This unannounced inspection was carried out on 12 February 2016. Sutton Lodge Nursing Home provides nursing and residential care for up to 28 people. On the day of our inspection 18 people lived at the service. The accommodation is arranged over three floors and includes communal areas for people.
There was not a registered manager in place at the time of the inspection. 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. We were assisted by the interim manager on the day of the inspection.
People’s safety was not assured as identified risks of harm were not appropriately managed. A fire exit was blocked and staff had not always been trained to use emergency equipment. We recommend that steps are taken to ensure people’s safety at all times within the service.
Other risks had been assessed and managed appropriately to keep people safe. One member of staff told us “I have the knowledge to keep people safe; it’s about looking for dangers, like not leaving hoists raised where people could hit their heads.” Evacuation plans were available for people.
People’s human rights could be affected because the requirements of the Mental Capacity Act (MCA) and Deprivation of Liberty (DoLS) were not always followed. The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Some mental capacity assessments had not been completed around specific decisions that needed to be made. However staff had a good understanding of their responsibilities under the MCA. We recommend that specific mental capacity assessments are completed for particular decisions that needed to be made.
People were not always cared for by staff that had all the appropriate training to undertake their role. There were gaps in training around challenging behaviour and dementia. Not all staff were up to date with their refresher training. However there were good practices from staff around the work that they undertook. None of the clinical staff had undergone one to one supervisions which gave staff an opportunity to discuss how they worked and what training was needed. We recommend that staff are provided with training to ensure that they are aware of best practice.
People did not always have a detailed care plan around their identified needs for example around diabetes and behaviour that challenges. However the care that people received from staff did reflect their needs. Staff had knowledge of people’s needs and what care was required. We recommend that care plans are updated and detailed to reflect the needs of people that lived at the service.
People said that they felt safe at the service. One person said “I feel safe, there is always staff around.” There were sufficient members of staff deployed around the service to meet people’s needs. One member of staff told us “I do think there are enough staff, the numbers are fine.”
People’s medicines were administered safely and medicines were appropriately stored. Staff were trained to administer medicines safely. Incidents and accidents were recorded with detail around what happened, how it was dealt with and what steps were taken to reduce the risk of this happening again.
Staff had knowledge of safeguarding adults procedures and what to do if they suspected any type of abuse. There was a Safeguarding Adults policy and staff had received training regarding this. Appropriate checks had been undertaken to ensure that only suitable staff were employed at the service.
People at risk of dehydration or malnutrition had effective systems in place to support them. Where people were at risk steps were taken to ensure that they received the most appropriate care. People did have access to a range of health care professionals and advice was sought from them when needed.
People told us that they liked the food that was provided. One person said, “If I don’t like what’s on the menu then I have a salad to my taste.”
Although we observed occasions where staff could have been more caring and respectful on the whole staff displayed caring and dignified behaviour towards people. People told us that staff were caring.
People and relatives said that they were involved in the planning of their care and we found that care plans reflected people’s wants and desires.
People participated in a range of activities that included meditation, games, nail painting, arts and crafts, seasonal events and entertainers. Other activities included a ‘Zoo’ lab where animals were brought in for people to touch. People told us that they enjoyed the activities.
There was a complaints procedure in place for people to access and complaints were dealt with appropriately. One person said “If I was unhappy about anything I would mention it to the carers but I’ve never had to.”
Audits of systems and practices carried out were effective. Where concerns had been identified these were being addressed. Surveys and meetings took place to identify improvements that needed to be made.
Staff said they felt supported and listen to by the registered manager. Regular staff meetings took place and staff contributed to how the service ran.
Services that provide health and social care to people are required to inform the Care Quality Commission (CQC) of important events that happen in the service. Staff at the service had informed the CQC of significant events in a timely way. This meant we could check that appropriate action had been taken.
We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.