Sutton House is a care home which is registered to provide care to up to five people. The home specialises in the care of people with a learning disability and have behaviours that challenge others. At the time of our inspection there were five people living at Sutton House.

At the last inspection in November 2015, the service was rated as Good. At this inspection we found the service remained Good.

There was a registered manager in place. 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 continued to receive care and support from staff who understood how to keep them safe. Staff understood how to protect people from abuse and were clear about the steps they would need to take if they suspected someone was unsafe. Staff were available to meet people’s needs and understood how to best support people and the risks to their well-being. People were supported by staff to have their medicines as prescribed and checks were made to ensure staff supported people with their medicines appropriately.

People continued to receive effective care and support from staff that had the skills to meet their individual needs. Staff were supported by the management team through regular supervisions and staff meetings. Staff understood they could only care for and support people who consented to being cared for and throughout the inspection we saw people supported to communicate their choices. Staff supported people in the least restrictive way possible; the policies and systems in the service supported this practice

People enjoyed mealtimes, menus were planned at the beginning of each week with the input of people living in the home and we saw people were encouraged to be involved in the preparation of food and drinks. Staff responded when people were unwell and arranged appropriate healthcare appointments in support of people’s well-being.

People continued to receive support from caring staff who treated them with dignity and respect. We saw people were happy in the company of staff, who they looked to for support and reassurance when needed. People were involved in how their care and support was received and their choices were respected by staff.

The service remained responsive. Staff provided care that took account of people’s individual needs and preferences. People and their relatives were listened to and felt confident they could raise any issues should the need arise and action would be taken.

The service was well led. At the last inspection of November 2015 a new manager was in place but they had not registered with CQC. At this inspection we found that there was a registered manager in place who, with the support of the project manager had taken action to introduce new checks and processes to assure themselves of the quality of care being delivered.

Relatives and staff spoke highly of the management team and positively about the teamwork of the staff group within the service. Staff were supported through supervisions, team meetings and training to provide care and support in line with people needs and wishes. The quality of service provision and care was monitored and actions taken where required to improve people’s experience of living at the home.

Further information is in the detailed findings below.

This was an unannounced inspection. At the last inspection carried out on 27 October 2014 we found that the provider was not meeting the regulation in relation to having suitable arrangements in place to act in accordance with the consent of the people using the service After the inspection the provider sent us an action plan setting out the improvements that they would make. At this inspection we found that the provider had made improvements and there were systems in place to provide care to people with their consent.

Sutton House is a care home which is registered to provide care to up to five people. The home specialises in the care of people with a learning disability and have behaviours that challenge others. At the time of our inspection there were five people living at Sutton House.

Sutton House is required to have 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 the time of this inspection, this service had not had a registered manager in post since February 2013. An acting manager had been in post for five weeks and we saw that they had applied to become the registered manager.

Systems were in place to monitor the quality of the service but these could be more robust to ensure people received a consistent high quality service.

There was a positive and inclusive atmosphere within the home and people were at the heart of the service.

The provider had systems and processes in place to protect people from the risk of avoidable harm. Staff understood the different types of abuse and knew what action they would take if they thought a person was at risk of harm.

There were enough staff, who had received appropriate training so that they were able to meet people’s needs.

People were supported to receive their medication as prescribed

Staff sought people’s consent before providing care and support. Staff understood the circumstances when the legal requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLS) were to be followed.

People were supported to have food that they enjoyed and meal times were flexible to meet people’s needs.

People were supported to stay healthy and accessed health care professionals as required.

People were treated with kindness and compassion. We saw that care was inclusive and people benefitted from positive interactions with staff.

People’s right to privacy was promoted and people’s independence was encouraged.

People received care from a staff team that knew them well. People benefitted from the opportunities to take part in activities that they enjoyed and that were important to them.

Staff were aware of the signs that would indicate that a person was unhappy, so that they could take appropriate actions. Information was available in easy read formats to inform people about how to complain.

This was an unannounced inspection. At the last inspection carried out on 8 October 2013 we found that the provider was not meeting the regulation in relation to the care and welfare of people who use services. Following our October 2013 inspection the provider sent us an action plan telling us about the improvements they were going to make to information contained in people’s care records. During this inspection we found that further improvement was still required with people’s care records.

Sutton House is a care home which is registered to provide care to up to five people. The home specialises in the care of people with a learning disability who have behaviours that may challenge others. At the time of our inspection there were five people living at Sutton House.

