Sutton Court Care Centre is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Sutton Court Care Centre accommodates 63 people across four separate units, each of which have separate adapted facilities, however, people often spend time together in the ground floor lounge. One of the units specialises in providing care to people living with dementia. At the time of our inspection 61 people were using the service.

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 revi

We carried out an unannounced comprehensive inspection of this service on 9 and 13 December 2016. We rated the service ‘Requires improvement’ overall and in two key questions we asked of providers, ‘Is the service caring?’ and ‘Is the service well-led?’. A breach of legal requirement was found in regards to treating people with dignity and respect. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements. They stated they would take the necessary action to address the breach of regulation by 1 March 2017.

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’.

This inspection took place on 9 and 12 December 2016 and was unannounced. The last inspection of Sutton Court Care Centre was carried on 12 and 16 May 2016 when we rated the service 'Requires Improvement' overall. This was because we found the provider continued to fail to operate effective governance systems. Specifically, the provider’s arrangements to monitor the quality and safety of the care and support people received at the home had failed to identify that up to date moving and handling and falls risk assessments were not always in place. The meant people might be at risk of receiving unsafe care and/or being harmed. We also identified two new issues in respect of staff not receiving up to date moving and handling training and staff turnover in the past year being high. This meant staff might not have the right knowledge, skills and experience to meet the needs of people they were supporting.

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

We last carried out a comprehensive inspection of Sutton Court Care Centre on 6 October 2015 when we found the provider was in breach of a regulation. Specifically, we found the provider had failed to operate good governance systems to effectively monitor the quality and safety of the service people who lived at the home received. We rated all the key questions as good, except for well-led which was rated required improvement. The service was rated good overall. After the inspection the provider wrote to us to say what action they intended to take to meet their legal requirements in relation to the breach of regulation described above. Since the beginning of 2016 we have also received concerning information about the way medicines were managed in the home and the high number of serious injuries sustained by people after they had been involved in a fall at the home.

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 a

This inspection took place on 6 October 2015 and was unannounced. The last Care Quality Commission (CQC) inspection of the home was carried out on 28 October 2013, where we found the service was meeting all the regulations we looked at.

Sutton Court Care Centre is a four storey purpose built 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. There were 60 people residing at the home when we visited, three-quarters of whom were living with dementia.

The service had a registered manager in post. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

The governance systems the provider had established to monitor the quality of the care people using the service received were not always operated effectively. For example, the providers quality monitoring systems had failed to identify a number of omissions on medication administration records (MARs) where staff had not signed for medicines they had administered. These systems had also failed to notice information such as employment references were sometimes missing from staff files.

This represents 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.

People told us they were happy with the standard of care provided at the home. We saw staff looked after people in a way which was kind and caring. Our discussions with people using the service and their relatives supported this. People’s rights to privacy and dignity were also respected. When people were nearing the end of their life they received compassionate and supportive care.

People were safe at Sutton Court Care Centre. Staff knew how to protect people if they suspected they were at risk of abuse or harm. They had received training in safeguarding adults at risk and knew how and when to report their concerns if they suspected someone was at risk of abuse. The provider had a formal procedure in place for staff to follow to ensure concerns were reported to the appropriate person.

Risks to people’s health, safety and welfare were routinely assessed by the home and plans were in place to enable staff to minimise the identified risks people might face. Regular maintenance and service checks were carried out of the premises to ensure the environment and equipment was safe. The service also managed accidents and incidents appropriately and suitable arrangements were in place to deal with emergencies.

People were given their prescribed medicines at times they needed them.

People were supported to keep healthy and well. Staff ensured people were able to access community based health and social care services quickly when they needed them. Staff also worked closely with other health and social care professionals to ensure people received the care and support they needed. There was a choice of meals, snacks and drinks and staff supported people to stay hydrated and to eat well.

Support plans had been developed for each person using the service which reflected their specific needs and preferences for how they were cared for and supported. They gave guidance and informed staff on how people’s needs should be met. People were appropriately supported by staff to make decisions about their care and support needs. These were discussed and reviewed with them regularly.

People were encouraged to maintain relationships that were important to them. There were no restrictions on visiting times and we saw staff made people’s guests feel welcome.

People were also supported to undertake social activities of their choosing. We saw staff actively encouraged and supported people to be as independent as they could and wanted to be.

There was an established and stable staff team at the home. There were enough suitably competent staff to care for and support people. The management team continuously reviewed and planned staffing levels to ensure there were enough staff to meet the needs of people using the service. The provider had carried out appropriate checks to ensure they were suitable and fit to work at the home.

Staff received relevant training to help them in their roles. Staff were supported by the senior staff team and had a good understanding and awareness of people’s needs and how these should be met. The way they supported people during the inspection was kind, caring, and respectful.

Staff supported people to make choices about day to day decisions. The management team and other staff were knowledgeable about the Mental Capacity Act (2005) and best interests meetings were held in line with the Act to make decisions on behalf of people who did not have the capacity to make decisions themselves.

Deprivation of Liberty Safeguards (DoLS) were in place to protect people’s safety, and the staff were aware of what this meant and how to support people appropriately. DoLS provides a process to make sure that people are only deprived of their liberty in a safe and correct way, when it is in their best interests and there is no other way to look after them.

The service had a clear management structure in place. We saw the registered manager and area manager both led by example and demonstrated good leadership. The views and ideas of people using the service, their relatives, professional representatives and staff were routinely sought by the provider and used to improve the service they provided. People and their relatives 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.

Sutton Court Care Centre provides care and support for up to 63 people. On the day that we inspected the service there were 61 people living there. During our visit we were able to speak with 20 people and also some relatives that were visiting. All of them were very happy with the care and support that they received and the majority of the comments they made were positive. People told us that they knew how to make a complaint, should they need to, but had never found it necessary.

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.

The majority of the feedback that we received from people was very positive. Comments included “staff are very kind”, “I like living here” and “I don’t have any problems”, People knew how to raise any concerns they might have were confident that they would be addressed. People looked well cared for, clean and appropriately dressed for the time of year. Those who were being nursed in bed looked comfortable and well hydrated. A relative we spoke with confirmed that they had been involved in discussions about how the person should be supported.

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.

People that we spoke with about this service were all very positive about their experiences. It is a purpose built home, decorated and maintained to a high standard and with consideration to the needs of the people who live there. They said that they have been able to bring in pictures, photos and small items of furniture to make their rooms more personalised.

Despite being uncertain about having a care plan or being aware if they had contributed to the way that their care was delivered, all of the people that we spoke with told us that staff were very kind and helpful and things were done in the way that they wanted.

They said that they were able to have some choice in who helped them with their personal care and several of them knew that they had a key worker, or “special carer” One person told us that their care worker had been changed for them because they didn’t really get on with them and it had not been a problem.

Everyone said that they were free to choose how they spent their days and, although some people would like more to do, there are some activities arranged for those who wish to join in. They said that their relatives are always made welcome and we saw that there were several visitors to the home during the course of the day.

Everyone said that the food served in the home was very good. They were able to have a choice of meal and tea and coffee was freely available. Relatives and visitors often join them for lunch.

We asked people about what they would do if they wanted to make a complaint. There is a complaints procedure in place however, they all said that they would tell the staff or manager and it would be sorted out. Some people also said they would tell the owner who was often in the home and came to talk to them.