Archived: Kingsmead Lodge

Kingsmead Lodge is a residential care service that is registered to provide accommodation, nursing and personal care for up to 20 people. Care and support was provided to people living with a learning disability or autistic spectrum disorder, physical disabilities and younger adults. At the time of this inspection Kingsmead Lodge was providing support for seven people.

Kingsmead 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.

Kingsmead 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 was not operating in line with the values that underpin the 'Registering the Right Support' and other best practice guidance. Kingsmead Lodge is a purpose built care home for people with learning disabilities. It provides ground floor accommodation for up to 20 people. The internal features of the service did not reflect a domestic style property. For example, there were several offices close to the communal areas and people’s bedrooms, there was an industrial style kitchen and signage around the service indicated that people were living in a care home. Nursing and care staff wore uniforms which clearly identified they were employed to support people. The buildings design did not fit into the local residential area and there was external signage that identified it as a care home.

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

Risks to people's health and wellbeing were not consistently managed. People did not always receive safe support in relation to their epilepsy and complex eating and drinking needs. Systems used to monitor people’s health were not always applied consistently.

Processes in place for assessing and monitoring the quality of the service had failed to identify that people were not always protected from avoidable harm. People’s epilepsy was not always managed safely, and staff practice did not always ensure people received safe care. Safe care practices were not always recorded accurately within people’s care records.

People did not always receive support to meet their assessed mobility needs. This was due to a lack of partnership working between Kingsmead Lodge and physiotherapy services operated by Sussex Health Care. There was a lack of clinical oversight and agency nursing staff had not received regular clinical supervision.

People had received support to stay safe during the current national pandemic of COVID-19 and the service demonstrated good infection control procedures. Personal COVID-19 risk assessments had not been undertaken with staff to ensure their safety. We have made a recommendation to the provider about this.

Medicines were managed safely. Staff used positive behaviour support strategies to enable people to understand and manage their behaviour’s that may challenge. People were observed to be engaging positively with staff supporting them. The environment was bright, spacious and personalised and people’s craft and artwork were displayed. Visitors to the service provided consistently positive feedback about the manager and the service people received.

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.

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

We last inspected this service in January 2020. The service was rated requires improvement (published 7 July 2020) and there were four breaches of regulations. At this inspection not enough improvement had been made and the provider was still in breach of regulations.

The service remains rated as requires improvement. This service has been rated as requires improvement for the last two consecutive inspections.

This service had been in Special Measures since September 2018. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This was a planned inspection based on the previous rating.

We carried out an unannounced comprehensive inspection of this service on 14 and 15 January 2020. Breaches of legal requirements were found in relation to Regulations 9 (Person Centred Care), 12 (Safe Care and Treatment),Regulation 18 (Staffing) and 17 (Good Governance). On 23 March 2020 we imposed conditions on the provider’s registration detailing that Kingsmead Lodge must submit a monthly report addressing actions taken to improve epilepsy care, the amount of clinical oversight at the service and actions to improve the use of NEWS and behaviours which challenge.

In January 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 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 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. We looked at the previous breaches of Regulation 12 -Safe Care and Treatment and Regulation 17 -Good Governance. Not enough improvement had been made and the provider remained in breach of Regulation 12 and 17.

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 Kingsmead 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 have identified continued breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to Regulation 12- Safe Care and Treatment and Regulation 17- Good Governance

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.

Kingsmead 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 this inspection Kingsmead Lodge was providing support for eight people.

Kingsmead 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.

Kingsmead 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 with meaningful activities or be supported to access the wider community.

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

Risks to people were not always adequately assessed, monitored and managed, causing or exposing people to the risk of harm. Ongoing risks relating to epilepsy management, choking, behaviours which challenge and NEWS scores (National Early Warning Score charts) were not always managed safely. Best practice guidance was not always considered when assessing people’s needs, or what people wanted from their support. Ongoing work was required to make the care planning process holistic and further involve people within the design and formation of their care plan.

Further work was required to ensure all agency nursing staff were competent to provide effective care. Clinical supervisions for agency nursing staff were not routinely carried out and the high usage of agency nursing staff meant staff were not always accountable for their actions. Systems and processes to assess, monitor and improve the quality and safety of the service were not consistently operated effectively. Staff’s competence and knowledge on how to respond to emergency situations varied.

