Sutherlands Nursing Home

Sutherlands nursing home provides personal care and support for up to 52 people in a purpose built

building. At the time of our inspection the service was not providing any regulated nursing support and there

were 16 people using the service, all residing on the ground floor.

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

Medicines were not well managed. We identified a number of concerns relating to the correct storage of medicated creams, in addition to required paperwork to ensure people received their medicines as intended.

Although governance at the service showed some signs of improvement since our last inspection, enough had not been done at this inspection and we were still concerned that full oversight had not been established.

Healthcare professionals gave mixed feedback on their experience of the service. Some identified failings that had occurred with seeking and following healthcare professionals direction to keep people safe, others felt improvements were now being made and this was supporting people to live safer, more fulfilling lives.

People and family members we spoke with were happy with the support now being offered. They felt staff were approachable and kind and that the manager was contactable if they required support.

Care records had improved since our last inspection. Daily recording evidenced the support people were receiving and sufficient detail was captured to ensure people could be supported consistently.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. We observed people being offered choice during both days of inspection, and people told us they were offered choice. However, we identified that capacity assessments themselves required further review and expansion to ensure correct processes were taken when assessing a person's capacity.

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. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

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 21 July 2022). The service remains rated requires improvement. This service has been rated requires improvement for the last 2 consecutive inspections.

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 the provider has made some improvements but remains in breach of regulations.

Why we inspected

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 focused inspection of this service on 14 June 2022. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve the safe care and treatment of people and the governance of the service.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained 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 Sutherlands Nursing Home on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to medicines management and the governance of the service 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 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Sutherlands nursing home provides personal care and support for up to 52 people in a purpose built building. At the time of our inspection the service was not providing any regulated nursing support and there were 27 people using the service.

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

When people had experienced falls, referrals to the specialist falls service had not always been made. This placed them at risk of repeated falls due to a lack of specialist involvement.

Care plans did not always contain details about how to keep people safe and provide consistent care to meet their identified needs.

Medicines were not consistently managed to ensure people received their medicines as prescribed.

Effective oversight had not been maintained by the provider to ensure regular auditing of documentation and practice had taken place since our last inspection.

Staff had not completed all the required training to ensure they could effectively meet people’s individual health care needs.

The provider and operations manager had implemented an action plan prior to our inspection to make improvements to the service. We saw this action plan was beginning to take effect but would take time to be fully embedded at the service.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

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 24 November 2020)

Why we inspected

We received concerns in relation to the oversight of this service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

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

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Sutherlands Nursing Home on our website at www.cqc.org.uk.

We have identified breaches in relation to safe care and treatment, including the management of medicines and record keeping and the good governance and over sight of the service.

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.

We found the following examples of good practice.

Staff were observed to be wearing Personal Protective Equipment (PPE) in line with current government guidelines, this ensured the safety of people supported, visitors and the staff team.

The environment appeared clean, well maintained and welcoming throughout. Ventilation was encouraged in numerous areas of the service to encourage air replacement within the service.

Safe visits for the people residing at the service was facilitated by the staff team. Staff ensured visitors follow current government guidance and completed a Lateral Flow Test before entering the building.

Clear guidance was displayed to ensure people were reminded on how to keep safe with social distancing and correct procedures for donning and doffing PPE.

Sutherlands Nursing Home is a residential care home providing personal and nursing care in one purpose-built property. The service can support up to 52 people, they were providing care to 37 older people at the time of the inspection. A unit on the first floor specialises in care to people living with dementia.

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

People were happy with the care home and the staff that provided their care.

People felt safe living at the home and staff knew how to report possible harm. Staff assessed and reduced risks as much as possible, and there was equipment in place to help people remain as independent as possible. The provider obtained key recruitment checks before new staff started work and there were enough staff working at the service.

People received their medicines and staff knew how these should be given. Medicine records were completed accurately and with enough detail. Staff used protective equipment, such as masks, gloves and aprons, the service was clean and measures had been taken to reduce the risk of transmission of infection.

Systems to monitor how well the home was running were carried out. Concerns were followed up to make sure action was taken to rectify any issues. Changes were made where issues had occurred elsewhere, so that the risk of a similar incident occurring again was reduced. People were asked their view of the home and action was taken to change any areas they were not happy with.

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 October 2018).

Why we inspected

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 coronavirus and other infection outbreaks effectively.

The inspection was prompted in part due to concerns received about assessing risks, staffing, medicines, and infection prevention and control. A decision was made for us to inspect and examine those risks.

