We carried out this inspection on 19, 20 and 21 July 2017 and the first day of the inspection was unannounced. When we previously inspected this location in October 2016, we identified six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found the environment was unclean and systems to monitor the cleaning of the environment lacking; people’s consent to care was not always sought and was not recorded; staff were not appropriately trained to meet the needs of the people who used the service; people’s care needs were not being met in a person-centred way; people’s privacy, dignity and rights to confidentiality was not upheld or respected and records were not being appropriately maintained and systems and processes had not been established to monitor the service effectively.

When we visited the service, although a manager was registered with the Care Quality Commission they were no longer in post and a new manager had been appointed. Their interview for registration with the Care Quality Commission took place in Manchester on the second day of our inspection. 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.

The Sycamores is a residential care home in the Tameside area of Greater Manchester. The home provides personal care to older people and people living with dementia type conditions. It is situated close to local amenities and transport links. The service was registered for 60 people and at the time of our inspection there were 35 people using the service.

At this inspection we found that the service had improved and the six regulatory requirements previously breached at the inspection conducted in October 2016 had been satisfactorily addressed.

We have made a recommendation however to replace the floor covering in three bedrooms identified to the manager and to replace the stained armchairs in the main lounge on Ash unit.

Staff spoken with understood their responsibilities in keeping people safe and the action to take should they become aware of any abuse or witness any poor practice by their colleagues. They were confident that the manager would take appropriate action if any issues about safeguarding concerns were raised.

Robust recruitment procedures were in place and the required pre-employment checks for new staff were carried out before they started working in the home. During the inspection we saw that there were sufficient numbers of staff available to assist and support people throughout the day and night.

Risk assessments were in place, which provided information and guidance to staff about how to support people and mitigate any known risks to their health, safety and wellbeing.

Records were available to demonstrate that the provider had made sure all equipment and utilities, such as electrical circuits, portable appliance testing (PAT), gas safety, hoists, fire alarm system and nurse call system were regularly maintained and serviced by an approved contractor.

We found that medicines were safely managed and only appropriately trained staff had the responsibility for administering medicines to people.

Records seen demonstrated that on-going staff training was taking place, along with formal staff supervision on a one-to-one basis.

Records were available to demonstrate that where appropriate mental capacity assessments and deprivation of liberty safeguards authorisations were in place. We saw records that indicated people and / or their representative had given their consent to their care and treatment.

People told us that they enjoyed the food provided and the choices of meals available to them. During the mealtime we observed that the meals served were nicely cooked and well-pr

The inspection took place on 3 and 4 October 2016. The inspection was unannounced. This meant the service didn’t know we would be inspecting them.

The Sycamores is a residential care home in the Tameside area of Manchester. The home provides personal care to older people and people with dementia type conditions. It is situated close to local amenities and transport links. The service was registered for 60 people and at the time of our inspection there were 45 people using the service.

The home had a registered manager employed to manage the service. 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 found that the service had issues with infection control and mal odours were present throughout the service, in corridors, in communal areas and peoples bedrooms.

Poor hygiene standards were evident within the service.

People’s personal care needs were not always met in accordance with their care plans.

People’s dignity and privacy was not always observed.

We spoke with a range of different team members; care, kitchen, maintenance, laundry, activities co-ordinators and domestic staff. They told us they felt well supported and that the manager was supportive and approachable. The manager was not present at the time of our inspection and was on annual leave so the inspection was carried out with the deputy manager. Throughout the day we saw that people who used the service and staff had a good rapport with the deputy manager.

Although the deputy manager was busy throughout the inspection the atmosphere within the home was sedate. We saw that some staff interacted with each other and the people who used the service in a friendly, supportive, positive manner. However we also observed some negative staff attitudes.

We observed how medicines were administered. We looked at how records were kept and spoke with the senior staff about how this was carried out and how staff were trained to administer medicines and we found that the medicine administering process was safe.

From looking at people’s detailed care plans we saw that they were written in the first person and contained some personal history information. The care plans did contain a one page profile however these were more task focussed than ‘person centred.’ Person centred is when the person receiving support is central to all decision making related to their support. Care plans were regularly reviewed and updated by the care staff and the registered manager.

Individual care plans contained risk assessments. These identified risks and described the measures and interventions to be taken to ensure people were protected from the risk of harm. The care records we viewed also showed us that people’s health was monitored and referrals were made to other health care professionals where necessary, for example: their doctor, optician or district nursing team.

Our observations during the inspection showed us that people who used the service were supported by sufficient numbers of staff to meet their individual needs and wishes. However we found different agency staff were used regularly who didn’t always know the people who used the service.

When we looked at the staff training records the information contained indicated staff were not always supported to maintain and develop their skills through training and development opportunities as some staff training was out of date or incomplete.

