Background to this inspection
Updated
6 January 2022
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.
Inspection team
The inspection was carried out by two inspectors.
Service and service type
Sutton Court Nursing Home Limited- 19 Stone Lane is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
The registered manager covers some other services for the provider, Sutton Court Nursing Home also has a home manager who works exclusively at the service, providing day to day management.
Notice of inspection
This inspection was unannounced.
What we did before inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all of this information to plan our inspection.
During the inspection
We spoke with five people who used the service and two relatives about their experience of the care provided. We spoke with four members of staff including the registered manager, the home manager and care workers. We reviewed a range of records. This included six people's care records and multiple medication records. We looked at three staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We looked at training data and quality assurance records. We contacted three professionals who regularly visit the service.
Updated
6 January 2022
About the service
Sutton Court Nursing Home Limited -19 Stone Lane 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 six people; at the time of inspection six people were living at the service.
People’s experience of using this service and what we found
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 in their best interests; the policies and systems in the service did not support this practice.
People’s risk assessments did not always contain adequate information to provide staff with guidance to mitigate risks and these were not regularly reviewed. We have made a recommendation about the need to ensure risk assessment systems are person-centred, proportionate and consider the least restrictive option to ensure people’s freedom, choice and control.
Governance systems did not ensure people were always kept safe or that they received a high quality of care and support in line with their individual needs. Monitoring and assessments in relation to health and safety were not always undertaken.
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 that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.
Based on our review of safe, effective and well-led, the service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.
Right support:
The model of care and setting did not always maximise people's choice, control and independence. Not everyone was being supported in a way that enabled them to have choice and control in their daily lives, for example, the kitchen was kept locked to keep people safe, and staff held the key. This practice did not support people’s rights. The registered manager has since taken action to ensure access to the kitchen was risk assessed and people were not restricted. Managers had undertaken recent positive behaviour support training and were working with staff to develop their skills to actively support people’s strengths and choice.
Right care:
Care was not always person-centred and did not always promote people’s dignity, privacy and human rights. There were some shortfalls in support and risk plans which did not always focus on people’s aspirations or goals. This meant people’s quality of life had not always been considered. People were supported by staff who knew them well and who had received suitable induction and training. People were supported to be involved in their care.
Right culture:
The ethos, values, attitudes and behaviours of leaders and care staff did not always ensure people using services lead confident, inclusive and empowered lives. People were not always supported by managers and staff who understood best practice in relation to supporting people with a learning disability and autistic people. The leadership of the service was in the process of updating their knowledge. Staff felt valued and empowered to suggest improvements and question poor practice. Governance systems were in the process of being reviewed to ensure they identified shortfalls.
People told us they felt safe. The provider had recently reviewed their safeguarding policy which meant incidents were being managed safely. People were receiving medicines in line with the prescriber’s instructions. People were supported by staff who had received suitable induction and training.
People were supported by staff who knew them well and were supported to eat a healthy balanced diet. People had access to health care and were encouraged to lead healthy lives. Relatives were positive and told us about the links they had with the managers and how they were consistently involved in decisions affecting their loved ones support.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
The last rating for this service was good (published 27 November 2018).
Why we inspected
This inspection was prompted in part due to concerns about people's safety we identified in another of the provider’s locations. We inspected in order to provide assurance people were safe and to check the service was applying the principles of Right support, right care, right culture.
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 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 had taken some actions to mitigate the risks. This is an ongoing process.
Ratings from previous comprehensive inspections for those key questions not inspected were used in calculating the overall rating at this inspection.
The overall rating for the service has changed from good 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 Nursing Home Limited- 19 Stone Lane on our website at www.cqc.org.uk.
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 the need for consent 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 request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.