We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 which looks at the overall quality of the service. The inspection was unannounced.

The Sycamores provides accommodation and personal care for up to 36 older people who may also have a diagnosis of dementia, over three floors. At the time of our inspection visit there were 34 people living at the home.

At the last inspection, the service was rated Good overall. At this inspection we found the service has maintained an overall Good rating, but has been rated ‘Requires Improvement’ in ‘Safe’.

There was an experienced registered manager at the home. 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. We refer to the registered manager as the manager in the body of this report.

Staff understood their responsibilities to protect people from the risk of abuse. The manager checked staff’s suitability for their role before they started working at the home and made sure there were enough staff to support people safely. Medicines were stored, administered and managed safely.

The manager and provider identified risks to people’s environment, and management plans were in place to protect people from those risks. However, risks to people’s individual health and wellbeing were not always consistently managed to minimise risks to people’s health.

People we spoke with told us they were happy at the home. They told us the staff were kind and caring. People were involved in planning their care with the support of their relatives and staff, to make sure their care plans met their individual needs, abilities and preferences. Care plans were regularly reviewed and staff asked other health professionals for advice and support when people’s health needs changed.

People were cared for and supported by staff who had the skills and training to meet their needs. The registered manager and staff understood their responsibilities in relation to the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards.

People were supported to eat and drink enough to maintain a balanced diet that met their individual dietary needs and preferences.

People who lived at the home and staff had confidence in the registered manager, who was supported by a hands-on management team. The provider had implemented systems that ensured staff and management had access to the most up-to-date information at the press of a button and enabled relatives to be fully informed and involved in their relations’ care.

The provider employed a lifestyle coach, whose time was dedicated to supporting people to make the most of each day through physical and mental stimulation.

People, their relatives and healthcare professionals were encouraged to share their opinions about the quality of the service, to ensure planned improvements focused on people’s experiences. The provider listened and acted on people’s views to improve the service.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service. The inspection was unannounced.

The service provides accommodation and personal care for up to 36 older people who may also have a diagnosis of dementia. The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

At our previous inspection in December 2013, we found there was a breach in meeting the legal requirements for records. We found there were gaps in recording food, fluid and repositioning charts for people who were identified as at high risk. The deputy director of operations had already identified gaps in records as a concern during their recent internal audit. They were already progressing an action plan to address the issue.  

During this inspection we found the necessary improvements had been made to meet the requirement for records. We saw food, fluid and repositioning charts were completed and up to date for the people whose care plans we reviewed. The handover matrix tool had been revised to include a twice weekly check and sign-off by the care manager or registered manager of key supplementary records for minimising risks to people’s health.

All the people we spoke with told us they were happy at the home. They told us the staff were kind and helped them to maintain their interests and involvement in the local community. We saw staff understood people who were not able to communicate verbally and were compassionate and understanding with them.

People’s care was centred around their individual needs because the deputy director of operations observed how people who could not communicate verbally responded to staff’s actions. Care plans were regularly reviewed and staff asked other health professionals for advice and support when people’s health needs changed.

The registered manager understood their responsibility to comply with the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).  No one was under a DoLS at the time of our inspection. For people who were assessed as not having capacity, records showed that their families were involved in discussions about who should make decisions in their relation’s best interests.

People who lived at the home and staff had confidence in the registered manager, who was supported by a hands-on management team. The service was accredited by relevant dementia schemes. The provider had consulted people and relatives in planned refurbishments which would improve the way people used the premises.

We spoke with five people that used the service and they all told us that they were satisfied with the service they received. One person told us “I find it very good, I get up when I want to and if I need anything I press my buzzer and the staff come”. Another person told us “I am quite content, I get to choose what I want to do.”

We spoke with two relatives of people that used the service, they were both happy with the service that their relative received. One relative told us “I can’t fault the place, the staff have really taken the time to get to know my (relative)”.

We spoke with five staff members who told us that they felt well supported in their roles and that there were enough staff on duty to meet the people’s needs. We observed staff responding promptly to call bells throughout our visit.

We found that people’s needs were assessed and care plans were put in place to ensure that people’s needs were met. We found that people’s likes, dislikes and preferences were recorded in their care plans and we observed staff carrying out care and support and communicating with people as described in their care plans. We found that risks associated with people’s care were identified and control measures had been put in place to ensure people’s safety.

We found that there were appropriate arrangements in place to protect people from the risks associated with medicines and that staff supported people appropriately with their medication.

However, we identified there were some gaps in the records that were kept of people’s care and support which meant that there was not an accurate record of the care and support that they received. We also found that there were inconsistencies in some people’s care records.

When we visited Sycamores we met with most of the people using the service. We met and spoke with three relatives, three members of staff, the care manager and the registered manager. The people who used the service were not able to talk to us about their care because of their complex needs, however when we asked them if they were comfortable they smiled and nodded.

We asked relatives about the care provided to their family and they each told us that the care delivered to people was good. They told us, “Very good personal care is given by staff” and “I am perfectly happy with XX’s care, they are always clean and smart.”

We saw people's bedrooms were clean, warm and well furnished. People had brought some personal items with them into the care home and this made their rooms "homely".

We saw that mealtimes were a relaxed and social occasion and that people had a choice about what they wanted to eat and drink.

Staff told us they had sufficient information about how to support the needs of the people who used the service. Records we looked at showed that staff communicated people’s changed needs to managers so that health and medical care could be sought promptly.

We found the provider recruited staff to work in the care home only after checks had taken place to show people who used the service would be safe and not at risk of harm from the staff delivering care to them.

During this review we visited five of the provider's care homes. We visited The Limes on 14 June 2011, we visited Westlands on 15 June 2011, we visted Fourways on 16 June 2011, we visited Woodside on 21 June 2011 and we visited The Sycamores on 22 June 2011.

We spoke with 17 people using these services and eight relatives who were visiting at the time. People told us they liked living at the care home and felt well cared for. One person told us 'we like it because staff 'speak nicely' and said staff were ‘friendly’ towards them. People told us they were happy with the care they received and encouraged by staff to maintain as much independence as possible. We saw people making their own drinks when they wanted to and helping with the washing up after lunch. People told us they liked doing this. Each person we spoke with told us they felt safe and would be able to talk to staff if they felt concerned about their care. Some people were not able to talk to us about their care because of their dementia, however when we asked them if they were comfortable they smiled and nodded.

We asked people about the food being served to them and they told us they enjoyed their meals and there was always a choice.

Relatives told us they had no concerns about how their family member was being cared for. They told us that care given was 'respectful' and 'nothing was to much trouble'.

Relatives we spoke with at each care home told us that staff had ‘time for everybody’ and the managers were very approachable. Relatives liked the way that they could be involved with the care of their family member and join in with activities if they wanted to. Relatives made particular comments about how well the staff kept them informed about their family member's care needs.

Relatives told us the food looked good and people always had sufficient to eat and drink. They told us that snacks and drinks were always ‘available' and they could make a cup of tea for their family member whenever they visited.