Background to this inspection
Updated
15 March 2023
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.
Inspection team
The inspection was conducted by 2 inspectors, a member of the CQC medicines team, a nurse specialist advisor and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Service and service type
Sycamore Lodge is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Sycamore Lodge is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
Registered Manager
This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations. At the time of our inspection there was a registered manager in post.
Notice of inspection
This inspection was unannounced.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.
During the inspection
We spoke with 9 people who used the service and 3 visiting relatives. We observed how people were being cared for and supported. Our observations included the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us. We spoke with a number of staff, including 3 care workers, 1 senior care worker, 2 nurses, the activities coordinator, a quality assurance manager, the deputy manager and the registered manager. We looked at the care records of 13 people and 8 people’s medicines support records, and 8 staff recruitment files. We also looked at a variety of records related to the running of the service, including, maintenance checks, meeting minutes and quality audits.
Updated
15 March 2023
About the service
Sycamore Lodge is a care home with nursing for up to 77 older people. The home is divided into five units. At the time of our inspection 62 people were living at the home. Some people were being cared for at the end of their lives and some people were living with the experience of dementia. The home is operated by Minster Care Group who provide care and support in care homes throughout the United Kingdom.
People’s experience of using this service and what we found
People were supported to take their medicines safely but we saw some practice issues needed improvement. We also found some safe environment issues. The registered manager responded to these promptly and we were assured that they had maintained people’s safety.
There were enough staff to keep people safe. Staff had training on how to recognise and report safeguarding concerns and they knew how to do so. The registered manager worked with other agencies to investigate concerns. The home was clean and there were procedures in place for preventing and controlling the spread of infection.
People's care plans set out personalised information about their care preferences and the support they needed, including their communication needs. People were supported at the end of their life to have a comfortable and dignified death.
The provider had appropriate procedures in place for responding to and learning from incidents and complaints. There were systems in place to monitor the quality of the service. The provider took action in response to audits and checks to improve and develop the service. The staff worked with other services to provide people with joined up care.
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.
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 17 December 2021). 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.
Why we inspected
We carried out an unannounced comprehensive inspection of this service on 23 November 2021. 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, Responsive and Well-led which contain those requirements. 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 changed from requires improvement to good. 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 Sycamore Lodge on our website at www.cqc.org.uk.
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.