19 Stone Lane

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.

The home is located within a residential area in Worthing. Communal areas include a sitting room, dining room and games room. Bedrooms are of single occupancy and have en-suite facilities. People have access to a rear garden.

At our last inspection we rated the service as Good. At this inspection we found the evidence continued to support an overall rating of Good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At this inspection we found the service remained Good.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People living with a learning disability using the service can live as ordinary a life as any citizen.

People were at the heart of the service. People received a high standard of person-centred care that was responsive to their needs. Staff went out of their way to provide support to people and worked additional hours to achieve this. Thought had been given to ensure that people’s needs were met in a responsive and innovative way. Staff found creative ways of supporting people to live full and meaningful lives. People were supported to be part of the local community and there was a culture of social inclusion.

Care plans were detailed and provided clear guidance to staff on how to support people. Information was provided to people in an accessible format. Communication was good and staff communicated with people in their preferred way, such as with pictures or signs. Staff were trained in communication skills that met people’s needs.

People were supported by kind and caring staff. Staff were observed helping and supporting people who became distressed or anxious in a calm and soothing manner. People were consulted and involved in decisions about their care and support; they were treated with dignity and respect.

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.

Staff had a good awareness of the principles of safeguarding people from abuse. We observed staff supported people safely and in a way that encouraged their independence. Risks to people were fully assessed and there was guidance for staff on controlling risks to people. Sufficient numbers of well-trained staff were provided so people’s needs were met. Checks were made to ensure newly appointed staff were suitable to work in a care setting. Medicines were safely managed. The premises were safe and well maintained. Accidents and incidents were reviewed to see if any changes in service provision were needed. The home was clean and hygienic.

Robust processes were effective for auditing and monitoring the quality of the service and complaints were responded to appropriately in line with the provider’s complaints procedure.

Further information is in the detailed findings below.

Sutton Court Nursing Home Limited – 19 Stone Lane, is registered to provide accommodation and personal care for up to six adults with a learning disability, autism and/or mental health needs. At the time of our inspection, five people were living at the home, within an age range of 27 – 40 years. The home is situated in a residential area close to public transport and local shops. Communal areas include a sitting room, kitchen with dining area off and a games room with access to electronic games, exercise equipment and sensory lights. Each person has their own bedroom. People have access to a large rear garden, a trampoline and summer house.

A registered manager was in post. 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.

Staff had been trained to recognise the signs of potential abuse and knew what action to take if they suspected abuse was taking place. People’s risks were identified, assessed and managed appropriately and risk assessments or ‘guidelines’ were drawn up in a person-centred way. There were sufficient numbers of staff on duty to meet people’s needs and safe recruitment practices were followed. People’s medicines were managed safely. An upstairs shower room was in need of a deep clean and the registered manager made arrangements for this to be done. A new shower door was ordered.

Staff were trained in a range of areas and all training was up to date and current. New staff followed a period of induction and completed the Care Certificate, a universally recognised qualification. Staff received regular supervisions from their manager and were encouraged to participate in additional training and qualifications. Staff meetings were held and a recent meeting included refresher training on the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards (DoLS). Staff understood the requirements of this legislation and put what they had learned into practice. People had sufficient to eat and drink and were encouraged to maintain a balanced diet. They had access to a range of healthcare services and professionals. People’s rooms were personalised to reflect their personal tastes.

People were looked after by kind and caring staff and warm, friendly relationships had been developed. Staff understood people well, their likes and dislikes and preferences. People were encouraged to stay in touch with people that mattered to them and their spiritual needs were supported. People were encouraged to express their views and to be involved in all aspects of their care.

A wide range of activities were available to people, at the provider’s day facility, at home or in the community. People chose how they would like to spend their days and were encouraged to pursue hobbies that were of interest to them. Care plans provided detailed, comprehensive information and guidance to staff and were completed in a person-centred way. The provider had a complaints policy in place and complaints were managed appropriately.