We found no evidence during this inspection that people were at risk of harm from these concerns. Please see the safe and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Sutherlands Nursing Home on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Our last full comprehensive inspection of this service was in May 2017. At that inspection we rated the home overall as Requires Improvement. At that inspection we identified a breach of legal requirements within the key question of Effective.

Following that inspection, we received a number of concerns regarding the quality of care being provided to people. Therefore, we conducted a focused inspection in October 2017 that concentrated on the Safe and Well Led areas only where we found four breaches of three regulations. This was because the provider had failed to ensure that: risks to people’s safety had been adequately managed and that people received their medicines correctly; staff did not have the appropriate skills and knowledge to provide people with safe care; robust systems were not in place to assess and monitor the quality and safety of care provided to people. The home was therefore rated as Requires Improvement in both of these key questions.

During this latest inspection the registered manager demonstrated to us that improvements had been made and the home is now rated Good over all. The provider is no longer in breach of any of the regulations that we found at our inspection in October 2017. However, further improvements were needed in some areas as detailed below.

Sutherlands Nursing Home is a ‘care home’. The provider advertises themselves as providing specialist care, including nursing care to people living with dementia. It is registered to provide residential and nursing care for up to 52 people and care. At the time of the inspection there were 40 people living in the home. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The management of the home was led by a registered manager. 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 home is run.

People felt safe living in the home and systems were in place to protect them from the risk of abuse. Risks to people’s safety and individual needs were clearly identified managed well. New systems to make improvements to this were implemented following our last inspection had become embedded. People received their medicines correctly and there were systems in place to safely store, manage and administer these.

There were enough staff to keep people safe and to meet their needs. New staff working at the home had been subject to the appropriate checks before their employment began. These checks were designed to ensure staff were safe to work within care. Any incidents or accidents that had occurred had been reported, investigated and learnt from.

Staff had received training in a number of different areas to provide them with the skills and knowledge to support people effectively. Further training was to be provided to staff regarding dementia care to help them develop their skills further and gain confidence on how to assist people who may regularly become upset or distressed. Staff also received adequate support and guidance in their roles.

People received enough to eat and drink to meet their individual needs. Consent was usually obtained from people before any care was provided. Although staff did not always check with people before assisting them to move in their wheelchair. Where people could not consent, staff acted in line with the relevant legislation and only made decisions on people’s behalf in their best interests.

We have made a recommendation to the provider in relation to the environment in the Minton Unit area of the home where people were living with dementia. Further improvements were needed to the design and decoration, that meet best practice guidelines.

People’s healthcare was monitored and any needs met. Relationships had been developed with outside healthcare professionals who visited the home regularly in response to any concerns raised. The registered manager had established meetings with the local GP surgery which had led to improvements in communications and monitoring of peoples’ healthcare needs.

People were offered choice and were involved in making decisions about their own care. The staff were kind and caring and treated people with dignity and respect. Staff supported people to maintain friendships and relationships. People's friends and family could visit when they wanted with no restriction to this.

People received stimulation from a range of activities that were on offer. This included one to one chats within people’s rooms and trips to the local shops. This was being developed further in conjunction with the people living in the home and their relatives.

People and staff were able to raise concerns or complaints without fear which demonstrated an open culture. Any complaints or concerns raised had been appropriately investigated and dealt with.

Audits were in place to monitor the quality of the service people received. The registered manager reviewed the recorded accident and incidents. These were analysed to identify any patterns or trends and plans were put in place to reduce the risk of them happening again in the future. The registered manager was well regarded by people and their relatives who found them to be open, friendly and professional. Staff were happy working at the service, and felt supported by the registered manager and worked well as a team to deliver care to people.

Sutherlands Nursing Home provides accommodation and personal and nursing care for a maximum of 52 older people, some of whom may be living with dementia. At the time of our inspection there were 41 people living in the home.

At this inspection, there were four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

There was no registered manager in place at the time of our inspection; the home had not had a registered manager since May 2014. It is a condition of the provider’s registration that they must have one. 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.

Safeguarding adults' procedures were in place and staff understood how to protect people from the risk of abuse. There was a whistle-blowing procedure available and staff said they would use it if they needed to.

Assessments of risks to people’s safety had been completed but these were not comprehensive. Staff did not always provide support or monitoring of people’s safety as identified in these plans.

Medicines for application to people’s skin were not always stored safely; records and checks to ensure this were incomplete. People did not always receive their medicines on time or as the prescriber intended.

