This service has been subject to a period of increased monitoring and support by commissioners. The service has been the subject of multiple safeguarding investigations by the local authority and partner agencies. As a result of concerns raised, the provider is currently subject to a police investigation. No conclusions have yet been drawn from this.

In July and November 2017 we identified the care provided as ‘Inadequate’ or ‘Requires Improvement’. In January 2018 we found the provider had not made required improvements and therefore their rating did not improve. In April 2018 the service was again rated as requiring improvement overall, with the ‘Well-led’ domain being rated Inadequate.

At this inspection, some improvements were seen and acknowledged; but these were not sufficient or wide-spread enough to improve the final rating. The overall rating has reduced to ‘Inadequate’ despite some of people’s experiences and documentation being better in some areas. This is because there was evidence at this inspection that risks to people’s safety remained; and that similar themes had been raised at our last inspection of Orchard Lodge and at several others of the provider’s services. This showed that information about risk was not being appropriately used or shared between services for the purpose of driving improvement. The failure by the provider to fully address these known and significant risks has led to the rating of the Safe section being reduced to ‘Inadequate’ as a result.

The service will remain in special measures. We do this when services have been rated as 'Inadequate' in any key question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services in special measures. This was the fifth inspection since July 2017 where the provider remained in breach of Health and Social Care Regulations.

We imposed conditions on the provider’s registration. The conditions are therefore imposed at each service operated by the provider. CQC imposed the conditions due to repeated and significant concerns about the quality and safety of care at a number of services operated by the provider. The conditions mean that the provider must send to the CQC, monthly information about incidents and accidents, unplanned hospital admissions and staffing. We will use this information to help us review and monitor the provider’s services and actions to improve, and to inform our inspections.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration. For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of

The service has been subject to a period of increased monitoring and support by commissioners. The service has been the subject of multiple safeguarding investigations by the local authority and partner agencies. As a result of concerns raised, the provider is currently subject to a police investigation. West Sussex Safeguarding Adults Board have also published information on their website regarding safeguarding concerns about Orchard Lodge.

In July and November 2017 we identified the care provided as ‘Inadequate’ or ‘Requires Improvement’. At the last inspection on 8 and 9 January 2018 we inspected Orchard Lodge and found the provider had not made required improvements and therefore their rating did not improve. The provider informed us of the action they were taking to improve the quality of care they provided.

The overall rating for this service is ‘Requires improvement’. However, this service remains in 'special measures'. We do this when services have been rated as 'Inadequate' in any key question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services in special measures.This was the fourth inspection since July 2017 where the provider remained in breach of Health and Social Care Regulations.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Orchard Lodge has not had a registered manager since April 2017. Since that time there had been three managers who submitted and later withdrew their applications to become the registered manager. At this inspection, there was a new manager in post who had submitted an application to become a registered manager. They had been working at the home for two weeks. 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.

Orchard Lodge is a residential care home that also provides nursing care. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Orchard Lodge provides accommodation in two units called Boldings and Orchard East, which are all on one site. Orchard Lodge p

The inspection took place on 8 and 9 January 2018. It was a focused inspection to check the provider had taken the actions they told us they would to improve the quality of care provided to people.

The service has been subject to a period of increased monitoring and support by commissioners. The service has been the subject of multiple safeguarding investigations by the local authority and partner agencies. As a result of concerns raised, the provider is currently subject to a police investigation. West Sussex Safeguarding Adults Board have also published information on their website regarding safeguarding concerns about Orchard Lodge.

In July 2017 we identified areas of care as ‘Inadequate’ or ‘Requires Improvement’. The service received an overall rating of Inadequate, so the service was placed into 'special measures'. On 2, 3 and 6 November 2017 we inspected Orchard Lodge and found the provider had not made required improvements and therefore their rating did not improve. Shortly after the inspection we wrote to the provider and informed them that despite some improvements the Care Quality Commission remained significantly concerned about some areas of care and safety which had yet to improve and highlighted some new potential safety risks for people living at the home. The provider informed us of the action they were taking to improve the quality of care they provided.

At this inspection the provider had not improved the rating for Safe and Well-led from Inadequate because to do so requires consistent good practice over time and we found new areas of potential risk for people. We will check this during our next planned comprehensive inspection.

The overall rating for this service is ‘inadequate’ and the service therefore remains in ‘special measures.’ Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

This service will remain in special measures and continue to be kept under review by CQC and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months. If there is not enough improvement, so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This could lead to cancelling their registration, or to varying the terms of their registration. For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

At the last inspection we found systems to assess and monitor the service were in place, but they were not effective. Shortly after the inspection the provider wrote to us to inform us of the action they were taking. At this inspection we continued to find they were not sufficiently robust as they had not ensured a delivery of consistent, high quality care across the service or pro-actively identified all the issues we found during the inspection. This included checks made on how medicines were managed and a lack of analysis and monitoring of the skills and competencies of agency registered nurses.

