This inspection took place on 02 May 2017 and was unannounced.

At the last comprehensive inspection in 17 and 19 February 2016 the registered provider did not meet the requirements of the regulations of the Health and Social Care Act 2008 (Regulated Activities) 2014 in relation to unsafe management of medicines and was rated as Requires improvement. We carried out a focused inspection visit on 31 January 2017 and checked what progress had been made in relation to improving the safety of people's medicines management.

During the focused inspection on 31 January 2017, the service had demonstrated improvements. However we needed to see these were sustained so the rating was not changed at that inspection.

On this inspection those improvements had been sustained and the service is no longer rated as requires improvement for any of the five key questions.

At the last comprehensive inspection people gave mixed views about meals, the design of the home was not geared towards dementia, activities were limited and there were no formal ways for people to give their views of the home. At this inspection these areas had improved and people were more satisfied with care and routines in the home.

The Sylvester Care Centre is registered to provide personal care for up to 25 people whose needs are associated with their mental health. The home offers support for life and does not offer rehabilitation services. There are twenty one single rooms and two double rooms, eleven of which have en-suite facilities. All floors have a range of bathrooms and toilets in close proximity to people's bedrooms and communal areas. The home is situated close to local amenities.

At the time of the inspection visit twenty five people lived at the home.

There had been a change of registered manager since the last inspection. The new manager was an experienced member of staff who had been part of the management team for some time. They were registered with the commission the day after the second day of the inspection visit. 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.

Although a small number of people had limited verbal communication and were unable to converse with us, we were able to speak with eleven people who lived at the home.

People told us they felt safe at The Sylvester. One person said, “The staff are good here. They make sure I am safe and well.” Another person told us, “It’s a very good place. Staff keep us safe.” Procedures were in place and risk assessments completed to reduce the risks of abuse and unsafe care. People told us staff were friendly and helpful. They told us they were treated with respect and valued.

We looked at how medicines were managed as a member of staff had left the medicines trolley unattended on the last comprehensive inspection. On this inspection staff managed medicines competently and ensured they did not leave them unattended. People told us they felt staff gave them their medicines correctly and when they needed them. We saw they were given as prescribed and stored and disposed of correctly.

We looked at how the home was staffed. People said there were enough staff to support them well and give them help when they wanted this. We saw there were enough staff to provide safe care and supervision.

We looked at the recruitment of three recently appointed members of staff. We found appropriate checks had been undertaken before they had commenced their employment. This reduced the risk of appointing unsuitable staff.

Staff had been trained and had the skills and knowledge to provide support to people they cared for. They received regular support and supervision from senior staff.

Infection control practice was good

We carried out an unannounced comprehensive inspection of The Sylvester Care Centre on 17 and 19 February 2016. During this inspection we found a breach of legal requirements. This was because the provider had failed to ensure safe management of medicines. We asked the provider to send us a report that said what action they were going to take in relation to safe medicines management

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach. We undertook a focused inspection on 31 January 2017 to check they had followed their plan and to confirm they now met legal requirements.

This report only covers our findings in relation to the latest inspection. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘The Sylvester Care Centre on our website at www.cqc.org.uk

The Sylvester Care Centre is registered to provide personal care for fourteen people whose needs are associated with their mental health. The home offers support for life and does not offer rehabilitation services. There are twenty one single rooms and two double rooms, eleven of which have en-suite facilities. All floors have a range of bathrooms and toilets in close proximity to people's bedrooms and communal areas. The home is situated close to local amenities.

A registered manager was in place. 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.

At our focused inspection on the 31 January 2017 the provider had followed their plan which they had told us would be completed by July 2016 and legal requirements had been met.

Staff managed medicines safely with appropriate gaps between the times of administering them. They were stored securely and not left unattended. Pain relief tools were in place to assist staff to give people with limited communication pain relief when they needed it.

We could not improve the rating for safe from requires improvement because to do so requires consistent good practice over time. We will check this during our next planned comprehensive inspection.

This inspection took place on 17 and 19 February 2016 and was an unannounced inspection.

On the day of inspection there were twenty five people living at the home.

The Sylvester Care Centre is located in a residential area in central Blackpool. The home is registered to provide residential care and support for up to 25 people. There are twenty one single rooms and two double rooms, eleven of which have en-suite facilities. All floors have a range of bathrooms and toilets in close proximity to people's bedrooms and communal areas. The home is situated close to local amenities.

