Sutton Court

About the service

Sutton Court is a residential care home for people living with a learning disability and autistic people. It is registered to provide personal care for up to 10 people. At the time of inspection eight people were living at the service.

People’s experience of using this service and what we found

Right Support

People and relatives told us staff supported people to take part in activities. One person said, “It’s better now, calmer, I do more things for myself.” Staff had adopted new approaches; People were supported to be involved in ordinary daily activities such as housework. It was clear that people were proud of their achievements and this change had improved their feelings of independence. At the last inspection people had little to do when at home, now they had more to occupy and interest them. People told us they were following their interests more and showed us examples of craft projects they had completed. People told us they were going out to leisure activities that interested them such as the theatre and to see a film they were keen on. The service gave people care and support in a safe, clean environment. People did show us items that needed replacement in their home, such as worn bedding and damaged furniture. The manager said they would address this. It was evident that improvements had been made since the last inspection and people were seeing the changes as positive. Managers and staff acknowledged more was needed. This included ensuring guidelines to support people to identify and work towards their goals and aspirations were recorded. This would also ensure staff were consistent with each person’s needs.

Right Care

We observed people receiving kind and compassionate care. A relative said, “They (staff) do care about them (named family member).” Staff protected and respected people's privacy and dignity. Staff had been recently trained about learning disabilities and autism and knew people well. Staff told us the new knowledge had changed the way they supported people. A relative told us of improvements, "(Person’s name) seems to be buying more girly stuff now, makes tea and walking around more." People who had individual ways of communicating, using body language, sounds, Makaton (a form of sign language), pictures and symbols we observed to be responding positively to staff’s improved understanding and practice in their use. Staff required more learning about communication and the approaches and tools to use with autistic people in order to create and implement effective communication plans. The home manager told us, “We want to learn more.” Staff understood how to protect people from poor care and abuse. The service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it. People and relatives told us they felt safe. Training had supported staff to understand what people needed when they became distressed, one staff said, “I've learned sign language (person’s name) likes to interact with singing & signing it takes their mind off of things.”

Right culture

The new emphasis on improving people’s quality of life experiences had begun to make a positive impact for people. We observed people were talking with staff on a more equal footing and were gaining in confidence to make choices, which we saw staff respecting. For example, one person did not want to prepare the lunch they had planned and told staff what they wanted instead. Staff encouraged their choice and helped them find the ingredients needed. The provider had invested in training and development for managers and staff, such as positive behavioural support (PBS) which had helped managers and staff understand the reasons people might behave in a certain way when distressed. Managers now knew how to analyse incidents and share the learning from them to reduce situations which cause people distress. People who had sensory perception and processing needs had been referred to health professionals for assessment. Staff had begun to recognise some sensory needs, for example a person who has difficulty with noise was being supported to use noise reduction equipment. Investment in learning for managers and staff was reflected in staff practice. People and relatives told us they could talk to managers and staff freely. One person said, “I like all the staff.”

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 Inadequate (28, 29, 30 June 2021). 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 improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since 30 June 2021. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This was a planned comprehensive inspection based on the previous rating. 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.

We carried out an unannounced comprehensive inspection of this service on 28, 29 and 30 June 2021. Breaches of legal requirements were found in the following regulations. Safe care and treatment, safeguarding service users from abuse and improper treatment, staffing, person- centred care and good governance. The provider completed an action plan after the last inspection to show what they would do and by when to improve. We undertook this inspection to check they had followed their action plan and to confirm they now met legal requirements. The overall rating for the service has changed from inadequate to requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Sutton court on our website at www.cqc.org.uk.

Follow up

We will continue to monitor the service through the providers monthly report on conditions. We will speak with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Sutton Court is a residential care home for people living with a learning disability and autistic people. It is registered to provide personal care for up to 10 people; at the time of inspection 10 people were living at the service.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities most people take for granted. Right support, right care, right culture is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability or autistic people.

People’s experience of using this service and what we found

The service could not show how they met some of the principles of Right support, right care, right culture. The model of support did not always promote maximum choice and independence. The ethos, attitudes and behaviours of managers and staff did not always ensure that people lead confident inclusive and empowered lives.

People were not always protected from abuse and poor care. Staff had failed to report safeguarding incidents. The provider had not ensured managers and staff had suitable training, skills and knowledge to support people whose behaviours may challenge themselves or others safely in least restrictive and most person-centred way.

The service did not focus on people’s quality of life and care delivery was not always person centred. Staff knew people well and often showed kindness but they did not always recognise how to promote people’s rights, choice and independence. People’s human rights were not always upheld. Care and activities were not planned or delivered in a way that met people’s individual needs.

People’s communication needs were not always met and information was not shared in a way people could understand.

People were not supported by managers and staff who understood best practice in relation to learning disability and/or autism. Governance systems did not ensure people were kept safe and received a high quality of care and support in line with their individual needs. Medicines were not effectively checked, and errors were not reported. Risk assessments in relation to health and safety were not always undertaken.

Some people were not always supported to have maximum choice and control of their lives and staff¿did not¿always support¿them in the least restrictive way possible¿and in their best interests; the policies and systems in the service¿were not always understood by managers and staff.¿

People and relatives gave mixed views of the service. Some people had lived at Sutton Court for many years and told us they were generally happy with the support, one person told us they would like to move, and some people were unable to express an opinion. One person said they liked to have support from female staff and this was what they got.

People told us they enjoyed the meals and had a range of foods available to them.