Ongoing work was required to ensure the provision of activities were meaningful and that people were regularly accessing the wider community on a regular basis. Safeguarding systems were in place, however, where people required support to manage their finances, financial care plans were not always in place. We have made a recommendation for improvement.

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.

Medicines were being managed safely. There were safe recruitment practices. The premises had been designed to accommodate people’s needs and was decorated in a personalised manner. Relatives told us that a number of recent improvements had been made at the service and spoke highly of the management team. People responded to staff with smiles and staff understood the importance of promoting people’s dignity and independence. People’s cultural and religious needs were being met.

People and staff were involved in the running of the service and staff felt able to raise new ideas and discuss any concerns with the management team. Relatives spoke highly of the kind and caring interactions between staff and their loved ones.

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 this service in May 2019. The service was rated Inadequate (Published 19 August 2019). There were multiple breaches of regulations and the service remained placed in special measures. The provider was found to be in breach of Regulation 12 – Safe Care and Treatment, Regulation 10 – Dignity and Respect, Regulation 9 – Person Centred Care, Regulation 18 – Staffing and Regulation 17 – Good Governance. At this inspection, some improvements had been made but the provider remained in breach of four regulations, Regulations 9, 12, 18 and 17.

This service has been in ‘special measures’ since September 2018.

There had been no registered manager at Kingsmead Lodge since February 2018. The provider had failed comply with Section 33 of the Health and Social Care Act which stipulates that it is a condition of their registration to have a registered manager at the location.

Why we inspected:

This was a planned inspection based on the previous rating.

Enforcement:

At this inspection, we have identified four continued breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Regulations 9 (Person Centred Care), 12 (Safe Care and Treatment), Regulation 18 (Staffing) and 17 (Good Governance).

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.

On 23 March 2020, we imposed further conditions on the provider's registration telling them that they could not admit any service users into Kingsmead Lodge without the prior agreement of the Care Quality Commission. We also imposed a condition which requires the provider to tell us how they will address clinical oversight at Kingsmead Lodge, management of epilepsy and how they are responding to people’s deteriorating health. The condition requires the provider to submit a monthly report to the Commission on their actions to improve in these areas.

Follow up:

The overall rating for this service is ‘Requires improvement’. However, the service remains in ‘special measures’. We do this when services have been rated as 'Inadequate' in any Key Question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services 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, we will take action in line with our enforcement procedures.

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.

Kingsmead 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 this inspection Kingsmead Lodge was providing support for 10 people. At the end of the first day, one person moved out as planned to another service. On the second day of the inspection, the service was providing support for 9 people.

Kingsmead 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. This does not include Kingsmead Lodge but the investigation is on-going and no conclusions have yet been reached.

Kingsmead Lodge had been built and registered before the 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.

Kingsmead Lodge requires further development to be able to deliver support for people that is consistent with the values that underpin RRS. For example, care planning processes did not always consider people’s personal information and how these informed their individual support needs and wishes. People did not always agree, identify, review or develop individual support outcomes and aspirations or take part in meaningful activities. People’s communication needs were not fully supported to enable them to have maximum control of their lives.

People’s experience of using this service:

Risks to people were not always assessed, monitored and managed safely. This included risks associated with people’s behaviours that may challenge, skin integrity, postural, mobility, choking and health monitoring support needs.

Information about people’s care and treatment was not always made available in the most accessible way for people.

Medicines were not always managed safely.

There were not always enough suitably qualified, competent, skilled and experienced staff deployed to meet people’s needs.

Lessons were not always learned and improvements made when things had gone wrong at the service.

People’s needs and choices were not always assessed effectively so staff did not always know or understand how to support people to achieve their preferred outcomes.

People were not always receiving respectful or dignified support and staff did not always promote people’s independence.

People did not always receive personalised care that was responsive to their individual needs, including support to follow their interests and access meaningful social activities.

Quality assurance and governance systems were not operating effectively.

Staff and management were not supported to understand or fulfil their responsibilities and ensure that regulatory and contractual requirements were met and quality performance and risks were understood and managed.

There were safe recruitment practices.

People and those acting lawfully on their behalf had been consulted and given consent before people were being provided with support.

Conditions on authorisations to deprive a person of their liberty were being met appropriately.

The service was clean and hygienic. The design, decoration and adaptation of the premises met people’s individual needs.

