2 February 2023
During an inspection looking at part of the service
Sylvan House is a residential care home providing accommodation and personal care to up to 20 people. The service provides support to older people and younger adults, including those who may be living with dementia. At the time of our inspection there were 19 people using the service.
People’s experience of using this service and what we found
At the last inspection we identified a breach in regulation regarding the management of risk. At this inspection we found that enough improvements had not been made and the provider was still in breach of regulation. For example, some care plans contained inconsistent information regarding people’s needs, and not all care plans contained sufficient information to ensure staff knew how to support them safely and ensure their needs were met. Checks required to ensure the safety of the building and equipment were not always completed regularly and we saw some risks in the environment, such as fire doors that were not working effectively.
At the last inspection we identified a breach in regulation regarding the governance of the service. At this inspection we found that improvements had been made and the provider was no longer in breach of regulation regarding this, although further improvements were still required. New systems had been implemented to help monitor the quality and safety of the service, but they did not identify all the issues we highlighted during the inspection, such as those relating to fire doors and people’s care plans.
Medicines were stored and administered safely. Staff had completed medicines training and most had had their competency checked to ensure they were able to manage people’s medicines safely. However, some newly recruited night staff had not yet completed their competency assessment and temporary arrangements were in place with on-call staff to ensure people would still receive medicines if they needed them overnight.
There was a newly implemented system in place to manage Deprivation of Liberty Safeguards (DoLS), and the manager had begun making relevant applications for people. Although mental capacity assessments had been completed when necessary, further work was required to ensure these were always completed fully and in line with guidance.
People told us they were happy with the cleanliness of their home and that their relatives were supported to visit the home. There were procedures in place to help manage the prevention and control of infections, such as policies, audits and cleaning schedules, but these could be improved. A planned refurbishment of the home was in process, however there were some infection control risks identified. For instance, we saw visibly dirty chairs in the lounge, chipped wood and the basement required work to ensure the area was maintained safely and in line with infection control guidance. Personal protective equipment was available to staff when this was required to be used.
People told us they felt safe living in Sylvan House. There were sufficient numbers of safely recruited staff available to support people and people told us they received the support they needed, when they needed it. Staff knew how to raise any safeguarding concerns they had. Accidents and incidents were reported, and actions taken to help prevent future incidents when possible.
There was no registered manager at the time of this inspection, however a new manager was in post and they were in the process of registering with the Commission. The manager was aware of their responsibilities and working hard to implement new processes in order to achieve the necessary improvements.
Relatives told us the home was managed well and they were always kept well informed about any changes through meetings, newsletters and conversations with staff. Staff told us they were well supported, could raise any issues with the manager and had regular meetings where they could share their views.
The manager worked closely with other health and social care professionals to help ensure people's needs were met. They were aware of their role and responsibilities and was responsive to the issues raised during the inspection.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection and update
The last rating for this service was requires improvement (published 1 March 2022) and breaches of regulation were identified. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found that some improvement had been made, but further improvements were still required, and the provider remained in breach of regulation 12 (Safe care and treatment).
At our last inspection we recommended that the provider review staffing levels to ensure enough staff were available in the event of an emergency. this inspection we found this had been acted on.
Why we inspected
This inspection was carried out to follow up on action we told the provider to take at the last inspection. We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.
For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Sylvan House on our website at www.cqc.org.uk
Enforcement and Recommendations
We have identified breaches in relation to the management of risk at this inspection. Please see the action we have told the provider to take at the end of this report.
Follow up
We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.