About the service:

• Norfolk Lodge is a residential care home that provides care and support for up to eight people with a learning disability and other complex needs, including autism and mental health. At the time of our inspection there were five people living at the home.

• Norfolk Lodge is owned and operated by the provider Sussex Healthcare. 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 August 2018 we found seven breaches of regulation in relation to person centred care, dignity, consent, safe care and treatment, safeguarding, governance and staffing. At this inspection we found one breach had been met in relation to dignity and six regulations continued to be breached. We also found a new breach of the registration regulations relating to informing us of significant incidents.

• The service has 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. People with learning disabilities and autism using the service can live as ordinary a life as any citizen. These values were not always seen consistently in practice at the service. For example, some people could live independent lives and were supported to do so. However, other people were not receiving the assistance with communication they needed to be as independent as possible.

People’s experience of using this service:

• Some aspects of the service remained unsafe.

• Some people were at risk from harm as some risk assessments were not effective in reducing the likelihood of harm and staff had not taken steps to keep people safe after an injury.

• Not all incidents had been reported to the local safeguarding authority as per the provider’s policy or agreement with the local authority and CQC.

• Staff had not consistently been deployed in a safe way. There were times when staff that were trained to use essential equipment were not working, leaving people at risk of unsafe care and treatment.

• Learning from incidents had not been consistently implemented. One person had experienced episodes of choking and these were not reported by staff.

• Staff told us they needed more training to meet people’s needs around behaviours that could be challenging to others.

• Some health needs were not being met effectively.

• 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 did not always receive personalised care. One person required adaptations, and care documents in large print and these were not being provided.

• There was no registered manager in day to day charge of the service. Although the registered manager was still registered with CQC they were no longer managing the service, had left the employment of the provider, and the provider was recruiting a new registered manager.

• Quality audits had not been effective in highlighting and putting right all the shortfalls we found at this inspection.

• People were supported in a kind and caring way by staff who knew them well.

• People told us that they liked their staff and could get help when they needed it.

• People received sensitive support when they were upset.

• People had enough to eat and drink and knew how to make a complaint.

• The new management team were working towards making positive changes to the service and had worked with other stakeholders to improve the support people received.

More information is in the detailed findings below.

Rating at last inspection:

At our last inspection in August 2018,

This inspection took place over two days on 28 and 29 August 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 July 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.

Norfolk Lodge is a “care home”. 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.

Norfolk Lodge is registered to provide care and support for up to eight people with learning difficulties, older people and younger adults. At the time of the inspection there were six people living permanently at the home and one person staying there for respite care. The home is a converted house in the centre of Horsham. The house has an accessible garden and the local shops, park and theatre are nearby.

At the last inspection on 19 September 2016 we rated the home as Good overall. At this inspection on 28 and 29 August 2018 we rated the service as Inadequate in Safe and identified breaches of seven regulations and other areas of practice that needed to improve. Breaches included, failures to keep people safe from abuse, failures to identify and manage risks effectively, failure to maintain sufficient numbers of suitable staff, failures in providing appropriate care to meet people’s needs, failure to protect people’s dignity and to obtain consent, and failures in management systems to identify shortfalls. The overall rating for the home is now requires improvement.

Systems for recording incidents and raising safeguarding alerts were not operating consistently. Some records included details of incidents that had resulted in physical and psychological ill-treatment of people living at the home. These incidents had not always been identified and reported as potential safeguarding incidents.

Risks had not always been assessed, reviewed and managed to ensure that people were protected from harm and abuse. Systems for identifying trends and patterns had not been effective in identifying and managing risks. Staff did not all have the training and skills they needed to care for people safely and there were not always enough staff on duty to support people when incidents occurred.

Assessments and care plans were not sufficiently personalised and detailed to guide staff in how to provide appropriate care that met people’s needs. Care plans had not been developed in line with current best practice for supporting people with behaviour that could be challenging.

People were not always given the support they needed to protect their dignity.

Management systems and processes had failed to identify the shortfalls in practice that we found. The quality and safety of the service was not effectively monitored, risks were not being assessed, and managed and records were not complete and accurate. This meant that systems were not effective in supporting management oversight at the home.

Staff had received training in the Mental Capacity Act and understood the principles. However, practice was inconsistent with regard to obtaining consent from people and for identifying the least restrictive options for supporting people to be safe.

The registered manager was aware of their responsibilities under the Accessible Information Standard, however there was inconsistent practice with regard to ensuring that peo

This inspection took place on 19 September 2016 and was unannounced.

Norfolk Lodge is a residential care home, which provides care and support for up to eight people with a learning disability and other complex needs, including autism and mental health. At the time of our inspection there were six people living at the home.

Norfolk Lodge is a town house with communal areas over two floors (ground and first floor). The second floor of the house accommodated the manager’s office and the laundry room but there were no bedrooms on this floor. There was a kitchen and shared dining area which was open and accessible to people. There was a back garden and we were told that people helped with the gardening. There were two lounges (one on each floor) that were used both for down time (watching television/movies) and for activities. There was a small sitting area between two parts of the building with games and puzzles.

The service is required to have a registered manager. 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. A manager was appointed in April 2016; they had submitted an application to CQC to register as the manager of the service.

Although staff understood how to support people and we were confident they received consistent support, some people's individual care records did not accurately reflect their needs or were incomplete. This meant that it was not always possible to be clear if a person was supported in the right way. We have made a recommendation that the provider ensures agreed support is documented to ensure a consistent approach.

The complaints procedure was clearly displayed within the service; however was not in a suitable format for all of the people who used the service to understand and make use of. The manager recognised this needed further revision to meet the needs of people in this service.

People told us they felt safe with the home’s staff. There were policies and procedures regarding the safeguarding of adults and staff knew what action to take if they thought anyone was at risk of potential harm.

People’s risks were identified, assessed and managed appropriately. There were also risk assessments in place to help keep people safe in the event of an unforeseen emergency such as fire or flood.

Thorough recruitment processes were in place for newly appointed staff to check they were suitable to work with people. There were sufficient numbers of staff to meet people’s needs safely. People told us there were enough staff on duty and records and staff confirmed this.

People were supported to take their medicines as directed by their GP. Records showed that medicines were obtained, stored, administered and disposed of safely.

The CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Whilst no-one living at the home was currently subject to DoLS, the manager understood when an application should be made and how to submit one. The provider was meeting the requirements of DoLS. There were no restrictions imposed on people and they were able to make individual decisions for themselves. The manager and staff were guided by the principles of the Mental Capacity Act 2005 (MCA) regarding best interests decisions should anyone be deemed to lack capacity.

Staff received training to help them meet people’s needs. Staff received an induction and regular supervision including monitoring of their performance. Staff were supported to develop their skills through additional training such as National Vocational Qualification (NVQ) or care diplomas. All staff completed an induction before working unsupervised. People were well supported and said staff were knowledgeable