A scheduled inspection of the service was last carried out in June 2014. The service was not meeting the requirements of the regulations that were inspected at that time. There were breaches in infection control, records and staff recruitment. A follow up inspection was carried out in August 2014 to check if the home had become compliant with those regulations. On that inspection they were meeting the assessed regulations.

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 told us they felt safe living at The Sylvester Care Centre. The registered manager had systems in place to record safeguarding concerns, accidents and incidents and take necessary action as required. Staff we spoke with knew the steps they would take if they became aware of abuse. Risk assessments were in place to reduce risks to people’s safety. However some practices while keeping people safe, restricted people’s freedom and independence.

The communal areas of the home had been redecorated and a downstairs bathroom had been refurbished to make a more comfortable environment. A new office and medicines room had been created at the edge of the dining room. This helped the management team to monitor what was happening in the home. However a number of bedrooms were in a poor state of maintenance and décor and were sparse of personal belongings.

Medicines procedures were not always followed or medicines given as prescribed. There was no individual person-centred guidance in place for people’s PRN pain relieving medicines, as recommended in current national medicines guidance NICE Managing Medicines in Care Homes guidance March 2014. On occasions the spacing between doses of the pain-relieving medicines containing paracetamol did not leave a gap of minimum 4-6 hours. Not leaving an adequate gap between doses of this medicine could place people at risk of unnecessary side effects.

People told us staff were respectful and caring and respected their privacy. Staff were available when people needed them to assist with people’s personal care needs. However activities were limited by the way staff were deployed. People said they were often bored and there was nothing to do. People living with dementia were often left with little interaction or meaningful activity.

Staff understood the requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLS) which meant they were working within the law to support people who may lack capacity to make their own decisions.

People told us the meals were good but drinks and snacks were only provided at set times. However senior staff said this was not the case and meals and snacks and drinks were available at all times.

Although people we spoke with told us they had no complaints, people’s understanding on how to complain if they were unhappy with something was variable.

There were procedures in place to monitor the quality of the service. Any issues found on audits were acted on. People said they could talk to the staff and express any ideas or concerns informally. However there w

At our previous inspection in June 2014 we found the home was not meeting some of the standards we assessed. Some areas of infection control were not adequate, staff recruitment was not always safe and personal care records were not stored safely.

We asked the service to provide us with an action plan demonstrating what they had done to address these issues of non-compliance. We received an action plan from the registered manager. This detailed the procedures put in place to address the concerns. This inspection was to see what actions had been taken.

On this inspection, these areas of concern had improved and the home was meeting the necessary standards. This meant the service was compliant. We observed the home was clean with no unpleasant odours. Actions had been taken to ensure flooring, furnishings and external areas were clean and protected people from the risk of infection. Personal protective clothing was accessible to assist with infection control.

We saw that staff recruitment had been carried out safely on this inspection. The necessary checks had been made to assist senior staff with recruiting suitable staff. Records were stored securely in a lockable cupboard on this inspection. The senior member of staff on each shift kept the key with them.

We only briefly spoke with people about the home. They told us they were happy at The Sylvester.

The inspection was led by one inspector. Information we gathered during the inspection helped answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

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

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

People told us that the staff were good and caring and always willing to help. One person said, "The staff are very good here. They will talk to you and encourage you.” Another person told us, “I am satisfied with my care. The staff are kind.” A relative said of their family member, “The home suits him. He is quite content here.”

People living in the home were treated with respect and dignity. There were enough staff on the inspection to support people as they needed. We saw that care and support was planned and delivered in a way that was intended to ensure people's safety and welfare. Religious and cultural needs were taken into account and these were being met appropriately.

The home had policies and procedures in relation to the Mental Capacity Act and best interests meetings had been carried out to assist with particular decisions. Staff were aware of Deprivation of Liberty Safeguards. Relevant staff had been trained to understand when an application should be made. This meant that people would be safeguarded as required.

Some areas of the home were safe, clean and hygienic; others were not and did not consistently follow safe practices around infection control. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to infection control and hygiene.

Service contracts were in place. Maintenance records we looked at showed that regular safety checks were carried out. Any repairs were completed quickly and safely. These measures ensured the home was maintained.

