The inspection took place on 24 and 25 January 2018. This was a comprehensive inspection and it was unannounced.

Services operated by the provider had been subject to a period of increased monitoring and support by commissioners. As a result of concerns raised, the provider is currently subject to a police investigation. One allegation relates to Beechcroft Care Centre specifically. 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 January 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.

Beechcroft Care Centre 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.

Beechcoft Care Centre is registered to provide nursing and accommodation for up to 30 people who may have a learning disability, physical disabilities and complex health needs. At the time of our inspection there were 23 people living at the home. Accommodation is provided across three units called Beechcroft Care Centre, Chestnut Lodge and Hazel Lodge. Each unit has a separate living room, dining room and kitchenette. Rooms were of single occupancy and had en-suite facilities. The home offers the use of specialist baths, spa pool and physiotherapy.

A registered manager was in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Beechcroft Care Centre has not been operated and developed in line with the values that underpin the Registering the Right Support and other best practice guidance. Beechcroft Care Centre was designed, built and registered before this guidance was published. However, the provider has not developed or adapted Beechcroft Care Centre in response to changes in best practice guidance. Had the provider applied to register Beechcroft Care Centre 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. Beechcroft Care Centre is a large clinical setting rather than a small-scale homely environment. Beechcroft Care Centre is geographically isolated on a campus in rural East Grinstead with many people having moved to East Grinstead from other local authority areas and therefore not as able to retain ties with their local communities. For some people, there were limited opportunities to have meaningful engagement with the local community amenities. Some people had limited contact with specialist health and social care support in the community due to specialist staff (e.g physiotherapy) that were employed by the provider. Some people attended a local college for morning or afternoon sessions. However, most people's social engagement and activities took place either at Beechcroft Care Centre or at another service operated by the provider, such as the provider's day centre.

We found inconsistencies within how risks were being managed on behalf of people. We identified gaps within the guidance for sta

This comprehensive inspection took place on 12 September 2016. The inspection was unannounced.

Beechcroft Care Centre is nursing home that provides accommodation, nursing and personal care to 30 young adults with learning and physical disabilities. Accommodation is provided in three houses called Beechcroft Care Centre, Chestnut Lodge and Hazel Lodge, which are all on one site.

There were 28 people living on site at the time of our visit. People living at each house had their own bedroom and en-suite bathroom. There is a communal lounge and separate dining room on the ground floor of each building. This is where people can socialise and eat their meals if they wish. The houses offer the use of specialist baths, spa pool, physiotherapy, weekly GP visits, 24-hour nurse support, multi-sensory room, social and recreational activities programme and a swimming pool. Transport is available for people to access the community.

We previously carried out an unannounced comprehensive inspection of this service on 18, 19 and 20 January 2016. At that inspection, a number of breaches of legal requirements were found. As a result, the service was rated 'Requires Improvement'. We met with the provider to discuss our concerns and issued one Warning Notice, which required the provider to take immediate action in relation to the effective governance of the service.

Following our last inspection, the manager at that time left the service. The provider transferred a manager from another one of their services in April 2016 to manage Beechcroft Care Centre. The appointed manager was already registered with the Care Quality Commission in November 2014. The manager was familiar with the people living at the service and the staffing team due to their previous experience managing the service. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 this inspection, we confirmed that the registered manager and provider had taken sufficient action to address previous concerns and comply with required standards. As a result, the provider has complied with the Warning Notice and requirements we issued and had sustained improvements across all domains. Therefore the overall rating of the service has improved to ‘good.’

Systems were in place to identify risks and protect people from harm. Risk assessments were in place and reviewed monthly. Where someone was identified as being at risk, actions were identified on how to reduce the risk and referrals were made to health professionals as required.

Staff worked closely with community health professionals and therapists to maximise people's well-being. People felt safe and had positive and caring relationships with the staff that supported them.

People were protected against avoidable harm and abuse. Good systems were in place for reporting accidents and incidents and the service was responsive to people's individual needs.

Staff enjoyed working at the service and felt well supported in their roles. They had access to a wide range of training, which equipped them to deliver their roles effectively. Staff completed an induction course based on nationally recognised standards and spent time working with experienced staff before they were allowed to support people unsupervised. This ensured they had the appropriate knowledge and skills to support people effectively. Records showed that the training, which the provider had assessed as mandatory was up to date. Staff told us that they felt supported and received training to enable them to understand about the needs of the people they care for. People and their relatives felt the staff had the skills and knowledge to support people well.

There were sufficient numbers of staff

This comprehensive inspection took place on 18, 19 and 20 January 2016. The inspection was unannounced.

Beechcroft Care Centre is nursing home that provides accommodation, nursing and personal care to 30 young adults with leaning and physical disabilities. Accommodation is provided in three houses called Beechcroft Care Centre, Chestnut Lodge and Hazel Lodge which are all on one site.

There were 20 people living on site at the time of our visit. In each house there is a communal lounge and separate dining room on the ground floor where people can socialise and eat their meals if they wish. The houses share transport for access to the community and offers the use of specialist baths, spa pool, physiotherapy, weekly GP visits, 24-hour nurse support, multi-sensory room, social and recreational activities programme and a swimming pool.

At the time of the inspection there was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. Following the inspection we were informed that the registered manager had left this service and an area manager was managing the service in the interim.

People confirmed they felt safe and staff demonstrated a good understanding of how to protect adults at risk. However risks associated; with people’s care were not always appropriately assessed and plans had not always been developed to ensure that staff met people’s needs consistently and reduced risks.

Recruitment practices and appropriate pre-employment checks were undertaken. The registered manager and staff told us that they had not been operating with sufficient staff on most days. There was a lack of clarity between the registered manager and provider about how many staff were required and how this should be deployed. Staff deployment was not effective and we found that people’s care had been impacted by this. Staff supervisions were taking place although not as frequently as the policy stated and improvements need to be made in supporting staff to understand the specific needs of people using the service.

People confirmed staff involved them in making decisions. The registered manager demonstrated a good understanding of the Mental Capacity Act 2005. Although staff had received training in this area they were unable to demonstrate they had a good understanding of the legislation. However we observed staff following the principles of the Act by seeking people’s consent and offering least restrictive care. The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The service had submitted applications for DoLS for some people living in the home to the supervisory body.

People described staff as kind and caring. They felt they were treated with respect and dignity. Most observations reflected this however we observed examples where staff did not treat people with respect and dignity. Whilst staff knew people well, care plans and care records were not always personalised, accurate, up to date and reflective of people’s needs and preferences.

People and their relatives knew how to make a complaint and these had been investigated. Records were kept of the complaints and actions taken.

Systems were in place to gather people’s views but these were not always used effectively to improve the service. Staff described the registered manager as open and approachable. They were confident any concerns would be addressed and staff and people felt listened to. There were ineffective systems and processes in place to monitor the quality and safety of the service and action had not been taken to respond to known shortfalls and risks. This had impacted upon the qual