Archived: Sutton Lodge Residential Care Home

Sutton Lodge Residential Care Home provides personal care for up to 24 older people in one single storey building. At the time of the inspection 18 people were supported some of whom were living with dementia.

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

We found multiple concerns at this inspection relating to the safety of the environment and management of people’s care needs. In addition, the provider had not ensured authorisation was sought when people were deprived of their liberty when in receipt of their care. The provider had not ensured staff had received up to date training or that enough staff were available to ensure people received safe, person-centred care.

Following the inspection, we met with the provider to discuss our concerns. As a result, the provider has made the decision to close the service. We will continue to work closely with the provider and local authority until people have moved to alternative accommodation. Where a service is rated inadequate overall it would usually be placed into special measures. This is a process which ensures the service is monitored closely. Because the provider has made the decision to close the service on this occasion it will not be placed into special measures.

The impact of the concerns were that people’s care and support was not planned effectively to meet their needs in the way they preferred. Not all areas of support people required were met and they were at times in distress or anxious because of this. Staff did not have enough time to spend with people and this meant people were at risk of isolation.

Staff had not received up to date training to ensure they knew how to manage people’s care safely in line with legislation and best practice. This placed people at risk of avoidable harm.

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 and update

The last rating for this service was requires improvement (published 6 March 2018). The service had been rated requires improvement four consecutive times prior to this current inspection. The provider completed an action plan after the last inspection to show what they would do and by when to improve. Enough improvement had not been made at this inspection and the provider was still in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to safety of the premises and management of risk, staff training and staffing levels, person-centred care and safeguarding of people from improper treatment, in addition to the provider’s oversight of the service. Please see the action we have told the provider to take at the end of this report.

Follow up

The provider made the decision to close the service following the inspection. We will work with the provider and local authority until the service is closed to ensure people are moved to alternative accommodation safely.

Sutton Lodge Residential Care Home is registered to provide accommodation and personal care for 24 adults of all ages. The service can also provide care for people who have physical adaptive needs. There were 14 people living in the service at the time of our inspection visit. Some of the people lived with dementia and had special communication needs.

The service was run by a company who was the registered provider. There was a registered manager 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. In this report when we speak about both the company and the registered manager we refer to them as being, ‘the registered persons’.

This is the fourth consecutive time the service has been rated as 'Requires Improvement'.

At the last inspection on 13 October 2016 although there were no breaches of regulations we found shortfalls in the arrangements that had been made to manage the service so that people consistently received safe and responsive care. At the present inspection we found two breaches of regulations. This was because the registered persons had failed to assess risks to people’s health and safety and had not done all that is practical to keep people safe. In addition, the registered persons had failed to assess, monitor and improve the quality and safety of the service in the carrying on of the regulated activity. This was because people had not been fully involved in the development of the service and quality checks had had not always resulted in shortfalls quickly being quickly put right. In addition, the registered persons had not made robust arrangements to ensure that the service complied fully with a number of regulatory requirements. You can see what action we have told the registered persons to take at the end of the full version of this report.

Our other findings are as follows. We found that improvements were needed to ensure that people were fully safeguarded from the risk of financial mistreatment. In addition, lessons had not always been quickly learned when things had gone wrong. Furthermore, background checks on new care staff had not always been completed in the right way. However, medicines were managed correctly and sufficient care staff had been deployed.

Suitable arrangements had not always been made to enable people to receive care that fully promoted effective outcomes. This included national guidelines not always being followed to ensure that care was always provided in a lawful way and was the least restrictive possible. Furthermore, some parts of the accommodation were not designed, adapted and decorated to meet people’s needs and expectations. Although in practice care staff knew how to provide people with most of the practical assistance they needed, some of them had not received all of the training that the registered persons considered to be necessary. In addition, some of the arrangements used to ensure that people had enough hydration and nutrition to maintain a balanced diet were not robust. However, suitable provision had been made to help people receive a coordinated care when they moved between different services and people had been supported to receive on-going healthcare assistance.

Care staff had not always been given all of the resources they needed to provide people with a service that consistently promoted their dignity. However, people were supported to express their views and be actively involved in making decisions about their care. In addition, people's privacy and independence were respected and confidential information was kept private.

People did not always receive responsive care and treatment including having information presented to them in an accessible manner. In addition, people had not been offered sufficient opportunities to pursue their hobbies and interests and to engage in social activities. However, suitable provision had been made to promote equality and diversity. This included the registered persons recognising the importance of appropriately supporting people who chose gay, lesbian, bisexual and transgender lifestyles. Records showed that complaints and concerns had been properly managed and resolved. Furthermore, suitable provision had been made to support people at the end of their life to have a comfortable, dignified and pain-free death.

Records did not demonstrate that sufficient attention had been given to promoting the financial sustainability of the service. However, the registered manager promoted a positive culture in the service that was intended to achieve good outcomes for people. Care staff had been helped to understand their responsibilities to develop good team work and to speak out if they had any concerns. Furthermore, the registered persons were actively working in partnership with other agencies to support the development of joined-up care.

People living at the home were older people. Some people required more assistance either because of physical illnesses or because they were experiencing difficulties coping with everyday tasks, with some having loss of memory.

There was no registered manager 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.

CQC is required by law to monitor the operation of the Mental Capacity Act 2005 Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS authorisations are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves. At the time of our inspection there were no people subject to such an authorisation.

We found that there were not sufficient staff to meet the needs of people using the service at all times. The provider had not taken into consideration the complex needs of each person to ensure their needs could be met through a 24 hour period.

