Sutton Lodge

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• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

People and those important to them had mixed feedback regarding staffing levels. People and relatives did feel staff were well trained and kind. We received mixed feedback regarding peoples medicine care and support. People and those important to them were supported to understand safeguarding and how to raise concerns when they did not feel safe. Staff understood their duty to protect people from abuse and knew how and when to report any concerns they had to managers. When concerns had been raised, managers reported these promptly to the relevant agencies and worked proactively with them to make sure timely action was taken to safeguard people from further risk. Safety risks to people were managed well. Managers assessed and reviewed safety risks to people and made sure people, and those important to them, were involved in making decisions about how they wished to be supported to stay safe.

This service scored 69 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

People told us they felt safe from abuse. One person said, “Yes, I feel safe, I just enjoy it.” Another person said “I’m double safe! Somebody watches me if I walk outside.” Relatives told us they felt their loved ones were safe. One relative told us, “[person] is safe, [person] is very well looked after. If there was a problem I would go straight to the manager.”

Staff understood how to respond to allegations of abuse. Staff told us that they had no concerns, but if they did, they were confident the management team would act appropriately. Staff were confident in using whistleblowing processes if they felt concerns were not being responded to. The management team understood how to respond to allegations of abuse. They had a clear process of how to investigate and keep people safe. Staff knew where to find the safeguarding policy. They were aware of the policy guidance and knew how to follow it to keep people safe from potential abuse.

There were clear processes and systems in place to safeguard people from abuse. If an allegation of abuse was made, there were appropriate policies in place to guide the staff team. Records showed that incidents were quickly investigated and referred to the local authority safeguarding team if needed. Staff had completed safeguarding training.

People and their relatives told us they had been involved in their care planning. One person told us, “I am involved in care planning for her, and they’re reviewed regularly.” A relative told us, “We have been involved in his care plan, it was reviewed two weeks ago, and we can talk to them [staff] about it. Relatives told us that staff understood their loved ones needs well and offered support to keep them safe. One relative told us, “My relative has a stoma and they know how to manage that. They got the nurse from the hospital to tell them how to do it.” Another relative told us, “They seem to know how to manage behaviour, when people get a bit upset.” Another relative told us, “My relative can no longer use the call bell, but he has a falls sensor and they respond to that.”

The staff team knew people well. Staff were able to explain people’s identified risks and the management plans in place to manage individual risks.

We saw people were supported safely. We observed people were being supported by staff who knew people’s needs well. We saw equipment, such as hoists and wheelchairs, which were seen to be being used safely.

People’s needs were clearly documented in their care plans, so staff had clear guidance on a person’s mental, physical, and social needs. Staff knew how to support people to manage risk. For example, people had individual risk assessments and care plans detailing actions to be taken. Where incidents had occurred, there was opportunities for staff and people to review what had happened and ensure measures were put in place to prevent re-occurrence. Staff kept clear records on how they had supported people and at what time. This allowed for changes in people’s needs to be identified and improvements made to their planned care.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

We received mixed feedback regarding staffing levels. One person said, “They need more staff. Sometimes there's only one staff on working and I'm waiting for ages.” Relatives told us, “ I would prefer more one to one time, my relative is always better with more one to one.” Another relative told us, “The day shift seem very busy, they [staff] weren’t happy a few weeks ago but they seem better now.”

