Archived: Wisteria Lodge

Wisteria Lodge is a residential nursing home providing personal and nursing care to 20 people with learning disabilities, physical disabilities and a range of neurological conditions such as autism. The service comprises of two separate buildings: Wisteria Lodge, and Stable Lodge. At the time of this inspection there were 19 people living at the service. The service is located in a rural setting and is purpose built to provide ground floor accessible accommodation for people with complex health needs and disabilities.

Wisteria Lodge is owned and operated by the provider Sussex Healthcare. Services operated by Sussex Healthcare have been subject to a period of increased monitoring and support by local authority commissioners. Due to concerns raised about the provider, Sussex Healthcare is currently subject to a police investigation. The investigation is on-going, and no conclusions have yet been reached.

People’s experience of using this service and what we found

There was unsafe monitoring and management of risks around behaviours that may challenge others, deteriorating health needs, choking risks, access to assessed levels of physiotherapy, risks around constipation care and skin integrity. People were not being protected from abuse or neglect at Wisteria Lodge.

There was a lack of learning when things went wrong. Incidents had not been managed well so that staff and people could learn from them and prevent them reoccurring. There was a lack of effective governance and systems and audits did not highlight all concerns or remedy shortfalls that were identified.

The culture in the service was not person centred, for example people who were communicating distress were not supported to use communication aids and their support did not change despite their distress being recorded regularly.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

Based on our review of Safe and Well led the service was not able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right support:

• Model of care and setting did not maximise people’s choice, control and independence

• The service was rural and located in private grounds. Opportunities for people to access the community were limited as the drivers were absent from work and not adequately replaced.

Right care:

• Care was not person-centred and did not promote people’s dignity, privacy and human rights

• People did not receive person centred support. For example, activities were in groups and not personalised or individualised so some people became bored or distressed.

• Staff did not always know when people may be in pain or distress.

Right culture:

• Ethos, values, attitudes and behaviours of leaders and care staff did not ensure people using services lead confident, inclusive and empowered lives

• The service did not have a positive culture and people were not supported to be as independent as they could. Some people were not receiving the correct level of support with physiotherapy putting them at risk of reduced physical movement.

Rating at last inspection and update.

The last rating for this service was Inadequate (published 19 February 2021).

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

We carried out an unannounced focused inspection of this service on 25 and 26 November 2020. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, safeguarding people from abuse and improper treatment, good governance, and staffing.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has stayed at Inadequate. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Wisteria Lodge on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to, safe care and treatment, safeguarding, good governance and staffing. We previously identified a breach relating to person centred care, but this has not been reviewed at our last inspection or this current inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures:

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Wisteria Lodge is a residential nursing home providing personal and nursing care for up to 20 people with the following support needs: learning disabilities or autistic spectrum disorder, physical disabilities, younger adults. At the time of our inspection there were 19 people living at the service. There were two lodges (Wisteria Lodge and Stable Lodge) which made up the service. Each lodge had its own dining area, lounge, nursing station and medicines room and kitchenette. People had their own rooms and they were en-suite.

Wisteria Lodge is owned and operated by the provider Sussex Healthcare. Services operated by the provider had been subject to a period of increased monitoring and support by local authority commissioners. As a result of concerns previously raised, the provider is currently subject to a police investigation, though this does not specifically involve Wisteria Lodge. The investigation is on-going, and no conclusions have yet been reached.

People’s experience of using this service and what we found

People were not receiving safe care and treatment. Risks around people’s behaviours of concern, constipation, epilepsy, positioning, unexplained injuries, choking, and monitoring people's health needs were not being managed safely. Systems to protect people from possible neglect or abuse were not effective.

Medicines were not being managed safely, such as poor stock control for some medicines and people not receiving medicines as directed by their doctor. Staff did not have the competencies to support people with behaviours that may challenge others.

Lessons had not been learned consistently. There had been a high number of bruises and injuries to people, and this had not been picked up in audits or lessons learned. The culture at the service was not always person centred. Outcomes for people were not positive and there were times we saw people supported in a way that was not safe.

At the time of our inspection the registered manager was off sick, and the clinical lead was overseeing the service. Both left the provider’s employ shortly after our inspection meaning there was no registered manager in day to day charge of the service. The clinical lead in post at the time of our inspection had also left shortly after our inspection. Following our inspection, we were informed that a registered manager had been seconded from the management post of another service, and the provider was actively recruiting to the vacant registered managers post.