This inspection identified repeat breaches of Regulations 9, 12, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

This inspection identified a further breach of Regulation 10 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Rating at last inspection:

We last inspected Kingsmead Lodge on 28 January 2019 and the final report was published on 30 April 2019. The service was rated Inadequate.

Kingsmead Lodge has been rated overall Inadequate in the two previous inspections that had taken place at the service between September and December 2018.

At each of these three previous consecutive inspections between September 2018 and January 2019 there have been multiple and repeated breaches of Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Kingsmead Lodge has been placed in Special Measures since October 2018. In the case of Kingsmead Lodge the service was rated Inadequate in October 2018 and at each subsequent inspection, so has not been removed from Special Measures. For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. Services in Special Measures will be kept under review and, if needed could be escalated to urgent enforcement action.

Why we inspected: This inspection took place on 22 and 23 May 2019. This inspection was scheduled and planned based on the previous rating to explore if the provider had acted to significantly improve the service to ensure compliance with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Enforcement: On 23 March 2020, we imposed conditions on the provider's registration telling them that they could not admit any service users into the service without the prior agreement of the Care Quality Commission. We also imposed a condition which requires the provider to tell us how they will address clinical oversight at the service, management of epilepsy and how they are responding to people’s deteriorating health. The condition requires the provider to submit a monthly report to the Commission on their actions to improve in these areas

We imposed conditions on the provider’s registration, due to repeated and significant concerns about the quality and safety of care at several services they operate. The conditions are therefore imposed at each service operated by the provider, including Kingsmead Lodge.

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.

Follow up: The overall rating for this service is ‘Inadequate’ and the service remains in Special Measures. Services in special measures will be closely monitored and are expected to make significant improvements to ensure their rating is at least good. Where necessary, another inspection will be conducted within or before a further six months. If there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will act to prevent the provider from operating this service. This will lead to cancelling or varying the terms of their registration.

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 reached. We used the information of concern raised by partner agencies to help 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 January 2019, we have inspected a number of Sussex Health Care locations in relation to concerns about variation in quality and safety across their services and have reported on what we found.

A focussed inspection had been undertaken on 3 December 2018. That inspection was carried out due to an increase in reported concerns and information that suggested people at the service were potentially at risk. The provider was in breach of four regulations of the Health and Social Care Act 2008 (regulated Activities Regulations 2014; Regulation 11 Need for Consent, Regulation 12 Safe Care and Treatment, Regulation 17 Good Governance and Regulation 18 Staffing. Risks to people’s safety had not been properly mitigated. There were continued concerns around the management of percutaneous endoscopic gastrostomy (PEG) feeding tubes. There was unsafe and inconsistent use of the national early warning score system to identify and inform staff actions when a person’s health deteriorated. Medicine errors continued to be identified and the management of accidents and incidents continued to cause concern. The provider had not always ensured that people’s consent to care and treatment had been sought in accordance with the Mental Capacity Act (MCA) 2005. Some people displayed behaviours which may challenge others yet not all staff had received specific training on how to manage such behaviours safely and effectively. Systems and quality assurance processes to monitor and oversee care remained ineffective and were not sufficiently robust to ensure consistent and quality support throughout the service.

Following what was found at the December 2018 inspection, the CQC continued to be alerted of incidents and concerns following that inspection. Due to the nature of the concerns, we determined it necessary to carry out a comprehensive inspection as soon as possible to investigate these concerns, which we did on 28 and 29 January 2019. As a result of these urgent timescales, we were unable to supply the provider with the draft report from the December 2018 inspection as this was still in the process of being completed. However, we provided feedback of the inspection, including the areas of concern that needed to improve, at the end of the inspection. We also provided a feedback sheet detailing those areas. We found that there had been little improvement and that concerns remained over the risks to people's safety. There were continued breaches of the four regulations above as well as a breach of Regulation 9 as personalised care was not consistently provided to all service users.

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.

Kingsmead Lodge provides nursing and personal care for up to 20 people who may have learning disabilities, physical disabilities and sensory impairments. Most people had complex mobility and communication needs. At the time of our inspection there were 10 people living at Kingsmead Lodge. People living at the service had their own bedroom and en-suite bathroom. The service had two areas 'west' and 'east' wing, but operated as one home, and people had access to all communal areas such as the activities room and dining areas.

