Sutton Court Care Centre

Sutton Court Care Centre is a residential care home providing nursing care to up to 63 people. The service provides support to older people, some of whom are living with dementia. At the time of our inspection there were 60 people using the service.

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

Sutton Court Care Centre were committed to providing high quality care that achieved good outcomes for people. There was a continued strive to improve and the management team had worked with other health and social care professionals to further strengthen links across the two areas to benefit people’s care and wellbeing. They were participating in several pilots and projects that used digital solutions to provide enhanced care. This included a system which enabled staff to access people’s care records as well as their health records, including GP records and summary records from stays in hospital. This enabled staff to provide more coordinated streamlined care. They were using technology to provide more accurate readings on people’s health which could be accessed remotely by their GP and pharmacist to provide a more responsive service which enabled timely escalation of care when people’s health declined. The service contributed to the wider health and social care landscape by being a dedicated service for the discharge of covid positive people from hospital during the covid-19 pandemic. Learning from this initiative had been used to improve transitions from hospital to the care home. The staff were also actively participating in several initiatives to support research into dementia in order to better understand the illness and how people living with dementia could be supported.

People’s wellbeing was central to the care and support provided by staff at Sutton Court Care Centre. People were happy, safe, and comfortable living at Sutton Court Care. They received safe care that met their needs from staff who knew them well. 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. Safe medicines management practices were in place. People were protected from the risk of abuse and supported to live a life free from discrimination.

Governance systems were in place to closely monitor practices and if areas requiring improvement were identified these were acted upon promptly. Staff felt comfortable speaking openly with the management team. They felt listened to and supported in their roles. The senior management team were aware of their regulatory duties and reported any necessary information to the CQC, the local authority and funding authorities.

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 12 February 2021).

Why we inspected

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

Follow up

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

We found the following examples of good practice.

People were in contact with their families. Relatives could have window visits and people receiving end of life care were able to have visits in their rooms. Staff made sure visits were carried out in a safe way. When relatives were not able to visit, they kept in touch with people through video and telephone calls.

Staff screened all visitors to the service for symptoms of infection and there was information about the safety procedures visitors should follow to ensure their safety and the safety of residents and staff. Staff tested visitors for COVID-19 using lateral flow tests and visitors completed a test and trace form. Residents and staff were tested for COVID-19 in line with current government guidance.

All staff had been trained in infection prevention and control (IPC) and the use of personal protective equipment (PPE). There were designated areas for staff to don and doff PPE and hand sanitising and washing facilities were easily accessible to people, staff and visitors. There were COVID-19 and hand washing information signs throughout the home. We observed staff followed current IPC guidance and practice throughout our visit. Staff only worked at this location and did not work at the provider's other locations. This reduced the risk of staff spreading infection between locations.

Staff cleaned the home regularly during the day and at night, including disinfecting the home.

The service's IPC policy was up to date and in line with current guidance. The provider had carried out COVID-19 risk assessments for people and staff. The service had plans in place to respond immediately and appropriately to an outbreak of infection to ensure the safety of people and staff.

We were assured that this service met good infection prevention and control guidelines as a designated care setting

Further information is in the detailed findings below.

At our last comprehensive inspection on 9 December 2016 we found the provider was in breach of a legal requirement relating to treating people with dignity and respect and rated the service ‘requires improvement’ overall for the key questions ‘caring’ and ‘well-led’. We undertook a focused inspection on 10 April 2017 at which point the provider had taken sufficient action to address our previous concerns and we improved the rating to ‘good’ overall and for each key question. At this inspection on 6 February 2018 we found the provider remained ‘good’.

Processes remained in place to keep people safe and free from harm. Staff were knowledgeable in safeguarding adults’ procedures and any concerns were discussed with the registered manager and local authority safeguarding team. Plans were in place to manage and mitigate risks to people. The registered manager regularly reviewed any incidents that occurred and liaised with the provider’s physiotherapist to support with falls prevention and management. There were sufficient staff to meet people’s needs. People received their medicines as prescribed. Infection control procedures were adhered to.

People were supported by staff that had the knowledge and skills to undertake their duties. Staff completed a programme of training and received regular supervision. Staff supported people to eat and drink sufficient amounts and met their dietary requirements. Healthcare professionals regularly visited the service and people had their health needs met. Staff worked with specialist healthcare professionals to implement best practice guidance at the service, particularly in regards to end of life care and supporting people living with dementia. Staff adhered to the Mental Capacity Act 2005 and conditions specified in people’s Deprivation of Liberty Safeguards authorisations.

