This inspection was carried out on 18 May 2017. Sutton Lodge Care Home provides residential, nursing and respite care for older people who are physically frail. It is registered to accommodate up to 28 people. At the time of our inspection 20 people were living at the service.

There was a registered manager in post and present on the day of the inspection. 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 service is run.

There were enough staff to support the needs of people. When people required support this was provided quickly by staff. People were protected from the risk of abuse and staff understood their roles and responsibilities. People told us that they felt safe and relatives had peace of mind that their family members were looked after in a safe environment.

Staff understood the risks to people. Staff encouraged and supported people to lead their lives as independently as possible whilst ensuring they were kept safe. People’s medicines were managed in a safe way. In the event of an emergency plans were in place to keep people safe.

Staff receiving appropriate training and supervision to provide effective care to people. People felt that they were being supported by staff that were effective in their role.

People's human rights were protected because the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty (DoLS) were being followed. MCA assessments were completed where needed. Staff understood MCA and why it was important to understand if people had capacity to make decisions.

People enjoyed the food at the service. Staff supported people nutritional and hydration needs and people accessed health care professionals when needed.

Staff were caring and considerate to people’s needs. People and relatives said that staff were caring and kind to them and treated them with dignity. People and relatives were involved in their care planning and the care that was provided was person centred.

Care plans were detailed and provided guidance to staff on best to support people. Staff communicated with each other the changes to people care. People were able to participate in a range of activities both inside and outside of the service.

Systems were in place if complaints and concerns were received. The provider had systems in place to regularly assess and monitor the quality of the care provided. The provider actively sought, encouraged and supported people's involvement in the improvement of the service.

People told us the staff were friendly and management were always approachable. Staff were encouraged to contribute to the improvement of the service. Staff told us they would report any concerns to their manager. Staff felt that management were very supportive and staff felt valued.

The registered manager had informed the CQC of significant events. Records were accurate and kept securely.

This unannounced inspection was carried out on 12 February 2016. Sutton Lodge Nursing Home provides nursing and residential care for up to 28 people. On the day of our inspection 18 people lived at the service. The accommodation is arranged over three floors and includes communal areas for people.

There was not a registered manager in place at the time of the 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. We were assisted by the interim manager on the day of the inspection.

People’s safety was not assured as identified risks of harm were not appropriately managed. A fire exit was blocked and staff had not always been trained to use emergency equipment. We recommend that steps are taken to ensure people’s safety at all times within the service.

Other risks had been assessed and managed appropriately to keep people safe. One member of staff told us “I have the knowledge to keep people safe; it’s about looking for dangers, like not leaving hoists raised where people could hit their heads.” Evacuation plans were available for people.

People’s human rights could be affected because the requirements of the Mental Capacity Act (MCA) and Deprivation of Liberty (DoLS) were not always followed. The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Some mental capacity assessments had not been completed around specific decisions that needed to be made. However staff had a good understanding of their responsibilities under the MCA. We recommend that specific mental capacity assessments are completed for particular decisions that needed to be made.

People were not always cared for by staff that had all the appropriate training to undertake their role. There were gaps in training around challenging behaviour and dementia. Not all staff were up to date with their refresher training. However there were good practices from staff around the work that they undertook. None of the clinical staff had undergone one to one supervisions which gave staff an opportunity to discuss how they worked and what training was needed. We recommend that staff are provided with training to ensure that they are aware of best practice.

People did not always have a detailed care plan around their identified needs for example around diabetes and behaviour that challenges. However the care that people received from staff did reflect their needs. Staff had knowledge of people’s needs and what care was required. We recommend that care plans are updated and detailed to reflect the needs of people that lived at the service.

People said that they felt safe at the service. One person said “I feel safe, there is always staff around.” There were sufficient members of staff deployed around the service to meet people’s needs. One member of staff told us “I do think there are enough staff, the numbers are fine.”

People’s medicines were administered safely and medicines were appropriately stored. Staff were trained to administer medicines safely. Incidents and accidents were recorded with detail around what happened, how it was dealt with and what steps were taken to reduce the risk of this happening again.

Staff had knowledge of safeguarding adults procedures and what to do if they suspected any type of abuse. There was a Safeguarding Adults policy and staff had received training

We visited Sutton Lodge Nursing Home to check if they had become compliant with the compliance actions we made during our inspection in July 2013. We did not on this occasion have discussions with people who used the service or staff. We met with the registered provider during this visit.

During our inspection we spoke with five people who used the service, one relative, three members of staff, the activities co-ordinator and the registered manager.

People who used the service were complimentary about the care they received from staff employed at the service. They told us that staff were caring and they were always available. They told us they made choices every day about their lives and how they wanted to be looked after. Not all the people we spoke with could recall what a care plan was. They said they could not remember if they had seen one.

People told us they felt safe living at the service. One person told us, “Staff are very kind and caring.” Another person told us, “Staff always tell me what they are doing when they help me with my care.”

People told us that the service was always clean and tidy. They said that their bedrooms were cleaned every day. One person told us, We have a resident of the day when our bedrooms get a thorough clean from top to bottom.”

People told us that there was enough staff at the service to meet their needs. They told us that they could get help from staff when they needed it.

We saw staff talking to people in a respectful manner and offering support as and when required. Staff were offering choices to people. People were engaged in activities during our inspection. For example, the hairdresser was attending to people and we saw staff playing a game of cards with one person.

We spoke to six people on the day of the site visit.

Some of the peoples’ responses included

“Staff looked after us and we make choices about the things we want to do,” “The staff always help me with my personal care in private with the doors closed.

Four people told us that they did not know about their care plans but that their relatives knew about them.

People who used the service told us that they felt very safe with the staff that looked after them. Some of the people’s responses included “The staff here are very caring and they always treat me well.”

People told us there was always a member of staff available when they called them. They told us that members of staff were very caring and that they always talked to them.

All six of the people we spoke to told us that their views about the home were considered by the manager. They told us that they had regular resident and relatives meetings that were attended by the manager and staff at the home and their suggestions were acted upon.