We inspected this home on 31 October 2018 and it was unannounced. This meant that they did not know we were coming. We undertook our last inspection of the home on 9, 23, 27 February 2018 and 9 March 2018 where it was rated as inadequate in safe, effective, responsive and well-led and requires improvement in caring. This meant the home was inadequate overall and placed in special measures.

At our last inspection we identified a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to, safeguarding service users from abuse and improper treatment, dignity and respect, staffing, safe care and treatment relating to risks, infection control, the environment and safe handling of medicines. We also identified breaches in relation to consent, meeting nutritional and hydration needs, fit and proper person employed, person-centred care, and good governance. We also identified a breach of Regulation 18 of the Care Quality Commission (Registrations) Regulation 2009 (Part 4), notification of other incidents. We also made recommendations in relation to induction training for new staff, the timely involvement of professionals and receiving and acting on complaints.

Following the last inspection, we met with the senior management team for the provider including the nominated individual to discuss our findings and we asked them to complete an action plan to show what they would do and by when to improve the key questions of safe, effective, caring responsive and well led to at least good. We also undertook enforcement action which placed conditions on the registration for Sutton Grange with the Care Quality Commission. These included, providing an action plan each month to the Care Quality Commission that demonstrated the improvements in the home and that no people to be admitted to Banks View unit without written consent from the Care Quality Commission. We also placed a condition that an assessment of the skills, numbers and deployment of staff required to meet the needs of people in the home is undertaken and an assessment of the training and support required by those staff to meet the needs of people is undertaken.

During this inspection we found significant improvements had been made in the key questions for safe, effective, caring, responsive and well-led. Whilst improvements were noted the home needed to embed these improvements and demonstrate their sustainability. Although improvements were noted in relation to the safe handling of medicines we identified an ongoing breach of Regulation 12 Safe care and treatment. You can see what action we have taken at the back of the full version of this report.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

Sutton Grange is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Sutton Grange is registered to provide accommodation for up to 70 persons who require nursing or personal care and treatment of disease, disorder or injury for people living with a dementia, older people and people with a physical disability. On the day of our inspection 26 people were living in the home.

Sutton Grange is a purpose-built home with four units over two floors. We undertook a tour of the building which confirmed Banks View was closed this supported one of the conditions of their registration. All people’s bedrooms were of single occupancy and ensuite facilities were available. Com

This inspection took place on 9, 23, 27 February and 9 March 2018. All four days were unannounced which meant the service did not know we were going. We undertook this urgent comprehensive inspection as a result of concerning information we received from the local authority in relation to the care people who used the service received. Following the first day of our inspection we met with senior members of the management team on behalf of the provider, which included the nominated individual to discuss our concerns. The service was last inspected on 23 and 24 May 2016 and was rated as good overall. Effective was rated as requires improvement and a recommendation was made in relation to the meal time experience for people who used the service.

During this inspection we identified a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to; safeguarding people from abuse and improper treatment, staffing, risks, the environment, infection control, deprivation of liberty safeguarding, records and good governance. We will report on our actions for these when this is complete.

We also identified a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to, consent, staff training, nutrition and hydration, person centred care, dignity and respect, equality and diversity and activities. You can see what action we have taken at the bottom of the full version of this report. We made the following recommendations in relation to induction training for new staff, the timely involvement of professionals and receiving and acting on complaints. We also identified a breach of Regulation 18 of the Care Quality Commission (Registrations) Regulation 2009 (Part 4). Notification of other incidents.

Sutton Grange is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Sutton Grange is registered to provide accommodation for persons who require nursing or personal care and treatment of disease, disorder or injury for people living with a dementia, older people and people with a physical disability. The service can accommodate up to 70 people in four separate units; Banks view, Silver birch, Blossom walk and Red house gardens. Banks View specialised in the nursing care of people living with a dementia, Silver birch specialised in general nursing care, Blossom walk specialised in the care of people living with a dementia and Red house gardens specialised in personal care needs.

On the first day of our inspection 57 people were receiving care at the service. On the subsequent days of our inspection 51 were receiving care at the service. A registered manager is required as part of the services registration requirements. At the time of the first day of our inspection there was a registered manager in post. On day two, three and four of the inspection a new home manager had taken over the day to day responsibility for 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 2008 and associated Regulations about how the service is run.

Systems to ensure people who used the service were protected from abuse were inadequate. We observed a number of incidents where people were exposed to the risk of harm. Whilst some people told us they felt safe in the home others told us they did not.

Risk assessments failed to include detailed and relevant information to support and protect people from any identified risks. We saw a number of identified risks in the home that had not been acted upon appropriately, such as choking for people who used t

This inspection took place on 23 & 24 May 2016 and was unannounced.

Sutton Grange provides 24 hour nursing and residential care to 70 people. At the time of our inspection there were 35 people who lived at the home. The home is a purpose built and split into four areas. Each area has good communal facilities including a lounge, dining room and bathroom facilities. A secured garden area is provided at the rear of the premises along with garden areas at the front.

The home did not have a registered manager. The manager had left shortly before our inspection. An interim manager had been appointed whilst the provider recruited a suitable replacement for the registered manager. 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 supported to eat and drink enough to maintain their health. People's dietary requirements were explored and the information was readily available to kitchen staff to ensure these were met. However, we found inconsistencies in staff practice between different areas of the home. We have made a recommendation about this.

People were safe living at the home because they were supported by a sufficient number of staff who had the right skills and knowledge to meet their needs. Staff understood their responsibilities with regard to reporting suspected abuse, in order to safeguard people.

The service followed safe recruitment practices to ensure only suitable candidates were employed to work with people who lived at the home. The service had ensured risks to individuals had been assessed and measures put in place to minimise such risks. A comprehensive plan was in place in case of emergencies which included detail about how each person should be supported in the event of an evacuation.

Staff received induction and on-going training to enable them to meet the needs of people they supported effectively. Staff were supported by way of regular supervision, appraisal and access to management.

Effective systems were in place to ensure people's medicines were managed safely. Only trained staff were allowed to administer medicines.

Where people did not have the capacity to understand or consent to a decision the provider had followed the requirements of the Mental Capacity Act (2005). An appropriate assessment of people's ability to make decisions for themselves had been completed. Where people's liberty may be restricted to keep them safe, the provider had followed the requirements of the Deprivation of Liberty Safeguards (DoLS) to ensure the person's rights were protected.

However, we found the system to monitor DoLS authorisations had not been effective in identifying two authorisations had expired. The deputy manager had implemented a new system which remedied this.

People could access external healthcare services as they required and were supported to do so. People had access to a wide range of activities which were provided seven days a week.

Staff were kind and caring and treated people with respect. We witnessed many positive and caring interactions throughout or inspection. Staff knew people's likes and dislikes which helped them provide individualised care for people.

Plans of care were based around the individual preferences of people as well as their medical needs. People and their relatives were involved in reviews of care to ensure it was of a good standard and meeting the person's needs.

The provider had implemented effective systems to assess, monitor and improve the quality of care and support that was delivered to people. People, their relatives and staff were involved in developing the service.