Warm and caring relationships had been developed at the service. Staff were polite and friendly when engaging people. Staff supported people to make choices and communicated with people in a way they understood. People’s religious and cultural needs were met. People’s family members were welcomed at the service and there were no restrictions for visitors. People’s privacy and dignity was maintained.

People’s care and support needs were met. The service was in the process of transitioning from paper to electronic care records. Whilst this was being carried out we saw some records had not been regularly reviewed and lacked some detail about how people were to be supported. There were plans to fully implement the electronic records by May 2018. The service had been accredited with the gold standard framework recognising good practice with end of life support. A full activities programme was in place, this included use of various well-being initiatives and student volunteers regularly visited the service to engage people in activities. A complaints process remained in place and the service had received a number of compliments from people and their relatives.

A registered manager was in post. Staff felt well supported by the registered manager and felt able to have open and honest conversations with them. Staff and people’s feedback was obtained through a programme of regular meetings. People also contributed to service delivery through the development of a ‘residents’ newsletter. A programme of audits was in place to review and monitor the quality of service delivery. The registered manager worked with a local university to implement learning from research projects to continue to develop the quality of service provision. The registered manager adhered to the requirements of the CQC registration and submitted notifications about key events that occurred at the service.

We undertook this focused inspection to check the provider had followed their plan and to confirm they have made the necessary improvements and now met legal requirements. This report only covers our findings in relation to those areas where improvements were required. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Sutton Court Care Centre’ on our website at www.cqc.org.uk

Sutton Court Care Centre can provide nursing and personal care for up to 63 older people. At the time of our inspection there were 60 people residing at the home, some of whom were living with dementia.

We found that sufficient action had been taken to address the previous breach of regulation and we observed people being treated with dignity and respect. Staff spoke to people in a polite and friendly manner and informed them before providing any support so the person was aware of what to expect. The management team had improved their quality assurance and monitoring processes to ensure staff treated people in a kind and considerate manner, including observing interactions as part of staff supervision.

The provider has taken sufficient action to improve the rating for the key questions ‘Is the service caring?’ and ‘Is the service well-led?’. The rating for this service had improved from ‘requires improvement’ to ‘good’.

We took enforcement action against the provider by issuing Warning and Requirement Notices and told them to take action to make improvements.

Since our last inspection the provider had made some improvements, most notably to the ways in which they monitored the quality and safety of the care and support people received at the home. This included appropriately maintaining moving and handling and falls risk management plans and ensuring moving and handling training was kept up to date for staff.

Sutton Court Care Centre is a residential care home that can provide nursing and personal care for up to 63 older people. This four storey purpose built care home has four distinct units located on each floor of the building, including a specialist 22 bedded dementia unit on the first floor. At the time of our inspection there were 62 people residing at the home, of whom approximately half were living with dementia and/or had complex health care needs.

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.

At this inspection we found the provider did not ensure staff treated people with respect and dignity at all times. Although people told us they were happy living at the home and we observed most of the interaction between staff and people using the service were characterised by dignity and compassion, we found some staff did not always engage with people in a caring and respectful way. For example, on one occasion we witnessed a member of staff use inappropriate language when talking to a person who lived at the home. We also found half of the 12 members of staff we observed supporting people to eat their lunchtime meal did not always engage well with the person they were assisting. For example, very little attempt was made by these staff to make eye contact, explain what was on people’s plates or speak to the person they were supporting to eat and drink.

This was a breach of the Health and Social Care (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

There were robust procedures in place to safeguard people from harm and abuse. Staff were familiar with how to recognise and report abuse. The provider assessed and managed risks to people’s safety in a way that considered their individual needs and promoted their independence. There were enough staff to keep people safe and recruitment procedures were designed to prevent people from being cared for by unsuitable staff. Medicines were managed safely.

Staff received appropriate training and support to ensure they had the knowledge and skills needed to perform their roles effectively. 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 received a variety of nutritious food that met their individual needs. They received the support they needed to stay healthy and to access healthcare services.

People received personalised support that was responsive to their individual needs. Staff were aware of people's needs, goals, abilities, likes and dislikes. People received support to maintain contact with their families and to meet their religious and cultural needs. People took part in a range of individual and group activities to suit their abilities and interests.