Audits had not been effective in highlighting issues found at this inspection or improving the care and support people received. Management of the service was ineffective and had not ensured improvements were made.

The provider had not worked effectively with all partner agencies. There had been safeguarding incidents that had not been alerted to the local safeguarding adults team or notified to CQC. Local health teams had not always been made aware of people’s changing needs.

The provider was not able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture at Wisteria Lodge. People’s experience of care was not always person centred such as at mealtimes. The model of care and setting did not maximise people’s choice, control and independence. Staff wore uniforms and name badges to say they were care staff when coming and going with people. The service is bigger than most domestic style properties. There were identifying signs on the road before the service’s private drive, the service grounds and on the exterior of the service to indicate it was a care home.

Right care:

Care was not always person-centred or promoted people’s dignity, privacy and human rights.

People were not supported safely.

People were not always listened to.

Staff did not always respond in a compassionate or appropriate way when people experienced pain or distress.

Right culture:

The management team had left shortly after our inspection and a new team had been put in place.

There were times we observed care and support that was not indicative of a person-centred culture, such as one person asking repeatedly for an extra drink and staff not responding to them.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was requires improvement (published 9 September 2020).

At the last inspection we found multiple breaches of regulations. At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

We carried out an unannounced comprehensive inspection of this service on 28 and 29 January 2020. Breaches of legal requirements were found, and we served a warning notice. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from Requires Improvement to Inadequate. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Wisteria Lodge on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care and treatment, safeguarding people from abuse, good governance, and staffing at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Wisteria Lodge is a residential care service that is registered to provide accommodation, nursing and personal care for up to 20 people with the following support needs; learning disabilities or autistic spectrum disorder, physical disabilities, younger adults. At the time of our inspection there were 17 people living at the service. Accommodation is provided across two lodges called Wisteria Lodge and Stable Lodge. Each lodge has a separate living room, dining room and kitchenette. Rooms are of single occupancy and have en-suite facilities.

Wisteria Lodge is owned and operated by the provider Sussex Healthcare. Services operated by Sussex Healthcare have been subject to a period of increased monitoring and support by local authority commissioners. Due to concerns raised about the provider, Sussex Healthcare is currently subject to a police investigation in relation to incidents that occurred between 2016 and 2018. The investigation is on-going, and no conclusions have yet been reached.

Wisteria Lodge had been built and registered before the Care Quality Commission (CQC) policy for providers of learning disability or autism services ‘Registering the Right Support’ (RRS) had been published. The guidance and values included in the RRS policy advocate choice and promotion of independence and inclusion, so people using learning disability or autism services can live as ordinary a life as any other citizen.

The service did not consistently apply the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people did not fully reflect the principles and values of Registering the Right Support for the following reasons; People did not always receive personalised care. Staff did not always plan, review or develop people’s individual support needs and wishes with them. People did not always have support to access the wider community.

People’s experience of using this service and what we found:

Risks relating to people’s care and safety was not always assessed or monitored. Risks relating to behaviours which challenge, and epilepsy management were not consistently mitigated. Further work was required to make the care planning process holistic and further involve people within the design and formation of their care plan.

The outcomes for people did not fully reflect the principles and values of Registering the Right Support as engagement in the community needed improvement. People did not always have personalised goals to help increase their independence or participation in community activities. Further work was required to ensure people’s communication needs were met.

People were not always supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not always support this practice. We have made a recommendation for improvement. The care planning process failed to reflect and consider best practice guidance.

Quality assurance frameworks were in place; these were not consistently effective in driving improvement or identifying shortfalls. Links and engagement with the local community required strengthening.

Staff felt supported and had access to a range of training. The building was purpose built and met people's needs, with wide corridors, en-suite shower rooms, and ceiling hoists. People could access outside areas and were observed using the grounds. The service was clean, and the risk of infections was mitigated by a dedicated and effective housekeeping team. Complaints were dealt with in line with the provider's policy.

Staffing levels appeared to be safe from our observations and staff and relatives confirmed that the service had enough staff available to meet people’s needs. Staff received ongoing supervisions and competency assessments were completed to ensure staff had the right skills and knowledge.

