About the service: Sutton House is a residential care home providing care and support to seven men living with a learning disability.

People’s experience of using this service: Sutton House provided an excellent service. People led full lives and were happy. People’s experience was summed up by one person who told us, “I think it is outstanding here, the staff are brilliant. It has changed me, it has made me feel good.”

The outcomes for people living at Sutton House reflected the principles and values of Registering the Right Support in the following ways; promotion of choice and control, independence and inclusion. People's support focused on them having as full a life as possible, gaining new skills and growing in confidence and independence.

People were safe and protected from avoidable harm and abuse. Risks were managed safely whilst respecting people’s choices. People were supported to develop the skills and confidence they needed to maintain their own safety. People received their medicines as prescribed. There were enough staff meet people’s need and preferences and ensure their safety.

The team at Sutton House were passionate about maximising people’s capacity to make decisions. People were supported by a team of staff who were skilled in meeting people's needs and received on-going training and development to enable them to deliver the most effective service. People received healthcare support from a range of internal and external healthcare professionals and staff empowered people to understand and maintain their own health. People had enough to eat and drink, they were encouraged to make choices about food and drink and provide feedback.

The service had a person-centred culture focussed on the promotion of people's rights to make choices, this resulted in people being valued and treated as individuals. Respect for privacy and dignity was at the heart of the service. People were supported by exceptionally caring staff that knew them well and understood how to maximise their potential. People were supported to maintain relationships with their families and friends and the value of relationships was central to the success of the service. People’s independence was promoted and they received support to achieve their dreams, wishes and aspirations.

People received a personalised service which was responsive to their individual needs. People had active social lives and were a part of their local community. People directed their own support and staff were committed to supporting people to experience a good life. People were encouraged to provide feedback on the service and felt they could raise concerns.

Since our last inspection the provider and registered manager had sustained a high-quality service, resulting continued in positive outcomes for people. The registered manager promoted a culture of equality and person-centred support. They had a vision for the home which was based upon ensuring people’s happiness and upholding their human rights. People and their families were unanimously positive about Sutton House and impact it had on their lives. Suggestions from people, families and staff were used to drive improvements. Robust quality assurance processes ensured the safety and quality of the service.

The service met the characteristics of outstanding in most areas. For more details, please see the full report which is on the CQC website at www.cqc.org.uk.

Rating at last inspection: Outstanding, report published 16 June 2016.

Why we inspected: This was a scheduled inspection based upon the previous rating.

Follow up: We will continue to monitor this service and plan to inspect in line with our inspection schedule for those services rated Outstanding.

We inspected the service on 9 March 2016. Sutton House provides accommodation, personal care and support for up to six adults with learning disabilities. On the day of our inspection six people were using the service.

The service had a registered manager in place at the time of our 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.

People were given the information they needed to ensure they knew what to do if they were at risk of harm and were supported by staff who knew how to protect people from the risk of harm. Risks in relation to people’s daily life were assessed and planned for to protect them from harm.

People were supported by enough staff to ensure they received care and support when they needed it. Medicines were managed safely and people received their medicines as prescribed.

People were supported by staff who had the knowledge and skills to provide safe and appropriate care and support. People were supported to make decisions and procedures were in place to protect people who lacked capacity to make decisions.

People were supported to maintain their nutrition and staff were monitoring and responding to people’s health conditions.

People lived in a service where staff valued and listened to them. People’s choices were acted upon by staff who went the extra mile to support them to live a fulfilled life and cared for them in a way they preferred. People’s potential was recognised and they were supported to develop their skills and knowledge. People were supported to enjoy a rich and active social life.

People lived in a service where they were educated in what standards to expect from the service and what to do if standards fell below what was expected. They benefited from an open and inclusive culture of leadership which placed people at the heart of the service and strove to continually improve. People were involved in giving their views on how the service was run and there were effective systems in place to monitor and improve the quality of the service provided.

A single inspector carried out this inspection. We talked with four people who used the service and observed how people were being cared for. We spoke with the registered manager and three members of staff. We looked at the care and support records of four people who used the service and the records of staff training and quality audits.

This helped us to answer the questions below.

Is the service safe?

People’s care records contained risk assessments and action plans to ensure the care provided was safe and appropriate for their needs. Support plans were reviewed in conjunction with the people who used the service, to ensure care was provided in accordance with their wishes.

Safeguards were in place to ensure that when people lacked the ability to make decisions about their care and treatment, mental capacity assessments were carried out and action taken to ensure best interest decisions were made. Staff had undertaken training in adult safeguarding, the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards and understood the implications of these for their practice.