We received mixed feedback from staff and the management team regarding staffing. Staff told us there was not always enough staff. Staff comments included, "At least half of our residents require 2:1. The most difficult time is morning and bedtime because there are only 3 care staff and one staff has to stay to supervise the lounges for falls which leaves the other 2 staff to do all the transfers of people. So, if another person needs support they have to wait until the other two staff are finished." Another staff member told us, “We have raised this with the new management, and they have told us they are recruiting but no one is coming for the jobs, so they have no other staff to put on shifts." A staff member said, “There have been issues with night staffing and a lot of sickness and then the use of agency who do not know the residents. Everyone's rushed off their feet, but we do try ensuring everyone's needs are being met. Our job is hard because there is not enough staff and we're rushing. Very tasked focused to ensure the red flags are ticked off the work phones. Lots of buzzers going off at night there can be multiple buzzers going off, sometimes you have to check the person is okay and tell them you will be back to respond to another buzzer.” Staff told us they had raised this with the two new managers. We shared this feedback, and the senior management team felt this was not accurate, they told us they were not aware of any staff raising concerns regarding the staffing levels. They told us they had checked with their human resources and welfare office. Staff had raised concerns regarding the dependency tool not being accurate for people's assessed needs, the senior management told us they were not aware of this and that staff also had not shared any concerns regarding the dependency tool not being accurate.

We saw staff were suitably trained to complete their roles. Staff used their training to respond effectively to people’s needs.

There was not a clear robust system in place to show which staff were on shift each day. We were provided with rotas to review staffing; however, we were told the rota was not always an accurate record to show staffing. For example, agency staff were not recorded on the rota. The senior management told us they would check agency invoices or the signing in book to evidence an agency staff member on a shift. Furthermore, we reviewed the rota and showed concerns regarding a new member of staff on shift included in the numbers. However, after our visit the senior management told us the rota given to us on the day of the assessment was not accurate and they would check, the senior management shared a clocking system record to evidence which staff were on shift. Staff had received the appropriate training to do their jobs safely. However, due to what we found regarding medicines management we were not always assured staff who were responsible for auditing medicines were competent at identifying concerns, errors or sufficient stock levels. The provider had safe systems to recruit staff safely. This included gathering references and undertaking a Disclosure and Barring Service (DBS) check. The DBS check identifies any convictions a person has or whether they are barred from working with vulnerable adults.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

We received mixed feedback from relatives regarding safe medicines management. One relative told us, “I don’t think they all know how to give medicines properly. I complained about one person on one occasion [person] asthma inhaler was just put on their face without a word and they panicked and couldn’t breathe. When the carer did it again, she explained what she was doing, and it was fine.” Another relative told us, “I can discuss changes of medication with them, [person] has just had to change from pills to liquid for one thing.”

Staff felt they had adequate training to support people with their medicines safely. Staff told us, “Completed medication training, complete the training every year.” Staff told us they apply topical medicines such as creams but do not sign the medication records. The senior staff member told us they sign to say a care assistant has applied the cream but do not record the carer's name. The management team told us, they use an electronic system that is not accessible to care assistant staff, this is the reason for the senior staff to update the medicines records for topical medicines. Since our visit the management team have told us, “We have updated our medication policy to require the carers (who applied the cream) to have their name or initial included on the Omnicell Medication system.”

Processes did not always support safe medicine management. Some people required ‘as needed’ medicine and staff were not always provided with clear written guidance on how this should be administered. For example, a person had been prescribed a medicine, and the prescriber had stated take one or two capsules. However, staff did not have any guidance to follow to indicate when one or two capsules should be given. We found topical medicines were not stored in a locked area, to prevent people accessing them unsafely. Since our visit the management team have told us they have taken action and topical medication will be stored in their lockable treatment room. We found topical medicines labels were not always legible. Peoples names and instructions were not visible. This meant there was a risk of people not receiving their topical medications as prescribed. Senior care staff had access to the medication records. However, care staff who appiled topical medcines did not have access to provide them with guidance on where to apply creams. We found one entry within the controls drug book did not meet the required standards. We found an entry that was not legible.. Staff told us they had by accident added another person’s stock on the wrong page. It was difficult to understand what had happened because a date was incorrect and there was no written explanation or investigation of the error. The management team took action and told us they have updated their medication policy to provide guidance to staff on what steps to take when recording an error of a controlled drug. Where medicines needed to be stored at a certain temperature, this had been done. For example, one person required their medicine in a fridge. Staff had checked the fridge temperature daily to ensure it was working as expected. Medication audit systems were in place. However, we were not assured they were completed by competent members of staff because all audits completed did not identify concerns or errors.