This inspection took place on 16 and 17 January 2019 and was unannounced.

Sycamore Cottage Rest Home Limited (Sycamore Cottage) is a 'care home'. People in care homes receive accommodation and nursing or personal care, as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Sycamore Cottage provides care for up to 20 older people living with differing stages of dementia. There were 11 people living at the home on the first day of our inspection, with one person receiving treatment in hospital. On the second day another person was supported to move into the home. Accommodation was provided over two floors of a converted residential dwelling, with a stair lift that provided access to the second floor.

At our inspection in November 2017 we found that the provider had acted on the risks and shortfalls that had been previously identified, to ensure people were safe. Whilst we recognised that improvements had been made to the service’s systems and processes for maintaining standards and improving the service; many of the changes were still a work in progress and had not yet been sustained. At this inspection the provider demonstrated that the required improvements had been sustained and had become embedded in practice.

The home was consistently well-managed by the home manager who provided clear and direct leadership. Staff consistently told us the management team had created a supportive environment where their opinions and views were discussed and taken seriously, which made them feel their contributions were valued.

Quality assurance systems monitored the quality of service being delivered, which were effectively operated by the management team, to drive continual improvement in the service.

People experienced care that made them feel safe and were protected from avoidable harm and discrimination. When concerns had been raised, thorough investigations were carried out, in partnership with local safeguarding bodies.

Risks were assessed, monitored and managed effectively. Staff were aware of people’s individual risks and how to support them to remain safe.

There were sufficient staff to respond quickly and provide safe and effective care to people. The home manager operated a robust recruitment process, based on relevant pre-employment checks, which assessed the suitability of candidates to support older people and those living with dementia.

The provider proactively reviewed all accidents and incidents and acted to reduce the risk of a future recurrence.

People's dignity and human rights were protected, whilst keeping them and others safe. Staff supported people who experienced behaviour which may challenge others sensitively, in accordance with their positive behaviour support plans.

People received their prescribed medicines safely, from staff who had their competency to administer medicines assessed annually. People's medicines plans were reviewed regularly to ensure they still required the medicines they were prescribed.

High standards of cleanliness and hygiene were maintained throughout the home, which reduced the risk of infection. Staff followed the required standards of food safety and hygiene, when preparing, serving and handling food.

The operations manager and home manager ensured staff had an effective induction, ongoing training and support to maintain necessary skills and knowledge to support people effectively.

People were supported to eat and drink enough to protect them from the risk of malnutrition and dehydration. Risks to people with more complex nutritional needs were promptly referred to relevant dietetic specialists.

Each person had an individual health action plan which detailed the completion of important monthly health checks. People were promptly referred to external services when required, which maintained their health.

The home had not been originally d

This inspection was unannounced and took place on 2 and 3 November 2017. Sycamore Cottage Rest Home Limited provides care for up to 20 older people living with differing stages of dementia. There were 13 people living at the home on the first day of our inspection, with one person moving to alternative care provision later that day. Accommodation was provided over two floors of a converted residential dwelling, with a stair lift that provided access to the second floor.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements had been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

The registered manager had left the home in November 2016 and Sycamore Cottage did not have a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. At this inspection the home had a new manager who had been appointed on 6 September 2017. The new manager was being supported by an external management consultant and the deputy manager. The new manager had commenced the process to become the registered manager with the CQC.

On 2 and 3 March 2017 we inspected Sycamore Cottage Rest Home Limited and judged the provider to be in breach of seven regulations. We served a warning notice on the provider to make necessary improvements to ensure people received safe care and treatment. On 7 and 8 June 2017 we completed a focused inspection of Sycamore Cottage Rest Home Limited and found required improvements in relation to the warning notice had been completed so people experienced safe care and treatment.

After the inspection on 2 and 3 March 2017 we imposed four conditions on the provider’s registration. These were to ensure, people were safeguarded from avoidable abuse and improper treatment; the provider had appropriate processes to assess and monitor the quality of their service; the provider maintained accurate records of the care provided to people and decisions made relating to their care; the provider only employed fit and proper persons; and staff had all received the necessary training and support to carry out the duties they were employed to perform. At this inspection we found the provider had complied with all of the conditions imposed on their registration.

Since our inspection in March 2017 the manager of the home had sent weekly reports with action plans detailing the improvements to be made and progress that had been made. The conditions imposed on the provider’s registration required the provider to submit monthly reports to us detailing all training provided to staff; audits of all safeguarding incidents; recruitment checks; all medicine errors and medicines management; all bruising incidents; behaviours that challenge incidents; infection control; care plans; staff guidance and CQC notifications. The manager had effectively completed all relevant action plans and the requested monthly reports, which demonstrated all of the required improvements had been made.

At our inspection in March 2017 the provider was not meeting the regulations in relation to obtaining valid consent to people’s care and providing person centred care. We asked the provider to send us a report detailing what action they were going to take to make necessary improvements. At this inspection we found the provider had made the required improvements and ensured valid consent was sought from people who consistently received person centred care.

