The inspection took place on 25 September 2017 and was unannounced. The inspection continued on 26 September 2017 and was announced.

Sutton Veny House is set in 25 acres of land and provides accommodation and nursing care for up to 28 people including people with dementia. 22 people were living in the home at the time of our inspection. The home is split across four floors. There are nine bedrooms on the ground floor five of which are en-suite. The first floor is accessed by a passenger lift or two sets of stairs. There are 10 bedrooms on the first floor and a further two on the second floor. A hair salon, the kitchen and laundry are on the lower ground floor. People had a communal dining room, a drawing room and veranda which led out into a level access garden.

The service had 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.

Sutton Veny House was not always managed well. Nine out of 12 staff told us that the registered manager was not approachable. We were given several examples of when the manager had either been abrupt or dismissive. We were told that this made some staff sad and upset. The registered manager felt that they were approachable. However, they were able to recall some examples of when they may have been abrupt with staff and raised their voice at them in public areas of the home. This did not demonstrate an open or inclusive approach and supported what staff had told us. Following the inspection the registered manager told us what actions they were going to take in reflection of the feedback given.

Medicines were being stored and administered from two areas in the home. This meant that there was a risk of nurses getting distracted during administration which increased the risk of medicine errors. The registered manager told us that a temporary clinical room would be identified to house all medicines and equipment.

We were told that six monthly reviews took place with people, family, professionals and staff. However, these were currently out of date and new meetings were being arranged. We noted that some meetings should have taken place in July and August 2017.

The registered manager had a good awareness of the Mental Capacity Act (MCA) and training records showed that staff had received training in Deprivation of Liberty Safeguards (DOLS). The service completed capacity assessments and recorded best interest decisions. This ensured that people were not at risk of decisions being made which may not be in their best interest. Staff also had a good understanding of the principles linked to MCA.

There were enough staff. Sutton Veny House had recently taken some new admissions with complex needs. These included people who required two staff to assist them. Following the inspection the manager confirmed that an additional staff member had been put on to morning shifts.

People and staff told us that the service was safe. Staff were able to tell us how they would report and recognise signs of abuse and told us they had received safeguarding training. We reviewed the training records which confirmed this.

Care plans were in place which detailed the care and support people needed to remain safe whilst having control and making choices about how they lived their lives. Each person had an electronic care file which also included guidelines to make sure staff supported people in a way they preferred. Risk assessments were completed.

Medicines were administered by registered nurses. Medicine Administration Records (MAR) reviewed showed no gaps. This told us that people were receiving their medicines as prescribed.

Staff had a good knowledge of people’s support needs and received regular mandat

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

During our last inspection on 24 April 2014 we found the provider to be in breach of Regulation 23, Supporting workers. Not all staff were receiving regular supervision and support or had undergone an annual appraisal. Regulation 10, Assessing and monitoring the quality of service provision. There was a lack of robust monitoring and planning of the staffing levels. This had impacted on the availability of staff cover and had resulted in some shifts not meeting the minimum staff number set by the provider. The provider wrote to us with an action plan of improvements that would be made. During this inspection we found the provider had made the necessary improvements.

Sutton Veny House is a residential care home providing accommodation and nursing care for up to 28 older people. At the time of our visit there were 16 people living at the home. Sutton Veny House is set in a rural location situated in 25 acres of grounds and parkland within the village of Sutton Veny. Most bedrooms are en-suite and there is a lift between floors. The gardens are landscaped with several seating areas including a sensory garden.

The service had a registered manager who was responsible for the day to day operation of the home. 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. The registered manager was present on the day of the inspection.

People and their families praised the staff and registered manager at Sutton Very House for their kindness and compassion. People had developed caring relationships with staff and were treated with dignity and respect. People enjoyed the surroundings of the home and the calm attitude of staff as they went about their work. Staff took time to sit and chat with people.

The care records demonstrated that people’s care needs had been assessed and considered their emotional, health and social care needs. People’s care needs were regularly reviewed to ensure they received appropriate and safe care, particularly if their care needs changed. Staff worked closely with health and social care professionals for guidance and support around people’s care needs.