There were insufficient numbers of suitably qualified staff on duty. The assessed levels of staffing required were not provided. It was not clear whose responsibility it was to arrange for the correct levels required to be on duty. Staff were task orientated and did not focus on people receiving good quality timely care, because they did not have the time to do so.

People were at risk of receiving unsafe care because they were not always monitored when this was identified as necessary. Staff had not been provided with the training required. They were not suitably experienced to provide support to people living with advanced dementia safely. They were not trained to support people who displayed behaviours which could challenge others and place them at risk. These staff often worked unsupervised by experienced staff.

The provider’s recruitment process ensured they only employed staff deemed suitable to work with people in a care setting.

Records to monitor people's intake of food and fluids were not always completed by staff.

There were issues regarding the governance and quality monitoring of the home. The provider's quality monitoring did not always identify shortfalls in the provision of care to people. The provider’s and manager’s audits and checks were not effective in identifying issues around the home.

There was a high turnover of management positions, including the posts of manager, clinical lead and operations manager. Further changes to the management team were on-going or expected, leading to concerns that inconsistent leadership would continue.

The service is registered to provide accommodation for up to 52 people who require nursing or personal care. The home is located in a residential area on the outskirts of Wymondham, is purpose built and accommodation is offered on two floors. Internally, the home is divided into four units, each with a number of bedrooms with ensuite facilities, a sitting/dining area and bathrooms. The three units on the ground floor are all linked and offer a service mainly to people who need nursing care. Minton unit on the first floor offers accommodation for up to 12 people who are living with dementia. On the day of our inspection there were thirty two people using the service.

There was a manager at the service who had been appointed since the last inspection and had applied to the CQC to become registered. 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.

During our inspection we found a well-planned, well managed service. However the service had yet to implement all the necessary improvements and demonstrate sustainability. We had every confidence in their ability to do so and felt the improvements made in a short period of time were significant. Successful recruitment meant the service was fully staffed and people received continuity of care by staff who were well supported to fulfil their roles. There were robust recruitment procedures to help ensure only suitable staff were employed. Staff were supported through an induction programme, meaningful training and regular supervision. However we found due to staff sickness staff were at times stretched and not always able to provide activities to people. Most people required one to one support and there were not enough staff to provide this across the week.

People received their medicines as required and there were safe systems in place to ensure staff were adequately trained and able to administer medicines in line with organisational policies.

Risks to people’s safety were minimised through robust risk assessment and planning to ensure risks were reduced as far as reasonably possible. There was also sufficient management oversight of risk. Equipment was well maintained and the building fit for purpose.

Staff received training to help them recognise different types of abuse and take appropriate actions to ensure people were protected from harm or actual abuse.

People were supported according to their preferences but engagement with people, their relatives and staff in the planning of care needed further consideration as did how staff supported people who lacked mental capacity. Staff had received training in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) but this was not fully embedded and staff were not always following due processes.

People were supported to eat and drink in sufficient quantities and risks from unplanned weight loss and, or dehydration were monitored and risks reduced.

Staff were kind, caring and familiar with people’s needs. They promoted people’s independence as far as reasonably possible and worked in line with people’s wishes.

The service worked inclusively and asked people and their relatives for their feedback to help them plan and continuously improve the service they offered.

The care plans were personalised and in good detail. However we found some gaps and felt the lack of evidenced involvement with staff, people and relatives could be a contributing factor to this. The manager was updating records and moving away from a generic to more individualised plan of care. We identified gaps in the level and suitability of activities for people. On the day of our inspection the activity staff was not at work and this had an impact. We saw some evidence of regular activity but this was limited in scope.

Since the last inspection the service has worked hard to implement and evidence how they were meeting their action plan. However the service had not implemented all the change necessary or demonstrated how they can sustain and embed the improvements already made. We did see a strong, cohesive management team who lead by example and put good systems in place to support their staff and create an atmosphere of openness and transparency. This meant that areas of improvement were identified and addressed through education rather than blame.

We found a breach of the Health and Social Care Act 2008(Regulated Activities) Regulations 2014 in some regulations. You can see what action we told the provider to take at the back of the full version of this report.

This comprehensive inspection took place on 10 and 18 August 2016 and was unannounced. There were 34 people living at the home when we visited.

This home requires a registered manager as a condition of its registration. 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 home is run. At the time of this inspection there was no registered manager in post. The provider had appointed a manager who, on the first day of our visit to the home, had been in post for 10 days. The previous manager, who had not been registered, was working at the home as a nurse. People, relatives and staff were all very impressed with the new manager and had confidence that changes would be made.