People and their relatives were asked for their views about the service through regular meetings or through an annual questionnaire. Overall people were happy with the care provided at the home. Staff felt well supported by management and spoke highly of the registered manager. A range of audit systems was in place to monitor the quality of care delivered and the service overall.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

Regular checks were made to ensure that the environment was clean, hygienic and safe. There was a quality assurance system in place so that the manager and staff learnt from events such as incidents, complaints and comments.

We saw that the risks people might face had been carefully assessed and were regularly reviewed. Up to date guidelines were in place for staff to follow, with the actions needed to minimize the risks, while enabling the person to do what they wanted safely.

There were policies and procedures in place in relation to the Mental Capacity Act and the Deprivation of Liberty Safeguards (DoLS). While no applications had been made to the local authority's DoLS team the relevant staff had received training, knew when and how an application should be submitted and sought advice from the team if necessary.

From our observations and discussions with staff we found that they received the appropriate training and had the knowledge and skills to support people safely. People using the service told us that if they had any concerns they would talk to staff who they were sure would listen and take action. One person told us 'I feel safe here'.

Safeguarding procedures were robust and staff we spoke with were well informed about the subject and told us they would not hesitate to report suspected abuse or concerns of poor practice in order to protect people's safety.

Is the service effective?

People or their relatives told us that they were satisfied with the care provided and felt their needs were being met. Evidence showed that staff received appropriate training and support to provide effective care and treatment for people using the service who had complex needs and some of whom displayed challenging behaviours from time to time. It was clear from what we saw and from speaking with staff that they had a good understanding of people's needs, knew them well and were able to recognise early signs of change in behaviour or well-being and act appropriately.

People we spoke with told us about their achievements over time as a result of the care and support provided. One person was now able to maintain their own activity board in their room and another person was pleased to tell us that they had cooked meals for everyone in the house several times and had started working as a volunteer in a local caf' kitchen which they enjoyed.

Relatives we spoke with told us 'They have done a good job with our relative' and another said 'Our relative's health is much better in this home 'they have done wonders for them'.

Is the service caring?

People were supported by caring and attentive staff. We saw that support workers treated people with compassion, dignity and respect and were friendly, patient and positive when interacting with them, using a modified sign language to communicate effectively when necessary. Staff appeared knowledgeable about people's individual needs and provided support when required while encouraging them to do as much as possible for themselves. One person said 'I love it here. They care about me and help me to do as much as I can for myself'. One relative told us 'The support our relative gets is amazing 'they pay attention to their individual needs' and another said 'Our relative has great care in the home, they always look clean and tidy when we go and the staff always make us feel welcome'.

Is the service responsive?

Everyone living in the home had a person centred support plan which they had been involved in drawing up and amending. This detailed the way they wished to communicate with others, their likes and dislikes, interests, goals and support needs. Records confirmed that people received the care and support as described in their support plans and people we spoke with confirmed that staff listened to them, understood and respected their wishes and provided the care required at the right time and as they wanted.

Each person had a key worker who was responsible for helping them achieve their goals and everyone had access to a wide range of activities of their choice both within the home and in the community. People were encouraged and supported to maintain close contact with their families and one relative said 'The staff understand our relative so well and have helped them reach their full potential and manage their syndrome by themselves'.

Is the service well-led?

The service had a quality assurance system in place and the evidence seen showed that any concerns or shortfalls identified were addressed quickly and improvements implemented when required.

People and their representatives told us that they could express their views about the care delivered at any time directly to the manager and staff or indirectly by completing the annual satisfaction survey. They were confident that they would be listened to and examples were given of where action had been taken to improve the service provided.

Staff we spoke with told us they were clear about their roles and responsibilities and were well supported in their roles by the manager and a good team of staff who all worked effectively together.

People were cared for, or supported by, suitably qualified, skilled and experienced staff. Staff had completed a robust recruitment and vetting process to ensure they were appropriate for the role.

The provider had various methods for ensuring the quality of their service. This included obtaining feedback from people, visitors and staff. People's views and feedback were considered in the on-going improvement of the home.