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Inspection carried out on 1 February 2017

During a routine inspection

We carried out an unannounced inspection of Sutton Beeches on the 1st and 10th of February 2016.

Sutton Beeches community support centre is a two storey building set in its own grounds in a residential area. It is owned and managed by Cheshire West and Chester Council and provides respite care and rehabilitation for up to 30 people.

A registered manager had been in post since 2014. 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 carried out an unannounced comprehensive inspection of this service on 22 December 2015 and 5 January 2016. Breaches of legal requirements were found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

We found that the registered person failed to ensure that proper and safe management of medicines. This was a breach of regulation 12 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

This visit found that systems had been put into place to reduce the risks associated with unsafe management of medication. This included appropriate storage of controlled medication. In addition to this, the temperatures of medication refrigerators were better monitored to enable the safe and effective storage of medication. Systems had been put into place to ensure that people did not run out of prescribed creams or other medications.

At our last visit, we found that the registered person failed to ensure that systems were in place to regularly assess, monitor and improve the quality and safety of the service. This was a breach of regulation 17 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

This visit also found that audits in relation to care plans and medication administration had enabled any deficiencies to be quickly identified and addressed so that people were not put at risk. Monthly audits were conducted by the registered manager enabling an ongoing commentary of the quality of the service to be gained.

Our last visit had found that care plans were not person centred and had not been reviewed regularly. This visit found that care plans outlined the specific needs unique to individuals. The contents of care plans had been agreed by individuals and where changes were considered, these were agreed with individuals before they were implemented. Care plans showed evidence that as goals were achieved, new goals to meet the changing needs of people were set with their agreement.

Staff demonstrated a good understanding of the types of abuse that could affect people who used the service. Staff had received training in this and were knowledgeable about where poor practice could be reported.

Staffing levels were maintained in sufficient numbers to meet the needs of people who used the service. These levels were confirmed by staff rotas.

Recruitment of staff was robust. Checks were in place to ensure that people were protected by the recruitment process. Risk assessments relating to the environment and risks associated with the support provided were in place and reviewed.

The premises were clean and hygienic. All areas were well maintained.

Staff received the training and supervision they needed to perform their role. A structured induction was in place to prepare new members of staff to perform their role.

Staff had received training in the Mental Capacity Act 2005 and were able to outline its principles and how it affected the people who were supported.

People were provided with a choice of meals and offered regular drinks. Nutrition provided met the dietary requirements and preferences of people.

People felt cared about and observations noted that staff provided support in a caring and dignified manner. Staff were able to outline how they would support people with their privacy and dignity taken into account.

People had all their health and social needs assessed by the registered provider. This was translated into a plan of care which was personalised and reviewed regularly.

People knew how to make a complaint if needed. Complaints records were maintained and where complaints were made, the registered provider sought to respond to the complainant and investigate these appropriately.

The registered manager had responded to shortcomings during our last inspection by submitting an action plan. This visit found that action had been taken to address these so that people were not put at risk. The registered manager had gained the views of people who used the service and had introduced audits to measure the quality of the support provided.

Staff told us that the manager was open to ideas and felt that they were approachable and supportive. The registered manager had been transparent in providing information about the performance of the service following our last visit by providing details of its rating and the inspection report.

Inspection carried out on 22 December 2015

During a routine inspection

We inspected this service on 22 December 2015 and 5 January 2016 and the inspection was unannounced on both days.

Sutton Beeches community support centre is a two storey building set in its own grounds in a residential area. It is owned and managed by Cheshire West and Chester Council and provides respite care and rehabilitation (low level discharge to assess) for up to 30 people. At the time of this inspection there were five people staying at the service. The service was under a voluntary agreement not to admit people.

The previous inspection was undertaken in April 2015 and action was needed in relation to the environment being properly maintained and safe. An action plan was received and during this inspection we found that the service had addressed the compliance actions and that these were now met.

There is a registered manager in place at this 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.

People told us that they felt safe at the service and that the staff understood their care needs. People commented “The staff are lovely”, “I feel safe here with the staff” and “Love being here.”

