We carried out a review of the data available to us about Sutton Grange on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Sutton Grange, you can give feedback on this service.
Sutton Grange is a residential nursing home providing accommodation for people who require nursing or personal care and treatment of disease, disorder or injury for up to 70 older people, people with a physical disability, younger adults or people living with a dementia. At the time of the inspection 44 people were living at the service and a further 6 people visited the home for day care support. The service was purpose built over two floors with lift access to the first floors. There were four units in the service, Red house and Blossom Walk which supported people with residential care needs and, Silver Birch which supported people with nursing care needs. The Woodlands unit which supported people with nursing dementia needs had recently opened following the removal of conditions from the registration of the service. All units of the service had access to outside space. The service was situated in a small residential area in Banks close to the outskirts of Southport. Parking facilities were available.
People’s experience of using this service and what we found
We received mixed feedback about the staffing numbers in the service. A senior member of management undertook a full review of the staffing required. We made a recommendation about this. Safe recruitment practices were in place. People and relatives told us they felt safe in the service and staff had undertaken training. Medicines were being managed safely and people’s risks were considered. The service was clean and tidy and had been developed to support the needs of people living there.
A range of training was provided to ensure staff had the knowledge and skills to support people’s needs. 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. Records confirmed people’s consent had been obtained. We observed a positive dining experience. People were offered a choice of meals according to their likes and needs.
People were positive about the care they received. People were supported to be involved in decisions and were treated with dignity and respect. Care files contained good information about people’s individual needs, and these had been updated. A range of activities were provided to people both in the service and in the community. Complaints were investigated an acted on appropriately.
Positive feedback was received about the registered manager and the changes made in the service. Team meetings were being undertaken with all members of the staff team. Evidence was seen that the service worked well with relevant professionals to improve outcomes for people.
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 10 December 2018). Since the last inspection the Care Quality Commission has lifted the conditions on the registration for Sutton Grange with the Care Quality Commission imposed earlier.
Why we inspected
This was a planned inspection based on the previous rating.
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.
At our last inspection we identified a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to, safeguarding service users from abuse and improper treatment, dignity and respect, staffing, safe care and treatment relating to risks, infection control, the environment and safe handling of medicines. We also identified breaches in relation to consent, meeting nutritional and hydration needs, fit and proper person employed, person-centred care, and good governance. We also identified a breach of Regulation 18 of the Care Quality Commission (Registrations) Regulation 2009 (Part 4), notification of other incidents. We also made recommendations in relation to induction training for new staff, the timely involvement of professionals and receiving and acting on complaints.
Following the last inspection, we met with the senior management team for the provider including the nominated individual to discuss our findings and we asked them to complete an action plan to show what they would do and by when to improve the key questions of safe, effective, caring responsive and well led to at least good. We also undertook enforcement action which placed conditions on the registration for Sutton Grange with the Care Quality Commission. These included, providing an action plan each month to the Care Quality Commission that demonstrated the improvements in the home and that no people to be admitted to Banks View unit without written consent from the Care Quality Commission. We also placed a condition that an assessment of the skills, numbers and deployment of staff required to meet the needs of people in the home is undertaken and an assessment of the training and support required by those staff to meet the needs of people is undertaken.
During this inspection we found significant improvements had been made in the key questions for safe, effective, caring, responsive and well-led. Whilst improvements were noted the home needed to embed these improvements and demonstrate their sustainability. Although improvements were noted in relation to the safe handling of medicines we identified an ongoing breach of Regulation 12 Safe care and treatment. You can see what action we have taken at the back of the full version of this report.
This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.
Sutton Grange 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. Sutton Grange is registered to provide accommodation for up to 70 persons who require nursing or personal care and treatment of disease, disorder or injury for people living with a dementia, older people and people with a physical disability. On the day of our inspection 26 people were living in the home.
Sutton Grange is a purpose-built home with four units over two floors. We undertook a tour of the building which confirmed Banks View was closed this supported one of the conditions of their registration. All people’s bedrooms were of single occupancy and ensuite facilities were available. Communal lounges and dining facilities were available on each unit as well as a communal café area in the entrance to the home.
The service had a registered manager who had been in post since 18 July 2018 at the time of our inspection. 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 was run.
Improvements were noted in the handling of medicines in the home. However, we identified that further improvements were required to ensure people received their medicines safely.
