Sydenham House

Sydenham House is a residential service providing personal care for up to 49 people, some of whom are living with dementia. The service consists of one purpose-built building, which includes individual bedrooms and communal spaces spread over two floors and an accessible garden. At the time of our inspection there were 40 people using the service.

People’s experience of using this service and what we found

We found significant concerns with staffing levels, management of medicines and risks to people, Mental Capacity assessments, staff support and management oversight which placed people at increased risk of harm.

The service did not have a robust system in place to monitor the quality and safety of the service. Management oversight did not identify or address the issues we found during the inspection.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

The provider did not always promote a positive culture at the service. We received negative feedback from people and staff about the pressures of low staff numbers. We found this impacted the quality care people received.

Staff followed infection prevention and control measures.

Appropriate recruitment procedures were in place for staff employed by the service to ensure they had been assessed as safe to work with vulnerable adults.

People and relatives told us people felt safe with the care and support they or their relative received. Policies and procedures were in place to protect people from abuse.

People had access to a balanced and healthy diet and were satisfied with the food on offer.

Relatives told us communication was good with the service and they felt satisfied with the support their relatives received.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 30 December 2019) and there were breaches of regulation. At this inspection we found the provider remained in breach of regulations. The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 10 December 2019. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions safe, effective and Well-led which contain those requirements.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Sydenham House on our website at www.cqc.org.uk.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We made a recommendation about transition arrangements when people start living at the service.

We found several breaches of regulation and issued the registered manager and provider with warning notices in relation to safe care and treatment and good governance.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Sydenham House is registered to provide accommodation with personal care for up to 49 people. When we visited, 43 people lived there, however four people were in hospital.

People’s experience of using this service and what we found:

People were supported by staff that were caring and treated them with dignity and respect. Feedback we received from people and their relatives about care provision and staff was positive. We made observations that people were relaxed in the company of staff.

Governance systems included internal and provider level audits and regular checks of the environment and service to ensure people received good care. We found these systems were not always fully effective in driving improvement. Whilst it was not evident this had any significant impact on people, it did not evidence a fully effective governance system was in operation and placed people at risk.

Not all risks in relation to the management of medicines were managed safely and this placed people at risk. We reviewed the plans in place to support people safely from the building during an evacuation. Some of these were either inaccurate or not completed, placing people at risk. We found for one person who had a specific medical condition a care plan on the management of the condition had not been completed. The service management and some staff were not aware of this person’s condition.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests. However, the policies and systems in the service had not ensured that all of the people who were deprived of their liberty were done so with the appropriate legal authority.

Staff had received safeguarding training and the service had appropriate safeguarding systems and processes. Staff we spoke with were knowledgeable about when and how to report safeguarding concerns. There were effective systems that ensured the service and environment were safe.

People were supported by staff who received regular training and had the skills and knowledge to meet their needs. Staff told us they were well supported by the service management and commented positively on the service leadership. The service worked together with a range of healthcare professionals to support people where needed.

Since 2016 onwards all organisations that provide publicly funded adult social care are legally required to follow the Accessible Information Standard (AIS). The standard was introduced to make sure people are given information in a way they can understand. There was evidence that where needed, the service supported people to communicate and understand through the use of pictorial aids.

People's concerns and complaints were listened to and responded to. People and their relatives commented positively about the service management and the quality of care provided. People spoke positively about the activity provision within the service, and there were a number of links between the local community and Sydenham House.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection:

The last rating for this service was Good (published May 2017)

Why we inspected:

This was a planned inspection based on the previous rating.

Follow up:

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety and will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Sydenham House provides personal care and accommodation to up to 49 people. The home specialises in the care of older people including a small group of people living with dementia. At the time of this inspection there were 36 people living at the home.

There is a registered manager in post. 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 last inspection of this service was carried out in February 2016. At that inspection we rated the service ‘Requires Improvement.’ We found that improvements needed to be made to make sure people received their meals in a timely manner. We also found that although the provider’s quality assurance systems had highlighted areas for improvement these had not always been acted upon to make sure people received an improved service. Following the inspection the provider produced an action plan which had resulted in improvements to the service provided to people.

At this inspection we found there were enough staff at meal times to make sure people did not have to wait for an excessive amount of time for their meals. People who needed help to eat their meal received this in a timely and discreet manner.

The provider and registered manager were using their quality assurance systems effectively to make improvements to the service offered to people and to their safety. These included changes to staff deployment at night and responding to satisfaction surveys.

