equipment was in good working order and documentation to support regular servicing was seen. The premises and gardens was accessible for people with mobility needs and safe for those who walked with purpose. Health and safety checks had been undertaken to ensure safe management of utilities, food hygiene, hazardous substances, moving and handling equipment, staff safety and welfare. There was a business continuity plan which instructed staff on what to do in the event of the service not being able to function normally, such as a loss of power or evacuation of the property. There were detailed fire risk assessments, which covered all areas in the home. Premises risk assessments and health and safety assessments were reviewed on an annual basis, which included gas, electrical safety, legionella and fire equipment.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. People and relatives told us, "Not more carers, but housekeepers, one has left recently," and "I think more activity staff would be helpful, so there could be more trips out for them." Staff told us, “Staffing is alright, sometimes we need more staff if people are poorly or more confused, but we manage," and "We do discuss staffing levels, because it can be busy, we all think it would be good to have more help at meal times, breakfast is always busy as people are asking for assistance getting up, can be manic." The provider had a recommended quota of 1 member of staff per 5 residents. The registered manager was aware that this did not incorporate the differing needs of people living in the home. Staff told us although staffing levels were safe and they were managing to meet people’s needs, it could be a struggle to meet people’s nutritional needs consistently. We shared this feedback with regional management. We looked at 6 months of rotas and the staffing levels were consistent supported by relief staff to cover sickness and holidays. Care delivery was supported by records that evidenced that people’s care needs were being met. However, on reviewing audits for weight loss and falls, it was highlighted that staffing levels needed to be reviewed, this is further mentioned in the well led section of this report. Staff were recruited safely. The provider undertook checks on new staff before they started work. This included checking their eligibility to work in the UK, and Disclosure and Barring Service (DBS) checks. The DBS helps employers make safer recruitment decisions and prevent unsuitable people from working with vulnerable people. Registered nurses have a unique registration code called a PIN. This tells the provider that they are fit to practice as nurses.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly. People and their relatives did not share any concerns about the cleanliness of the environment. One person said, “They keep my room lovely and clean, and tidy.” And another said, “I am happy with the place, it seems clean.” A relative said, “I have no cause to complain, always looks clean.” Some staff said that the home can have odours at times, but that the environment is clean and the cleaners work hard. One said, “I think we need another cleaner, we only have one at the moment, it’s a lot for them to do.” We saw that the home environment was kept generally clean and tidy, however there were unpleasant odours in some areas of the service. This was discussed with the registered manager and solutions explored. The provider was currently recruiting housekeepers and using agency as a short term solution. The provider followed best practice guidelines regarding the prevention and control of infection which was updated as guidance changed. The provider’s infection prevention and control policy was up to date and all staff had received infection control and food hygiene training. Cleaning schedules were completed and regular audits were carried out and actions planned to address any shortfalls, however these processes had not identified the issues we identified. This is reflected in the well-led question.

People and relatives said, “Staff keep us informed of any changes, let us know what the doctor says. I trust them totally and get informed of changes. I have no concerns,” and “I get my medicines on time and never missed.” Staff told us they complete training before administering medicines and then have to pass a regular competency assessment. One senior care staff said, “We all receive really good training and support from the registered nurse.” Staff who gave medicines had the relevant knowledge, training and competency that ensured medicines were handled safely. We observed staff giving medicines safely and were recorded accurately. Risk assessments were in place for certain medicines. All discrepancies and medicine errors were recorded and investigated and action taken as required. Daily and monthly audits were carried out, and any shortfalls were addressed. Protocols for 'as required' (PRN) medicines such as pain relief medicines were in place.