At the last inspection we found a lack of accessible specific guidance in relation to aspects of people's healthcare needs. The provider wrote to us and told us the actions they were taking. At this inspection we found some aspects of care planning had improved. However, care records did not demonstrate people had received the safe care and treatment as referred to in their care plans. This included gaps within daily records when

The inspection took place on 2, 3 and 6 November 2017.

This inspection was a comprehensive inspection brought forward due to concerns shared with the Commission from the local authority safeguarding team. The concerns were regarding how a person was supported when they became acutely unwell prior to their admission to hospital. Our inspection did not examine the specifics of this incident and the allegation. However, we used the information of concern raised by partner agencies to plan areas we would inspect and to judge the safety and quality of the service at the time of the inspection.

The service had been subject to a period of increased monitoring and support by commissioners. The service has been the subject of multiple safeguarding investigations by the local authority and partner agencies. As a result of concerns raised, the provider is currently subject to a police investigation. West Sussex Safeguarding Adults Board have also published information on their website regarding safeguarding concerns about Orchard Lodge. Between May and November 2017 we have inspected a number of Sussex Health Care locations in relation to concerns about variations in quality and safety across their services and will report on what we find.

At this inspection we also focused on the areas of care we identified as 'Inadequate' or 'Requiring Improvement' at the last inspection in July 2017. The service received an overall rating of Inadequate, therefore the service was placed into ‘special measures’. At this inspection we could not improve the rating for Safe and Well-led from Inadequate because to do so requires consistent good practice over time and we found new areas of potential risk for people. We will check this during our next planned comprehensive inspection.

This service will remain in special measures therefore continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement, so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration, or to varying the terms of their registration. For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

At this inspection there was a manager in post who had commenced their application to become 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.

Orchard Lodge provides accommodation in three units called Boldings, Orchard East and Orchard West, which are all on one site. Orchard Lodge provides nursing and personal care for up to 33 people who may have a learning disability, physical disabilities and complex health needs. Most people had complex mobility and communication needs. At the time of our inspection there were 27 people living at Orchard Lodge and one person receiving short term care.

People living at the service had their own bedrooms and en-suite bathrooms. In each unit, there was a communal lounge and separate dining room where people could socialise and eat their meals if they wished. The units shared transport for access to the community and offered 24-hour nurse support and a social and recreational activities programme. The home environment was spacious throughout and adapted to meet the needs of people who use wheelchairs. The home was decorated with pi

The inspection took place on 6 and 7 July 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 8 safeguarding investigations by the local authority and partner agencies. As a result of concerns raised, the provider is currently subject to a police investigation. West Sussex Safeguarding Adults Board have also published information on their website regarding safeguarding concerns about Orchard Lodge. Our inspection did not examine specific incidents and 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.

Orchard Lodge provides accommodation in three units called Boldings, Orchard East and Orchard West, which are all on one site. Orchard Lodge provides nursing and personal care for up to 33 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 28 people living at Orchard Lodge.

People living at the service had their own bedroom and en-suite bathroom. In each unit, there was a communal lounge and separate dining room where people could socialise and eat their meals if they wish. The units shared transport for access to the community and offered 24-hour nurse support and a social and recreational activities programme. The home environment is spacious throughout and adapted to meet the needs of people who use wheelchairs. The home was decorated with pictures and photographs of people living at the home. Orchard Lodge also offers a spa and hydrotherapy facilities however they were not fit for use at the time of our inspection.

A home manager started working at Orchard Lodge in April 2017 and had submitted an application to register with the commission. 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. Although the home manager was new to Orchard Lodge they had been working for the provider for 15 years.

At the last inspection in November 2016 the service was found to be complying with legal requirements and was given a rating of ‘Good’. However, at this inspection we found that 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.

The information of concern shared with the CQC about specific incidents and safeguarding concerns indicated potential concerns about the management of risk related to complex health conditions (Epilepsy, Asthma and dysphagia (difficulty swallowing), deployment of suitably qualified and skilled staff and care of percutaneous endoscopic gastrostomy (PEG) feeding tubes for people who were not able to take food and drink by mouth. Therefore we examined those risks in detail as part of this inspection.

We found concerns regarding how staff were deployed particularly in Orchard West. There were not enough staff readily available to meet people’s needs and to ensure the safety of people at all times, therefore placing people at risk fro

The inspection took place on 1 and 2 November 2016 and was unannounced.

At our last inspection, in September 2015, we found breaches of the regulations in relation to good governance and how the provider had responded to feedback as well as the provider’s failure to display their rating from our inspection in 2014. At this inspection, we found that there had been a great improvement in how the service was managed and delivered. The breaches in regulation had been addressed.