People felt safe at the home and with the staff who supported them. People told us staff were always kind and caring towards them. One person told us “I definitely feel safe and I sleep well because I have no worries.”

People told us they were able to make choices about their day to day lives and staff supported them when they requested help. People felt there were enough staff to meet their needs and said staff responded to them promptly when they needed assistance. Staff received training which enabled them to provide safe and effective care to people.

There were opportunities for people to take part in activities or to pursue their own hobbies and interests. People’s privacy was respected and they could choose how and where they spent their time. One person told us “You can do what you like within reason. They seem able to accommodate most things.”

Staff monitored people’s health and supported them to access healthcare professionals to meet their individual needs. People received their medicines safely from staff who had received specific training.

The registered manager involved people in the running of the home by arranging meetings and giving people opportunities to be part of the recruitment process for new staff. People felt confident that if they raised any concerns these would be listened to. One person told us “I have said when things don’t suit and they have always listened and done something about it.”

This inspection was unannounced and took place on 10th February 2016.

Sydenham House provides care and accommodation for up to 50 people. The home specialises in the care of older people. One part of the home, Daisy Way, had been developed as a dementia friendly unit where people could enjoy a quieter environment. At the time of this inspection there were 45 people living at the home.

The last inspection was carried out on 18 February 2014. No concerns were identified with the care being provided to people at that inspection.

There is a registered manager in post. 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.

Most people were satisfied with the choice and quality of food provided. Some aspects of the service of food required improvement as people waited too long and this affected their enjoyment of their meal.

The home had a quality assurance system in place designed to gather information from people who lived in the home and the staff who supported them. Some aspects of this process needed to be improved.

People felt safe at the home and praised the staff who supported them One person said “If I had any worries I would talk to the manager. I have a key worker who is very helpful. And the staff are very nice. I am definitely safe. No worries at all.”

There were sufficient numbers of staff available at all times to keep people safe and to meet their needs. People said “They come pretty quickly when you ring the bell. I have always got one by my bed.”

Risks of abuse to people were minimised because the service’s recruitment procedures included checks to ensure new staff were suitable. Staff received training to enable them to recognise and report any possible abuse. Staff felt confident that any concerns reported would be dealt with to make sure people were protected. People received medicines safely and at the prescribed times.

People told us they were well cared for. They felt staff showed kindness towards them and were always polite. “Staff are nice people. Very gentle.” “It is lovely. They can’t do too much for you. The first thing they say when a visitor arrives is do you want a cup of tea. We couldn’t be better looked after. Really lovely.”

People received care and support that met their needs and took account of their individual wishes. People had access to the healthcare professionals they needed. Staff were prompt in seeking advice from appropriate professionals if they had concerns about a person’s health. A small number of people’s health needs were not followed up appropriately.

People were involved in decisions about any care and treatment and were able to make choices about their day to day routines. Care plans contained risks assessments which outlined measures in place to enable people to take part in activities with minimum risk to themselves and others.

People knew how to make a complaint if they were unhappy with any aspect of their care. People were confident that any complaints made would be taken seriously and action would be taken to address any issues.

People we spoke with said 'staff ask if we need anything' and 'staff offer to help'. Other comments included 'it's lovely here' and 'they're caring'. One person said 'you ask them anything and they'll do it'. Staff we spoke with said 'we know people's needs quite well'.

Care plans were seen to contain detailed information about activities of daily living and staff told us that the support plans gave them the information they needed to be able to provide appropriate care.

We observed lunch in the dining room. Whilst most people enjoyed their meals we saw that one person did not have a pleasant dining experience.

People staying in The Willows, which was a 'step up, step down' unit for people not well enough to go home but who didn't need to be in hospital, were encouraged to self-medicate for the last week of their stay to ensure they were able to manage.

We saw that there was a comprehensive quality assurance system in place which linked to the essential standards of quality and safety.

We spoke to fourteen people in the home. Everyone asked was happy with the care and support that they received. People said "We couldn't be better looked after. Staff are good. Really good.'

We saw that the home was clean and there was evidence of infection control measures in place in people's rooms and throughout the service.

We saw that the home operated a system of recruitment that was designed to employ staff who were suitable for their post and safe to care for people in the home.

The provider Somerset Care Ltd had developed a quality assurance programme which was in line with the essential standards of quality and safety. The programme combines themed interviews with people who live in the home, direct observation of staff and a comprehensive system of audits.