The service had an open and transparent culture. People felt comfortable raising any issues they might have about the home with staff. The service had arrangements in place to deal with people’s concerns and complaints appropriately. The provider also routinely gathered feedback from people and their representatives through surveys. They used feedback alongside their own audits and quality checks to continually assess, monitor and improve the quality of the service. The service had a clear vision and values and demonstrated an inclusive and empowering culture where people were involved in the day to day running of the service.

We undertook this unannounced focused inspection on 12 and 16 May 2016 to check the provider had implemented their action plan in regard to the breach of regulation identified at the October 2015 inspection and, to look specifically at what arrangements the service had in place to prevent falls and manage medicines.

This report only covers our findings in relation to those topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Sutton Court Care Centre’ on our website at www.cqc.org.uk’.

Sutton Court Care Centre is a four storey purpose built residential care home that provides accommodation, nursing and personal care for up to 63 older people. The home is divided into four distinct units which are located on each floor of the building. At the time of our inspection 61 people were using the service, 38 of whom were living with dementia. Four other people had mental health needs.

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.

During our focused inspection, we found the provider had taken some action to improve the way they monitored the quality and safety of the service people who lived at the home received, which included closer scrutiny of staff’s medication handling practices. However, the provider acknowledges more work needs to be done to improve how they operate their governance systems in order to make them effective over a sustained period of time. Specifically, the new governance systems the provider had introduced since our last inspection still failed to identify that up to date risk assessments were always available in care plans to mitigate the risk of people falling, and risks associated with moving and handling. The meant people might be at risk of receiving unsafe care and/or being harmed because risks to their health and safety was not always consistently assessed and reviewed.

We also found staff had not received training in some key aspects of their role, which included learning disability and mental health awareness. In addition, whilst we saw systems were in place to ensure staff remained up to date with most of their existing knowledge and skills, we found moving and handling training was not being refreshed at regular enough intervals. This meant staff might not have the qualifications, competency and skills to meet people’s needs and/or keep people safe.

In addition, the service had experienced unusually high levels of staff turnover in the last 12 months. We discussed staff continuity with the registered manager. They told us they had recently recruited 20 new members’ of staff which meant the home was now almost fully staffed, although the registered manager conceded that it would take time for all these new employees’ to complete their induction and to familiarise themselves with the needs and preferences of the people they would be supporting. The registered manager also told us they had recently introduced staff exit interviews to help them understand why the home had experienced such high levels of staff turnover recently.

The issues outlined above notwithstanding we saw the provider had ensured sufficient numbers of staff were deployed throughout the home during our inspection. The provider carried out appropriate checks to ensure staff were ‘fit’ to work with people who lived at the home. People also received their medicines as prescribed and staff knew how to manage medicines safely.

The breach of regulation relating to good governance remains outstanding from the service’s last inspection. We have taken enforcement action against the provider and have issued a Warning Notice because of repeated breaches of the Health and Social Care (Regulated Activities) Regulations 2014. We also identified two new breaches of the Health and Social Care (Regulated Activities) Regulations 2014 in relation to a failure by the provider to mitigate risks to people and others, and to ensure staff were suitably trained for every aspect of their role. You can see what action we told the provider to take in relation to these two breaches of regulations, at the back of the full version of the report.

We saw that people were offered choice as to how they spent their days, and they told us 'I can spend my days as I want to', 'my relatives can visit at any time' and 'I like to stay in my room and watch the television and staff respect that'. They told us that staff involved them when they were planning how they needed to be supported. People told us that they enjoyed the activities that were arranged for them at Sutton Court.

People told us they enjoyed their meals and there were always choices offered to them. We saw that staff had procedures in place to identify those people who may not be eating or drinking enough to keep them well nourished.

We saw that the providers worked cooperatively with other healthcare professionals to meet people's needs. This included the home's doctor and community support teams. Medication procedures were in place to make sure people received their medication as it had been prescribed by their doctors.

There were sufficient staff on duty both to meet people's needs and to ensure that the home was always clean and tidy. An on-going training programme was in place so that staff always had the right skills that they needed to support people.

There was a complaints procedure in place and the manager kept a record of any issues that were raised. These were all addressed appropriately.

People told us they enjoyed the meals in the home and that there was always a choice. We saw that there was help available for those who needed it.

Staff were able to access training to help them in their role and there was a programme of supervision and appraisal in place. The service had developed ways of assuring themselves that they were meeting the needs of the people who lived there.