Sutton House is required to have 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 and associated Regulations about how the service is run. At the time of this inspection, this service had not have a registered manager in post and had not since February 2013. An acting manager had been in post for six weeks at the time of our inspection. The acting manager told us that they would complete the registration application process to the CQC before the end of November 2014.

Relatives and staff we spoke with told us that they thought people were safe. There were systems and processes in place to protect people from the risk of harm. These included a safe living environment and enclosed garden and staff training. We found that some risks to people had been assessed to reduce the risk of harm to people. However, during our inspection we identified other risks that had not been assessed. This showed that risks to people were not always identified by staff. We discussed this with the acting manager and staff and found that appropriate measures to reduce the risk of harm or injury to people themselves or others had not always been considered or identified as a risk.

We found that the provider was not meeting the requirements set out in the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards (DoLS). This meant that mental capacity assessments had not been completed to determine peoples’ ability to make decisions about their lives, such as where they lived. The acting and deputy manager and care staff did not demonstrate their understanding of their responsibilities under this Act and as a result were not acting in accordance with the law.

People had their prescribed medicines available to them and appropriate records were kept when medicines were administered by trained care staff. However, we found that delays may occur when administering peoples’ prescribed ‘when required’ medicine due to the staff agreement in place to gain permission from management prior to administration of such medicines.

We found that feedback surveys to monitor and improve the quality of service people received had not been used since 2012. This meant that people and their relatives had not had the opportunity to give written feedback. This meant that opportunities had been missed to gather and look at feedback to see if any action was needed to improve the quality of the services provided.

On the day of our inspection three people lived at the home, we met all three people. Two of the three people were unable to verbally share with us their views about their care due to their individual needs. We used different ways to evidence their experiences such as observing care, looking at their records and speaking with staff. Following our inspection we conducted telephone interviews with two relatives.

We spoke with the service manager who was responsible for the running of the home and four members of staff.

Risk assessments were in place to support people’s needs. However, the lack of appropriate care plans for people’s health meant that people may not always receive care in a consistent manner.

Systems were in place to ensure that people received medication that they needed to maintain their health.

Recruitment processes were adequate which gave people who used the service some assurance that only suitable staff had been employed.

People were cared for by staff who were supported, supervised and trained to deliver care to an appropriate standard. One person told us, "The staff are nice I get on with them".

Systems were in place to regularly assess and monitor the quality of service that people received. A relative told us," The service is fantastic".

There were five people living at the home on the day of our inspection. No one knew we would be inspecting that day. We spoke with people living at the home and two relatives. One person told us,” I am very happy here”. Relatives we spoke with said,” We are pleased they seem happy and settled”.

As people had complex needs and were not all able to tell us about the service they received we used different methods to help us understand their experiences, including observation. We observed good interactions between staff and people living there.

We found that people were treated with respect and dignity and that they were given choices about how they wanted to live their lives.

We saw that care plans lacked instruction on how staff should care for people with specific health conditions to keep them in good health.

We identified that medication systems were not as robust and as safe as they should be to prevent people being placed at risk of ill health.

Recruitment processes had not been as thorough and safe as they should have been to give assurance that only suitable staff had been employed.

Records and staff both confirmed that systems had been used to monitor how the home had been run to benefit the people who lived there.

We met three people who lived in the home. They indicated that they were happy and they looked relaxed in the company of staff. We saw that where people did not communicate verbally, staff were able to interpret people’s gestures and respond appropriately to their requests.

People who lived in the home told us that the staff were ‘kind’. They compared the home favourably to other homes they had lived in. They told us about activities and the ways in which staff helped them to take part in the surrounding community. They showed us the items which they had chosen in their rooms. People said that they felt safe in this home.

Relatives of people who lived in the home told us:

“I am always made to feel welcome when I visit and I feel that my (relation) is treated well, with patience and consistency by the staff.”

“The home is always clean, warm and welcoming.”

“The manager has spent much time discussing behavioural issues and is constantly striving for a better understanding of my (relation) so that strategies can be put in place to help X. I feel that he values my contribution and insights that I have as a parent.”

“The home is always well maintained whenever we visit, with plenty of staff present and we are always given a friendly welcome.”

“The staff have sought our input on Xs likes/dislikes during his time there and also seek advice on possible ways to deal with his various behaviours.”

“We are very happy with the home overall and think that it is run very well by friendly and caring staff.”

A professional visitor to the home told us:

“I welcome the opportunity to comment on Sutton House as I have been very pleased with the work they have done with my client.”