Archived: Woodhurst Lodge

Woodhurst Lodge provides nursing and personal care in one building for up to 10 people living with a range of neurological conditions and/or acquired brain injury. At the time of our inspection, eight people were living at the service. The service is in a rural setting and is purpose built to accommodate the needs of people with complex disabilities and neurological conditions. Accommodation is provided on one level. Communal areas include a lounge and dining room, with access to gardens and grounds.

Woodhurst 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

Risks to people's health were not consistently managed. People did not always receive safe support in relation to infection prevention and control. People's risk of aspiration was not always documented. Systems used to monitor people's health were not always applied consistently. This meant people could not be assured of receiving appropriate care and treatment and were placed at increased risk of avoidable harm.

Staff training and supervision did not always ensure people received safe care and treatment. There were not adequate processes in place for assessing and monitoring the quality of the services provided and that records were accurate and complete. Systems had failed to identify that people were not always protected from avoidable harm. Safe care practices were not always recorded accurately within people's care records. Lessons learnt were not always identified or translated into practice.

People’s care plans were not always suitably individualised around their needs to ensure they were supported to have maximum choice and control of their lives. People were supported in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. Throughout the inspection we saw people treated with dignity and respect. People and their relatives confirmed this was also their experience.

People were involved in activities and these were specific to peoples interests and wishes. The Covid-19 pandemic had significantly reduced participation in activities outside of the building, however the service had increased the range of meaningful activities that could happen inside the building and grounds. People’s rooms were personalised and the atmosphere in the service was one of calm.

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

Rating at last inspection and update

In December 2018 the Care Quality Commission imposed provider wide 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 several 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 carried out an unannounced comprehensive inspection of this service on 13 and 14 August 2019. A breach of legal requirements was found in Regulation 17 (Good Governance). The provider completed an action plan after the last inspection to show what they would do and by when to improve. This service has been rated Requires improvement for the last four consecutive inspections. We will describe what we will do about the repeat Requires improvement in the follow up section below.

Why we inspected

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, Responsive 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 remained Requires Improvement. 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 Woodhurst Lodge on our website at www.cqc.org.uk.

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 have found evidence the provider needs to make improvements. Please see the Safe, and Well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

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 have identified one continued breach of the Health and Social Care Act 2008 (Regulated Activities) Regulation 17- Good Governance, and two new breaches in relation to Regulation 12- Safe Care and Treatment and Regulation 18- Staffing.

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 for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Woodhurst Lodge provides nursing and personal care for up to 10 people living with physical disabilities, learning disability and a range of neurological conditions and/or acquired brain injury. At the time of our inspection, eight people were living at the service. The service is located in a rural setting and is purpose built to accommodate the needs of people with complex disabilities and neurological conditions. Accommodation is provided on one level. Communal areas include a lounge and dining room, with access to gardens and grounds.

The provider and its associated locations have been subject to a period of increased monitoring and support by commissioners. Investigations are ongoing by the local authority, police and partner agencies at some of the provider's locations, including Woodhurst Lodge. The police investigation is ongoing and no conclusions have been reached. Our inspection did not examine specific incidents and safeguarding allegations which have formed part of these investigations. 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.

We imposed conditions on the provider’s registration. The conditions are therefore imposed at each location 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 locations 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.

At the previous inspection in August 2018 we found two breaches of regulations in relation to person centred care, activities, monitoring and governance. At this inspection we found one breach continued in monitoring and governance.

Woodhurst Lodge has not been operated and developed in line with the values that underpin the Registering the Right Support and other best practice guidance. Woodhurst Lodge was designed, built and registered before the guidance was published. However, the provider has not developed or adapted Woodhurst Lodge in response to changes in best practice guidance. Had the provider applied to register Woodhurst Lodge today, the application would be unlikely to be granted. The model 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.

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

The service did not always 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. Parts of the service were clinical and unhomely. Many of the providers other services had been purpose built and looked the same. The service was not easily integrated in the community and access to the community was limited at weekends and during the evenings. People could not be fully integrated within society due to the remoteness and isolation of the service.

Although activities had improved since the last inspection, further work was required to ensure activities were assessed and based on people’s hobbies and preferences. The evaluation of activities was not in place to assess whether the activity was meaningful for the person, what the desired outcome was or what people were trying to achieve. People’s emotional needs were not consistently being met. Many people had experienced life changing injuries, yet how those injuries impacted upon their wellbeing was not factored into care planning. People were able to complain although information was not available in different formats to suit individual needs.

