Sutton Veny House

Sutton Veny House is a care home providing accommodation with personal and nursing care to up to 28 people. The service provides support to adults over and under 65 years. At the time of our inspection there were 24 people using the service.

Accommodation was provided in 1 adapted building. People had their own rooms and access to communal rooms such as a large lounge and dining room on the ground floor. People could also access the large gardens from the ground floor.

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

People and relatives told us people were safe. People were happy living at the service and could have visits from friends and family at any time. Relatives felt able to speak with the registered manager about any issue and told us they felt listened to. Staff had received training on safeguarding, and they understood how to report any concerns about abuse.

People were being supported by enough staff to meet their needs. At times people told us staff were busy and there may be a delay in answering call bells. However, they had not experienced any impact from any delay experienced. The registered manager monitored call bells to check they had been timely answered. Staff had been recruited safely.

Medicines were managed safely. Staff had training on medicines management and medicines records we reviewed had no gaps in recording. People had their medicines as prescribed. Risks to people’s safety had been assessed and management plans were in place. This gave staff guidance on how to support people safely. Nursing staff reviewed all care records to make sure they reflected people’s up to date needs. Staff liaised with local healthcare professionals to make sure health needs were met.

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.

Health and safety checks were being completed and the provider made sure equipment was serviced regularly. The home was clean and smelt fresh. People told us they were happy with the cleanliness standards of their rooms. Staff had access to personal protective equipment and had received training on infection prevention and control.

People and relatives told us the staff were caring and the care received was good. We observed interactions between staff and people that were kind and caring. People and relatives thought the service was well-managed and they felt able to share any concerns with the registered manager. The provider visited regularly to carry out quality monitoring and also spoke with people, relatives and staff.

Some staff were less positive about the approach of the registered manager and shared concerns with us. We have made 1 recommendation about listening to staff feedback. We observed the registered manager interacting with people, relatives and staff and did not observe any behaviour or attitude of concern.

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 11 July 2022).

Why we inspected

This inspection was prompted by a safeguarding concern raised which the local authority was investigating. A decision was made to undertake a focused inspection to review the key questions of safe and well-led to assess wider risks for people. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

We found no evidence during this inspection that people were at risk of harm from this concern. 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 Sutton Veny House on our website at www.cqc.org.uk.

Recommendations

We have made 1 recommendation about listening and responding to staff feedback.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Sutton Veny House is a care home providing personal and nursing care to up to 28 people accommodated in one adapted building. There were 25 people living at the service at the time of our inspection. People had their own rooms, some of which had en-suite toilet and shower facilities. There were communal rooms and extensive, well maintained gardens. There were six bungalows in the grounds. Staff from the home provided emergency call out cover for people living in the bungalows.

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

Risks people faced had been identified, with action taken to minimise harm. Equipment had been serviced to ensure each item was safe to use. There were enough staff to support people safely and robust recruitment procedures were being followed. The home was clean, and there were effective infection prevention and control measures in place. Reflective practice was an integral form of staff’s learning, and also used to improve the service.

People felt safe at the home although one person told us night staff were rough when repositioning them in bed. The registered manager took immediate action in response to this allegation.

Staff received a range of training and support to help them do their job effectively. Staff felt valued and morale was good within the team. People were assessed before being offered a place at the home.

The home was a grade 2 building with original features. Due to this, there was a delay before hot water reached the handwash basins in some people’s en-suite facilities. One room was also prone to being cold. The registered manager said in the future, they would carefully consider the appropriateness of the rooms and the people being placed in them.

Whilst people received a choice, and alternatives to the main menu were accommodated, there was variable feedback about the food. The registered manager said they would look into this, and work with people to enable them to have food which met their preferences.

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.

People and their relatives were complimentary about the staff, although two said the practice of the night staff could be improved upon. The registered manager took immediate action, and devised an ongoing plan to improve the night-time culture. People were encouraged to make decisions, and their rights to privacy, dignity and independence were promoted.

People received person-centred care, which reflected their needs and wishes. Each person had a care plan in place that covered a range of topics including communication. People were encouraged to maintain relationships, and additional phones were purchased to enable this. Opportunities for social activities were arranged, although not all met people’s preferences and at a time that was convenient. People and their relatives knew how to raise a concern, and were confident they would be listened to. End of life care could be provided at the home if required. Staff were passionate about ensuring good care to people and their families at this time.

People, their relatives and staff were complimentary about the new manager. New processes had been implemented and the culture of the home had improved. There were a range of audits to assess the safety and quality of the service. The registered manager spent time with people, to build relationships and monitor care provision. There was a desire to continually develop the service, and respond to feedback that was received.

We have made one recommendation for the provider to keep the hot water and heating systems under review.

