About the service:

• Horncastle Care Centre is a residential care home that provides nursing care and support for up to 20 people. Some people had neurological conditions, physical disabilities, a learning disability and other complex health and communication needs. There are two ‘units’ named Willow and Maple Lodge each with their own dining area. At the time of our inspection there were 19 people living at the service. Four people were receiving short term care.

• Horncastle Care Centre is owned and operated by the provider Sussex Healthcare. Whilst Horncastle Care Centre is not part of the investigation, services operated by the provider had been subject to a period of increased monitoring and support by local authority 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 yet been reached.

• At the previous inspection in April 2018 we found five breaches of regulation in relation to safe care and treatment, protecting service users from abuse, staff training, adaption of the home and governance. At this inspection we found these breaches continued. We also found new breaches of regulations relating to person centred care, dignity and consent.

• The service had not been developed and designed in line with the values that underpin the 'Registering the Right Support' and other best practice guidance. These values include choice, promotion of independence and inclusion. These values were not always seen consistently in practice at the service. For example, some people were not treated with dignity and other people were not being supported to attend meaningful activities and access the community often enough. For more details, please see the full report which is on the CQC website at www.cqc.org.uk.

• All of the areas of concern we found during this inspection had already been highlighted to the provider following inspections of some of their other services. Learning had not been effectively shared to ensure that people living at Horncastle Care Centre received consistently safe, effective and well-led care.

People’s experience of using this service:

• A number of aspects of the service remained unsafe. This included risks associated with constipation, epilepsy, skin integrity and behaviour management.

• Some people were at risk as some risk assessments were not in place. Risk assessments that were in place were not always effective in reducing the possibility of harm. Staff had not always taken steps to keep people safe as there were failings in meeting some people's health needs such as bowel, epilepsy and skin integrity management.

• People were not consistently protected from abuse as concerns had not been identified by the provider.

• Learning from incidents had not been consistently implemented. Most of the areas of concern we found during this inspection, such as risks associated with health needs not being reduced and poor-quality auditing, had already been highlighted to the provider following inspections of some of their other services.

• The provider failed to ensure agency care staff had the necessary training they required to carry out their role, such as training about epilepsy and people's specific diagnoses.

• Adaptions had not been made to ensure people could move independently around the home.

• People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible; the policies and systems in the service did not support this practice.

• People were not consistently treated with dignity and the language some staff used was not person centred.

• People did not always receive personalised care. Some people were not provided with a range of person-centred activities.

• The previous inspections rated the well led domain as ‘Requires Improvement’. At this inspection the rating has reduced to Inadequate, therefore, lead

The inspection took place on 12 and 13 April 2018. This was a comprehensive inspection and it was unannounced.

Services operated by the provider had been subject to a period of increased monitoring and support by commissioners. As a result of concerns raised, the provider is currently subject to a police investigation. We used the information of concern raised by partner agencies to plan what areas we would inspect and to judge the safety and quality of the service at the time of the inspection. Between May 2017 and April 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.

Horncastle 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.

Horncastle Care Centre is registered to provide nursing and accommodation for up to 20 people who may have a learning disability, neurological conditions, physical disabilities and other complex health needs. At the time of our inspection there were 19 people living at the home. Accommodation is provided across two units called Willow Lodge and Maple Lodge. Each unit has a separate living room, dining room and kitchenette. Rooms were of single occupancy and had en-suite facilities. The home offers the use of specialist baths, a spa pool and physiotherapist.

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.

Some features of Horncastle Care Centre had been developed in line with the values that underpin the Registering the Right Support and other best practice guidance. This includes involving people and their families and taking into account their preferences, providing access to the local community amenities and ensuring people had access to routine medical screenings. However Horncastle Care Centre is a large clinical setting, split into two units. It is in a geographically isolated area rather than a small-scale home environment with easy access to local amenities and services. The design and layout of the premises meant that people could not always move independently around the service without support from staff.

The service did not always demonstrate the correct action had been taken after an incident had occurred including whether it had been shared with the local authority safeguarding team for their review. We found inconsistencies within how risks were being managed on behalf of people.

There were missed opportunities to provide staff with essential training to assist them in carrying out their role and responsibilities. Systems were not always effective in measuring and monitoring the quality of the service provided. There were ineffective systems in place to drive continuous improvement.

People's consent to care and treatment was gained in line with the requirements of the Mental Capacity Act 2005 and people were treated with dignity and respect. Care records were accessible for the people being written about and they reflected people received personalised care that met their needs. We observed people enjoyed the activities they were offered. Staff received supervisions and appraisals and they found the registered manager’s approach supportive.

People were provided choices on a daily basis regarding what food they ate and clothes they wore and complaints were managed effectively. The provider sought feedback from people and their relatives regarding the care rec

The inspection took place on 10 January 2017 and was unannounced. Horncastle Care Centre is registered as a care home with nursing. It provides accommodation, care and support for up to 20 adults with learning and physical disabilities in two separate bungalows. Maple Lodge provides a home for 10 adults with acquired brain injury and neurological conditions. Willow Lodge provides a home for 10 young adults with learning and physical disabilities. The Care Centre is in a rural location not far from the town of East Grinstead.

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

People living at Horncastle Care Centre had a range of complex needs. There were robust arrangements in place to ensure that risks to people were identified, assessed and managed to protect people from avoidable harm whilst supporting their freedom. Staff had a clear understanding about their responsibilities with regard to safeguarding people. The provider had safe systems in place for recruitment of staff to ensure that they were suitable to work with people. There were enough staff on duty to support people and they told us that they felt safe living at the Care Centre. People’s medicines were managed safely by trained staff.

Staff were well supported and received the training they needed to be effective in their roles. One staff member said, “We are well supported with training and courses.” Staff understood their responsibilities to comply with the Mental capacity Act 2005 and there were systems in place to ensure that people’s rights were protected. People told us that they had confidence in the staff, one person said, “They are really, really good at what they do. I can’t fault the staff at all.” People had support to access the health care services that they needed. A relative told us, “Staff are excellent, they always have a qualified nurse on duty. Any pain is dealt with quickly and they get the doctor in. It’s better than at home, they notice more.” People had enough to eat and drink and they told us they enjoyed the food. People who needed help with eating and drinking were supported by staff who were patient and attentive.

People spoke highly of the caring nature of the staff, one person said “The staff are excellent. ” Staff knew people well and understood how to communicate effectively with people to support them to express their wishes about their care. People were enabled to be in control of their support, one person said, “They always accommodate me.” Staff had developed caring relationships with people and spoke of them in a positive and respectful way. Staff were mindful of protecting people’s privacy and confidentiality.

People had comprehensive care plans that guided staff in how to provide care in a person centred way. Things that were important to people, their preferences and wishes were included in plans to ensure they received support in the way that they wanted to. Staff supported people to follow their interests and to have access to facilities in the local community. When at home, people were occupied with activities that they found stimulating and that were meaningful to them.

People and their relatives knew how to raise complaints or concerns and felt comfortable to do so. Complaints were addressed in a timely way by the registered manager. Feedback about the quality of the service was gathered in a range of ways and contributed to the development of the service. The registered manager had systems and processes in place to monitor service provision, to look for trends or patterns that needed to be addressed and to ensure that recording was accurate and robust.

There was clear leaders