Individual and environmental risk assessments had been completed that provided important information about how to keep people safe. The environment was being monitored regularly and servicing and checks had been undertaken that confirmed the home was safe for people to live in and staff to work in. People and relatives told us they felt safe in the home. The training matrix confirmed staff had undertaken the relevant training to keep people safe.
Staff files we looked at confirmed they were recruited safely to their role. Relevant checks had been completed this included proof of identity and Disclosure and Barring Service checks. The training matrix for the home confirmed staff had undertaken the relevant training to equip them with the skills to deliver good care to people.
Deprivation of liberty applications had been submitted to the assessing authority appropriately. Where completed applications had been received these were reflected in people’s care files. 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 told us they were happy with the meals provided to them. A variety of choices were available to people and where specialised meals were required these were provided.
People were very happy with the care they received in the home and the positive improvements in the service. People consistently told us they were treated with dignity and respect and staff we spoke with said they ensured people’s dignity, privacy and respect was maintained.
Information relating to advocacy services was available to people where they required support with decisions.
Care plans were detailed and comprehensive and reflected people’s individual needs and how to manage these safely. Advanced decisions and Do Not Attempt Cardio Pulmonary Resuscitation were recorded in people’s care files where it was relevant. Care files demonstrated relevant professionals had been involved in people’s care and health reviews had taken place.
A comprehensive programme of activities was provided to people who used the service. Activities co-ordinators actively supported people to engage in activities of their choosing. Records were detailed and reflected what activities had been undertaken by people.
Good systems to deal with complaints was in place. These included details of the complaint along with the outcome from these. Regular meetings and feedback about the service was being undertaken that ensured the views of all was considered by the management of the home.
The feedback about the registered manager was consistently very good. All people told us of the improvements in the service recently.
Systems were seen that confirmed the home was being monitored regularly and recently. Records included the findings of audits that would enable actions to be taken to improve the home for the benefit of those who lived, worked and visited it.
During this inspection we identified a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to; safeguarding people from abuse and improper treatment, staffing, risks, the environment, infection control, deprivation of liberty safeguarding, records and good governance. We will report on our actions for these when this is complete.
We also identified a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to, consent, staff training, nutrition and hydration, person centred care, dignity and respect, equality and diversity and activities. You can see what action we have taken at the bottom of the full version of this report. We made the following recommendations in relation to induction training for new staff, the timely involvement of professionals and receiving and acting on complaints. We also identified a breach of Regulation 18 of the Care Quality Commission (Registrations) Regulation 2009 (Part 4). Notification of other incidents.
Sutton Grange 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.
Sutton Grange is registered to provide accommodation for persons who require nursing or personal care and treatment of disease, disorder or injury for people living with a dementia, older people and people with a physical disability. The service can accommodate up to 70 people in four separate units; Banks view, Silver birch, Blossom walk and Red house gardens. Banks View specialised in the nursing care of people living with a dementia, Silver birch specialised in general nursing care, Blossom walk specialised in the care of people living with a dementia and Red house gardens specialised in personal care needs.
On the first day of our inspection 57 people were receiving care at the service. On the subsequent days of our inspection 51 were receiving care at the service. A registered manager is required as part of the services registration requirements. At the time of the first day of our inspection there was a registered manager in post. On day two, three and four of the inspection a new home manager had taken over the day to day responsibility for the home. 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.
Systems to ensure people who used the service were protected from abuse were inadequate. We observed a number of incidents where people were exposed to the risk of harm. Whilst some people told us they felt safe in the home others told us they did not.
Risk assessments failed to include detailed and relevant information to support and protect people from any identified risks. We saw a number of identified risks in the home that had not been acted upon appropriately, such as choking for people who used the service. We identified a number of infection risks in the home, including dirty gloves left in public areas, a dirty soiled bed pan and a lack of liquid soap and paper towels for people to use.
We identified a number of concerns in relation to the safe handling of medicines. Staff were seen to be disrupted during the administration of medicines. Gaps in medication records were seen, which meant people did not receive their medicines as prescribed. Records to administer medicines covertly were brief and lacked detail about how to administer these safely. We were made aware of an incident that had occurred relating to administration of medicines covertly.
We identified a number of concerns in relation to the dining experience for some people living in the home. Records we looked at had not been completed in full and where specialist guidance had been provided we saw this had not been followed.