We found concerns with the medication administration, which meant that we could not be confident that people received their medication administered as prescribed. We also found concerns with the quality assurance systems in place which were limited and audits of the medication, environment or care plans did not take place. This meant that these areas were not checked to ensure information was up to date and accurate.

You can see what action we told the provider to take at the back of the full version of the report.

We saw that the staff team understood people’s care and support needs, and the staff we observed were kind and treated people with respect. We looked at the care records of all the people who were staying at the service. We found the information was basic and not person-centred. We have made a recommendation regarding the information in the care plans and the reviewing of them.

The registered provider had policies and procedures in place to guide staff in relation to the Mental Capacity Act 2005 and staff recruitment.

We found the registered provider had systems in place to ensure that people were protected from the risk of potential harm or abuse. Staff had received training in safeguarding adults and during discussions said they would report any suspected allegations of abuse to the person in charge. Policies and procedures related to safeguarding adults from abuse were available to the staff team. This meant that staff had documents available to them to help them understand the risk of potential harm or abuse of people who lived at the service.

We found the service was clean, hygienic and well maintained.

Good recruitment practices were in place and that pre-employment checks were completed prior to a new member of staff working at the service. This meant that the people could be confident that they were protected from staff that were known to be unsuitable.

We looked at staff training and we saw that staff undertook a range of training in line with their identified roles. Staff had up to date supervision and appraisals and had the opportunity to attend relevant meetings.

There were enough staff working to meet the needs of people. People who stayed at the service said that staff were available when they needed them. A range of activities were available to encourage social contact and stimulation. We noted that an activities coordinator was employed at the service and that there were planned activities throughout the month.

We looked at how complaints were dealt with. People told us they would approach the staff on duty or the management team. The registered provider had not received any complaints since the last inspection, however, processes were in place should a complaint be raised and these showed they would be dealt with in a timely manner.

People told us the food was very good. We observed the lunch time meal being served and saw that sufficient staff were available to help people as required throughout the mealtime.

Inspection carried out on 23rd and 24th April 2015

During a routine inspection

We carried out an unannounced inspection of Sutton Beeches on the 1st and 10th of February 2016.

Sutton Beeches community support centre is a two storey building set in its own grounds in a residential area. It is owned and managed by Cheshire West and Chester Council and provides respite care and rehabilitation for up to 30 people.

A registered manager had been in post since 2014. 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 carried out an unannounced comprehensive inspection of this service on 22 December 2015 and 5 January 2016. Breaches of legal requirements were found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

We found that the registered person failed to ensure that proper and safe management of medicines. This was a breach of regulation 12 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

This visit found that systems had been put into place to reduce the risks associated with unsafe management of medication. This included appropriate storage of controlled medication. In addition to this, the temperatures of medication refrigerators were better monitored to enable the safe and effective storage of medication. Systems had been put into place to ensure that people did not run out of prescribed creams or other medications.

At our last visit, we found that the registered person failed to ensure that systems were in place to regularly assess, monitor and improve the quality and safety of the service. This was a breach of regulation 17 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

This visit also found that audits in relation to care plans and medication administration had enabled any deficiencies to be quickly identified and addressed so that people were not put at risk. Monthly audits were conducted by the registered manager enabling an ongoing commentary of the quality of the service to be gained.

Our last visit had found that care plans were not person centred and had not been reviewed regularly. This visit found that care plans outlined the specific needs unique to individuals. The contents of care plans had been agreed by individuals and where changes were considered, these were agreed with individuals before they were implemented. Care plans showed evidence that as goals were achieved, new goals to meet the changing needs of people were set with their agreement.

Staff demonstrated a good understanding of the types of abuse that could affect people who used the service. Staff had received training in this and were knowledgeable about where poor practice could be reported.

Staffing levels were maintained in sufficient numbers to meet the needs of people who used the service. These levels were confirmed by staff rotas.

Recruitment of staff was robust. Checks were in place to ensure that people were protected by the recruitment process. Risk assessments relating to the environment and risks associated with the support provided were in place and reviewed.