Safe systems were in place for the management of people’s medicines and staff had completed training and competency assessment in medicines administration to ensure their knowledge and skills were up to date.

Is the service effective?

Full assessments of each person’s support needs were undertaken and support plans were reviewed regularly and updated as necessary to ensure the support provided was appropriate to each person’s individual needs.

An advocacy service was available for people if they needed it and information was provided in easy read format to enable people to understand how an advocate could provide them with additional support. There was a range of other information provided in accessible formats within the home to enable people to raise concerns and ensure their voices were heard.

We saw there was involvement from a range of professionals in each person’s care, ensuring care was effective and specialist input obtained where necessary.

There was a structured approach to training and appraisal of staff to ensure staff were supported to function effectively in their job roles.

Is the service caring?

People who used the service were happy with the care and support provided. They told us staff were kind and protected their privacy during care activities. We saw staff encouraging people to express their views and taking time to make sure they understood their wishes.

People’s preferences, interests, and diverse needs were recorded and care and support was provided in accordance with their wishes.

People were encouraged to participate in activities they enjoyed thus promoting their well-being.

Is the service responsive?

People were engaged in a wide range of activities in the local community and when they identified a change in their preferences this was listened to and alternatives explored with them.

Feedback was sought from people who used the service and we saw a number of examples of improvements which had been implemented as a result of this feedback.

People told us they had had no reason to complain but they knew how to make a complaint if necessary and who to contact if they were not satisfied with the response. However, they told us they were confident their concerns would be dealt with by the staff and manager.

Is the service well led?

Systems were in place to monitor and assess the quality of the service and records showed that quality audits had been carried out regularly. Issues for improvement identified from the audits had been acted on.

There was a planned approach to education and training and staff had received the training they required to deliver safe and effective care. Staff received regular supervision and appraisal. They told us they felt well supported by the manager and encouraged to undertake further development.

Key areas we looked at such as medicines management were supported by policies and procedures which identified the standards and practices expected.

Prior to our inspection we reviewed all the information we had received from the provider. We spoke with five people who used the service and one person’s relative to establish their views on the quality of service provision. We also spoke with the registered manager and two support staff. We looked at some of the records held in the service including the care files for two people. We observed the support people who used the service received from the support staff and carried out a full tour of the building.

We found that systems were in place to gain and review consent from people who used the service and support staff respected people’s opinions and views.

People told us they were provided with a choice of suitable and nutritious food and drink in sufficient quantities to meet their individual needs. They also said they were encouraged to contribute to the preparation of daily meals to enhance their independent living skills.

We found that the registered manager had ensured that appropriate training had been provided to the support staff. People told us they felt the staff had the right qualifications, skills and knowledge to perform their duties in a safe and competent way.

People told us they felt confident in highlighting any concerns or complaints to the management team and confirmed they felt safe and well cared for.

During our visit we spoke with two care staff, the deputy manager and the registered manager of the service. We spoke with one person who used the service. It was not possible to speak with other people who used the service as they were out at college or engaged in other activities. We spoke with the relatives of three people who used the service.

The person we spoke with who used the service told use they were very happy and felt safe living at Sutton House. Also that they got on well with the other people living in the house. They said they liked the staff and felt comfortable they could raise any concerns they might have.

All of the relatives we spoke with told us they were happy with the care and support their family members received. One relative told us, “Staff are very caring and really good at keeping you informed.” Another told us, “I trust the staff implicitly with the care of my family member.” Another said, “I’ve been really impressed with the activities they organise and I’ve seen my family member make great progress.”

Relatives told us that staff supported their family member’s health and personal care needs and took prompt action to get them medical attention when it was needed. They also said that staff always treated their family members with respect.

All of the staff we spoke with said the provider was very good in terms of ensuring that staff training was up-to-date and that they really enjoyed working at the service.

The home was warm and welcoming, properly maintained and homely. There was clear and accurate record keeping, staff training and supervision in place.

We spoke with one person who was using the service who told us they decided how they spent their time. This person told us, “I am happy at the home, nothing makes me sad and I feel good.” They told us they felt staff kept them safe. They also told us that if they had concerns they knew who to speak with. This person had a care plan that was centred on them as an individual and they were able to make decisions and be involved in planning their care and support. Their safety was assessed regularly and they had their privacy and independence respected and upheld.

We were unable to speak with the remaining four people who used the service because one person declined and three others were being supported to access the community as they wished.