We inspected the service on 22 December 2017. The inspection was unannounced. Sutton Lodge Residential Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Sutton Lodge Residential Care Home is registered to provide accommodation and personal care for 24 adults of all ages. The service can also provide care for people who have physical adaptive needs. There were 14 people living in the service at the time of our inspection visit. Some of the people lived with dementia and had special communication needs.

The service was run by a company who was the registered provider. 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. In this report when we speak about both the company and the registered manager we refer to them as being, ‘the registered persons’.

This is the fourth consecutive time the service has been rated as 'Requires Improvement'.

At the last inspection on 13 October 2016 although there were no breaches of regulations we found shortfalls in the arrangements that had been made to manage the service so that people consistently received safe and responsive care. At the present inspection we found two breaches of regulations. This was because the registered persons had failed to assess risks to people’s health and safety and had not done all that is practical to keep people safe. In addition, the registered persons had failed to assess, monitor and improve the quality and safety of the service in the carrying on of the regulated activity. This was because people had not been fully involved in the development of the service and quality checks had had not always resulted in shortfalls quickly being quickly put right. In addition, the registered persons had not made robust arrangements to ensure that the service complied fully with a number of regulatory requirements. You can see what action we have told the registered persons to take at the end of the full version of this report.

Our other findings are as follows. We found that improvements were needed to ensure that people were fully safeguarded from the risk of financial mistreatment. In addition, lessons had not always been quickly learned when things had gone wrong. Furthermore, background checks on new care staff had not always been completed in the right way. However, medicines were managed correctly and sufficient care staff had been deployed.

Suitable arrangements had not always been made to enable people to receive care that fully promoted effective outcomes. This included national guidelines not always being followed to ensure that care was always provided in a lawful way and was the least restrictive possible. Furthermore, some parts of the accommodation were not designed, adapted and decorated to meet people’s needs and expectations. Although in practice care staff knew how to provide people with most of the practical assistance they needed, some of them had not received all of the training that the registered persons considered to be necessary. In addition, some of the arrangements used to ensure that people had enough hydration and nutrition to maintain a balanced diet were not robust. However, suitable provision had been made to help people receive a coordinated care when they moved between different services and people had been supported to receive on-going healthcare assistance.

Care staff had not always been given all of the resources they needed to provide people with a service that consistently pro

We inspected Sutton Lodge Residential Home on 13 October 2016. This was an unannounced inspection. The service provides care and support for up to 24 people. When we undertook our inspection there were 15 people living at the home.

People living at the home were older people. Some people required more assistance either because of physical illnesses or because they were experiencing difficulties coping with everyday tasks, with some having loss of memory.

There was no 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.

CQC is required by law to monitor the operation of the Mental Capacity Act 2005 Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS authorisations are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves. At the time of our inspection there were no people subject to such an authorisation.

We found that there were not sufficient staff to meet the needs of people using the service at all times. The provider had not taken into consideration the complex needs of each person to ensure their needs could be met through a 24 hour period.

We found that people’s health care needs were assessed, and care planned and delivered in a consistent way through the use of a care plan. People were involved in the planning of their care and had agreed to the care provided. The information and guidance provided to staff in the care plans was clear. Risks associated with people’s care needs were assessed and plans put in place to minimise risk in order to keep people safe.

People were treated with kindness and respect. The staff in the home took time to speak with the people they were supporting. We saw many positive interactions and people enjoyed talking to the staff in the home. The staff on duty knew the people they were supporting and the choices they had made about their care and their lives. People were supported to maintain their independence and control over their lives. However, there was little stimulation for people during the day to keep them occupied and social activities were limited to group events three times a week.

Staff had taken care in finding out what people wanted from their lives and had supported them in their choices. They had used family and friends as guides to obtain information. However there was little stimulation and social activities for people to take part in each day.

People had a choice of meals, snacks and drinks. Meals could be taken in a dining room, a sitting room or people’s own bedrooms. Staff encouraged people to eat their meals and gave assistance to those that required it.

The provider used safe systems when new staff were recruited. All new staff completed training before working in the home. The staff were aware of their responsibilities to protect people from harm or abuse. They knew the action to take if they were concerned about the welfare of an individual.

There was no plan of maintenance in place and some areas of the home were looking in need of refurbishment and redecoration. Some pathways had uneven surfaces and were a trip hazard if people which to walk in the grounds.

People had been consulted about the development of the home and some quality checks had been completed to ensure services met people’s requirements. There had been a lapse in quality checks being made to test the quality of the services being offered, so the provider did not have up to date information as to whether people were currently happy staying in the home. The provider's website and signage at the front of the home gave incorrec

We carried out an unannounced comprehensive inspection on 28 April 2015. Three breaches of a legal requirement were found. After the inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches.

