This inspection was carried out on 29 March 2018 and was unannounced. Sutton Village Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and we looked at both during this inspection. The service provides accommodation and personal care to up to 33 people. This includes an extension with 10 single en-suite bedrooms. Both parts of the home have a range of communal rooms and bathrooms. The service has parking facilities, a courtyard and a garden.The service had a registered manager. A registered manager is a person who has registered with the CQC 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 the last inspection on 30 March 2017 and 04 April 2017, we found the service requires improvement.
During this inspection, we found that although the service had taken steps to make improvements, which we recommended during the last inspection, the service continued to requires improvement.
At the last inspection, the service was in breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider had failed to ensure systems and process were established and operated effectively to assess, monitor, mitigate risks and improve the quality and safety of the service. We asked the provider to complete an action plan to show what they would do and by when to improve the key question well-led to at least good. The registered manager completed an action plan showing how they would meet Regulation 17 of the Health and Social Care Act 2008, to improve the governance of the service.
During this inspection, we saw that the registered manager and provider had put systems in place and improvements had been made so there was no longer a breach of Regulation 17. However, some further improvement was still required.
We found medications were not always administered as prescribed. This was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Two people had not received their pain patches which could have put them at risk of possible harm. Guidance to support staff to administer specific medication did not always include sufficient information for staff to administer these as prescribed. You can see what action we told the provider to take at the back of the full version of the report.
Risk assessments were in place; however, risks were not always appropriately reviewed and updated when people’s needs changed. This meant people could have been at risk of potential harm. For example, we saw for one person action had been taken to protect them from the risk of falling. However, their risk assessment had not been updated after they had experienced falls, to ensure staff were aware of additional measures that were needed to prevent further falls.
Staff were recruited appropriately and there was sufficient staff. However, they were not always deployed appropriately at meal times. This meant some people were not supported to eat their meals at the same time as everyone else and had to wait to be supported.
Staff had received safeguarding training and were knowledgeable about safeguarding and how to report concerns to protect people from harm.
The service was clean and infection and prevention control procedures were in place to prevent the spread of infection.
People were supported by staff who had received relevant training and were suitably qualified for their role, to meet people’s needs.
Consent was gained before care and support was delivered and the principles of the Mental Capacity Act (MCA) were followed within the service.
CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The registered manager was aware of their responsibility in relation to DoLS. When people were unable to consent to their care and staying at the service the registered manager had applied for DoLS as necessary.
People were supported to meet their nutritional needs and maintain a balanced diet. People were offered choice at meal times and if people’s choices were not available, staff would seek to accommodate their preferences.
People were cared for by staff who were kind and respectful and treated people with dignity. People were supported to maintain their independence where possible.
People’s healthcare needs were responded to and when concerns were identified, relevant professionals were contacted for their advice and guidance.
Care plans were in place for people who used the service so staff knew how to meet their needs; These were detailed and person-centred. However, some of the care plans we saw were not updated as people's needs changed. The registered manager told us they were aware of which ones required updating and would ensure this was completed.
People were supported to access social and leisure activities and maintain relationships with family and friends. The service had developed links with the local community and worked in partnership with other professionals and organisations.
People were supported until the end of their life. The registered manager had developed a template for recording people’s preferences and wishes about the support they may want at the end of their life. However, these had not been completed so people’s wishes were not recorded. The registered manager told us these would be completed, so people had the opportunity to express their wishes for future care if they wanted to.
Records showed very few complaints were received. A complaints policy was in place and people told us they knew how to make a complaint if needed.
The registered manager understood and fulfilled their responsibilities to report accidents and incidents, as well as other notifiable events to the Care Quality Commission as required.