Archived: Beech Lodge - Horsham

Below is a summary of what we found. The summary describes what people using 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.

Is the service safe?

We found that people using the service were experiencing safe and appropriate care. Their needs had been assessed and their care and treatment planned and delivered in accordance with individual care plans. People were receiving consistent and safe levels of support. We saw that people were protected against risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

People living in the home had complex needs, including physical and learning disabilities. Of the 29 people accommodated, three used verbal communication to express their wishes. Staff demonstrated significant skill in their understanding and interpretation of people's non-verbal methods of communication. They used observations to determine whether people without verbal methods of communication were happy or upset and explored and reported any concerns, ensuring people's safety.

Relatives considered staff to be suitably skilled and competent and their practice to be safe and observations supported this view. We inspected the staff rota and found sufficient staff on duty to safely meet people's needs. Procedures for dealing with emergencies were in place and staff were able to describe them.

A person using the service said, 'I feel safe here'. During the course of the visit another person raised concerns that were referred by home for investigation under safeguarding procedures. We saw an on-going programme of safeguarding training for staff. This ensured they could recognise indicators of abuse and knew the procedure to follow to safeguard people.

Records showed that mental capacity assessments had been carried out for people. There was an on-going programme of staff training to ensure staffs' understanding of their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). Whilst none of the people had a DoLS authorisation records showed that senior staff and management were clear in what circumstances an application should be made and knew how to submit one. We saw that where people did not have capacity to consent, the provider had acted in accordance with legal requirements.

The home was clean and well maintained. A range of audits had taken place to ensure the safety of the environment. Relatives were complimentary about standards of cleanliness and odour control. Records demonstrated diligence in ensuring the safety of people and staff in the use and maintenance of the home's vehicles.

Is the service effective?

We found that people experienced effective, safe and appropriate care, treatment and support that met their needs and respected their rights. Comprehensive multi-disciplinary assessments had been carried out and individualised, person-centred care plans produced. These took account of peoples' diversity, rights and preferences and records showed that people and/or their representative had been involved in this process. Care plans had been reviewed monthly and updated as necessary. This meant that changes in peoples' needs had been identified and responded to. The home employed a physiotherapist and physiotherapy assistants who worked alongside staff, providing individualised and group physiotherapy. We saw that people had access to health and specialist services. They were provided with the equipment they needed to meet their individual needs.

Two people using the service told us that staff respected their privacy and dignity. They were offered a choice of clothes and meals and said staff sought and respected their wishes. They had chosen the social and educational activities they took part in and used community facilities. Their comments included, "I go to bed when I want, usually at about nine o'clock and lie in every morning, getting up at about 10 o'clock.' Also, 'Staff always ask me what I would like to do each day'.

Contact with relatives established that most considered the service effective in the way needs were met. A full time activities organiser and two activities assistants were employed and people engaged in a diverse range of social and educational activities. Since the last inspection Redwood House had ceased provision of residential accommodation. The building was being used for a weekly outreach service in place of a college based service. The activities organiser told us that organised excursions had been increased this year.

Is the service caring?

A person using the service told us, 'Staff are kind'. People were dressed in clean clothing appropriate to their age and weather conditions. Attention had been given to their personal hygiene and grooming. Staff were knowledgeable about people's preferences and lifestyle choices. We saw that they were attentive to people, with high levels of engagement. Their interactions with people and general approach was friendly, cheerful, caring and respectful. Concerns raised by a relative who felt the needs of their relative were not fully met and communication systems and the keyworker system needed improvement were brought to the 'acting' managers attention.

Is the service responsive?

Systems were in place for analysing incidents, complaints and safeguarding alerts. Discussions with the 'acting' manager and records showed complaints and concerns had been taken seriously. Learning from complaints had been fed back to complainants and action plans developed to address concerns. This meant that people could be assured that their concerns and complaints would be investigated and action taken, as necessary.

The home had a robust safeguarding procedure. Immediate action was taken by management in response to an allegation made by a person using the service at the time of the inspection visit. They also ensured the same individual had access to a call bell when informed that their call bell was not working.

Is the service well-led?

The home had been without a registered manager for one month. An area manager told us that action was being taken to recruit a new home manager. Area managers regularly visited the home, providing support and guidance to the 'acting' manager. The 'acting' manager was a registered nurse. They had worked at the home for eight years and in the capacity of deputy manager for two years. Effective systems were in place for monitoring the quality of services and assessing and managing risk. Feedback from quality surveys and learning from incidents and complaints had been constructively used to promote continuous service improvement and development. Overall observations confirmed that the home was well- led.

In Redwood House there were five people with learning disabilities who were receiving personal care only. In Oak Lodge there were nine people with physical and learning disabilities who were receiving nursing care. In Beech Lodge there were 17 people with physical and learning disabilities who were receiving nursing care.

We met and spoke with 22 of the 31 people using the service.

People using the service had complex physical and learning disability needs, which meant they might have had difficulty describing their experiences of the service. We gathered evidence by spending time watching how people spent their time, the support they got from staff and whether or not they had positive experiences.

We saw that staff addressed people by their preferred names. Personal care was carried out in private and staff were discreet when asking about care needs. We observed that staff were familiar with the needs of people using the service and were able to interpret the non-verbal prompts or body language people used to express their feelings.

The service did not have a registered manager. We spoke with the area manager who was overseeing the service in the absence of a manager. We also spoke with the two nurses and three care staff.