The inspection took place on 27 January 2017.

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.

This inspection took place on 15 September 2015 and was unannounced.

Four Seasons (Evedale) Limited is registered to provide accommodation and care at The Sycamores and The Poplars for up to 72 older people. Accommodation is arranged in two separate units with level access to the ground floors and a passenger lift in each unit to the upper floor rooms. There were at total of 38 people living at the service when we visited. 27 of these were in ‘The Sycamores’ that provides some nursing and the other 11 were living in ‘The Poplars’, which specialises in caring for people living with dementia.

There was an acting manager in post at the time of our inspection and they had applied to become registered. 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 and associated Regulations about how the service is run. We will continue to monitor the application of the acting manager until they have registered.

People were safely cared for by enough staff who knew what action to take to keep everyone safe. The provider used safe systems when new staff were recruited and all risks to safety were minimised. Medicines were stored safely and we saw that people’s medicines were managed so that they all received them safely.

Staff received regular training and additional information about how to meet people’s individual needs.

People had sufficient food and drink and staff encouraged and supported them individually, if needed. People’s health needs were met by the nurse on duty and by local GPs, community nurses and any additional healthcare support, which was promptly arranged when needed.

Staff were kind to people and cared about them. Choices were given to people at all times. People’s privacy and dignity were respected and detailed personal information was held securely.

The service responded well to most people’s needs, interests and preferences, but more attention was needed for those with more complex needs. The procedure and recording system for responding to any concerns or complaints raised was in the process of improving. Feedback from people was welcomed and encouraged.

The acting manager had made improvements in the way the service was led and was in the process of improving her leadership of ‘The Poplars’ unit. Some audits and checks were made on the quality of the service, but the provider had not always responded in a timely manner to all the items noted for repair or replacement. On going improvements were taking place.

Since the completion of the inspection we were informed that the acting manager who was there at the time was replaced by another acting manager who then started the registration procedure with CQC.

We undertook this inspection in response to information we had received that highlighted concerns about the care at The Sycamores. Prior to our inspection we reviewed all the information we had received from and about the provider. We spoke with three people who used the service and a relative to gain their views on the quality of service provision. A person who used the service said, “Every single person is loved.”

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.

We looked at the care plan files of five people and we spoke with some of the people who lived in the Sycamores and the Poplars and their visiting relatives. We also used observation to help us understand the experiences of some people who used the service, because they were not all able to tell us their experiences.

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.

We found clear records of one to one supervision meetings for staff with a senior worker. Most staff had attended two of these meetings since our last visit. Senior staff told us they had commenced their own training in supervision skills and they had also signed up to undertake a management course.

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.

We used a number of different methods to help us understand the experiences of people using the service, because the people using the service had complex needs which meant they were not all able to tell us their experiences. Those that were able to give us their views were positive about the service they received.

We spoke with three people who used the service. They each confirmed that their needs were being met appropriately. One person told us, "They are good to me here and respectful." Another person said, "I can choose what I want to do here." A third person said, "They look after me here."

We observed staff having discussions with people and they took account of people's needs relating to dementia by gently guiding, supporting and encouraging as appropriate. They gave support to some people with eating and we saw equipment in place for those with needs relating to mobility.

Some relatives told us they thought there were not enough staff on duty as there had been more in the past. We found that this concern was related to The Poplars unit, where there were not so many people in residence. We observed that people's needs were being met in a timely fashion in both units during our visit. People told us that staff always helped them when they needed assistance. One person said, "The staff know how to look after me here. Sometimes they get upset when they are busy, but they are only human."