Archived: The Sycamores and The Poplars

The Sycamores and The Poplars is a residential care home providing personal and nursing care to up to 72 people. The service provides support to people over 18 years of age, older adults, and people living with dementia. At the time of our inspection there were 27 people using the service.

The care home premises consist of 2 buildings; The Sycamores and The Poplars. At the time of the inspection only The Sycamores was being used by the provider as a place for people to live. The provider’s regional manager told us that The Poplars was closed and would not be used for people to live in until refurbishment work had been completed. Although people were being supported in The Sycamores building, the provider’s laundry and kitchen facilities were in the adjacent Poplars building.

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

People told us they felt safe living in the care home. The provider’s policies and procedures, and the training received by staff, helped keep people safe from potential abuse. The Sycamores living environment was well maintained, which helped reduce risks to people. People were supported by staff who understood their care needs. Staff referred to people’s comprehensive care plans and risk assessments for guidance when necessary.

The provider used a lot of agency nurses, but aimed to use the same ones where possible, so they understood people’s care needs. Staff were safely recruited and their appropriateness to work in care properly assessed. Staffing levels were based on an assessment of the care needs of the people who lived at the care home, and was adequate to meet the needs of the 27 people living in the care home at the time of the inspection.

People’s prescribed medicines were safely managed and the provider’s infection prevention and control measures were appropriate. The Sycamores was well decorated, clean, and hygienic. People received health care support within the care home, and were also supported to access local primary health care services and specialist health care services when needed.

People told us the meals were nice and we saw that some people had been supported to regain an interest in food again, and gain some weight, as part of their assessed care needs. Mealtimes were relaxed and sociable occasions and people had a choice of menu items at each meal. Some people’s health was seen to have improved since they had moved into the care home. People were supported by staff who had received the necessary training to meet people’s care needs.

Staff had a kind and considerate approach to people. The care home had a busy but happy atmosphere. People’s privacy and dignity was protected when personal care tasks were being carried out, and people were supported to remain independent by doing as much for themselves as they were able.

People were supported to engage in a range of individual and group activities within the care home if they chose to. Families told us they found the manager and staff easy to contact and willing to listen to them if they had any concerns. Complaints and concerns were investigated appropriately and responded to by the manager.

Staff told us they felt supported by the manager and the provider. The manager and staff all understood their roles and how to ensure the service met the regulatory requirements. The provider had a comprehensive quality assessment system in place which helped to keep track of the quality of the service they provided, and to take any necessary action to improve things.

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; the policies and systems in the service supported this practice.

The care home had improved since the previous inspection and feedback from people, relatives, and external professionals reflected that.

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 14 November 2019). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

At our last inspection we recommended that the provider consider current legislation on safe storage and management of medicines to ensure safe practices. We also recommended that the provider considered current guidance on providing a dementia friendly environment for people who were living with dementia at the service. At this inspection we found the provider had acted on the recommendations and had made improvements.

Why we inspected

We inspected to follow up on the breaches identified in the previously rated inspection. The inspection was also prompted by a review of the information we held about the service, and feedback received from the local authority adult social services team which indicated the service had improved.

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.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Some areas of the service were not well maintained. There were a number of areas of unpainted wood and flaking plaster. There were a number of floors that required attention to ensure they were fluid impermeable and some water pipes that required attention to ensure they were disinfectable. This compromised infection control measures and the effectiveness of cleaning, which meant this could contribute to the spread of infection to people and staff.

Quality assurance audits undertaken by the provider, were not effective in identifying the shortfalls found during the inspection, though some of the areas mentioned above had been added to a maintenance list. The area manager stated these would be prioritised

We found the following examples of good practice.

¿ The provider had ensured continual supplies of personal protective equipment (PPE). This included face masks and aprons and we saw staff used these appropriately. Staff were encouraged to change their PPE regularly.

¿ Used PPE was disposed of in foot operated pedal bins situated throughout the service. This reduced the potential for transfer of infection.

¿ Staff encouraged people to wash their hands frequently throughout the day. Where this was not possible, hand sanitiser was offered as a means to reduce the transfer of infection.

¿ The provider participated in regular COVID-19 testing of people living in the service and staff. That ensured action could be taken swiftly to reduce the potential spread of infection if a positive test was returned.

¿ Areas were cleaned and disinfected with cleaning products approved to reduce the potential transfer of infection.

¿ Risk assessments had been completed to protect people and any staff who may be at a higher risk if they contracted COVID-19. Measures were in place to support them.

¿ Staff worked in set teams which lessened the potential of cross infection between shift members.

Further information is in the detailed findings below.

The Sycamores and Poplars is a nursing home providing personal and nursing care for older people, at the time of the inspection 13 people were using the service on Poplars unit and 24 people were using the service on Sycamore unit. The service can support up to 72 people across both units.