We found that people’s health care needs were assessed, and care planned and delivered in a consistent way through the use of a care plan. People were involved in the planning of their care and had agreed to the care provided. The information and guidance provided to staff in the care plans was clear. Risks associated with people’s care needs were assessed and plans put in place to minimise risk in order to keep people safe.

People were treated with kindness and respect. The staff in the home took time to speak with the people they were supporting. We saw many positive interactions and people enjoyed talking to the staff in the home. The staff on duty knew the people they were supporting and the choices they had made about their care and their lives. People were supported to maintain their independence and control over their lives. However, there was little stimulation for people during the day to keep them occupied and social activities were limited to group events three times a week.

Staff had taken care in finding out what people wanted from their lives and had supported them in their choices. They had used family and friends as guides to obtain information. However there was little stimulation and social activities for people to take part in each day.

People had a choice of meals, snacks and drinks. Meals could be taken in a dining room, a sitting room or people’s own bedrooms. Staff encouraged people to eat their meals and gave assistance to those that required it.

The provider used safe systems when new staff were recruited. All new staff completed training before working in the home. The staff were aware of their responsibilities to protect people from harm or abuse. They knew the action to take if they were concerned about the welfare of an individual.

There was no plan of maintenance in place and some areas of the home were looking in need of refurbishment and redecoration. Some pathways had uneven surfaces and were a trip hazard if people which to walk in the grounds.

People had been consulted about the development of the home and some quality checks had been completed to ensure services met people’s requirements. There had been a lapse in quality checks being made to test the quality of the services being offered, so the provider did not have up to date information as to whether people were currently happy staying in the home. The provider's website and signage at the front of the home gave incorrect information about the home as they had not been updated for some time.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who use the service, their relatives, the staff supporting them and from looking at records. We also spoke with health and social care professionals before, during and after the visit.

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

Is the service safe?

People were treated with respect and dignity by the staff. People told us they felt safe.

Safeguarding procedures were robust and staff understood how to protect the people they supported.

Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents. This reduced the risks to people and helped the service to continually improve. Regular checks were undertaken to ensure the environment was safe for people.

the Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards which applies to people living in care homes. While no applications have needed to be submitted, proper policies and procedures were in place to ensure that people who could not make decisions for themselves were protected.

The service was safe, clean and hygienic. Equipment was well maintained and serviced regularly to ensure its safety. Therefore people were not put at unnecessary risk. However there was no yearly maintenance plan in place to ensure work within the buildings and grounds would continually be maintained.

Is the service effective?

People's health and care needs were assessed with them, and they were involved in writing their plans of care. Specialist dietary, mobility and equipment needs had been identified in care plans where required. People said that they had been involved in writing them and they reflected their current needs.

People's needs were taken into account with signage and the layout of the service enabling people to move around freely and safely.

People told us they could express their views at group meetings, meetings on a one to one basis with staff and by completing surveys.

Is the service caring?

People were supported by kind and attentive staff. We saw that staff showed patience and gave encouragement when supporting people.

People commented, "Staff respect my wishes" and "All my needs are being met."

People who used the service, their relatives, friends and other professionals involved with the service attended meetings throughout the year. Where shortfalls or concerns were raised these were addressed by the provider. People told us they felt their opinions were valued by staff. They told us they also completed questionnaires at regular intervals during the year on a number of different topics.

People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

Is the service responsive?

People told us they could speak with staff each day and share their concerns. They told us staff acted quickly to address their concerns. Relatives told us they could speak with staff about their family member's needs, when that person could not make decisions for themselves.

Health and social care professionals told us staff reacted quickly to people's needs especially when a person's life was ending.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way.

The service had a quality assurance system. Records seen by us showed that identified shortfalls were addressed.. As a result the quality of the service was continuously improving.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and quality assurance processes that were in place. This helped to ensure that people received a good quality service at all times.

We observed staff assisting people with various tasks and noted that the staff were respectful in how they approached and spoke to people. Care plans and risk assessments were in place and we noted these were reviewed on a regular basis.

We reviewed the arrangements at Sutton lodge for obtaining consent and noted the provider had appropriate arrangements in place, although two consent forms were not signed or dated and the manager told us that they were waiting for relatives to visit to get them completed.

The home consisted of three living areas, the main building, the stables which were three self- contained units and the 'Vicarage'. We noted that the 'Vicarage' building was in a poor state of repair and had not been maintained to an appropriate standard which promoted people's wellbeing.

The equipment that was in use at the home had been regularly maintained to ensure it remained safe to use.

We reviewed the arrangements for monitoring the quality of care at Sutton Lodge and found these to be appropriate. Audits had been completed for various aspects of the home. However, there were no maintenance audits for the Vicarage building and the risks to people were not being managed effectively.

We reviewed notifications that the provider was required to send to the care quality commission to notify them about an event or the death of a person who used the service and found that these were appropriately completed and sent in a timely way.

People said staff respected their privacy and dignity and we saw staff were polite and courteous to them. People told us they were satisfied with the care provided, for example one said, 'The staff are good'. Another person said, 'They are all kind and caring.'

People told us they felt safe and comfortable to talk with staff if they had any problems and knew how to raise concerns. Staff had a good understanding of how to keep people safe and knew what to do if they were made aware of any allegations of abuse.

People said there were enough staff on duty to support them and they were attended to promptly when they needed assistance. We saw there is a varied training programme in place for staff to update their knowledge and skills.

We found there were satisfactory systems in place to monitor the quality of the service which took into account the views of people living in the home.

We spoke with the manager about making sure procedures and records were kept up to date and showed they were regularly reviewed and received confirmation after our visit of the action taken to address these matters.