Although care plans contained detailed information, one person’s file contained inaccurate information regarding their epilepsy and some staff were unclear about the support the person required. There was no positive behaviour support plan in place for one person and monitoring of incidents was inconsistent. Risks associated with the safety of the environment were identified and managed well. There was guidance to support people with their individual needs. People continued to be supported to have their medicines safely. Staff understood their responsibilities around keeping people safe and received safeguarding training. There continued to be enough staff to care for people safely. Incidents were learnt from to improve the support people received.

Staff had the right training and support to care for people effectively. People were supported to eat and drink safely and health needs were responded to and managed well.

Staff treated people with care, kindness and respect. People were supported to be involved in the service and staff engaged with people patiently and in their preferred way. When people were distressed staff responded promptly to support them.

The registered manager and staff were clear about their roles and responsibilities. People, staff and relatives were involved in improving the service and were asked for their feedback and thoughts about what could improve. Staff and people were positive about the registered manager and relatives told us they felt the registered manager was open and honest and things had improved since they had been in post.

Rating at last inspection and update

The last rating for this service was Requires Improvement (published 12 February 2019) and there were two breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection not enough improvement had been made/ sustained and the provider was still in breach of regulations.

This service has been rated requires improvement for the last two consecutive inspections and remains rated as requires improvement at this inspection. We found some areas of concern in the Safe domain which has now been rated Requires improvement having previously been rated Good.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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

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. The investigation is on-going and no conclusions have been made. 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 July 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.

Woodhurst Lodge is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Woodhurst Lodge is registered to provide accommodation and nursing care for up to 10 people with physical disabilities, learning disabilities and a range of neurological conditions and/or acquired brain injury. At the time of the inspection there were nine people living at the home. The home is located in a rural setting and is purpose built to accommodate the needs of people with complex physical disabilities and neurological conditions.

The home has a registered manager and they were present throughout the inspection. 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.

The last inspection on 19 July 2017 identified three breaches of the Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider had completed an improvement plan following the last inspection to show what they would do, and by when, to improve the key questions of is the service effective, caring, responsive and well-led, to at least good. At this inspection on 14 August 2018 there had been improvements in some areas of practice to address the identified breaches. However, in the key questions of responsive and well -led, it remained that some areas of practice required further improvement.

Woodhurst Lodge has not been operated and developed in line with the values that underpin the Registering the Right Support and other best practice guidance. Woodhurst Lodge was designed, built and registered before this guidance was published. However, the provider has not developed or adapted Woodhurst Lodge in response to changes in best practice guidance. Had the provider applied to register Woodhurst 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. Woodhurst Lodge is a large clinical setting rather than a small-scale homely environment. Woodhurst Lodge is geographically isolated in a rural area. For some people, there were limited opportunities to have meaningful engagement with the local community. Most people's social engagement and activities took place at Woodhurst Lodge.

Whilst improvements had been made to ensure that people’s social needs were met this was not consistent for everyone. Some people were not receiving the stimulation and social engagement that they needed to improve their quality of life. We identified this as an area of practice that continues to require improvement.

The registered manager was in the process of recruiting a suitable staff member to support people with personalised activities and meaningful occupation. Whist some improvements were evident the registered manager acknowledged that the planned improvements were not yet fully implemented. This meant that governance systems had not ensured improvements were consistent for all areas of the service and improvements were not yet fully embedded and sustained. This was an area of practice that continues to require improvement.

People, their relatives and staff spoke positively about the registered manager and changes that had been implemented at the home. One relative said, “The atmosphere has changed, staff are less anxious and more welcoming than before.”

People told us they felt safe living at the home. Risks were identified and managed effectively. Care plans provided clear guidance for staff in how to care for people safely. Incidents and accidents were recorded and monitored. There were enough suitable staff on duty and people received their medicines safely.

Staff had received the training and support they needed to enable them to be effective in their roles. One staff member told us, “The training has been really helpful and induction for new staff is very good.” Staff demonstrated a good understanding of their responsibilities including in safeguarding people, seeking consent and the Mental Capacity Act 2005. Assessments and care plans were holistic and identified people’s needs and preferences. Staff supported people to have enough to eat and drink and to access the health care services they needed. The home was accessible and had the adaptations and equipment needed to meet the complex needs of the people living there.