At the last inspection on 28 April 2015 we found that the provider was not meeting the standards of care we expect in relation to ensuring that there were sufficient staff on duty to meet people’s needs. Care could not be delivered to people as they wished and they told us their needs were not always met. The storage and control of medicines was not maintained and recording of medicines was poor. We could not tell whether people had received their prescribed medicines. There were no systems in place to ensure the quality of the service was being maintained. We did not know whether the provider was monitoring the quality of service people were receiving.

We undertook this focused inspection on 7 October 2015 to check that they had followed their plan and to confirm they now met the legal requirements. During this inspection on the 7 October 2015 we found the provider had made improvements in the areas we had identified.

This report only covers our findings in relations to those requirements. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Sutton Lodge on our website at www.cqc.org.uk.

Sutton Lodge provides care for older people who require nursing and personal care. It provides accommodation for up to 34 people. At the time of the inspection there were 14 people living at the home.

At the time of the inspection there had been no registered manager in post for five months. 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.

On the day of our inspection we found staff interacted well with people and people were cared for safely. People told us their needs were being met. Staff told us they had sufficient time to meet people’s needs. The provider had systems in place to ensure they knew the needs of people living at the home and could adjust the staffing levels when required.

Medicines were stored in a clean and tidy environment. Checks had been made to ensure staff used safe methods in administering medicines. The stock control had improved. All staff administering medicines had recently undergone further training in the safe administration of medicines.

Systems were in place to monitor the quality of the services being provided. Although audits had commenced there was not sufficient evidence to show this was going to be sustained.

The service provides care and support for up to 34 people. When we undertook our inspection there were 11 people living at the service.

We inspected Sutton Lodge Nursing and Residential Home on 28 April 2015. This was an unannounced inspection. Our last inspection took place on 12 June 2014.

The people in the home were mainly older people. They had mixed abilities to look after themselves. Some required help to walk. A couple of people preferred to remain in their bedrooms and not to socialise. The home looked after people in varying stages of dementia. There were no people who currently required nursing care.

Medicines were stored safely, but parts of the storage area was unclean and other equipment was stored in this area. Staff had not maintained accurate records of when medicines had been given and received by the pharmacy.

The staff on duty knew the people they were supporting and the choices they had made about their care and their lives. People were supported to maintain their independence and control over their lives. However, there was no method of assessing the dependency of people and ensuring sufficient staff were on duty to meet people’s needs.

People had been consulted about the development of the home but no quality checks had been completed to ensure the quality of services was being maintained.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 in relation to the number of staff available at times, the storage and record keeping of medicines and not monitoring the quality of the service. You can see what action we told the provider to take at the back of the full version of the report.

There was no registered manager in post. The registered manager of a sister home was overseeing the running of this home as well. The home had been without a registered manager since December 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.

CQC is required by law to monitor the operation of the Mental Capacity Act 2005 Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves or others. There were no DoLS authorisations in place at this time.

The people living at the home were elderly. Some were mobile and could walk around easily, whilst others required walking aids or wheelchairs. Some people were ill and were being nursed in their beds.

People’s health care needs were assessed, and care planned and delivered in a consistent way through the use of a care plan. People were involved in the planning of their care and had agreed to the care provided. The information and guidance provided to staff in the care plans was clear. Risks associated with people’s care needs were assessed and plans put in place to minimise risk in order to keep people safe.

People were treated with kindness, compassion and respect. Staff took time to speak with the people they were supporting.

People had a choice of meals, snacks and drinks. Meals could be taken in a dining room, sitting rooms or people’s own bedrooms. Staff encouraged people to eat their meals and gave assistance to those that required it. People were not supported to develop their own interests and hobbies.

The provider used safe systems when new staff were recruited. All new staff completed thorough training before working in the home. The staff were aware of their responsibilities to protect people from harm or abuse. They knew the action to take if they were concerned about the welfare of an individual. Staff had not received supervision to ensure they could do their jobs.

Our inspection team on this occasion was made up of one inspector. We considered our evidence to help us answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who use the service, their relatives, the staff supporting them and from looking at records. We also spoke with health and social care professionals before, during and after the visit.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People were treated with respect and dignity by the staff. People told us they felt safe.

Safeguarding procedures were robust and staff understood how to protect the people they supported.

Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents. This reduced the risks to people and helped the service to continually improve. Regular checks were undertaken to ensure the environment was safe for people.

the Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards which applies to people living in care homes. While no applications have needed to be submitted, proper policies and procedures were in place to ensure that people who could not make decisions for themselves were protected.

The service was safe, clean and hygienic. Equipment was well maintained and serviced regularly to ensure its safety. Therefore people were not put at unnecessary risk. However there was no yearly maintenance plan in place to ensure work within the buildings and grounds would continually be maintained.

