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Wisteria Lodge Requires improvement

We are carrying out a review of quality at Wisteria Lodge. We will publish a report when our review is complete. Find out more about our inspection reports.

Reports


Inspection carried out on 28 January 2020

During a routine inspection

About the service:

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 availab

Inspection carried out on 20 December 2018

During a routine inspection

This comprehensive inspection took place on 20 and 21 December 2018 and was unannounced.

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 ea

Inspection carried out on 13 March 2018

During a routine inspection

The inspection took place on 13 and 14 March 2018. This was a comprehensive inspection and it was unannounced.

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

Inspection carried out on 24 October 2016

During a routine inspection

This inspection took place on 24 and 25 October 2016. It was unannounced. There were 20 people living at Wisteria Lodge when we visited. People living there were all younger adults. The registered manager said people’s age range was 18 to 60 years. People all had a physical and/or learning disability, and needed nursing care due to their complex needs. Many people needed support with all of their personal care, eating and drinking and mobility needs. A few of the people were living with behaviours which may challenge others. Some people were living with medical needs, including epilepsy and diabetes.

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). Peo