We saw that the physical environment throughout the home was not dementia friendly and did not always reflect best practice in dementia care or meet the standards set out in national guidelines.

Staff we spoke with told us they had regular supervisions and appraisals with the manager, where they had

The inspection team was made up of one inspector. We set out to answer the question is the service safe?

Below is a summary of what we found. The summary is based on our observations during the inspection; speaking with staff, people using the service, the manager and from looking at records.

Is the service safe?

Staff manage medicines consistently and safely. The service stores medicines correctly, disposes of them safely and keeps accurate records.

There are enough competent staff on duty who have the right mix of skills to make sure that practice is safe and they can respond to unforeseen events. The service regularly reviews staffing levels and adapts them to people's changing needs. Recruitment systems are robust and make sure that the right staff are recruited to keep people safe.

People told us that they were very happy with the care and support they received at the service. Comments included: "The staff are absolutely fantastic, I am very well looked after”,” I only have to ring the bell and the staff come”, “I cannot think of any of the staff I don’t like or don’t get on with” and “I wouldn’t want to live or be anywhere else for my care”.

We spoke with four relatives of people using the service. They were very happy with the care their relative received. Comments included: “The staff are so caring and the reports I have received from my other relatives visiting the home has always been very positive and reiterates my own feeling about the service” and “Confidentiality is always maintained and I am always asked to sign paperwork, especially for financial matters”.

People living in The Sycamores Care Centre told us that they felt supported and well cared for and that care workers understood their needs and how to meet them.

Relatives and visiting healthcare professionals spoke highly of the service and comments included, “The staff are marvellous” and “They (the staff) know their job and keep me up to date with information about mum”.

We were told that things that were important to people such as their rights to privacy, dignity and respect was maintained by the staff working in the home and any concerns or worries would be listened to and addressed quickly and appropriately.

People appeared comfortable in their surroundings and told us that they were happy with their daily lifestyles including the choice of food available, the environment they lived in and the overall standard of service they received.

During our inspection we spoke with the new manager of the home, some of the people using the service, some of the staff on duty and a visitor to the home. We took a tour of the building, and spent some time observing the interactions between staff and the people who lived there. We looked at a selection of the provider’s policies and records, including a sample of people’s care records.

We considered the evidence collected under the outcomes and addressed the following questions: Is the service safe; is the service effective; is the service caring; is the service responsive; is the service well led?

Below is a summary of what we found. Please read the full report for the evidence supporting our summary.

Is the service safe?

We saw that people were treated with respect by staff. People we spoke with who used the service told us they felt safe living at The Sycamores and with the support they received. One person commented “I’m quite happy with things, I wouldn’t like to live on my own again”.

Policies and procedures were in place to support staff to manage people’s medicines safely. Staff with the responsibility for administering medicines in the home had received relevant training. Although people were receiving their prescribed medicines and treatments these were not always administered safely and in accordance with the policies and procedures in place.

A compliance action has been set in relation to this. The provider must send us an action plan advising how they will ensure people’s medicines will be administered safely at all times.

The staff team was skilled and experienced. However, staffing levels had been insufficient at times to meet people’s needs. A compliance action has been set in relation to this. The provider must send us an action plan advising how they will ensure staffing levels will be maintained at all times to meet people’s needs.

We saw that policies and procedures were in place to support staff in delivering safe and effective care. These policies and procedures included those in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards.

Is the service effective?

People’s health and care needs were assessed with them, or with the support of their relatives or other healthcare professionals when required.

All staff we spoke with confirmed that there was always a written care plan available on each person’s file.

The service had effective quality monitoring systems. These would help to identify if the service needed to review or amend any of its practices.

Is the service caring?

At the time of our visit people were being supported by kind and attentive staff. We observed care staff showing patience and giving general encouragement when supporting and assisting people. People using the service commented, “I’ve no worries – I just go from day to day” and “The staff are alright – they help me when I need it”.

The atmosphere in the home was calm, relaxed and friendly and staff we spoke with appeared to have a good knowledge and understanding of people’s needs.

Is the service responsive?

Evidence was seen in records to demonstrate that other healthcare professionals were involved in meeting people’s care and support needs where appropriate. For example, a visiting speech and language therapist, general practitioners and district nursing services. This meant that people using the service received co-ordinated care and support.

Is the service well led?

A new manager was in post that was yet to register with the Care Quality Commission.

We found that there were a number of systems in place to audit and monitor the quality of service and care being provided in The Sycamores. There were also independent audits by local commissioners of services to check the quality and standard of service delivery on a regular basis. Such monitoring of the service should help to ensure that people receive a high standard and quality of service at all times.