This inspection was carried out on the 24 and 25 September 2018 and the first day was unannounced.

At the last inspection on 15 and 16 February 2016 the service was rated as ‘Good’ across all domains. At this inspection we found that although the service remained ‘Good’ overall, in the domain of “Well-Led’ we have judged that it requires improvement because there had been insufficient provider input following the building of an extension to the home and increase in the number of people who used the home.

Since the last inspection in February 2016, the registered provider had built an extension to the home and the CQC was kept informed of this development. As a consequence the allowance for the maximum number of people who could reside at the home had increased from 25 to 32.

Sycamore Rise Residential Care Home is a 'care home' in Colne in the county of Lancashire. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided and both were looked at during this inspection.

The home is registered to provide accommodation and support for up to 32 people and cares for older people, including those living with dementia. At the time of our inspection 28 people were using the service.

There was a registered manager in place who had been registered since 1 October 2010. 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 using the service said they felt safe and that staff treated them well. There were enough staff on duty and deployed throughout the home to meet people’s care and support needs. Safeguarding adult’s procedures were robust and staff understood how to safeguard people they supported. There was a whistle-blowing procedure available and staff said they would use it if they needed to.

Appropriate recruitment checks took place before staff started work.

People were receiving their medicines as prescribed by health care professionals.

We found that people and their relatives, where appropriate, had been involved in planning for their care needs. Care plans and risk assessments provided clear information and guidance for staff on how to support people using the service with their needs.

There was a range of activities available for people to enjoy but relatives felt that since the home had been extended, staff did not have enough time to engage with people meaningfully. We have made a recommendation around this in the 'Responsive' section of this report.

People and their relatives knew about the home’s complaint’s procedure and said they were confident their complaints would be fully investigated and action taken if necessary.

We found that people were not being deprived of their liberty inappropriately and, where appropriate, DoLS applications were being made. The registered manager and staff were aware of the need to seek consent in line with the MCA.

Proper assessments were being made around ways of protecting people and action had been taken to support people with sufficient numbers of well-trained staff.

People were supported to maintain a balanced diet and had access to a range of healthcare professionals when required. People received appropriate end of life care and support.

The registered manager conducted regular checks to make sure people were receiving appropriate care and support. The registered manager took into account the views of people using the service, their relatives and staff through meetings and surveys. The results were analysed and action was taken to make improvements at the home. Staff said they enjoyed working at the home and received appropriate training and good support fr

We carried out an unannounced inspection of Sycamore Rise care home on the 15 and 16 February 2016.

Sycamore Rise care home is registered to provide accommodation, personal care and support for 23 people. Sycamore Rise is located in a rural location on the outskirts of Colne in Lancashire. The accommodation consists of 21 single and two twin-bedded rooms.

The service was last inspected in September 2013 and was found compliant in all areas inspected. At the time of this inspection there was a registered manager employed. 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.

Throughout this inspection we received positive feedback from people who used the service, visitors and community professionals. People expressed satisfaction with the service provided and spoke very highly of the staff that supported them. Comments included, “Staff are really good. Their interaction with people living here is great. They know my [relatives] needs well” and “Staff are very pleasant. What they are doing is invaluable and they make me very feel safe”.

We noted the service had robust processes and procedures in place to maintain a safe environment for people accessing the service and for staff and visitors. The service had detailed and up to date health and safety checks which covered areas such as water safety, fire safety, maintenance and a walk through inspection of the service to look for any obvious hazards. We noted ‘building risk assessments were also in place. These considered risks associated with ‘trips and falls’, in the kitchen area, bathroom, stairway and corridors.

We noted audits on equipment and furnishings were done on a monthly basis. These audits included bedrooms, lounge, stairs, lift and hoists. We saw the service had fire risk procedures in place and detailed annual fire risk assessments were followed. These risk assessment covered areas such as testing all call points, emergency lighting and fire extinguishers.

People using the service told us they felt safe living at the home. Visitors were also confident that their relatives were in a safe place. We noted robust safeguarding procedures were in place and staff showed a good understanding around recognising the signs of abuse. Staff had also undertaken safeguarding training.

At the time of inspection we found the service had adequate staffing levels. Staff told us they had time to undertake the caring role effectively. People told us their needs were met appropriately and staff had time to sit with them. We observed a good level of staff interaction to support this.

We found the service had a good recruitment system in place. We found appropriate documentation in people’s recruitment files. We noted the service required all new staff to undertake a thorough induction process. This required them to familiarise themselves with the people using the service, read the service’s policies and procedures and shadow experienced members of staff.

The service had processes in place for the appropriate administration of medicines. Staff were adequately trained in medicines management. Medicines were stored safely and in line with current guidance.

We saw the service had created detailed individual risk assessments for all people using the service. These risk assessments included behaviours which challenge, skin integrity, mobility and nutritional needs.

We saw detailed care plans which gave clear information about people's needs, wishes, feelings and health conditions. These were reviewed monthly by senior care staff with oversight of the registered manager when required.