Staff were kind and caring in their approach. They knew the people they were caring for well and treated them with dignity and respect. People were supported to express their views and staff involved relatives appropriately. One relative told us, “Things have really picked up, we have noticed a lot of improvements, we are more involved in things again now.”

People were supported to plan for care at the end of their life if they wanted to do so. Staff were responsive to complaints and took appropriate actions to resolve concerns raised by people or their relatives.

There were effective systems in place to provide management oversight. Lessons were learned when things went wrong and changes were made to improve the service. People and their relatives were involved in developments at the service and their views were sought.

We identified two continued breaches of the regulations. This is the second consecutive inspection where the overall rating has been Requires Improvement.

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.

The inspection was planned due to a previous rating of ‘Good’ published for Woodhurst Lodge in July 2015. However since that inspection, services operated by the provider had been subject to a period of increased monitoring and support by commissioners. Woodhurst Lodge had been the subject of one safeguarding concern about a person not receiving care as planned with their funding authority. As a result of concerns raised, the provider is currently subject to a police investigation. Our inspection did not examine specific incidents and safeguarding allegations which have formed part of these investigations. However, 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 and August 2017, 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.

Woodhurst Lodge is registered to provide accommodation and nursing care for up to 10 people with a range of neurological conditions and/or acquired brain injury. At the time of our inspection, the home was at full capacity. Communal areas include a dining room, sitting room, multi-sensory room, and spa facility. All rooms have en-suite wet room facilities and overhead tracking hoists. Woodhurst Lodge has extensive grounds which are accessible to people living at the home. The home is purpose-built and located in a rural setting, but within easy reach of the A23.

At the last inspection, the service was rated Good overall and in each domain, apart from Responsive, which was rated Requires Improvement. The rating of Requires Improvement was because there had been a change in the provision of activities which limited the opportunities for people to be involved in activities and spend time out in the community. However, at this inspection we found that the quality of safety and care had deteriorated and we identified three breaches of the Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

At the time of our inspection, the registered manager had recently transferred to one of the provider's other homes as manager, but had not cancelled their registration at Woodhurst Lodge. 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. The provider told us that a new manager had been recruited and was due to take up their post in September.

Staff had not always completed the training needed, and as required by the provider, to ensure their competency in providing support to people.

Care was not delivered in a personalised way and staff took little account of people’s documented interests when arranging activities. Care was not person-centred and staff did not always obtain people’s agreement when interacting with them. Care delivered by staff to people was task focused. People’s likes, dislikes and preferences were recorded in their care plans, but these were not taken into consideration when staff supported people.

Systems were not robust or effective in identifying the issues we found at inspection that have resulted in breaches of regulation. No system was in place to show how people were involved in developing the service and no formal feedback was obtained from relatives.

People were safe living at Woodhurst Lodge. The majority of staff had been trained to recognise the signs of potential abuse and knew what action to take if they suspected abuse was taking place. Risks to people were identified, assessed and managed appropriately. There was comprehensive information and guidance for staff on how to support people safely. Staffing levels were sufficient to meet people’s needs. Due to staff vacancies, the service relied heavily on agency staff to meet any shortfalls in staffing levels. However, agency staff were vetted before they worked at the service and a senior manager told us they tried to use the same agency staff to provide consistency of care. Safe recruitment practices were in place. Medicines, in the main, were managed safely.

Staff received regular supervision with their line managers and attended staff meetings. New staff followed an induction programme, including training, and shadowed experienced staff before working more independently. New staff studied for the Care Certificate, a universally recognised qualification. Staff understood the requirements of the Mental Capacity Act 2005, but from our observations, this was not always put into practice. People had sufficient to eat and drink and had a choice of meals. Special diets were catered for, for example, food was pureed due to people’s swallowing difficulties or risk of aspiration. People were supported to maintain good health and had their health needs met by a range of healthcare professionals.

Staff met people’s care needs, but care was delivered in an impersonal manner. Relatives confirmed they were involved in decisions relating to people’s care and with their care plans. People told us they were treated with dignity and respect.

Care plans provided detailed information and comprehensive guidance for staff on how to support people. Some parts of people’s care plans had been written in a person-centred way and in an accessible format. Complaints were managed, in the main, to the complainant’s satisfaction.