There was no registered manager at the time of this inspection. The service is required by a condition of its registration to have a registered manager. A registered manager is a person who 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 current manager had been in post at the service since November 2018. At the last inspection we were told that their position was not permanent and that they would remain in place until the provider had recruited a registered manager. Prior to this inspection, we were informed by the provider that they had successfully recruited a permanent manager, but they had yet to take up their position.

Kingsmead Lodge has not been operated and developed in line with all the values that underpin the Registering the Right Support and other best practice guidance. Kingsmead Lodge was designed, built and registered before this guidance was published. However, the provider has not developed or adapted Kingsmead Lodge in response to changes in best practice guidance. Had the provider applied to register Kingsmead 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. People with learning disabilities using the service should be able to live as ordinary a life as any citizen.

Protocols, guidance and instructions for staff to support people living with epilepsy were contradictory and confusing; exposing people to the risk of receiving too much of a rescue medicine. There were unmitigated risks to people’s safety around constipation and choking. There were significant shortfalls in the management and provision of fluids when providing support with people’s hydration.

The themes and concerns we identified and raised at this inspection were also identified at the last inspection and in other inspections at other locations owned by the provider. This had not encouraged the provider to ensure improvements to the quality and safety of care provided to all people living at Kingsmead Lodge had been made.

The provider had not always ensured that people's consent to care and treatment had been sought in accordance with the Mental Capacity Act (MCA) 2005.

There remained gaps in training that had not been addressed since the last inspection. Some people displayed behaviours which may challenge others, yet not all staff had received specific training on how to manage such behaviours safely and effectively.

Although some changes had been made to improve systems and quality assurance processes to monitor and oversee care, there remained shortfalls in the reviewing of care plans, risk assessments and guidance for staff.

Care records did not always use appropriate language that respected people who were being supported.

Activities and occupation were not consistently person-centred. One activity observed did not promote people's independence or dignity. The provider had failed to utilise guidance from The Accessible Information Standard when supporting people to be involved with their own care. Care records did not consistently demonstrate people's health needs were being met. Opportunities had been missed to support people to communicate effectively.

People’s nutritional needs were well met and they were supported to have enough food. There was enough food available and offered to people throughout our inspection at mealtimes and in-between. The menu offered flexibility to meet the needs of people and their specific dietary requirements. People had access to external health care professionals including GP's who visited the service weekly.

Staffing levels were sufficient to meet the care needs of people. The provider had safe and thorough recruitment practices in place to ensure that there were suitable staff to provide care.

People were able to receive visits from their relatives and friends whenever they wished at the service and staff knew people well. Staff had attended safeguarding adults training and knew how to protect people from abuse. Complaints were managed and responded to by the manager and the provider.

Staff ensured that equipment and the premises were maintained correctly and that measures were in place to mitigate risks and prevent infection.

People's care needs, in relation to their physical disabilities, had continued for the most part to be promoted through the environment of the service.

We found five breaches of Regulation and made one recommendation.

On 23 March 2020, we imposed conditions on the provider's registration telling them that they could not admit any service users into the service without the prior agreement of the Care Quality Commission. We also imposed a condition which requires the provider to tell us how they will address clinical oversight at the service, management of epilepsy and how they are responding to people’s deteriorating health. The condition requires the provider to submit a monthly report to the Commission on their actions to improve in these areas.

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 overall rating for this service is ‘Inadequate’ and the service re

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 September 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. Kingsmead Lodge is a care home that provides nursing and residential care.

There was a comprehensive inspection undertaken on the 12 and 13 September 2018. Due to an increase in reported concerns since that inspection and information that suggested people at the service were potentially at increased risk, we undertook this focussed inspection on 3 December 2018. The areas of concern informed our planning and we looked at the safety and quality of the service in the domains of Safe, Effective and Well-led.

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.

Kingsmead Lodge provides nursing and personal care for up to 20 people who may have learning disabilities, physical disabilities and sensory impairments. Most people had complex mobility and communication needs. At the time of our inspection there were 13 people living at Kingsmead Lodge. People living at the service had their own bedroom and en-suite bathroom. The home had two areas 'west' and 'east' wing, however, operated as one home and people had access to all communal areas such as the activities room and dining areas.

There was no registered manager at the time of this inspection. The service is required by a condition of its registration to have a registered manager. A registered manager is a person who 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.