People’s rights were recognised, respected and promoted. Staff were knowledgeable about the rights of people to make their own choices, this was reflected in the way the care plans were written and the way in which staff supported and encouraged people to make decisions when delivering care and support.

Staff had received training in how to recognise and report abuse. There was an open and transparent culture in the home and all staff were clear about how to report any concerns they had. Staff were confident that the registered manager would respond appropriately. People we spoke with knew how to make a complaint if they were not satisfied with the service they received.

There were systems in place to ensure that staff received appropriate support, guidance and training through supervision and an annual appraisal. Staff received training which was considered mandatory by the provider and in addition, more specific training based upon people’s needs such as, epilepsy training, behaviour management and diabetes. Staff were encouraged by the registered manager to be involved in improving the service and outcomes for people who live at Sutton Veny House.

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service caring, responsive, safe, effective and well-led? Below is a summary of what we found. The summary describes what people who used the service, their relatives and the staff told us, what we observed and the records we looked at.

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

This is a summary of what we found:

Is the service caring?

People looked well cared for. When we spoke with people they were complimentary about the care they received from staff, describing them as ‘caring’ and ‘friendly’.

Staff were kind and respectful to people at all times. They were attentive and alert to people's moods and we saw them comforting people when they became distressed or agitated. They demonstrated a good rapport with people, who appeared comfortable in their company, and to trust them.

Staff were knowledgeable about the people they cared for and knew people’s likes and dislikes and their preferred care routines. One relative told us that they were very happy with the care their family member received. Prior to our inspection we had received information of concern in relation to inadequate care. We did not find this to be the case on the day of our inspection.

Is the service responsive?

The home provided services for people with a high level of need and records clearly demonstrated how care and support should be provided in line with people's wishes.

There was a system in place to review the dependency needs of people and to change the level of support where required. Likewise, the nursing staff reviewed and monitored people’s care and treatment needs to ensure appropriate care was given in response to changing needs.

People’s care and treatment was reviewed on a regular basis with them, this enabled people to discuss any changes or preferences regarding their care and support.

People took part in activities if they wished to. The activities co-ordinator consulted with people about their interests and hobbies and the activities they would like to see in the home. This enabled the activities co-ordinator to set up activities according to people’s wishes. For people who either preferred to stay in their bed room or were bed-bound, a volunteer visited people in their rooms to offer social interaction, either by chatting or reading to them.

The provider had received two complaints regarding the provision of care and had acknowledged where there had been a drop in standards. The manager had put systems in place to minimise repeat occurrences.

Is the service safe?

The home had appropriate systems in place for the recruitment and selection of staff. The personnel records showed that staff employed to work at the home were suitable and had the skills and experience required to support people living in the home. All new staff completed a Disclosure and Barring Service (DBS) check to ensure that they were suitable and safe to work with vulnerable people.

The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We found there were appropriate policies and procedures in place and staff had been trained to understand when an application should be made. Staff understood the importance of enabling people to make safe choices and documents evidenced where people may need support with this.

The home was clean throughout and walkways were clutter free which enabled people to move around the home safely and freely.

Is the service effective?

The home had systems in place to ensure that people received the care they required. The care plans were person centred and demonstrated that people’s care and treatment needs had been assessed and were reviewed on a regular basis.

The nursing staff worked closely with other care staff in providing guidance when care and support needs changed which ensured a continuity of care. The head chef liaised with nursing and care staff in devising specialist diets or when dietary needs changed. People said they were happy that they received appropriate care and support.

The housekeeping and kitchen teams received appropriate training and support through a system of supervision and appraisals which enabled them to develop professionally and keep their skills up to date. All staff within the home were offered specific training which was relevant to their role, such as dementia awareness. However, not all care staff received regular formal supervision or appraisal. We have set a compliance action in relation to this and the provider must tell us how they plan to improve.

Is the service well-led?

There were quality assurance processes in place which were monitored externally through the provider. There were audits in place and checks were made regarding the environment, record keeping, infection control, medicines, falls risks and complaints. The home did not have up to date information in relation to staff training or a robust sytem in place for monitoring and responding to changes in staffing levels. We have set a compliance action in relation to this and the provider must tell us how they plan to improve.