People had enough food and drink to maintain their health. Fluid charts had been completed accurately and peoples recommended daily amounts were met. Staff worked in partnership with external healthcare professionals to promote positive outcomes for people. Relatives told us staff were kind, caring and treated their loved ones respectfully and we observed this to be the case.

People were safeguarded from abuse as far as reasonably possible and staff knew how to recognise and respond to any allegations of abuse. Medicines were being managed safely. There were safe recruitment practices. Relatives spoke highly of the care provided to their loved ones. One relative commented, “My relative is extremely well cared for.”

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection:

We last inspected Wisteria Lodge on 20 and 21 December 2018. The rating for the service was Requires Improvement (report published 5 March 2019). The service was found to be in breach of two regulations. Regulation 12 – Safe Care and Treatment and Regulation 17 – Good Governance. At this inspection, some improvements had been made but the provider remained in breach of Regulation 12 and 17 and a new breach of Regulation 9 – Person Centred Care was identified.

This service has been rated Requires Improvement for the last three consecutive inspections.

Why we inspected:

This was a planned inspection based on the previous rating.

Enforcement:

At this inspection, we have identified two continued breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 regulations 12 (Safe Care and Treatment), and 17 (Good Governance). We also identified a new breach of Regulation 9 (Person Centred Care).

We imposed conditions on the provider's registration. The conditions are therefore imposed at each service operated by the provider, including Wisteria Lodge. CQC imposed the conditions due to repeated and significant concerns about the quality and safety of care at a number of services operated by the provider.

The conditions mean that the provider must send to the CQC, monthly information about incidents and accidents, unplanned hospital admissions and staffing. We will use this information to help us review and monitor the provider's services and actions to improve, and to inform our inspections.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up:

We will request an action plan from the provider to understand what they will do to improve the standards of quality. We will also meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority and care commissioners to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Services operated by the provider had been subject to a period of increased monitoring and support by commissioners. As a result of concerns raised, the provider is currently subject to a police investigation. This is ongoing and no conclusions have yet been reached. We used the information of concern raised by partner agencies to plan what areas we would inspect and to judge the safety and quality of the service at the time of the inspection. Between May 2017 and December 2018, we have inspected a number of Sussex Health Care locations in relation to concerns about variation in quality and safety across their services and will report on what we find.

Wisteria Lodge is a care home that provides nursing and residential care. 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.

Wisteria Lodge is registered to provide nursing and accommodation for up to 20 people who have a learning disability, physical disabilities and complex health needs. At the time of our inspection there were 17 people living at the home. Accommodation is provided across two units called Wisteria Lodge and Stable Lodge. Each unit has a separate living room, dining room and kitchenette. Rooms are of single occupancy and have en-suite facilities. The home offers the use of specialist baths, hydro pools and physiotherapy.

A manager was in post who was in the process of registering with the Commission. The last manager had deregistered in September 2018. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Wisteria Lodge has not been operated and developed in line with the values that underpin the Registering the Right Support and other best practice guidance. Wisteria Lodge was designed, built and registered before this guidance was published. However, improvements have been made recently to adapt Wisteria Lodge in response to changes in best practice guidance and improvements are ongoing. For example, there are more opportunities for people to go out and to plan what they would like to do which promoted their health and wellbeing. Cultural and professional changes are being implemented to provide a service that meets the needs of people living with a learning disability and/or autism. Plans were ongoing to improve links with the local community, to broaden people’s horizons and to provide opportunities for them to engage in meaningful social activities.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve each of the key questions: safe, effective, caring, responsive and well led. Some improvements had been made to meet the breaches of regulation we identified at the last inspection in March 2018. More work was required to sustain these improvements in every aspect of the service to ensure these are embedded over time into the practice of the home to ensure people received a consistently high standard of care. We will review these improvements at our next inspection. At the last inspection we rated this service as Requires Improvement. At this inspection the service continues to be rated as Requires Improvement. This is the second time the service has a rating of Requires Improvement overall.

People did not always receive safe care and treatment. Risks to people had been identified and assessed and appropriate risk assessments had been drawn up. People’s needs in relation to their eating and drinking had been assessed and referrals made to healthcare professionals such as speech and language therapists and dieticians. However, we observed a staff member who did not follow the guidance in one person’s care plan in relation to their eating and drinking. This put the person at risk of aspirating or choking. An unsafe sling was found in one person’s room and should have been disposed of.

