This inspection took place on 24 and 25 September 2018. The first day was unannounced.

Our last full comprehensive inspection of this service was in May 2017. At that inspection we rated the home overall as Requires Improvement. At that inspection we identified a breach of legal requirements within the key question of Effective.

Following that inspection, we received a number of concerns regarding the quality of care being provided to people. Therefore, we conducted a focused inspection in October 2017 that concentrated on the Safe and Well Led areas only where we found four breaches of three regulations. This was because the provider had failed to ensure that: risks to people’s safety had been adequately managed and that people received their medicines correctly; staff did not have the appropriate skills and knowledge to provide people with safe care; robust systems were not in place to assess and monitor the quality and safety of care provided to people. The home was therefore rated as Requires Improvement in both of these key questions.

During this latest inspection the registered manager demonstrated to us that improvements had been made and the home is now rated Good over all. The provider is no longer in breach of any of the regulations that we found at our inspection in October 2017. However, further improvements were needed in some areas as detailed below.

Sutherlands Nursing Home is a ‘care home’. The provider advertises themselves as providing specialist care, including nursing care to people living with dementia. It is registered to provide residential and nursing care for up to 52 people and care. At the time of the inspection there were 40 people living in the home. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The management of the home was led by a registered manager. 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 home is run.

People felt safe living in the home and systems were in place to protect them from the risk of abuse. Risks to people’s safety and individual needs were clearly identified managed well. New systems to make improvements to this were implemented following our last inspection had become embedded. People received their medicines correctly and there were systems in place to safely store, manage and administer these.

There were enough staff to keep people safe and to meet their needs. New staff working at the home had been subject to the appropriate checks before their employment began. These checks were designed to ensure staff were safe to work within care. Any incidents or accidents that had occurred had been reported, investigated and learnt from.

Staff had received training in a number of different areas to provide them with the skills and knowledge to support people effectively. Further training was to be provided to staff regarding dementia care to help them develop their skills further and gain confidence on how to assist people who may regularly become upset or distressed. Staff also received adequate support and guidance in their roles.

People received enough to eat and drink to meet their individual needs. Consent was usually obtained from people before any care was provided. Although staff did not always check with people before assisting them to move in their wheelchair. Where people could not consent, staff acted in line with the relevant legislation and only made decisions on people’s behalf in their best interests.

We have made a recommendation to the provider in relation to the environment in the Minton Unit area of t

We carried out an unannounced comprehensive inspection of this service on 2 May 2017. After that inspection, we received concerns in relation to the safe care and treatment of people living at the home. Concerns were also raised by the local clinical commissioning group (CCG) and local authority. This included concerns regarding the management of people’s diabetes. Because of these concerns, we undertook this inspection on 2 and 4 October 2017 to look at the safety of the service and how it was managed. At our inspection, we did not identify any concerns with the management of people’s diabetes, however we identified concerns with other areas of people’s care. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Sutherlands Nursing Home on our website at www.cqc.org.uk.

Sutherlands Nursing Home provides accommodation and personal and nursing care for a maximum of 52 older people, some of whom may be living with dementia. At the time of our inspection there were 41 people living in the home.

At this inspection, there were four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

There was no registered manager in place at the time of our inspection; the home had not had a registered manager since May 2014. It is a condition of the provider’s registration that they must have one. 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.

Safeguarding adults' procedures were in place and staff understood how to protect people from the risk of abuse. There was a whistle-blowing procedure available and staff said they would use it if they needed to.

Assessments of risks to people’s safety had been completed but these were not comprehensive. Staff did not always provide support or monitoring of people’s safety as identified in these plans.

Medicines for application to people’s skin were not always stored safely; records and checks to ensure this were incomplete. People did not always receive their medicines on time or as the prescriber intended.

There were insufficient numbers of suitably qualified staff on duty. The assessed levels of staffing required were not provided. It was not clear whose responsibility it was to arrange for the correct levels required to be on duty. Staff were task orientated and did not focus on people receiving good quality timely care, because they did not have the time to do so.

People were at risk of receiving unsafe care because they were not always monitored when this was identified as necessary. Staff had not been provided with the training required. They were not suitably experienced to provide support to people living with advanced dementia safely. They were not trained to support people who displayed behaviours which could challenge others and place them at risk. These staff often worked unsupervised by experienced staff.

The provider’s recruitment process ensured they only employed staff deemed suitable to work with people in a care setting.

Records to monitor people's intake of food and fluids were not always completed by staff.

There were issues regarding the governance and quality monitoring of the home. The provider's quality monitoring did not always identify shortfalls in the provision of care to people. The provider’s and manager’s audits and checks were not effective in identifying issues around the home.