People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible; the policies and systems in the service did not support this practice.
Relevant assessments and applications to the assessing authority in relation to Deprivation of Liberty Safeguarding (DoLS) had not been completed appropriately. There was no safe system in place to monitor how many people had applications in relation to DoLS. None of the records we looked at had evidence of formal written consent to support the delivery of care to people.
There was insufficient, suitably qualified and knowledgeable staff to ensure people received safe care. Recruitment procedures were in place; however we saw induction training was inconsistent and not all staff had completed relevant inductions. Whilst some staff had received relevant and up to date training and competency checks not all staff had completed training to support the delivery of care to people.
We saw some evidence that people who used the service received good care. However, this was not consistently provided across the service. We saw one person being spoken to in an inappropriate manner and another person was dressed inappropriately.
There was limited evidence that people had been actively involved in the development of their care files in relation to their choices and needs. Some people were treated with dignity and respect; however not all people had a positive experience. We saw staff failed to respond appropriately when one person needed support with their personal care.
Whilst there was some evidence of care planning that supported the delivery of care for people. A number of records we looked at identified significant shortfalls in their content and how they supported the delivery of care to people. Where people required end of life care their care plans had not been developed to reflect their individual needs.
There was insufficient activities on offer to people who used the service. The feedback about the activities on offer to people was mixed.
We saw a system in place for dealing with complaints; however not all complaints had been acted upon appropriately. We saw some positive feedback in questionnaires from people and relatives. System’s and processes to assess the quality of service provided was inadequate and therefore failed to ensure Sutton Grange was safe for people to live in. There was a lack of oversight from the management in the home. It was clear a number of shortfalls in the operation of the home had impacted on the safety and delivery of care to people.
The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’.
Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.
Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.
The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.
If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.
You can see what action we told the provider to take at the back of the full version of the report. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.
Sutton Grange provides 24 hour nursing and residential care to 70 people. At the time of our inspection there were 35 people who lived at the home. The home is a purpose built and split into four areas. Each area has good communal facilities including a lounge, dining room and bathroom facilities. A secured garden area is provided at the rear of the premises along with garden areas at the front.
The home did not have a registered manager. The manager had left shortly before our inspection. An interim manager had been appointed whilst the provider recruited a suitable replacement for the 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 service is run.
People were supported to eat and drink enough to maintain their health. People's dietary requirements were explored and the information was readily available to kitchen staff to ensure these were met. However, we found inconsistencies in staff practice between different areas of the home. We have made a recommendation about this.
People were safe living at the home because they were supported by a sufficient number of staff who had the right skills and knowledge to meet their needs. Staff understood their responsibilities with regard to reporting suspected abuse, in order to safeguard people.
The service followed safe recruitment practices to ensure only suitable candidates were employed to work with people who lived at the home. The service had ensured risks to individuals had been assessed and measures put in place to minimise such risks. A comprehensive plan was in place in case of emergencies which included detail about how each person should be supported in the event of an evacuation.
Staff received induction and on-going training to enable them to meet the needs of people they supported effectively. Staff were supported by way of regular supervision, appraisal and access to management.
Effective systems were in place to ensure people's medicines were managed safely. Only trained staff were allowed to administer medicines.
Where people did not have the capacity to understand or consent to a decision the provider had followed the requirements of the Mental Capacity Act (2005). An appropriate assessment of people's ability to make decisions for themselves had been completed. Where people's liberty may be restricted to keep them safe, the provider had followed the requirements of the Deprivation of Liberty Safeguards (DoLS) to ensure the person's rights were protected.
However, we found the system to monitor DoLS authorisations had not been effective in identifying two authorisations had expired. The deputy manager had implemented a new system which remedied this.
People could access external healthcare services as they required and were supported to do so. People had access to a wide range of activities which were provided seven days a week.
Staff were kind and caring and treated people with respect. We witnessed many positive and caring interactions throughout or inspection. Staff knew people's likes and dislikes which helped them provide individualised care for people.
Plans of care were based around the individual preferences of people as well as their medical needs. People and their relatives were involved in reviews of care to ensure it was of a good standard and meeting the person's needs.
The provider had implemented effective systems to assess, monitor and improve the quality of care and support that was delivered to people. People, their relatives and staff were involved in developing the service.