We have made another recommendation about the social activity provision available to people.

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 requires improvement (published 08 August 2020)

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Sutton Veny House is a nursing home for up to 28 people accommodated in one adapted building. There were 15 people living at the service at the time of our inspection. People had their own rooms and communal areas to use such as a lounge and dining room. The home has extensive gardens and there are six bungalows in the grounds. Staff from the home provided emergency call out cover for people living in the bungalows.

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

People had their medicines as prescribed. Improvement had been made to how medicines were managed and record keeping for medicines administration had improved. Regular audits had been carried out of medicines management to monitor and check for quality and safety.

People told us they felt safe at the home and staff had been trained in safeguarding. We found two incidents of alleged abuse which had been investigated by the registered manager but had not been shared with the local authority. Following our site visit the registered manager took immediate action to make referrals.

People’s risks had been identified and assessed. There were safety measures in place which had been recorded clearly in people’s risk management plans. These had been kept under review by the nursing team with updates added when needed.

Staff had been recruited safely. People were being cared for by staff who were trained and supported by the management team. During the Covid pandemic, training had been adapted to enable staff to continue with development safely. For example, making sure social distancing was adhered to. There were sufficient numbers of staff deployed to meet people’s needs.

Quality monitoring systems had been reviewed and improved to make sure there were checks taking place in all areas of the service. Improvements had been identified and the provider and registered manager monitored actions until completed.

People’s views had been sought with action being taken to make changes where appropriate. The registered manager had adapted systems during the Covid pandemic to have meetings with people and care reviews. Staff used technology to involve professionals and families in people’s care where appropriate.

People, relatives and staff told us the service had improved since the new registered manager started. Comments included, “I would recommend [Sutton Veny House] to any of my friends, if they asked me would I say to have their relatives live there, then absolutely I would”, “The manager is amazing, she is so good with the residents, they love her. She is supportive and if there is a problem she is always on hand, always asks if we need help. She has been good with the virus, really supportive, she has been there for us the whole way through” and “The manager works well, very kind and understanding. Comes around regularly and asks us if we need anything.”

The home was clean and had not experienced any covid-19 infections. Staff wore personal protective equipment appropriately and safely. The home was closed to external visitors and had measures in place to reduce the risks of infection.

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 Inadequate (report published 22 January 2020) and there were multiple breaches of regulation. 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 improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since 22 January 2020. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We undertook this focused inspection to check whether the Warning Notices we previously served in relation to Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met.

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.

Sutton Veny House is a nursing home for up to 28 people on four floors. There were 17 people at the service during our inspection. There was a passenger lift to access the upper floors. People had a communal lounge, dining room and there were extensive gardens. Within the grounds were six bungalows which staff provided emergency call out cover for.

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

People were at risk of harm as the provider had failed to always assess and manage risks. Risk management plans were not robust and required monitoring was not carried out safely. There were not enough staff deployed to make sure people were safe day and night. Staff had not been recruited safely. People did not always receive their medicines as prescribed. Guidance was not available to support staff to know when to administer ‘as required’ medicines.

People’s needs were not always assessed thoroughly so the service could not be sure they could meet them prior to admission. Guidance for staff to support people’s healthcare was not up to date and was conflicting. Additional healthcare monitoring was not being carried out effectively. Mealtimes were hurried as there was not enough staff available and we observed undignified practice during mealtimes.

People told us the lack of staff available impacted on their dignity. People had to wait for long periods of time for staff to give them the support they needed. Whilst people and relatives thought the staff were kind and caring they said there were not enough of them. People had not been involved in their care and support. Care plans had been reviewed without their involvement. People were afraid to speak up and share their views, there was not an open and transparent culture at the service.

There was no registered manager at the service and since our last inspection there had been an inconsistency of leadership and periods of time without a manager. Quality monitoring was not robust and there had been no learning from incidents. Staff had not had meetings and all felt there was not enough of them to carry out their roles.

The environment was clean and free of odours. Staff used personal protective equipment appropriately.

Activities were available, and we saw people enjoyed activity such as pottery classes. Visitors were welcome at any time.

Staff followed the principles of the Mental Capacity Act (2005) and assessed capacity when needed. Where people lacked capacity staff followed best interest processes.

End of life care was provided, staff had completed care plans for people which recorded their wishes for care and support. People could see their GP weekly if they needed. Staff communicated with each other using handover notes to share changes in people’s needs.

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 (report published 16 November 2017.

Why we inspected

The inspection was prompted in part due to concerns received about staffing numbers and people being unsafe. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see the safe 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.

Enforcement

We have identified breaches in relation to unsafe staffing numbers, unsafe recruitment, failure to manage risks, unsafe medicines management and a lack of governance at this inspection.