At this inspection we found that the provider had acted on the risks and shortfalls that had been previously identified. Whilst we recognised that improvements were being made to the service’s systems and processes for mai

This inspection was unannounced and took place on 7 and 8 June 2017. This was a focused inspection completed to check the provider’s progress in meeting the requirements of regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (HSCA 2014) following our last inspection on 2 and 3 March 2017.

We found people's safety was being compromised in a number of areas. Risks to people in relation to the use of medicines, equipment, malnutrition, behaviour and the environment had not always been assessed and risk management plans in place were not sufficient to enable staff to keep people safe.

People's care records did not include all the information staff would need to provide safe care and when people received care this was not always recorded. Staff and the interim home manager could therefore not judge from people's records whether people had received their care as planned.

Medicines were not managed safely or administered and recorded appropriately to ensure people received their medicines as prescribed.

These circumstances were a breach of Regulation 12 (Safe care and treatment) of the HSCA 2014. The provider was served with a warning notice in relation to safe care and treatment which they were required to meet by 5 May 2017. We told the provider they needed to take action to meet all their legal requirements and we received a report setting out the action they would take to meet the regulation.

At this inspection, we found that the provider had followed their plan and the legal requirements in relation to providing people with safe treatment and care had been met.

This report only covers our findings in relation to this legal requirement. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Sycamore Cottage‘ on our website at www.cqc.org.uk. Other regulations which need to be considered to judge whether a service is safe were not considered during this inspection.

Sycamore Cottage Rest Home Limited (to be referred to as Sycamore Cottage throughout this report) provides care for up to 20 people living with differing stages of dementia. There were 15 people living at the home on the days of our latest inspection. Accommodation was provided over two floors of a converted residential dwelling, with a stair lift that provided access to the second floor.

The registered manager had left the home in November 2016 and Sycamore Cottage did not have a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 deputy manager had fulfilled the role of interim manager since November 2016. At this inspection the home had a manager who had been appointed from 1 May 2017. The new manager was being supported by an external management consultant and the deputy manager. The manager had commenced the process to become the registered manager with the CQC.

The provider had taken action to fully review and reorganise the processes and procedures to ensure the safe management of people’s prescribed medicines. The manager had completed competency assessments of most staff trained to administer medicines. Competency assessments for two remaining members of staff were scheduled to be completed immediately following the inspection.

People were protected from the risks of avoidable harm associated with the use of moving and positioning equipment fully serviced by qualified engineers. Staff had recently completed moving and positioning training with focus on how to use specific equipment to meet people’s individual needs.

People were protected from the risk associated with their skin breaking down by staff who provided care in accordance with p

We inspected Sycamore Cottage Rest Home Limited on 2 and 3 March 2017. This was an unannounced inspection.

Sycamore Cottage Rest Home Limited provides care for up to 20 people living with differing stages of dementia. There were 19 people living at the home on the days of our inspection. Accommodation was provided over two floors of a converted residential dwelling, with a stair lift that provided access to the second floor.

The registered manager had left the home in November 2016 and Sycamore Cottage Rest Home Limited did not have a registered manager in place on the day of the inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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. Following the inspection the registered provider informed us that a new manager had been recruited and they would be starting in April 2017 to ensure the registered provider would meet their registration requirement to have a registered manager in place. The deputy manager had fulfilled the role of interim home manager since November 2016.

We found an effective governance system to monitor the quality of the service and identify the risks to the health and safety of people was not in place. A regular programme of audits had not been completed in relation to the management of people's medicines, infection control practices, health and safety and quality of care records. The interim home manager and the registered provider had not identified the areas of concern we had found. As a result, action had not been taken to improve the quality of care and ensure the safety of people.

We found people's safety was being compromised in a number of areas. Risks to people in relation to the use of medicines, equipment, malnutrition, behaviour and the environment had not always been assessed and risk management plans in place were not sufficient to enable staff to keep people safe.

People's care records did not include all the information staff would need to provide people's care and when people received care this was not always recorded. Staff and the interim home manager could therefore not judge from people's records whether people had received their care as planned and their medicines as prescribed.

Medicines were not managed safely or administered and recorded appropriately to ensure people received their medicines as prescribed.

Staff had not received the support, induction, guidance and training to develop their skills and knowledge to ensure they could meet people’s needs and keep them safe. We found the support provided to people living with dementia did not always meet their needs and preferences.

Recruitment arrangements were not safe. All the information required to inform safe recruitment decisions was not available at the time the provider had determined applicants were suitable for their role.

Improvement was needed to ensure staff would always identify potential abuse, including neglect, so that action could be taken to report and investigate these concerns to protect people from potential harm.

Where people lacked the mental capacity to make informed decision, or give consent to their care, the registered provider did not always act in accordance with the requirements of the Mental Capacity Act 2005 and associated code of practice to ensure people’s right were upheld.

People's privacy and dignity were respected and they were complementary about the caring relationships they had built with staff.

Opportunities were available for people and their relatives to provide feedback about the service and this was taken into consideration when making improvements to the service.

People were supported to access the GP and offered a balanced diet.

The overall rating for this service is 'Ina