We looked at the recruitment of new staff. This showed that some required recruitment checks into qualifications and experience were not being followed. This put people at risk of being supported by staff without the appropriate skills. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to recruiting new staff.

We saw that care records were not stored securely and were stored openly in the dining room which was accessible to anyone in the home. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to keeping records securely.

Is the service effective?

People’s health and care needs were assessed and reviewed with them. We saw that care plans were up to date and reflected people’s current individual, dietary, cultural and religious needs.

People confirmed and records showed that people were able to see their visitors in private and that friends and relatives could visit whenever they wished.

The individual needs of people were taken into account with the layout of the home enabling people to move around freely and safely. The premises were suitable to meet the needs of people with physical impairments.

Is the service caring?

People told us that they were comfortable and content at The Sylvester Care Centre. One person said, “It is OK here, the staff are helpful and will spend time with you.” Good care practices were observed. People were supported by kind, attentive and informed staff. We saw that staff showed patience and gave encouragement and guidance when supporting people.

Care plans had been maintained, and regularly updated, recording the care and support people were receiving. However they sometimes needed additional information to provide a complete picture.

People said they could make their views known to the manager and staff. One person said, “I can say if I want to do something differently than they suggest.” A relative told us, “I am kept involved and know what is happening or if there are any changes in his care.”

Is the service responsive?

We observed people involved in social and leisure activities or chatting with staff. People said that they enjoyed the activities.

People said they had no complaints and were comfortable. They told us they knew how to make a complaint if they were unhappy. One person said, “I would just tell them [the staff] if I wasn’t happy about something.” Another person told us, “Everything is OK here the staff are good and listen to you if you don’t like something.” Relatives told us that they were pleased with the care and felt able to tell the manager if they were not happy about anything.

Is the service well-led?

The registered manager had only taken over the management of the home earlier in 2014 and was making significant changes in care and quality monitoring. She had started developing and increasing quality assurance checks. Senior staff identified and addressed any problems. We were notified of any incidents or issues relating to the home in a timely manner.

Staff had a good understanding of their roles and responsibilities and of the ethos of the home. They felt that they worked together effectively. Staff also received regular training to assist with their development.

Staff supervision had started and formal staff meetings were planned. This meant that staff had some involvement in decisions about the home.

We carried out this review to check whether The Sylvester Care Centre had taken action in relation to: -

Outcome 4 – Care and welfare of people who use services

Outcome 5 – Meeting nutritional needs

Outcome 10 – Safety and suitability of premises

Outcome 21 - Records

This was because the home was not compliant at previous inspections.

We spoke with a range of people about the home. They included the provider, manager, staff and people who lived at the home. We also had responses from external agencies including the local authority contracts team. This helped us to gain a balanced overview of what people experienced living at The Sylvester Care Centre.

Our tour of the home found that all maintenance issues found during our last inspection had been attended to. Additionally, the manager had addressed our concerns in meeting people’s nutritional needs.

We reviewed records and observed practices. We saw that people were relaxed and happy during engagements with staff. We observed staff delivering support in a respectful and dignified manner. People felt involved in their care. One person told us, “I’m in control of my care, but they support me in a good way”.

A new, more detailed care plan system was in place and more in-depth risk assessments were being introduced. It was clear from the records we reviewed that improvements had been made in this area. We were assured by the manager that these improvements would continue and be further developed.

We spoke individually with the manager, staff and people living at the Sylvester Care Centre. We also discussed care with relatives. We additionally observed care being undertaken throughout our inspection. We reviewed care records, policies and procedures, audits and risk assessment documentation.

The service did not always demonstrate good practice that ensured people were cared for in a supportive and respectful manner. One person told us, “I’m just feeling institutionalised I want out of here”. Another person said, “We sit in these chairs all day and watch TV”. However, another person told us, “I love it here – the manager is lovely”.

Additionally, although risk assessments were in-depth, care planning was poor and lacked detail. Some records we reviewed were overdue for review and did not always contain staff signatures. There was no evidence of people’s signatures on care records.

The home offered no choice for main meals and expenditure on food, particularly fresh produce, appeared to be inadequate. There was extensive damp in some rooms. A variety of fixtures, furnishing and flooring was in need of repair.

There were adequate levels of appropriately trained staff. The service additionally had processes in place to monitor the quality of its service.