At the last inspection we were informed that a new manager had been employed and was starting their role at the end of September 2018. However, we were told the manager had started their employment but had left their post in November 2018. At this inspection the service was being managed by a peripatetic manager who had been in post for one week. A peripatetic manager is one that works, or is based, at different locations for definite periods within the same company. We were told that the current manager would remain in post while the provider recruited for a permanent registered manager.

Kingsmead Lodge has not been operated and developed in line with all the values that underpin the Registering the Right Support and other best practice guidance. Kingsmead Lodge was designed, built and registered before this guidance was published. However, the provider has not developed or adapted Kingsmead Lodge in response to changes in best practice guidance. Had the provider applied to register Kingsmead 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. People with learning disabilities using the service should be able to live as ordinary a life as any citizen.

At the last inspection in September 2018, the service was found to be in breach of legal requirements and was given a rating of ‘Inadequate’. The provider wrote to us after the inspection to inform us the actions they were taking. At this inspection we found that the concerns around the quality and safety of care provided to people remained and continued. We identified the continuation of four breaches of the Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also found the provider was in continued breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009.This was due to a failure to notify the Commission of authorised Deprivation Liberty Safeguards (DoLS) which the provider is required to do by law.

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.

People living at Kingsmead Lodge had a learning disability, physical disabilities and some people had complex health needs. People were fully dependent on staff to meet their needs and to provide care and support that ensured they remained safe.

At the last inspection we had continuing concerns over the management of medicines. Since that inspection, we have been alerted to, and identified, continued mismanagement of medicines. Medicine administration errors continued to be reported that involved the under administration of medicines and the failure to ensure medicine administration records were updated.

Concerns about the management of risk continued. There was a continued failure to use the National Early Warning Score (NEWS) system consistently, particularly at times when its use would have provided a clearer indication of what actions were needed when a person’s health deteriorated.

Concerns around infection control procedures when staff supported people with percutaneous endoscopic gastrostomy feeding tubes (PEG) and percutaneous endoscopic jejunal feeding tubes (PEJ) management had been addressed. However, infection control procedures had not always been applied effectively elsewhere.

There remained gaps in training that had yet to be addressed since the last inspection. Some people displayed behaviours which may challenge others yet not all staff had received specific training on how to manage such behaviours safely and effectively.

Systems and quality assurance processes to monitor and oversee care remained ineffective and were not sufficiently robust to ensure consistent and quality support throughout the service. The provider had failed to ensure the necessary improvements had been made to the care provided since the last inspection.

Staffing levels were sufficient to meet the care needs of people although concerns were highlighted over the impact of the reduction to nursing levels at the service.

The provider did not always complete the required statutory notifications to the CQC when incidents occurred.

The provider had not always ensured that all people, their representatives and health professionals had been involved in making decisions in their best interests. They had not always ensured that people’s consent to care and treatment had been sought in accordance with the Mental Capacity Act (MCA) 2005.

People’s care needs, in relation to their physical disabilities, had continued for the most part to be promoted through the environment of the service.

People nutritional needs were well met and they were supported to have enough food and drink.

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

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 September 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. Kingsmead 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.

Kingsmead Lodge provides nursing and personal care for up to 20 people who may have learning disabilities, physical disabilities and sensory impairments. Most people had complex mobility and communication needs. At the time of our inspection there were 14 people living at Kingsmead Lodge. People living at the service had their own bedroom and en-suite bathroom. The home had two areas ‘west’ and ‘east’ wing however operated as one home and people had access to all communal areas such as the activities room and dining areas.

There was no registered manager at the time of this inspection. The service is required by a condition of its registration to have a registered manager. A registered manager is a person who 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. We were told a new manager had been employed and was starting their role at the end of September 2018.

Kingsmead Lodge has not been operated and developed in line with all the values that underpin the Registering the Right Support and other best practice guidance. Kingsmead Lodge was designed, built and registered before this guidance was published. However, the provider has not developed or adapted Kingsmead Lodge in response to changes in best practice guidance. Had the provider applied to register Kingsmead 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. People with learning disabilities using the service should be able to live as ordinary a life as any citizen.

At the last inspection in August 2017, the service was found to be in breach of legal requirements and was given a rating of ‘Requires Improvement’. The provider wrote to us after the inspection to inform us the actions they were taking. At this inspection we found that the quality and safety of care provided to people had deteriorated and we identified four breaches of the Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also found the provider was in breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009.This was due to a failure to notify the Commission of authorised Deprivation Liberty Safeguards (DoLS) which the provider is required to do by law.