We saw evidence of detailed training programmes for staff. All carers had a Level 2 or above NVQ (National Vocation

During our visit we spoke with one individual who lived in the home they told us, “The decorating looked better and brighter”.

We found systems had been implemented to assess, identify, detect the control and spread of healthcare associated infections.

Policies and procedures had been updated and infection control training had been arranged for all staff.

Improvements had been made to the environment and plans had also been made to update and maintain the patient bedroom areas.

We spoke with six people who lived in Sycamore Rise who all commented they were happy with the support and care they received in the home. They told us, "I like living here", “Staff look after me well and “It is a very homely place and I like being here."

We also spoke with two people’s relatives who lived in the home. They told us you could not fault the care and staff at the home. One relative told us that if they had any concerns or comments they had raised them with the manager who listened to them and addressed the issues.

We found there were processes in place to ensure, where people may not have had the capacity to make particular decisions, staff had the necessary information, training, policies and procedures to be able to act in their best interest.

We reviewed the care files of three people who lived in the home. We saw that care plans identified their needs and how to prevent any risks identified. Records we looked at included information on how they wished their care to be delivered and this was reviewed on a monthly basis.

The recruitment and selection of new staff included an interview and appropriate checks to ensure suitable people were employed in the home.

We found the home had no systems in place to assess, prevent, and detect health care associated infections and action was required to address this area. Part of the home we looked at had strong urine odours and checks were not in place to address these issues.

We found that some systems were in place to assess and monitor the quality of the service provided.

All the people spoken with told us they were happy with the care provided. We spoke with four people living in the home and five family members. They told us they were involved in decisions about their care and could make choices and decisions about how they spent their time.

People’s needs were assessed and care plans were personalised and reviewed regularly.

All of the people we spoke to told us that they liked the food and were always provided with an alternative if they didn’t like the choice of food on the menu. One person told us, “The food is always good here, we always get a choice”.

Two people spoken with told us they were able to voice any concerns about their care to a member of staff or the manager.

People who used the service told us they had no concerns or worries about the service they received. One person told us, "I feel safe here and they look after me well".

People we spoke to told us that staff always responded to call alarms in a timely manner. One person we spoke with thought there were always enough staff on duty to help the different people living and staying at the home. We found that there were sufficient numbers of suitably qualified staff to meet the needs of people who used the service.

The home had suitable and effective arrangements in place in relation to complaints and feedback about the home.

People we spoke to all said they were happy living at Sycamore Rise Home. They said there was lots going on during the day and activities had been arranged where family members were invited. They also said they had no concerns and the management and staff do a lot to keep people happy. People also told us that there was work going on outside to make the home look better, which they were happy with.

People told us that they were consulted with and enjoyed living at the home. They said that as a result of residents meetings that take place the breakfast menu had changed.

One person told us that he was able to get up when he wanted and have a lie in when he wanted to. People told us that they could change the television over when they wanted to and nobody is in charge of the remote control.

The people who lived there confirmed that care workers gave them the right amount of support and help with their medicines and that they had their medicines when they needed them. One person told us that their medicines ‘always come at the same times every day’.

They told us that they could ask for drinks during the day but drinks are not left out to help ourselves. They also said that they were provided with a choice of meals. One person said that they did not have a key to their room but if you wanted a key then the manager would arrange this. They said the gardens were magnificent and they go out in better weather but they don’t go out locally very much.

People said they were treated well and there were lots of activities to do during the day and they had there hair done. One individual said that should they have an issue with their rooms then they were able to change if a room becomes available. People said that if they wanted to have their meals in their rooms then this was arranged.

People told us that they are involved in decisions about their care.

The individuals made comments that,” they are well looked after and staff are very caring, we enjoy the food”.

People told us that they were “happy with the food and the meals were good”, “only one problem we want another drink with our breakfast and we have to ask”. People told us that “drinks are not always available but if we ask they will get us a drink”.

People told us that the “portion sizes were good and some of the cooks are better than others” and “the breakfast menu had changed for the better” and “you wont go hungry here”

We spoke to individuals living at the home who informed us that should they need to access the doctor, dentist, chiropodist, occupational therapists or the opticians then “this would be arranged by the staff”.

People who use the service told us that they knew about abuse and they “felt safe” and confident that they would speak to the manager if there were any concerns. People told us that they “know who to complain to” and “they would discuss complaints with the manager or staff”.

People told us that their rooms are cleaned regularly and the home is always clean but, “from the outside it was a little shabby and didn’t look very nice”. People told us that they “liked their rooms” and the” views were fabulous”.

People who lived at the home made positive comments about the staff team; their comments included “staff were very nice”, “can’t fault them”, and “staff were very caring”. People also told us that “staff worked very hard”. The people who use the service told us that the staff were “very nice and very caring but sometimes they were busy completing their paperwork”.

We were informed by some of the people who live at the home that there are “regular residents meetings held every month”. The individuals told us that as a result of these meetings “the breakfast menu had changed and visits out had been arranged”. The individuals who we spoke to commented that, “If they had an issue or problem they would raise it with the staff or the manager” and “they felt safe in the home”.