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

People were not always supported with adequate numbers of staff. The checks around agency staff’s suitability to work at the service were disorganised and did not show clearly that essential details were checked, or some agency staff had received an induction to the service.

People were not always protected from potential harm as safeguarding issues had not been clearly documented, and there was a lack of robust investigations documented following safeguarding concerns being raised.

There were aspects of the service such as the outside areas which had not been maintained to allow people to use and enjoy the facilities. There were improvements required to signage to support people living with dementia as they moved around the service.

People were not always 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; systems in the service did not support this practice. Mental capacity assessments and best interest decisions in place for people were not always consistent and the provider did not always follow the principles of the MCA.

Complaints were not always responded to in a timely way. The service was not always well managed, and the quality monitoring processes had not highlighted some of the issues we found during our inspection. Staff were not always supported in their roles and people and relatives did not always feel their views on how the service was run were listened to.

People’s privacy and dignity was maintained, and their independence encouraged. They were supported by a staff group who knew their needs and cared for them in a respectful and kind way. However, the lack of permanent nursing staff impacted on the continuity of care for some people. Although there was good information on people’s care needs there was some disorganisation of daily care records.

The risks to people’s safety were assessed using nationally recognised assessment tools and measures were in place to mitigate risks but still support people’s independence. People’s medicines were managed safely. There were processes in place to protect people from the risks of infection and staff showed a good understanding of their roles in reducing the spread of infection. People’s nutritional and health needs were well managed by the staff who supported them.

Rating at last inspection and update

The last rating for this service was Good (published 27 January 2017)

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

Why we inspected

This was a planned inspection based on the previous rating.

We have identified breaches in relation to adequate staffing, and governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

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. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The Sycamore and The Poplars is registered to provide accommodation for 38 people who require nursing or personal care. At the time of the inspection there were 35 people using the service.

On the day of our inspection there was 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.

People were safe living at the service because staff knew how to recognise and report any incidents of harm. Staff were confident that the registered manager would deal with any concerns that they reported. Systems were in place for staff to identify and manage risks. Staffing levels were adequate to meet people's needs. Staff received an induction, training and supervision and felt supported by the management team. Staff were recruited through safe recruitment practices. Medicines were safely administered and stored.

People did not always receive the necessary support during meal times and when drinks and snacks were provided. The principles of the Mental Capacity Act (2005), including Deprivation of Liberty Safeguards, had been followed when decisions were made about people’s care. People’s healthcare needs had been assessed and were regularly monitored. The service worked well with visiting healthcare professionals to ensure they provided effective care and support.

Staff were kind and caring towards the people they supported. Staff were aware of people's support needs and their personal preferences. People and/or their relatives were involved in the development and review of their care plans. People had access to independent advocacy services should they have required this support. People's independence, privacy and dignity were promoted and respected by staff.

People were supported to participate in activities, interests and hobbies of their choice. People’s care records contained guidance for staff on how to support them with their day to day care and support needs. People were provided with the information they needed if they wished to make a complaint.

Staff understood the values and vision of the service. The management team was supportive and approachable towards people, relatives, external professionals and staff. Quality assurance processes were in place to ensure people and others were safe in the service. The registered manager was aware of their regulatory responsibilities.

We also spoke with the registered manager, and two other members of staff. We looked at records including medication administration records and we observed the support people who used the service received from staff and carried out a tour of The Sycamores.

People were protected against the risk of abuse. We saw the provider had a safeguarding policy and procedure in place and staff members we spoke with were knowledgeable on this subject and told us their training included the area of safeguarding vulnerable adults.

We found that medicines were administered safely. One person who used the service said, 'They never miss my medication.'

We found that the provider had undertaken appropriate checks before staff were employed and there was an effective recruitment process in place.

One person told us, "I am well looked after here. They know what help I need." Another person said, 'I think I have what I need here - it suits me." A relative told us, "Nothing is too much trouble for them (staff). They also give people loving attention and I know my (relative) is very happy here."

We saw people received care as described in their plans and we found appropriate arrangements had been put in place to make sure people were protected against the risks associated with medicines.

We saw that the Poplars had recently been refurbished with new carpets and decoration and there were plans to refurbish the Sycamores and to replace some bathroom flooring in both units. All areas were clean and safe for people.

We found that people were cared for by suitable staff. One person we spoke with said, "They (the staff) all work hard. They must be the right sort of people, because they have a lot to put up with, but they keep smiling." A relative told us, "These carers are very enthusiastic in what they do. I think the people here are in safe hands."

The manager made sure all people's records were well maintained and held securely.

The manager was spending more time in The Poplars than previously.

Care staff told us that training had continued and they felt supported to do their jobs.