There was a high turnover of management positions, including the posts of manager, clinical lead and operations manager. Further changes to the management team were on-going or expected, leading to concerns tha

The inspection took place on the 2 May 2017 and was unannounced. The last inspection to this service was on the 10 and 18 August 2016 and the service was rated as requires improvement overall, with a rating of Inadequate in well led. We found that there were breaches of the Health and Social Care act 2008 in: Regulation 18: Notifications of other incidents, Regulation 11: Need for consent, Regulation 12 Safe care and treatment, and Regulation 14: Meeting nutritional and hydration needs. At this inspection things had improved significantly but we identified a repeat breach of regulation 11.

The service is registered to provide accommodation for up to 52 people who require nursing or personal care. The home is located in a residential area on the outskirts of Wymondham, is purpose built and accommodation is offered on two floors. Internally, the home is divided into four units, each with a number of bedrooms with ensuite facilities, a sitting/dining area and bathrooms. The three units on the ground floor are all linked and offer a service mainly to people who need nursing care. Minton unit on the first floor offers accommodation for up to 12 people who are living with dementia. On the day of our inspection there were thirty two people using the service.

There was a manager at the service who had been appointed since the last inspection and had applied to the CQC to become registered. 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 inspection we found a well-planned, well managed service. However the service had yet to implement all the necessary improvements and demonstrate sustainability. We had every confidence in their ability to do so and felt the improvements made in a short period of time were significant. Successful recruitment meant the service was fully staffed and people received continuity of care by staff who were well supported to fulfil their roles. There were robust recruitment procedures to help ensure only suitable staff were employed. Staff were supported through an induction programme, meaningful training and regular supervision. However we found due to staff sickness staff were at times stretched and not always able to provide activities to people. Most people required one to one support and there were not enough staff to provide this across the week.

People received their medicines as required and there were safe systems in place to ensure staff were adequately trained and able to administer medicines in line with organisational policies.

Risks to people’s safety were minimised through robust risk assessment and planning to ensure risks were reduced as far as reasonably possible. There was also sufficient management oversight of risk. Equipment was well maintained and the building fit for purpose.

Staff received training to help them recognise different types of abuse and take appropriate actions to ensure people were protected from harm or actual abuse.

People were supported according to their preferences but engagement with people, their relatives and staff in the planning of care needed further consideration as did how staff supported people who lacked mental capacity. Staff had received training in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) but this was not fully embedded and staff were not always following due processes.

People were supported to eat and drink in sufficient quantities and risks from unplanned weight loss and, or dehydration were monitored and risks reduced.

Staff were kind, caring and familiar with people’s needs. They promoted people’s independence as far as reasonably possible and worked in line with people’s wishes.

The service wo

Sutherlands Nursing Home offers accommodation for up to 52 people who require nursing or personal care. The home is located in a residential area on the outskirts of Wymondham, is purpose built and accommodation is offered on two floors. Internally, the home is divided into four units, each with a number of bedrooms with ensuite facilities, a sitting/dining area and bathrooms. The three units on the ground floor are all linked and offer a service mainly to people who need nursing care. Minton unit on the first floor offers accommodation for up to 12 people who are living with dementia. At the time of the inspection the two double bedrooms on this unit were being used as singles.

This comprehensive inspection took place on 10 and 18 August 2016 and was unannounced. There were 34 people living at the home when we visited.

This home requires a registered manager as a condition of its registration. A registered manager is a person who has registered with the Care Quality Commission (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 home is run. At the time of this inspection there was no registered manager in post. The provider had appointed a manager who, on the first day of our visit to the home, had been in post for 10 days. The previous manager, who had not been registered, was working at the home as a nurse. People, relatives and staff were all very impressed with the new manager and had confidence that changes would be made.

We last inspected this service on 26 and 28 January 2015 when we found that the service was not meeting the requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider was in breach of two regulations relating to staffing and good governance. Following that inspection, the provider sent us an action plan, detailing how they intended to meet the regulations. The provider wrote that all actions would be completed by 5 June 2015.

At this inspection we found that the provider had failed to take effective action and continued to be in breach of regulations relating to staffing and good governance. We also found that the provider was in breach of four further regulations relating to medicine management; consent; meeting nutrition and hydration needs; and notifications. You can see what action we told the provider to take at the back of the full version of this report.

People told us they felt safe and that they enjoyed living at Sutherlands Nursing Home. Staff had undergone training in safeguarding people from harm and they demonstrated they knew how to recognise and report any incidents of harm. Recruitment procedures ensured that only staff suitable to work at this care home were employed.

There were not enough staff to ensure that people were safe and that their assessed needs were met in a timely manner. This put people and staff at risk of harm.

Assessments of potential risks to people and to their health had been carried out and guidance recorded but staff had not always followed the guidance. There were a range of issues with the way medicines were managed and we could not be assured that people received their medicines safely and as they had been prescribed. Infection control procedures were not always followed, creating a risk of cross infection.

Staff had undergone training to provide them with the skills and knowledge they needed to carry out their role. However, some staff did not always put their training into practice.