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.

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.

Special Measures:

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

Sutton Veny House is set in 25 acres of land and provides accommodation and nursing care for up to 28 people including people with dementia. 22 people were living in the home at the time of our inspection. The home is split across four floors. There are nine bedrooms on the ground floor five of which are en-suite. The first floor is accessed by a passenger lift or two sets of stairs. There are 10 bedrooms on the first floor and a further two on the second floor. A hair salon, the kitchen and laundry are on the lower ground floor. People had a communal dining room, a drawing room and veranda which led out into a level access garden.

The service had a registered manager in place. 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.

Sutton Veny House was not always managed well. Nine out of 12 staff told us that the registered manager was not approachable. We were given several examples of when the manager had either been abrupt or dismissive. We were told that this made some staff sad and upset. The registered manager felt that they were approachable. However, they were able to recall some examples of when they may have been abrupt with staff and raised their voice at them in public areas of the home. This did not demonstrate an open or inclusive approach and supported what staff had told us. Following the inspection the registered manager told us what actions they were going to take in reflection of the feedback given.

Medicines were being stored and administered from two areas in the home. This meant that there was a risk of nurses getting distracted during administration which increased the risk of medicine errors. The registered manager told us that a temporary clinical room would be identified to house all medicines and equipment.

We were told that six monthly reviews took place with people, family, professionals and staff. However, these were currently out of date and new meetings were being arranged. We noted that some meetings should have taken place in July and August 2017.

The registered manager had a good awareness of the Mental Capacity Act (MCA) and training records showed that staff had received training in Deprivation of Liberty Safeguards (DOLS). The service completed capacity assessments and recorded best interest decisions. This ensured that people were not at risk of decisions being made which may not be in their best interest. Staff also had a good understanding of the principles linked to MCA.

There were enough staff. Sutton Veny House had recently taken some new admissions with complex needs. These included people who required two staff to assist them. Following the inspection the manager confirmed that an additional staff member had been put on to morning shifts.

People and staff told us that the service was safe. Staff were able to tell us how they would report and recognise signs of abuse and told us they had received safeguarding training. We reviewed the training records which confirmed this.

Care plans were in place which detailed the care and support people needed to remain safe whilst having control and making choices about how they lived their lives. Each person had an electronic care file which also included guidelines to make sure staff supported people in a way they preferred. Risk assessments were completed.

Medicines were administered by registered nurses. Medicine Administration Records (MAR) reviewed showed no gaps. This told us that people were receiving their medicines as prescribed.

Staff had a good knowledge of people’s support needs and received regular mandatory training as well as training specific to their roles for example, pressure area care and dementia.

Staff told us they received regular supervisions which were carried out by management. We reviewed records which confirmed this. Competency assessments in areas such as personal care and feeding had recently been introduced to ensure safe practice and reflective learning took place.

People were supported to maintain healthy balanced diets. Food was home cooked using fresh ingredients and people said that they enjoyed it. Food options reflected people’s likes, dislikes and dietary requirements. The chef told us that they baked birthday cakes for people.

People were supported to access healthcare appointments as and when required and staff followed professional’s advice when supporting people with ongoing care needs.

People told us that staff were caring. We observed positive interactions between staff and people throughout the inspection. This showed us that people felt comfortable with staff supporting them.

Staff treated people in a dignified manner. Staff had a good understanding of people’s likes, dislikes, interests and communication needs. Staff told us that they all had individual usernames and passwords to access the electronic system and that passwords were changed regularly.

There was a system in place for recording complaints which captured the detail and evidenced steps taken to address them. People and relatives told us that that they felt able to raise concerns or complaints and felt that these would be acted upon.

Staff had a good understanding of their roles and responsibilities. Information was shared with staff so that they had a good understanding of what was expected from them.

The service understood its reporting responsibilities to CQC and other regulatory bodies and provided information in a timely way.

Quality monitoring audits were completed by the management team and provider visits were carried out by the regional manager. The registered manager reviewed incident reports and analysed them to identify trends and/or learning which was then shared. This showed that there were good monitoring systems in place to ensure safe quality care and support was provided to people.

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

This is a summary of what we found:

Is the service caring?

People looked well cared for. When we spoke with people they were complimentary about the care they received from staff, describing them as 'caring' and 'friendly'.

Staff were kind and respectful to people at all times. They were attentive and alert to people's moods and we saw them comforting people when they became distressed or agitated. They demonstrated a good rapport with people, who appeared comfortable in their company, and to trust them.

Staff were knowledgeable about the people they cared for and knew people's likes and dislikes and their preferred care routines. One relative told us that they were very happy with the care their family member received. Prior to our inspection we had received information of concern in relation to inadequate care. We did not find this to be the case on the day of our inspection.