We last inspected this service on 26 and 28 January 2015 when we found that the service was not meeting the requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider was in breach of two regulations relating to staffing and good governance. Following that inspection, the provider sent us an action plan, detailing how they intended to meet the regulations. The provider wrote that all actions would be completed by 5 June 2015.

At this inspection we found that the provider had failed to take effective action and continued to be in breach of regulations relating to staffing and good governance. We also found that the provider was in breach of four further regulations relating to medicine management; consent; meeting nutrition and hydration needs; and notifications. You can see what action we told the provider to take at the back of the full version of this report.

People told us they felt safe and that they enjoyed living at Sutherlands Nursing Home. Staff had undergone training in safeguarding people from harm and they demonstrated they knew how to recognise and report any incidents of harm. Recruitment procedures ensured that only staff suitable to work at this care home were employed.

There were not enough staff to ensure that people were safe and that their assessed needs were met in a timely manner. This put people and staff at risk of harm.

Assessments of potential risks to people and to their health had been carried out and guidance recorded but staff had not always followed the guidance. There were a range of issues with the way medicines were managed and we could not be assured that people received their medicines safely and as they had been prescribed. Infection control procedures were not always followed, creating a risk of cross infection.

Staff had undergone training to provide them with the skills and knowledge they needed to carry out their role. However, some staff did not always put their training into practice.

The CQC monitors the operation of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS), which apply to care services. People’s capacity to make decisions for themselves had been assessed and applications for DoLS authorisations had been made for people assessed as having their liberty restricted. However, the procedures in place were not robust enough to ensure that the rights of people who did not have capacity to make decisions for themselves would be protected.

People were supported to maintain good health and their healthcare needs were met by the involvement of a range of healthcare professionals. People were not always given sufficient amounts of suitable food and drink to ensure that their nutrition and hydration needs were met.

There were some warm and caring interactions between the staff and the people they were supporting. People and their relatives praised the majority of the staff and their compassionate, caring attitude. Staff knew people’s needs well and respected people’s privacy and dignity. People were not always given opportunities to make choices in some aspects of their lives. Visitors were welcomed to the home at any time.

Care records were not always complete or up to date and guidance for staff was not always available. People’s past lives had not always been taken into account in providing their care. Charts to record aspects of people’s care were not always completed in a way that would provide detailed information to monitor and direct the care delivered.

Activities members of staff had been appointed and were developing a range of activities, outings and entertainment based on people’s individual needs. Complaints had not always been responded to appropriately.

The provider’s quality assurance process had not been effective in driving improvement in the service provided to people who lived at Sutherlands Nursing Home. Audits had identified a number of issues but the lack of action plans, monitoring and timescales resulted in the issues not being addressed. Audits from external agencies had not been used to improve the service.

People, their relatives and staff were not encouraged to share their views about the service being provided. Not all legal requirements were met by the service and we found that the provider had not notified CQC about allegations of abuse. Records were not always completed as required.

Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

Another person told us they had been helped by the home and the GP to contact a physiotherapist to assist with some hand exercises. This told us people were involved in decisions about their care.

Two family members spoken with were complimentary about the respect and dignity the staff team gave to their relative. One family member, who told us they spend most days at the home, said, 'This is a great home with superb staff. I am always included in decisions.'

Although the majority of people enjoyed their meal and said the food was good it was evident from our observation that not everyone had received their meal while it was hot. These people told us they had not enjoyed their meal.

One relative said, 'Staff are always available to talk to.' This told us that staff supported the person and their family members.

The home had held a meeting with relatives and action had been taken from that meeting. This showed that people were listened to and action was taken when requested. We read comments from thank you cards such as 'how kind staff are' and that they 'afforded dignity to my mother'.

Two people living in this home, told us they knew where the information was if they wanted to complain. They said they could talk to the staff or manager if they were unhappy about anything and that their concerns would be addressed. This showed that people's concerns would be acted upon.

Because most people living in the home were unable to tell us verbally what they thought about the care they received, we needed to observe how people were being supported. We found that staff spent time with them to ensure they were supported with their meals and drinks. They also tried to find ways to ensure that people were calm and to reduce agitation by distracting people and avoiding confrontation.

We found from our observation, records and discussion with staff that people's wishes were respected. Where people found it difficult to make informed decisions about their care this was assessed and discussed with professionals to agree what was in their best interests.

Recruitment procedures were sufficiently robust to help protect people from staff who may be unsuitable to work with vulnerable adults.

We also found that the home was appropriately maintained and people were able to have some of their own possessions around them to make their rooms more homely.