At the last inspection, we were concerned as medicines were managed unsafely. At this inspection, we remained concerned as we observed practices had failed to improve. This included how staff administered medicines to people.

Four people had a percutaneous endoscopic gastrostomy (PEG) or a percutaneous endoscopic jejunal (PEJ) feeding tubes fitted. Staff failed to implement infection control measures when supporting people with their medicines and enteral feeding systems. This included a failure to wash hands and/or wear gloves. One registered nurse had not received training in PEG/J yet supported people with this area of care.

We identified other gaps in training provided to staff. All people living at the home had a learning disability. Some people displayed behaviours which may challenge others yet not all staff had received specific training on how to manage such behaviours safely and effectively.

Activities and occupation were not consistently person-centred. One activity observed did not promote people's dignity. We made a recommendation to the provider to review this.

The provider had failed to utilise guidance from The Accessible Information Standard when supporting people to be involved with their own care. Care records did not consistently demonstrate people's health needs were being met. Opportunities had been missed to support people to communicate effectively.

Systems to assess and monitor the service were in place but these were not sufficiently robust as they had not ensured a delivery of consistent high care across the service. The provider had failed to ensure the necessary improvements had been made to the care provided since the last inspection.

The provider asked people and their relatives views on the care they received using various methods including satisfaction surveys. Relatives shared mixed views on the care their family members received. This included whether complaints were responded to in a timely manner. We made a recommendation to the provider to review how complaints were managed.

The environment is spacious throughout and adapted to meet the needs of people who use wheelchairs. The home was decorated with pictures and photographs of people living at the home. Environmental risks such as hoist equipment, wheelchairs and legionella checks were managed effectively through prompt and regular servicing. Staff employed by the home underwent a safe recruitment process.

People were able to receive visits from their relatives and friends whenever they wished at the home and staff knew people well. Staff had attended safeguarding adults training and knew how to protect people from abuse.

There was enough food and drink available and offered to people throughout our inspection at mealtimes and also in-between. The menu offered flexibility to meet the needs of people and their specific dietary requirements. People had access to external health care professionals including GP’s who visited the home weekly.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

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 bought forward as we had been made aware that following the identification of risks relating to people's care, the service had been subject to a period of increased monitoring and support by commissioners. The service has been the subject of nine safeguarding investigations by the local authority and partner agencies. As a result of concerns raised, the provider is currently subject to a police investigation. Our inspection did not examine specific 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.

Kingsmead Lodge provides nursing and personal care for up to 20 people who may have learning disabilities, physical disabilities and sensory impairments. Most people had complex mobility and communication needs. At the time of our inspection there were 17 people living at Kingsmead Lodge.

People living at the service had their own bedroom and en-suite toilet. The service was split into two wings, ‘West’ wing and ‘East’ wing. In each wing was a communal lounge and dining area where people could socialise and eat their meals if they wish. Twenty-four hour nurse support was available and there was a large activity room, sensory garden and sensory room. The environment was spacious throughout and adapted to meet the needs of people who used wheelchairs. The service was decorated with pictures and photographs of people living at the service. Kingsmead Lodge also offers a spa and hydrotherapy facilities which were in use at the time of our inspection.

The service had a registered manager who had been in post since October 2015. 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.

At the last inspection in January 2017 the service was found to be complying with legal requirements and was given a rating of 'Good'. However, we asked the provider to make improvements to the provision of meaningful activities and access to the community for people. At this inspection, we found improvements had not been made and 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.

Staffing levels were maintained with regular use of agency staff. However, staff confirmed this was having a negative effect on people’s well-being and quality of life. Staff felt there was added pressure to their role to oversee agency staff and ensure procedures were being followed. Overall staff felt people’s basic care needs were being met but they were struggling to meet people’s social, emotional and psychological needs.

Steps had been taken to ensure that activities were now available for people to access. An agency staff member was deployed each day to undertake group activities. However, for people who did not participate, the risk of social isolation had not been addressed or mitigated. People were not consistently receiving personalised care and those who were funded for one to one care were not receiving that care. Staff and relatives felt that the provision of meaningful activities for people had deteriorated.

Robust systems were not in place to ensure that agency staff had the necessary skills, training and competence to provide safe, effective and responsive care. Gaps in staff training also meant that not all staffed were competent and qualified to administer emergency medicines in the event of a person having a seizure. This impacted on the number of staff who were able to support people to access the community and go on trips away from the service.

