Archived: Sutton Hall and Lodge

Sutton Hall and Lodge 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.

Up to 60 older people can be accommodated over two floors. The ground floor supported people who may be living with dementia. Nursing care was available on both floors. 41 people used the service when we visited.

The service had a registered manager in place who was new in post since our last 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 is run.

People, their relatives and the staff we spoke with all felt the service had improved. They described the registered managers approach as positive and open. They told us the good leadership by the registered manager had improved quality and safety. Staff felt supported and morale was good. Training for staff was overall good. A definite team approach was seen which made people feel happy and well cared for.

Appropriate checks were completed by the registered manager and provider to ensure safety and quality. This included seeking feedback from people and their relatives and using information when concerns were raised positively. If things could be better the registered manager implemented actions to ensure continuous improvement.

We saw systems were safe in areas such as medicines, health and safety and risk management. We made a recommendation that the provider review the tool they use to understand the number of staff required. This was to ensure enough staff were available to support people with complex needs living with dementia.

We made a recommendation that staff receive more training around how to deal with people who display anxiety and or distress. In addition that a new care plan format be devised to help staff understand how to intervene in such situations.

Recruitment of the providers permanent staff was safe. Where agency workers were used the registered manager had not ensured appropriate information was received from the agency. This was something the registered manager dealt with during the inspection.

Positive change continued to be introduced by the provider, for example an electronic care plan system which will enable better review of people’s health, wellbeing and experience of the service.

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. Relatives told us they were fully involved in developing the care and support for their family member. People felt staff knew them well and used this information to support them in a person-centred way.

People had access to appropriate healthcare support and the team had good links with healthcare professionals. Positive initiatives had been introduced around hydration and pressure area care which meant people had maintained good health. Where people living with dementia required additional support to access health care this was supported if needed. People were supported with palliative care in conjunction with healthcare professionals to ensure they were pain free and comfortable.

Everyone we spoke with said they felt safe, well cared for and were positive about the service. They were treated with kindness and respect. They felt staff were well trained to provide effective support. Staff were aware of what good care looks like and through positive leadership had been supported to continue to improve their approach.

People who chose to join in the activities on offer felt they were good and meaningful. There were plans to develop care workers skills to enable them to use everyday tasks as meaningful interactions. The environment was being renovated to provide a more dementia friendly space.

This inspection was comprehensive, to review the improvements made by the provider to meet the Regulations, and to provide a new rating for the service. The inspection took place on 2 and 9 March 2017 and was unannounced on the first day.

Sutton Hall and Lodge is registered as a residential care home, which also provides nursing. The home can accommodate up to sixty adults and is set in private grounds. Accommodation is over two floors and there is a passenger lift as well as staircases available to access upper floors. The home is split into four units; each unit has fifteen bedrooms, with quiet and communal areas available. Two units, which are on the ground floor, have been set up specifically to care for the needs of people with a dementia type illness. At the time of this inspection a service was being provided to 51 people.

We found that improvements had been made and the service was no longer in breach of Regulations. However, we identified further improvements were needed with the provision of activities and the governance of the service.

The registered manager had a good oversight of the service and was aware of areas of practice that still needed to be improved. They had implemented new systems for monitoring the quality of the service. However, in light of mixed feedback regarding the registered manager, as well as the issues in relation to staffing and activities, we found the registered provider required further improvement to be well led.

There were two activity coordinators who supported people with activities in the day. Improvements were required to make sure activities were meaningful and stimulating for people, to encourage them to participate.

There were sufficient numbers of staff to make sure people’s needs were met, although there was a high use of agency staff. Recruitment procedures made sure staff had the required skills and were of suitable character and background. Staff told us they felt supported in their roles and there had improvements in teamwork. Staff were supported through training, regular supervisions and team meetings, to help them carry out their roles effectively.

There was a registered manager in post 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 is run.

People told us they felt safe at the service. Staff had been trained in safeguarding and were aware of the procedures to keep people safe.

People were supported to take medicines safely and as prescribed. Any issues regarding medicines management were identified promptly and action taken.

Risks to people had been assessed and plans put in place to keep risks to a minimum. There were regular health and safety checks to make sure people were kept safe in relation to fire and other environmental risks. There were clear guidelines to maintain standards of infection control. All areas of the service were kept to a satisfactory standard of cleanliness to make sure the risks of cross infection were kept to a minimum.