Systems had been put in place to measure and monitor the quality of care provided and the service overall, but these were not wholly effective and did not identify the issues we found at inspection.

Effective communication had been identified as an area of improvement by the provider. It was planned that all staff should receive dedicated training to enable them to meet people’s preferred way of communication. Not all staff communicated effectively with people.

Some staff had not received regular supervision within the last year according to the provider’s policy. The manager planned to ensure every member of staff received supervision in a timely manner. Staff completed a range of training to meet people’s needs, although there were gaps in training for some staff.

People were supported by kind and caring staff who knew them well. Most staff engaged with people positively, but we observed occasions when staff were task-orientated and did not consult with people to establish what they would like. Relatives spoke positively about the staff. People were treated with dignity and respect.

People were supported by staff who had completed safeguarding training and understood how to protect people from abuse. There were sufficient staff to meet people’s needs and staff were recruited safely. The lunchtime meal was organised over two sittings because of the availability of staff when people needed one-to-one support. When some people were having their lunch, others were invited to participate in an activity or went out. People’s safety in relation to the premises had been assessed and safety checks for equipment and fire safety systems had been completed. Plans were in place should people need to be evacuated in the event of an emergency. Medicines were managed safely. The home was clean and effective infection control systems had been introduced.

Consent to care and treatment was gained lawfully. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People had access to a range of healthcare professionals and services. Special diets were catered for and people could choose what they wanted to eat. People’s individual needs were met by the adaptation and design of the home. Hydrotherapy was available to people, although one hydro pool was out of action at the time of the inspection; the other hydro pool was operational. People could not easily access the hydro pools at a time when they were both out of commission, but were able to use a similar facility at one of the provider’s other locations.

Improvements had been made in relation to people’s care plans. Detailed advice and guidance was provided to staff which was based on people’s assessed needs. However, some staff did not always follow this advice and guidance from what we observed. Activities were organised at the home and people went on outings in the minibus. Further weekly minibus outings were planned for 2019. Concerns and complaints were addressed appropriately. Staff had been trained in end of life care.

People and their relatives were asked for their views about the service and overall these were positive. Staff felt supported by the new manager. The manager had a clear vision and strategy in relation to how they wanted to develop and improve the service.

We imposed conditions on the provider’s registration. The conditions are therefore imposed at each service operated by the provider. CQC imposed the conditions due to repeated and significant concerns about the quality and safety of care at a number of services operated by the provider. The conditions mean that the provider must send to the CQC, monthly information about incidents and accidents, unplanned hospital admissions and staffing. We will use this information to help us review and monitor the provider’s services and actions to improve, and to inform our inspections.

We found three breaches of regulations. Our detailed findings are shown below.

Services operated by the provider had been subject to a period of increased monitoring and support by commissioners. As a result of concerns raised, the provider is currently subject to a police investigation. We used the information of concern raised by partner agencies to plan what areas we would inspect and to judge the safety and quality of the service at the time of the inspection. Between May 2017 and March 2018, we have inspected a number of Sussex Health Care locations in relation to concerns about variation in quality and safety across their services and will report on what we find.

Wisteria Lodge is a care home that provides nursing and residential care. 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.

Wisteria Lodge is registered to provide nursing and accommodation for up to 20 people who may have a learning disability, physical disabilities and complex health needs. At the time of our inspection there were 19 people living at the home. Accommodation is provided across two units called Wisteria Lodge and Stable Lodge. Each unit has a separate living room, dining room and kitchenette. Rooms were of single occupancy and had en-suite facilities. The home offers the use of specialist baths, a spa pool and physiotherapy.

A registered manager was 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.

Wisteria Lodge has not been operated and developed in line with the values that underpin the Registering the Right Support and other best practice guidance. Wisteria Lodge was designed, built and registered before this guidance was published. However, the provider has not developed or adapted Wisteria Lodge in response to changes in best practice guidance. Had the provider applied to register Wisteria Lodge today, the application would be unlikely to be granted. The model and scale of care provided is not in keeping with the cultural and professional changes to how services for people with a learning disability and/or Autism should be operated to meet their needs.