Is the service effective?

People's health and care needs were assessed with them, and they were involved in writing their plans of care. Specialist dietary, mobility and equipment needs had been identified in care plans where required. People said that they had been involved in writing them and they reflected their current needs.

People's needs were taken into account with signage and the layout of the service enabling people to move around freely and safely.

People told us they could express their views at group meetings, meetings on a one to one basis with staff and by completing surveys.

Is the service caring?

People were supported by kind and attentive staff. We saw that staff showed patience and gave encouragement when supporting people.

People commented, "Staff respect my wishes" and "All my needs are being met."

People who used the service, their relatives, friends and other professionals involved with the service attended meetings throughout the year. Where shortfalls or concerns were raised these were addressed by the provider. People told us they felt their opinions were valued by staff. They told us they also completed questionnaires at regular intervals during the year on a number of different topics.

People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

Is the service responsive?

People told us they could speak with staff each day and share their concerns. They told us staff acted quickly to address their concerns. Relatives told us they could speak with staff about their family member's needs, when that person could not make decisions for themselves.

Health and social care professionals told us staff reacted quickly to people's needs especially when a person's life was ending.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way.

The service had a quality assurance system. Records seen by us showed that identified shortfalls were addressed.. As a result the quality of the service was continuously improving.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and quality assurance processes that were in place. This helped to ensure that people received a good quality service at all times.

On the day of our visit we observed people were participating in a reminiscence session. People looked well groomed and appeared to be relaxed in their surroundings. Some people had chosen to remain in their bedrooms and others were seated in communal areas. People told us they were able to make their own decisions about what they were involved in and that their wishes were respected. People told us that the standard of care was good and that they were happy living at Sutton lodge. We observed several people had visitors and they were welcomed by the staff.

We observed staff assisting people with various tasks and noted that the staff were respectful in how they approached and spoke to people. Care plans and risk assessments were in place and we noted these were reviewed on a regular basis.

We reviewed the arrangements at Sutton lodge for obtaining consent and noted the provider had appropriate arrangements in place, although two consent forms were not signed or dated and the manager told us that they were waiting for relatives to visit to get them completed.

The home consisted of three living areas, the main building, the stables which were three self- contained units and the “Vicarage”. We noted that the “Vicarage” building was in a poor state of repair and had not been maintained to an appropriate standard which promoted people’s wellbeing.

The equipment that was in use at the home had been regularly maintained to ensure it remained safe to use.

We reviewed the arrangements for monitoring the quality of care at Sutton Lodge and found these to be appropriate. Audits had been completed for various aspects of the home. However, there were no maintenance audits for the Vicarage building and the risks to people were not being managed effectively.

We reviewed notifications that the provider was required to send to the care quality commission to notify them about an event or the death of a person who used the service and found that these were appropriately completed and sent in a timely way.

People told us they were able to make their own decisions about the care and support they received. We were told for example, “I can have visitors whenever I want and if I feel like going for a lay down for half an hour I can.” People said they were able to make their own choices such as where they ate meals and whether or not they joined in with social activities.

People said staff respected their privacy and dignity and we saw staff were polite and courteous to them. People told us they were satisfied with the care provided, for example one said, “The staff are good”. Another person said, “They are all kind and caring.”

People told us they felt safe and comfortable to talk with staff if they had any problems and knew how to raise concerns. Staff had a good understanding of how to keep people safe and knew what to do if they were made aware of any allegations of abuse.

People said there were enough staff on duty to support them and they were attended to promptly when they needed assistance. We saw there is a varied training programme in place for staff to update their knowledge and skills.

We found there were satisfactory systems in place to monitor the quality of the service which took into account the views of people living in the home.

We spoke with the manager about making sure procedures and records were kept up to date and showed they were regularly reviewed and received confirmation after our visit of the action taken to address these matters.

When we spoke with a group of people living in the home, they all said that they had choices about everything in their lives, which included what they wore each day, the food they ate and when they got up and went to bed. Another person we spoke with said that they “get choices about everything.”

The people we spoke with were very complimentary about the care they received and praised the staff. One person told us that they knew all the carers and that “they are lovely and so kind.” Another person said that the care staff “are so easy to get on with.”

All the people we spoke with were able to tell us that they felt safe living in the home. One person said “I’ve got nothing to moan about” while another said “I feel safe and the staff are grand.”

We spoke with two members of staff during our visit. They knew what abuse was and who to contact if they needed to report any concerns about people’s safety. They all said they would have no hesitation in reporting any form of abuse to the appropriate person.

No-one raised any concerns or complaints during our visit but they said they would feel comfortable speaking to the manager or staff if anything arose. One person commented “I like everything.”