People told us they received appropriate health care supported by staff and told us about treatment they received. Managers had taken steps to support people who needed it to be more confident when attending health appointments.

People told us they had access to independent advocacy and staff supported people to maintain links with those that are important to them.

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 good (published 31 January 2019). The service has been rated requires improvement.

Why we inspected

The inspection was prompted in part by notification of a specific incident of alleged physical abuse. This incident is subject to a criminal investigation. As a result, this inspection did not examine the circumstances of the incident. We inspected to provide assurance the service was applying the principles of Right support, right care, right culture. The inspection was initially a targeted inspection in response to risk, we expanded this into a comprehensive inspection to look at all the five key questions due to further concerns identified.

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.

We have found evidence the provider needs to make improvements. Please see the safe, effective, caring, responsive and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Following the inspection the provider has taken some actions to mitigate the risks. This is an ongoing process.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to person-centred care, safe care and treatment, safeguarding, staffing and governance at this inspection.Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

People’s experience of using this service: We observed people were comfortable in their surroundings and felt safe and happy. One person spoke with us at length about their life at the home and how they spent their time. The person was relaxed and confident to have a conversation with us and took pleasure in showing us their room. Throughout the inspection, we observed positive interactions between people and staff, underpinned with banter and laughter. Staff spent time with people and listened patiently to any concerns they might have. People were treated with dignity and respect and had the privacy they required.

People were safe and were supported by staff who were trained to recognise the signs of any potential abuse. Staff had been trained in safeguarding and knew what action to take if they had any concerns about people’s safety. People’s risks were identified and assessed appropriately. Any accidents or incidents were recorded and lessons learned to prevent any reoccurrence. There were sufficient staff to meet people’s needs, to enable them to engage with activities outside the home and to attend health appointments. People were supported by staff whose suitability was checked at recruitment. People’s medicines were managed safely.

Before they came to live at the home, people’s needs were fully assessed to ensure that staff could meet their needs appropriately. Staff completed training and were experienced in their roles to provide effective care to people. Staff received regular supervisions and an annual appraisal. People were encouraged with a healthy diet and contributed to the planning of menus. People had access to a range of healthcare professionals and services. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People received personalised care that was tailored to meet their individual needs, preferences and choices. Care plans were detailed in the information and guidance provided to staff. Staff encouraged people in decisions relating to their care and in planning long and short-term goals. People chose their keyworker who supported them to make choices and to plan the activities they wanted to do. The provider had an accessible complaints policy so people understood how to make a complaint. No complaints had been received. No-one living at the home required end of life care at the time of the inspection.

People at the home knew the registered manager and the home manager well. People were comfortable in the company of the managers and support staff. Staff felt supported by the provider and the managers and felt that any suggestions would be listened to. People, relatives and staff felt the home was well run. They were asked for their feedback about the home through surveys and at meetings. Suggestions were welcomed and used to drive improvement as needed. A range of quality assurance systems measured and monitored the quality of care and the service overall, which was of a good standard.

This service met the characteristics of Good in all areas. More information is in the ‘Detailed Findings’ below.

Rating at the last inspection: Good. The last inspection report was published on 5 July 2016.

Why we inspected: This was a planned comprehensive inspection that was scheduled to take place in line with CQC scheduling guidelines for adult social care services.

Follow up: We will review the service in line with our methodology for 'Good' services.

Sutton Court provides support and accommodation for up to 10 adults with a learning disability or autism spectrum disorder.

A registered manager was in post when we visited. 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 we spoke with told us they felt safe. They knew what to do if they had concerns about their treatment or if they wished to complain. Staff confirmed they had been trained in how to identify and report any incidents of abuse they may witness.

Any potential risks to individual people had been identified and appropriately managed.

There were sufficient numbers of staff on duty with the necessary skills and experience to meet people’s needs.

People’s medicines had been administered and managed safely.

The registered manager and staff understood their role in relation to the Mental Capacity Act 2005 (MCA) and how the Deprivation of Liberty Safeguards (DoLS) should be put into practice. These safeguards protect the rights of people by ensuring, if there are any restrictions to their freedom and liberty, these have been authorised by the local authority as being required to protect the person from harm.

People were provided with support to access health care services in order to meet their needs.

Positive, caring relationships had been developed with staff to ensure people received the support they needed. They were encouraged to express their views and to be actively involved in making decisions about the support they received to maintain the lifestyle they have chosen.

The culture of the service was open, transparent and supportive. People and their relatives were encouraged to express their views and make suggestions so they may be used by the provider to make improvements.

We read in care records that every person had a personalised care and support plan that was suitable to their needs and reviewed regularly and that people were involved with these. We saw that there were regular community meetings where people's views were listened to and valued. Through observation we saw people being offered choice as to what they wanted to do and how their room ware decorated. We saw that regular audits of the service were completed by the provider ensuring that people who used the service benefited from a service that constantly monitored its quality of care provided.

Staff told us that they felt they had adequate training and were well supported in order to carry out their role and to meet the needs of the people in the home. We found that safeguarding training had been received by all staff and that their responsibility was well understood.

We found that people's care had been planned and implemented in line with their needs and preferences. People's care was discussed with them and consent was obtained. People's opinions and feedback were sought in order to continuously improve the service.

People told us they felt safe living at the home. Risks to people were adequately addressed and we found that people were safe from the risk of abuse and neglect. Staff had received appropriate training to keep people safe and well supported. Staff told us they were supported to carry out their roles safely and to a good standard.

We found that records were kept updated. People's care records were secure but were accessible to staff who needed them to maintain a record of people's care.