The registered manager and staff were aware of the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). DoLS are put in place to protect people where their freedom of movement is restricted. The registered manager had taken appropriate action for those people for whom restricted movement was a concern.

People were provided with sufficient amounts of food and drink. Mealtimes were an organised and sociable experience. The service made sure people’s health needs were met and involved other health professionals where needed.

People and relatives told us that staff were caring and that privacy and dignity were respected. Staff demonstrated a caring and kind approach with people.

People’s care plans were person centred, regularly reviewed and updated accordingly. Care plans detailed the support people required to have their needs met and included details of people’s preferences, likes and dislikes.

People and their relatives were able to make a compliant if they wished and any complaints were recorded and responded to appropriately. There were opportunities for people who used the service and their relatives to feedback their views and suggestions.

This inspection took place on 10, 11 and 16 August 2016 and was unannounced on the first two days. The previous inspection took place in September 2105 when the service was found to require improvements to ensure people's safety. We recommended that the provider review staffing levels and medicine management practice.

There was a manager in post at the time of our inspection who had applied to the CQC to be 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.

People told us they felt safe at the service. Staff had been trained in safeguarding. However, we identified one recent safeguarding incident that had not been reported correctly. This demonstrated that further learning was required to make sure procedures were followed and understood by all staff.

Improvements were required to make sure that people were supported to take medicines safely and as prescribed. Fridge storage temperatures were not recorded accurately and there were recording errors identified with the use of creams. A medicines audit action plan had been produced following an audit in June 2016, however, none of the actions had been followed up to ensure improvements were made.

Risks to people had been assessed and plans put in place to keep risks to a minimum. There were regular health and safety checks to make sure people were kept safe in relation to fire and other environmental risks.

There were enough staff on duty to make sure people’s needs were met, however, improvements were needed in the deployment and organisation of staffing in order to effectively meet people’s needs. Recruitment procedures made sure staff had the required skills and were of suitable character and background.

There were clear guidelines to maintain standards of infection control. However, we found that some parts of the home were not kept to a satisfactory standard of cleanliness and tidiness.

Staff told us they felt supported and there had been improvements in management support. Staff were supported through training, regular supervisions and team meetings to help them carry out their roles.

The manager and staff were aware of the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). DoLS are put in place to protect people where their freedom of movement is restricted. The registered manager had taken appropriate action for those people for whom restricted movement was a concern.

People were provided with sufficient amounts of food and drink. However, mealtimes were not well organised and on both days we visited the temporary cook was not provided with clear information about people’s nutritional requirements.

The service involved other health professionals where needed to support people, such as a doctor or speech and language therapist. We identified concerns with the use of electrical air flow mattresses to support people at risk of skin breakdown. Mattresses were not on the correct setting although this was corrected as soon as we informed the manager.

People and relatives told us that staff were caring and that privacy and dignity were respected. Staff demonstrated a caring and kind approach with people. Some people’s appearance suggested their personal grooming routine was not being followed, for example, dirty nails or unkempt hair. Improvements were required to make sure that people’s self-esteem and dignity was maintained.

People’s needs were regularly reviewed and appropriate changes were made to the support people received. Care plans detailed the support people required to have their needs met, although this was task orientated and there was little evidence that people’s preferences, likes and dislikes had been considered. There was a lack of information about how staff could provide a person centred service.

People and their relatives were able to make a compliant if they wished and any complaints were recorded and responded to appropriately.

The service had been through a difficult period recently, resulting in a number of staff changes. We found that improvements had been made to the service over the last few months but we identified a number of areas where further improvement was required. The manager had a good oversight of the service and was aware of areas of practice and leadership that needed to be improved. However, we found a number of shortfalls in the service which had not been picked up by internal quality monitoring. This showed that quality monitoring systems, and governance of the service being provided, were not sufficiently robust.

We identified three breaches of Regulation where action was required. These related to medicines arrangements, person centred care and good governance. You can see what action we have told the provider to take at the back of the report.

We found people's rights were respected and their consent to care was checked before care was provided.

People received safe appropriate care that met their needs. Care records were well maintained and provided evidence that people were receiving safe and appropriate care.

There was a robust and well organised system for the management of medication. This meant that people received their medication as prescribed and in a timely way.

Staff were supported to attend training. Staffing levels, and the way staff were deployed, meant people could have interesting, meaningful lives and their needs met.

There were systems in place to monitor how the service was operating. This meant the quality of the service was being kept under review.