We carried out an unannounced inspection of Sutton Beeches on the 1st and 10th of February 2016.

Sutton Beeches community support centre is a two storey building set in its own grounds in a residential area. It is owned and managed by Cheshire West and Chester Council and provides respite care and rehabilitation for up to 30 people.

A registered manager had been in post since 2014. 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 carried out an unannounced comprehensive inspection of this service on 22 December 2015 and 5 January 2016. Breaches of legal requirements were found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

We found that the registered person failed to ensure that proper and safe management of medicines. This was a breach of regulation 12 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

This visit found that systems had been put into place to reduce the risks associated with unsafe management of medication. This included appropriate storage of controlled medication. In addition to this, the temperatures of medication refrigerators were better monitored to enable the safe and effective storage of medication. Systems had been put into place to ensure that people did not run out of prescribed creams or other medications.

At our last visit, we found that the registered person failed to ensure that systems were in place to regularly assess, monitor and improve the quality and safety of the service. This was a breach of regulation 17 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

This visit also found that audits in relation to care plans and medication administration had enabled any deficiencies to be quickly identified and addressed so that people were not put at risk. Monthly audits were conducted by the registered manager enabling an ongoing commentary of the quality of the service to be gained.

Our last visit had found that care plans were not person centred and had not been reviewed regularly. This visit found that care plans outlined the specific needs unique to individuals. The contents of care plans had been agreed by individuals and where changes were considered, these were agreed with individuals before they were implemented. Care plans showed evidence that as goals were achieved, new goals to meet the changing needs of people were set with their agreement.

Staff demonstrated a good understanding of the types of abuse that could affect people who used the service. Staff had received training in this and were knowledgeable about where poor practice could be reported.

Staffing levels were maintained in sufficient numbers to meet the needs of people who used the service. These levels were confirmed by staff rotas.

Recruitment of staff was robust. Checks were in place to ensure that people were protected by the recruitment process. Risk assessments relating to the environment and risks associated with the support provided were in place and reviewed.

The premises were clean and hygienic. All areas were well maintained.

Staff received the training and supervision they needed to perform their role. A structured induction was in place to prepare new members of staff to perform their role.

Staff had received training in the Mental Capacity Act 2005 and were able to outline its principles and how it affected the people who were supported.

People were provided with a choice of meals and offered regular drinks. Nutrition provided met the dietary requirements and preferences

We inspected this service on 22 December 2015 and 5 January 2016 and the inspection was unannounced on both days.

Sutton Beeches community support centre is a two storey building set in its own grounds in a residential area. It is owned and managed by Cheshire West and Chester Council and provides respite care and rehabilitation (low level discharge to assess) for up to 30 people. At the time of this inspection there were five people staying at the service. The service was under a voluntary agreement not to admit people.

The previous inspection was undertaken in April 2015 and action was needed in relation to the environment being properly maintained and safe. An action plan was received and during this inspection we found that the service had addressed the compliance actions and that these were now met.

There is a registered manager in place at this 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.

People told us that they felt safe at the service and that the staff understood their care needs. People commented “The staff are lovely”, “I feel safe here with the staff” and “Love being here.”

We found concerns with the medication administration, which meant that we could not be confident that people received their medication administered as prescribed. We also found concerns with the quality assurance systems in place which were limited and audits of the medication, environment or care plans did not take place. This meant that these areas were not checked to ensure information was up to date and accurate.

You can see what action we told the provider to take at the back of the full version of the report.

We saw that the staff team understood people’s care and support needs, and the staff we observed were kind and treated people with respect. We looked at the care records of all the people who were staying at the service. We found the information was basic and not person-centred. We have made a recommendation regarding the information in the care plans and the reviewing of them.

The registered provider had policies and procedures in place to guide staff in relation to the Mental Capacity Act 2005 and staff recruitment.

We found the registered provider had systems in place to ensure that people were protected from the risk of potential harm or abuse. Staff had received training in safeguarding adults and during discussions said they would report any suspected allegations of abuse to the person in charge. Policies and procedures related to safeguarding adults from abuse were available to the staff team. This meant that staff had documents available to them to help them understand the risk of potential harm or abuse of people who lived at the service.

We found the service was clean, hygienic and well maintained.

Good recruitment practices were in place and that pre-employment checks were completed prior to a new member of staff working at the service. This meant that the people could be confident that they were protected from staff that were known to be unsuitable.

We looked at staff training and we saw that staff undertook a range of training in line with their identified roles. Staff had up to date supervision and appraisals and had the opportunity to attend relevant meetings.

There were enough staff working to meet the needs of people. People who stayed at the service said that staff were available when they needed them. A range of activities were available to encourage social contact and stimulation. We noted that an activities coordinator was employed at the service and that there were planned activities throughout the month.