The CQC monitors the operation of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS), which apply to care services. People’s capacity to make decisions for themselves had been assessed and applications for DoLS authorisations had been made for people assessed as having their liberty restricted. However, the

People told us staff were nice, offered them choices and “…ask me what I want.”

Another person told us they had been helped by the home and the GP to contact a physiotherapist to assist with some hand exercises. This told us people were involved in decisions about their care.

Two family members spoken with were complimentary about the respect and dignity the staff team gave to their relative. One family member, who told us they spend most days at the home, said, “This is a great home with superb staff. I am always included in decisions.”

Although the majority of people enjoyed their meal and said the food was good it was evident from our observation that not everyone had received their meal while it was hot. These people told us they had not enjoyed their meal.

One relative said, “Staff are always available to talk to.” This told us that staff supported the person and their family members.

The home had held a meeting with relatives and action had been taken from that meeting. This showed that people were listened to and action was taken when requested. We read comments from thank you cards such as ‘how kind staff are’ and that they ‘afforded dignity to my mother’.

Two people living in this home, told us they knew where the information was if they wanted to complain. They said they could talk to the staff or manager if they were unhappy about anything and that their concerns would be addressed. This showed that people’s concerns would be acted upon.

One person spoken with said that staff were always polite and respectful. They described staff as "...charming." They were satisfied with the care that they received and would "...find out who to speak to..." if they were not satisfied. They were able to maintain their religious faith while they were living in the home.

Because most people living in the home were unable to tell us verbally what they thought about the care they received, we needed to observe how people were being supported. We found that staff spent time with them to ensure they were supported with their meals and drinks. They also tried to find ways to ensure that people were calm and to reduce agitation by distracting people and avoiding confrontation.

We found from our observation, records and discussion with staff that people's wishes were respected. Where people found it difficult to make informed decisions about their care this was assessed and discussed with professionals to agree what was in their best interests.

Recruitment procedures were sufficiently robust to help protect people from staff who may be unsuitable to work with vulnerable adults.

We also found that the home was appropriately maintained and people were able to have some of their own possessions around them to make their rooms more homely.

We spoke with six people who live in the home. They told us that their needs were met and that they were consulted about the care and support that they were provided with. People were complimentary about the staff that cared for them and told us that they always treated them with respect and that their privacy was respected. They told us that there were enough staff on duty to assist them and that they felt safe living in the home. They also told us that the environment was comfortable and clean and that they were provided with good quality meals and daily activities.

The inspection took place on 26 and 28 January 2015 and was unannounced. It was carried out by two inspectors.

Sutherlands Nursing Home is a care home providing nursing care and support for up to 52 older people, some of whom may be living with cognitive impairments such as dementia.

The provider is required to have a registered manager at the service. 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.

However, there had not been a registered manager at the home since May 2014. The previous manager, who had not been registered, left the service in November 2014. The provider was recruiting for a new manager who would apply for registration. At the time of this inspection a previous registered manager of the service, referred to in this report as a supporting manager, had stepped in to manage the service three days a week.

There were not enough staff to ensure people’s needs were met. People who required support with eating and drinking received a poor standard of assistance. These concerns represented a breach of Regulation 22 of the Health and Social Care Act 2008 (Regulated Activities) 2010, which corresponds to Regulation 18(1) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The provider’s quality assurance systems were not being effectively or regularly utilised to determine the standard of service people received or where improvements could be made. Where people’s views had been sought through a questionnaire, no further work had been done on the information received to help drive improvement. There was no formal mechanism to obtain or act upon the views of staff to in relation to the care and treatment people received. These concerns represented a breach of Regulation 10 of the Health and Social Care Act 2008 (Regulated Activities) 2010, which corresponds to Regulation 17 of the Health and Social Care Act 2008 (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.

People felt safe living in the home. People’s relatives were satisfied that their relatives were supported safely. Staff knew about keeping people safe from abuse and were aware of safeguarding procedures and what actions they would need to take if they had any concerns.

People enjoyed their meals and were given choices in what to eat or drink. The food looked and smelled appetising. However, people requiring support with their meals did not always receive this in an effective manner.

The nursing care people received in the home was good. People were also supported with their health by a range of visiting health professionals.

People’s consent was sought before assistance was provided. If people were unable to give consent staff ensured that they provided care that was in the person’s best interest. The supporting manager was aware of the circumstances under which people could be deemed as being deprived of their liberty. They were taking action to comply with the provisions of the Deprivation of Liberty Safeguards (DoLS).

Staff were mainly caring and attentive to people’s needs, identifying when people required support without the person needing to ask. However, we found instances where this wasn’t always the case. Assistance was provided discreetly when necessary.

People’s needs were assessed and their care was planned to ensure their needs could be met. Staff knew the people they were supporting and told us about people’s likes, dislikes, their habits and how they needed to be supported to help maintain their safety and welfare. However, sometimes their preferences were not taken into account in the way that their care was organised and provided and sometimes care wasn’t adequately organised to ensure people’s safety and welfare.