Is the service responsive?

The home provided services for people with a high level of need and records clearly demonstrated how care and support should be provided in line with people's wishes.

There was a system in place to review the dependency needs of people and to change the level of support where required. Likewise, the nursing staff reviewed and monitored people's care and treatment needs to ensure appropriate care was given in response to changing needs.

People's care and treatment was reviewed on a regular basis with them, this enabled people to discuss any changes or preferences regarding their care and support.

People took part in activities if they wished to. The activities co-ordinator consulted with people about their interests and hobbies and the activities they would like to see in the home. This enabled the activities co-ordinator to set up activities according to people's wishes. For people who either preferred to stay in their bed room or were bed-bound, a volunteer visited people in their rooms to offer social interaction, either by chatting or reading to them.

The provider had received two complaints regarding the provision of care and had acknowledged where there had been a drop in standards. The manager had put systems in place to minimise repeat occurrences.

Is the service safe?

The home had appropriate systems in place for the recruitment and selection of staff. The personnel records showed that staff employed to work at the home were suitable and had the skills and experience required to support people living in the home. All new staff completed a Disclosure and Barring Service (DBS) check to ensure that they were suitable and safe to work with vulnerable people.

The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We found there were appropriate policies and procedures in place and staff had been trained to understand when an application should be made. Staff understood the importance of enabling people to make safe choices and documents evidenced where people may need support with this.

The home was clean throughout and walkways were clutter free which enabled people to move around the home safely and freely.

Is the service effective?

The home had systems in place to ensure that people received the care they required. The care plans were person centred and demonstrated that people's care and treatment needs had been assessed and were reviewed on a regular basis.

The nursing staff worked closely with other care staff in providing guidance when care and support needs changed which ensured a continuity of care. The head chef liaised with nursing and care staff in devising specialist diets or when dietary needs changed. People said they were happy that they received appropriate care and support.

The housekeeping and kitchen teams received appropriate training and support through a system of supervision and appraisals which enabled them to develop professionally and keep their skills up to date. All staff within the home were offered specific training which was relevant to their role, such as dementia awareness. However, not all care staff received regular formal supervision or appraisal. We have set a compliance action in relation to this and the provider must tell us how they plan to improve.

Is the service well-led?

There were quality assurance processes in place which were monitored externally through the provider. There were audits in place and checks were made regarding the environment, record keeping, infection control, medicines, falls risks and complaints. The home did not have up to date information in relation to staff training or a robust sytem in place for monitoring and responding to changes in staffing levels. We have set a compliance action in relation to this and the provider must tell us how they plan to improve.

People told us they would inform the manager if they had any complaints. One person said 'I have no complaints at all'. There was a clear procedure in place where people or their families could raise concerns and information was available to people regarding the complaint process.

People were asked for their opinion on the service they received through satisfaction questionnaires and the next survey was due towards the end of 2014. Staff were able to discuss concerns directly with the manager or through team meetings. More recently staff had raised the issue of staffing levels with the manager.

Staff said they had a good team and everyone got on well. Many of the staff had been employed at the home for several years. Staff were aware of the structures in place regarding accountability and were confident in their role and responsibilities.

The manager submitted notifications to the Care Quality Commission as required and reported relevant safeguarding concerns to the appropriate authorities.

People commented favourably on the treatment and care they received. One person told us 'we're looked after well' and another 'yes the staff do care.' A visitor told us 'I think they get the care they need.' Staff we spoke with showed a detailed knowledge of people's individual needs. What they told us was fully documented.

People commented favourably on the meals. One person said 'the food's very good ' and I've got my likes and dislikes,' another person said, 'if I don't like something they'll always give me something else.' The chef had a detailed knowledge of each person living in the home, their dietary needs and preferences.

People appreciated the standards of cleanliness. One person told us 'cleaning is done extremely well here.' All parts of the home we inspected were clean.

People said they felt there were enough staff on duty to meet their needs. One person told us 'oh yes there are enough staff.' A member of staff described staffing levels as 'fine.' The home had a stable staff team who worked to cover shifts if other staff were unable to come on duty.

The manager had reviewed the care plans of all the people who used the service. The views of people who used the service and their relatives were taken into account in the provision of their care.

Staff members had received training in respecting people who they care for and treating them with dignity. There was a staff member who was the dignity champion. They had completed an audit of how the staff cared for people in respect of meeting the dignity challenge. We saw many examples of good practice.

The staff rotas confirmed additional staff were on duty to assist people. The manager had devised an assessment tool to ensure the numbers of staff on duty was sufficient to meet people's assessed care needs

The manager told us 'we are improving quality and purpose in people's lives. We have all worked very hard and I would like to thank the Commission."