This was an unannounced inspection which took place on 10 October 2018. A second day, 12 October 2018 was dedicated to speaking to health professionals and people who visited the service.

Beech Lodge is registered to provide accommodation and nursing care for up to 40 people. The home comprises of three separate building: Beech Lodge, Oak Lodge and Redwood House. At the time of this inspection Redwood House was being used as a day centre and did not form part of this inspection. This is because day centre services are not regulated by the Care Quality Commission. The home is purpose built and well-equipped. It caters for young adults with physical and learning disabilities or autism. At the time of our visit there were 17 people living in Beech Lodge and nine people living in Oak Lodge.

We previously carried out an unannounced comprehensive inspection of this service in July and August 2017. Beech Lodge was awarded an overall rating of ‘Good’, rated as ‘Good’ in all question areas, apart from the ‘Well Led’, which was rated ‘Requires Improvement’ as there was no registered manager in post.

At this inspection we found that the overall rating had remained good, rated as 'Good' in all question areas, apart from the ‘Well Led’, which was rated ‘Requires Improvement’ as there was a lack of provider overall oversight.

This inspection was brought forward as services operated by the provider have been subjected to a period of increased monitoring and support by commissioners. As a result of concerns raised about other locations operated by the provider, the provider is currently subject to a police investigation. Since May 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.

Beech lodge was designed, built and registered before the guidance was published regarding Registering the Right Support and other best practice guidance. The model and scale of care provided was 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. The provider was not meeting this aspect of the registering

the right support guidance. Whilst the home was appropriately adapted and nicely decorated there were no plans in place to develop the model of the service to reflect the registering the right support guidance.

The registered manager informed us that he attended structured management meetings regularly. However, the registered manager had not received supervision since March 2017. He had innovative ideas to take forward such as a multi-disciplinary meeting form to further improve communication between all health professionals and had had no opportunity to discuss his plans and development on a one to one basis.

The registered manager was present during our inspection. The manager had been in post since March 2017. 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 spoke positively of the home and commented they felt safe. Our own observations and the records we looked at reflected the positive comments people made. Care plans reflected people’s assessed level of care needs and care delivery was person specific, holistic and based on people's preferences. Risk assessments included falls, skin damage, behaviours that distress, nutritional risks including swallowing problems and risk of choking, and moving and handling. For example, pressure relieving mattresses and cushions were in place for those who were susceptible to skin damage and pressure ulcers. The care plans also highlighted health risks such as diabetes and epilepsy.

This was an unannounced inspection which took place on 31 July and 1 August 2017.

Beech Lodge is registered to provide accommodation and nursing care for up to 40 people. The home comprises of three separate building: Beech Lodge, Oak Lodge and Redwood House. At the time of this inspection Redwood House was being used as a day centre and did not form part of this inspection. This is because day centre services are not regulated by the Care Quality Commission. The home is purpose built and well-equipped. It caters for young adults with physical and learning disabilities or autism. At the time of our visit there were 18 people living in Beech Lodge and nine people living in Oak Lodge.

We previously carried out an unannounced comprehensive inspection of this service on 6 and 8 July 2015 where it was awarded an overall rating of ‘Good’ and rated as ‘Good’ in all domains apart from the ‘Well Led’ domain which was rated ‘Requires Improvement’ as there was no registered manager in post.

This inspection was planned due to a previous overall rating of ‘Good’ published for Beech Lodge in August 2015. However since that inspection, we had been made aware that following the identification of significant risks relating to people's care, the service had been subject to a period of increased monitoring and support by commissioners. The service had been the subject to safeguarding investigations by the local authority and partner agencies. As a result of concerns raised, the provider is currently subject to a criminal investigation. Our inspection did not examine the incidents and safeguarding allegations which have formed part of a criminal investigation. 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.

During our inspection the manager was present. The manager had been in post since 6 March 2017 and had submitted an application to register with CQC. 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.