These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service should be able to live as ordinary a life as any citizen, but this was not always the case for people. Wisteria Lodge is a large clinical setting rather than a small-scale homely environment. Wisteria Lodge is geographically isolated on a campus in rural East Sussex with many people having moved to East Sussex from other local authority areas and therefore not as able to retain ties with their local communities. For some people, there were limited opportunities to have meaningful engagement with the local community amenities. Most people's social engagement and activities took place either at Wisteria Lodge or at another service operated by the provider, such as the provider's day centre.

Records did not always demonstrate the correct action had been taken after an incident had occurred including whether it had been shared with the local authority safeguarding team for their review. We found inconsistencies within how risks were being managed on behalf of people who had a diagnosis of epilepsy.

People's consent to care and treatment was not always gained in line with the requirements of the Mental Capacity Act 2005 and people were not always treated with dignity and respect.

Care records were not accessible for the people being written about and they did not always reflect that people received personalised care that met their needs. We identified staff were not working in accordance with some aspects of agreed care planning such as supporting people with meaningful and preferred activities.

Systems were not effective in measuring and monitoring the quality of the service provided. There were ineffective systems in place to drive continuous improvement.

Staff received supervisions and appraisals and they found the registered manager’s approach supportive.

People were provided choices on a daily basis regarding what food they ate and clothes they wore and complaints were managed effectively. The provider sought feedback from relatives regarding the care their family members received.

The registered manager had sought information about the new Key Lines of Enquiry (KLOE) which the Commission introduced from 1 November 2017. They were keen to improve the quality and safety of care provided to people living at the home.

At this inspection we found the service was in breach of five of the Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Wisteria Lodge consisted of two buildings – Wisteria Lodge and Stable Lodge. There was a large patio courtyard between the two buildings. All accommodation was on the ground floor and there was level floor access across all areas of the home. Each building had its own sitting/dining rooms. Each building had its own kitchen. Wisteria Lodge was situated in its own grounds, which were shared with other services, also owned by the provider. This group of services were situated in a rural area, north west of Uckfield in East Sussex. The provider for the service was SHC Rapkyns Group Limited, who own a range of services across south east England.

Wisteria Lodge had a 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.

Wisteria Lodge had been registered with the CQC for a period of time under a different provider, before this inspection. The home was registered by the current provider, SHC Rapkyns Group Limited, in November 2014, so this was the first inspection of the service since their new registration.

The provider had systems for audit of service provision. However some of their systems for audit required improvement because they had not identified certain areas. These included documentation relating to people’s personal emergency evacuation plans (PEEPS), prevention of pressure damage and clarity of wording when describing people’s needs and preferences. The provider’s audits had ensured people received quality care in other areas. This included the cleanliness of the home environment and appropriate equipment so staff could meet people’s individual needs. The registered manager and provider fostered an open culture.

People were safe at Wisteria Lodge. The provider ensured people received their medicines in a safe way, medicines were stored securely and records maintained. People were assessed for risk and their care plans outlined how they were to be supported to ensure their safety, for example where people had mobility needs or were at risk of choking. People’s healthcare needs were met and staff worked closely with external professionals to ensure the stability of people’s medical conditions. The safety of the environment and equipment was regularly reviewed.

Staffing levels ensured there were enough staff to keep people safe and enabled people to choose what they did during the day. Staffing levels meant people received the support they needed to eat and drink. The provider had effective systems for staff recruitment, which protected people.

Staff spoke positively about training and supervision. Staff described the range of training available which equipped them for their roles. This included training in safeguarding people from risk of abuse. All staff were aware of their responsibilities for safeguarding people. Staff said they felt listened to by managers and could raise matters during staff meetings and supervision.

People were treated with understanding and warmth. Staff clearly knew people as individuals and encouraged their independence. Staff understood the principals of the Mental Capacity Act 2005 (MCA). People had full records in relation to the MCA and deprivation of liberties safeguards (DoLS).

People were supported by staff who were responsive to their needs. People had care plans which were regularly reviewed. Staff followed what was stated in people’s care plans. A wide range of activities were available for people to participate in, both inside and out of the home. People’s relatives said they were consulted about people’s care plans and felt involved with developing people’s care plans. They also said they felt able to raise concerns with the manager.