This comprehensive inspection took place on 28 and 29 January 2019 and 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. 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

This focussed inspection took place on 3 December 2018 and 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. 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

This comprehensive inspection took place on 12 and 13 September 2018 and 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. 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 percuta

The inspection took place on 4 and 7 August 2017 and was unannounced.

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 c

The inspection took place on 4 January 2017 and was unannounced. Kingsmead Lodge is a nursing home for up to 20 younger people with complex physical and learning disabilities. On the day of the inspection there were 16 people living at the home.

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