We looked at how complaints were dealt with. People told us they would approach the staff o

Care and support was planned and delivered in a way that was intended to ensure people’s safety and welfare. Staff were witnessed as being kind and promoting of people’s independence. We reviewed three care plans. These were well presented, individualised and well organised.

The home provided evidence of assuring quality care to service users by asking them to complete a ‘quality questionnaire’. The feedback was monitored and grouped into common themes. Most of the comments were very positive, several comments deemed the service as ‘excellent’. Negative comments were investigated.

The three people we spoke to all said the staff gave them choices and promoted their independence. One service user had stayed with them previously and described it as a “home from home”. The three service users we spoke to all agreed the food was very good.

When asked all staff were able to say what they would do in an event of a medication error. The provider showed evidence of being able to store controlled drugs safely and record them correctly.

We spoke with a number of people who were using the service. One person told us “It is really very nice here, they are brilliant people always a smile on their faces. Very nice food. There are plenty of people to talk to, I never get bored, I’ve also got books and a television”. Another person said “Everything’s smashing, the ladies work very hard and nothing is too much trouble for them. If anyone complains there must be something wrong with them.” Another person commented “This is five star accommodation with gourmet meals. We have a good laugh with the staff”.

An individual rehabilitation programme was written for each person and this was put in place in consultation with an occupational therapist and a physiotherapist who were both based in the service. The support staff were responsible for implementing the programmes and recording progress.

People were given a satisfaction survey form to fill in at the end of their stay so that they could give their views about the service they had received.

A registered nurse was based at the centre full time which meant that any nursing needs people had could be attended to promptly. A doctor visited the service three times a week.

This inspection took place on the 24th and 25th of April 2015. The provider did not know we were visiting for the first day but was aware that we were visiting on the second day. Our last inspection in December 2013 found that the provider was compliant with our care standards.

This visit was in response to concerns that the Local Authority Quality team had had following a visit they had conducted.

Sutton Beeches community support centre is a two storey building set in its own grounds in a residential area. It is owned and managed by Cheshire West and Chester Council and provides respite care and rehabilitation for up to 30 people. At the time of our visit there were 26 people using the service.

The service has a registered manager who has been in post since October 2014. 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. The registered manager was present on both days of our visit.

At this inspection we found one breach 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.

We spoke to six people who used the service. Comments were positive. People told us that they felt safe being supported by the staff team and that staff did everything they could to ensure that they received the support they needed to return home. People told us that they felt that the staff team cared about them and responded to them in a positive and helpful manner. This view was echoed by a relative that we spoke with.

However we found that people who used the service did not always benefit from living in a well maintained and home-like environment. Refurbishment to the decoration, fixtures and fittings were noted to present a potential risk to people.

Staff we spoke with had little understanding of the Mental Capacity Act 2005 and had not received training on this. We did not see any evidence in care plans that an assumption had been made that people had capacity to make decisions or steps that the registered provider needed to take if the capacity of people to make decisions was uncertain.

People considered that their medical needs were attended to. One person told us that they had been able to re-establish family links during their stay at the service and this had been supported by the staff team. We found that the registered manager had made improvements to the service since they were appointed as manager it in October 2014. This included ensuring people’s needs were met.

We saw that pre-assessment information was received and assessed by the service. A system had been introduced whereby the detailed needs of people were outlined in all aspects of the support they required were assessed and then a decision made on whether admission was appropriate. This was in response to past occasions when pre-admission assessments received did not accurately reflect the actual needs of people. Once admission was agreed, the assessment information was translated into a care plan.

People who used the service did not always have care planning documentation that was person centred to them. Some care plans were generic in nature with general statements on how support was to be offered. Care plans did not include people being involved in their evaluation and were not presented in a format that took the communication needs of people into account. This was the case in respect of one person who had limited eyesight.

People knew how to make a complaint about the service they received. The registered provider had not received any complaints. The registered manager told us that they strived to deal with any concerns before they got to a formal stage.

The registered manager had been in post since October 2014. They told us that they were aware of the challenges they faced in respect of ensuring that the service met the needs of people. They had introduced a quality assurance systems relating to care planning, infection control, health and safety and medication. The registered manager had started to hold regular group supervisions with each staff team and had delegated supervisions to senior staff for care staff. The registered manager had recognised that the service had had experiences in the past of admitting people whose pre-assessment information was different from their actual needs. As a result they had introduced a system of reviewing pre-admission information from hospitals to ensure that people’s needs were met.

Staff and people using the service made positive comments about the registered manager. People using the service said that the manager was approachable and well-liked. Staff welcomed the registered manager’s approach to deal with issues they faced and felt that she was “dynamic” and had a clear vision.