The premises were clean and hygienic. All areas were well maintained.

Staff received the training and supervision they needed to perform their role. A structured induction was in place to prepare new members of staff to perform their role.

Staff had received training in the Mental Capacity Act 2005 and were able to outline its principles and how it affected the people who were supported.

People were provided with a choice of meals and offered regular drinks. Nutrition provided met the dietary requirements and preferences of people.

People felt cared about and observations noted that staff provided support in a caring and dignified manner. Staff were able to outline how they would support people with their privacy and dignity taken into account.

People had all their health and social needs assessed by the registered provider. This was translated into a plan of care which was personalised and reviewed regularly.

People knew how to make a complaint if needed. Complaints records were maintained and where complaints were made, the registered provider sought to respond to the complainant and investigate these appropriately.

The registered manager had responded to shortcomings during our last inspection by submitting an action plan. This visit found that action had been taken to address these so that people were not put at risk. The registered manager had gained the views of people who used the service and had introduced audits to measure the quality of the support provided.

Staff told us that the manager was open to ideas and felt that they were approachable and supportive. The registered manager had been transparent in providing information about the performance of the service following our last visit by providing details of its rating and the inspection report.

Inspection carried out on 2 November 2013

During a routine inspection

Care and support was planned and delivered in a way that was intended to ensure people’s safety and welfare. Staff were witnessed as being kind and promoting of people’s independence. We reviewed three care plans. These were well presented, individualised and well organised.

The home provided evidence of assuring quality care to service users by asking them to complete a ‘quality questionnaire’. The feedback was monitored and grouped into common themes. Most of the comments were very positive, several comments deemed the service as ‘excellent’. Negative comments were investigated.

The three people we spoke to all said the staff gave them choices and promoted their independence. One service user had stayed with them previously and described it as a “home from home”. The three service users we spoke to all agreed the food was very good.

When asked all staff were able to say what they would do in an event of a medication error. The provider showed evidence of being able to store controlled drugs safely and record them correctly.

Inspection carried out on 25 January 2013

During a routine inspection

We spoke with a number of people who were using the service. One person told us “It is really very nice here, they are brilliant people always a smile on their faces. Very nice food. There are plenty of people to talk to, I never get bored, I’ve also got books and a television”. Another person said “Everything’s smashing, the ladies work very hard and nothing is too much trouble for them. If anyone complains there must be something wrong with them.” Another person commented “This is five star accommodation with gourmet meals. We have a good laugh with the staff”.

An individual rehabilitation programme was written for each person and this was put in place in consultation with an occupational therapist and a physiotherapist who were both based in the service. The support staff were responsible for implementing the programmes and recording progress.

People were given a satisfaction survey form to fill in at the end of their stay so that they could give their views about the service they had received.

A registered nurse was based at the centre full time which meant that any nursing needs people had could be attended to promptly. A doctor visited the service three times a week.

Inspection carried out on 11, 12 April 2011

During a routine inspection

Sutton Beeches is divided into respite and rehabilitation units. During the inspection both units were visited and people were spoken with on the day.

People using the service confirmed that the staff were very supportive, kind and helpful. Other comments included:

“The staff are great here”

“The staff are always there if you need them”,

“The staff are very kind and helpful”

“The staff are good to me.”

Staff commented:

“The work very interesting and says it gives a good insight into dementia”

“The training here is good”

“The manager is very good and supportive”

“The senior staff are good and have an open door policy”

“I love my job and it’s good to meet different clients”

“The manager is very good with the staff and service users”

“The manager is approachable and very supportive to the staff team” “There is a

wide range of training available”

“It is good that the clients are not permanent and it’s nice to see them leave better than when they arrive. It is good to make a difference”

“There is some uncertainty within the staff team on job security and it would be better if we were fully informed about what is going to happen to the building and our jobs.”

Other professionals said:

“Staff are always helpful and approachable”

“Staff will provide information I needs to complete the assessment.”

Reports under our old system of regulation (including those from before CQC was created)