Everyone commented positively about the new manager and we found that they had implemented improvements at the home. These included a new interactive menu planning system that people could use to decide what they wanted to eat, further support and guidance for staff in order that they had the skills and knowledge to support people and more detailed care planning documentation.

The provider had quality monitoring processes in place and the manager had used these to drive improvements at the home. A range of quality and safety audits had been conducted and since the intervention of outside agencies processes had been amended to share learning from potential safeguarding situations.

People were supported to raise concerns. Information was provided in different formats in order that it was accessible and helped people to know their rights. Individualised support plans were in place that provided information for staff on how to deliver people’s care in the way they wanted it. Discussions with people and staff, and observations and examination of records confirmed that staff supported people in line with their wishes and the contents of their support plans.

An activity programme was in place that offered people a choice of events that they could participate in and enjoy. The home had its own minibus to transport people to community events. However, this was not always available when being used by people to attend

The inspection took place on 6 and 8 July 2015 and was an unannounced inspection.

Beech Lodge is registered to provide accommodation and nursing care for up to 40 people. The home comprises Beech Lodge, Oak Lodge and Redwood House. At the time of this inspection Redwood House was being used as a day centre and did not form part of this inspection. This is because day centre services are not regulated by the Care Quality Commission. The home is purpose built and well-equipped. It caters for young adults with physical and learning disabilities or autism. At the time of our visit there were 25 people living at the service, 17 in Beech Lodge and eight in Oak Lodge.

The service has a registered manager but this person was no longer working at the home. A new manager was appointed in October 2014 but had not yet made an application to register with us. The service is required by a condition of its registration to have 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. We found that the provider had not taken satisfactory steps to comply with this condition of their registration. 

The service had been the subject of a safeguarding enquiry by social services following two incidents in April 2015. The manager and staff had worked closely with social services. They had taken steps to make improvements and follow recommendations to enhance the quality and safety of the service. We found that Beech Lodge was providing a safe service and that people received support in line with their needs and preferences.

Staff understood local safeguarding procedures. They were able to speak about the action they would take if they were concerned that someone was at risk of abuse. Risks to people’s safety were assessed, documented and reviewed. The manager had overseen a review of people’s risk assessments, specifically in relation to moving and handling. The support people needed was clearly documented and included photographs of the equipment in use. Any accidents or incidents were recorded and reviewed in order to minimise the risk in future. People received their medicines safely and at the right time.

There were enough staff to meet people’s needs. Staff had received training and were supported in their professional development through regular supervision. The provider had a training academy and the manager encouraged staff to attend training to improve their knowledge, specifically around learning disabilities and autism. Staff were clear on their roles and responsibilities and were kept up-to-date via handovers and regular staff meetings.

People and/or their representatives were involved in decisions relating to their care and treatment. Staff were skilful in communicating with people. They understood how people’s capacity should be considered and had taken steps to ensure that people’s rights were protected in line with the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS).

People were treated with kindness and respect and appeared relaxed and happy in the company of staff. Staff supported people to participate in activities and took time to understand how they wished to spend their time. There was a varied activity programme which included trips and events outside of the home. The home was recruiting a driver and hoped to quickly resume more frequent outings. A visiting entertainer told us, “The staff here really do care for the residents, they encourage them with the music and join in with them”. During our visit people were outside enjoying the gardens and grounds. The design and adaptation of the home, including tracking hoists in each room, provided easy access for people.

Staff were attentive and noticed when people required assistance or reassurance. People were supported to enjoy a variety of food and drink and to maintain good health. Where there were changes in people’s needs, prompt action was taken to ensure that they received appropriate support. This often included the involvement of healthcare professionals, such as the GP, Speech and Language Therapist (SALT) or Dietician.

The home was well-led. Staff felt able to approach the manager and to raise any concerns they had. The manager had a system to monitor and review the quality of care delivered and was supported by monthly visits from a representative of the provider. The manager received feedback from people, their relatives, staff and visitors. They took prompt action to address any concerns. Where improvements had been identified, action plans were in place and used effectively.