The management of medicines was not safe as people did not always receive their medicines on time. Protocols involving the use of covert medicines had not routinely been reviewed to ensure the use of covert medicines was still required and the safest way to administer medicines.

Care plans and individual risk assessments were in place. However, documentation was not always fit for purpose or accurate. Discrepancies and gaps in recording had not consistently been identified by the provider as a shortfall and consequently the provider was unable to demonstrate if people received the care required or whether it was a failure to document the care provided.

Systems to assess and monitor the service were in place but these were not sufficiently robust as they had not ensured a delivery of consistent high care across the service or pro-actively identified all the issues we found during the inspection. Incident and accident documentation was in place and following advice from a recent monitoring visit from West Sussex County Council, the provider was reviewing all incidents and accidents to ascertain if any met the threshold for a safeguarding concern to be raised.

Mental capacity assessments were not consistently in place. The provider was in the process of reviewing all capacity assessments but in the interim, they were unable to demonstrate that the application of restrictive practice was in people’s best interest and lawful. We have identified this as an area of practice that needs improvement.

Care plans provided an overview of people’s life history, likes and dislikes. However, they were not consistently personalised and lacked reference to people’s personal preference on when they wished to get up and go to bed. We have identified this as an area of practice that needs improvement.

Environmental risks such as hoist equipment, wheelchairs and legionella checks were managed effectively through prompt and regular servicing. Staff employed by the home underwent a thorough safe recruitment process. People were supported at mealtimes to access food and drink of their choice.

Staff knew the people they were caring for very well. It was clear that permanent members of staff had built positive rapports with people. People’s privacy and dignity was respected and staff communicated with people in a kind and caring manner. People, relatives and staff spoke highly of the registered manager, describing her as having a “heart of gold.”

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We are considering our regulatory response to these breaches of legal requirements and will publish our action when this is complete.

The home had a registered manager who had been in post since October 2015. 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 not consistently supported to access the community when they wanted to. One person said, “I would like to be able to go out more.” A relative told us, “There are not enough staff for people to be able to access the community.” People did not always have enough to do. Organised activities were planned and people told us they enjoyed these. However staff were not always available to support them with meaningful activities and some people had little to interest or occupy them. We have identified this as an area of practice that needs to improve.

People had comprehensive and detailed care plans to guide staff in how best to meet their needs. Some people’s care plans had not been updated when their needs had changed. This meant that there was a risk that some people might receive care that was not appropriate for their needs. We identified this as an area of practice that needs to improve.

The provider had robust recruitment procedures in place to ensure that staff were suitable to work with people. Staff had a good understanding of how to keep people safe. They knew what to do if they suspected abuse and understood their responsibilities to report any concerns. Risk assessments were completed and reviewed regularly and care plans were developed to ensure that risks were managed effectively.

People received their medicines safely from staff who were trained. There were sufficient numbers of suitable staff to care for people safely. People were supported to have enough to eat and drink and people’s nutritional needs were managed effectively. People had access to health care services and received ongoing support from a range of health care professionals. One relative told us, “My relative did have health issues last year and they dealt with it very quickly, they let us know what was happening. It was excellent how it was handled.”

Staff had a clear understanding of their responsibilities to comply with the Mental Capacity Act 2005. People’s care plans included clear, personalised guidance for staff in how to seek consent from people. Staff told us they had the training and support they needed to be effective in their roles. One staff member told us that the training they had received was good, they said, “I’d say it helps us care for people better.” People and their relatives said that they had confidence in the staff. A relative said, “The staff are excellent.”

Staff knew the people they were caring for very well. They were able to communicate effectively with people and involved them in making decisions about their care and support. A health care professional gave us their views on the staff saying, “I love the way they are with the residents. They know them really well and are very knowledgeable and respectful”. Staff respected people’s privacy and maintained their confidentiality. A relative said, “They let people do as much as they can themselves and treat them like adults.”

The registered manager was described as approachable and caring by people, their relatives and the staff. People and relatives knew how to complain and said they would feel comfortable to do so. They told us that staff asked them for their views on the care provided and responses from a quality assurance survey were positive. There were robust systems and processes in place to monitor the quality of care and the registered manager had a clear oversight of the quality of the service. Auditing processes were in place and were used to help drive improvements.