People told us they would inform the manager if they had any complaints. One person said “I have no complaints at all”. There was a clear procedure in place where people or their families could raise concerns and information was available to people regarding the complaint process.

People were asked for their opinion on the service they received through satisfaction questionnaires and the next survey was due towards the end of 2014. Staff were able to discuss concerns directly with the manager or through team meetings. More recently staff had raised the issue of staffing levels with the manager.

Staff said they had a good team and everyone got on well. Many of the staff had been employed at the home for several years. Staff were aware of the structures in place regarding accountability and were confident in their role and responsibilities.

The manager submitted notifications to the Care Quality Commission as required and reported relevant safeguarding concerns to the appropriate authorities.

People said they took part in developing their own care plans. One person told us they felt “very much involved” in their treatment and care. A relative told us they felt listened to and fully consulted about their relative’s care. Staff told us they had been trained in the Mental Capacity Act (2005).

People commented favourably on the treatment and care they received. One person told us “we’re looked after well” and another “yes the staff do care.” A visitor told us “I think they get the care they need.” Staff we spoke with showed a detailed knowledge of people’s individual needs. What they told us was fully documented.

People commented favourably on the meals. One person said “the food’s very good – and I’ve got my likes and dislikes,” another person said, “if I don’t like something they’ll always give me something else.” The chef had a detailed knowledge of each person living in the home, their dietary needs and preferences.

People appreciated the standards of cleanliness. One person told us “cleaning is done extremely well here.” All parts of the home we inspected were clean.

People said they felt there were enough staff on duty to meet their needs. One person told us “oh yes there are enough staff.” A member of staff described staffing levels as “fine.” The home had a stable staff team who worked to cover shifts if other staff were unable to come on duty.

We spoke to five staff members and seven people who used the service. Some people were not able to speak to us directly due to their cognitive impairment; instead we observed their interactions with the staff team. We found the improvements we told the home to make around quality assurance had been made.

The manager had reviewed the care plans of all the people who used the service. The views of people who used the service and their relatives were taken into account in the provision of their care.

Staff members had received training in respecting people who they care for and treating them with dignity. There was a staff member who was the dignity champion. They had completed an audit of how the staff cared for people in respect of meeting the dignity challenge. We saw many examples of good practice.

The staff rotas confirmed additional staff were on duty to assist people. The manager had devised an assessment tool to ensure the numbers of staff on duty was sufficient to meet people’s assessed care needs

The manager told us “we are improving quality and purpose in people’s lives. We have all worked very hard and I would like to thank the Commission."

We visited Sutton Veny on 5 July 2012 and spent the day at the service. Our visit was

made to check on improvements we had told the service to make following an inspection

in December 2011.

We spoke to seven staff members, three relatives/carers and five people who used the

service. Some people were not able to speak to us directly due to their cognitive

impairment, instead we observed their interactions with the staff team.

We found the majority of improvements we told the home to make around quality

assurance had not been made. The manager had made some improvement, but there

was no system to take into account the views of people who used the service.

We spoke to five staff members and found they were not always following people's care plans to ensure their needs were met.

We saw the staff who were on duty at the time of the site visit were caring and kind in their manner towards people. We saw staff members helped people in a thoughtful and

considerate way. But staff members told us they did not have time to talk to people who used the service. We saw there was not sufficient staff to meet the needs of people that used the service. A visitor, who was a carer of a person living at the home, told us "there isn't enough staff here. We often can't find staff if we want them. There doesn't see to be many about when we visit".

People who live in the home told us that they were well cared for and treated with dignity and respect by the staff. People said they were involved in making decisions about their care and that nursing staff were approachable and professional.

People said they felt safe living in the home and were able to raise concerns if they needed to.

People said they enjoyed the variety of activities that were organised and that the food was of good quality.

Relatives told us they were made to feel welcome in the home and were kept informed of any concerns or issues

Staff told us they worked well as a team and were well supported by the senior staff. Regular training was provided and people were up to date with the required refreshers.