Orchard Lodge provides personal and nursing care for up to 33 people with learning and physical disabilities, including respite places. Most people have complex mobility and communication needs. Orchard Lodge is made up of two purpose built bungalows, Orchard Lodge which consists of two units and Boldings Lodge. At the time of inspection, there were 29 people living at the service.

The service has 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 spoke highly of the home. Relatives had confidence in the care provided and said that staff were welcoming.

People had developed good relationships with staff and had confidence in their skills and abilities. They told us that staff were kind and that they treated them respectfully. Staff had received training and were supported by the management through supervision and appraisal. Staff were able to pursue additional training which helped them to improve the care they provided to people.

Staff responded quickly to changes in people’s needs and adapted care and support to suit them. Were appropriate, referrals were made to healthcare professionals, such as the GP or Dietician, and advice followed.

People were involved in planning their care and in making suggestions on how the service was run. Since our last inspection, action had been taken to improve how people were supported with the use of communication systems and aids. Communication passports had also been devised and were available to staff and visitors to enable better communication with people. A new Speech and Language Therapist (SALT) had been employed on full-time hours by the provider. They told us that their initial focus would be on further improving communication support and guidelines.

Staff 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 felt safe at the service and there were enough staff to respond to their needs. 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 and reviewed. People received their medicines safely.

People enjoyed the meals at the service and were offered choice and flexibility in the menu. The chef had a good understanding of people’s likes and dislikes and took great care to provide specific dishes or supplies to meet people’s requests. A variety of activities were provided and a driver had been employed which helped to facilitate more regular outings. The premises were purpose built and provided space for people to move around freely, to relax and to enjoy outdoor spaces.

There was strong leadership within the home. The registered manager monitored the delivery of care and the provider had a system to monitor and review the quality of the service. Suggestions on improvements to the service were welcomed and people’s feedback encouraged. One care assistant said, “(Registered manager) is willing to change things, she’ll think about anything you suggest. Our ideas are more valued and I kno

The inspection took place on 3 November 2014 and was unannounced.

Orchard Lodge provides personal and nursing care for up to 33 people with learning and physical disabilities, including two respite places. Most people have complex mobility and communication needs. Orchard Lodge is made up of two purpose built bungalows, Orchard Lodge which consisted of two units and Boldings Lodge. At the time of inspection, there were 31 people living at the service, with an approximate age range of 20 to 50 years old.

The service has 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. The manager was in day to day charge at the service but had taken up a new role with the provider. The provider was recruiting for someone to take over as manager.

We observed that some people had equipment that restricted their free movement. Two people had stair gates across their bedroom doors and one person had a high-sided bed. Where people lacked the capacity to consent to these decisions relating to their care or treatment, the manager was unable to demonstrate that best interest decision making procedures had been followed. There was a risk that people could be deprived of their liberty without appropriate safeguards in place because the manager had not carried out assessments in line with the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS).

Suitable arrangements were not in place to monitor the status of staff training and to ensure that staff received refresher training in accordance with the provider’s policy. Some training had not been refreshed annually, as was the provider’s policy. While staff told us that they felt supported and that they had supervision meetings, we found that the manager had not conducted appraisals with staff.

There was a varied activity programme though records relating to people’s participation were incomplete. On the day of our visit people were engaged in organised activities such crafts, exercise and music.

People, their relatives and staff spoke positively about the service. There was a friendly atmosphere and people were treated with kindness and respect. Support was given in a caring way that helped people to maintain their independence as far as possible. Staff were able to communicate effectively with people, both verbally and by interpreting their body language or sounds. They were able to involve people in decisions relating to their care and how they wished to spend their time. Despite these positive findings, we observed a few occasions where people were not treated with dignity. We discussed these with the manager before leaving.

People felt safe living at Orchard Lodge. There were enough staff on duty to promote people’s safety. Risks to people’s safety were assessed and reviewed. Any accidents or incidents were recorded and reviewed in order to minimise the risk in future. 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. People received their medicines safely and at the right time.

People’s care was planned and reviewed on a regular basis. Where support from external healthcare professionals was required, the service had made timely and appropriate referrals. People were offered a variety of food and drink and were supported to eat and drink enough to meet their needs.

Staff were knowledgeable about people’s care needs and preferences. One member of staff told us, “It takes time to learn people’s needs. It starts with care plans, then you get to know the needs and look for various communication including body language and facial expression”. People, their representatives and healthcare professionals were involved in reviewing their care to ensure that it met with their needs and preferences. People and their representatives were able to share their views. They told us that issues raised had been addressed and overcome.

The provider had a system to monitor and review the quality of care delivered. This included internal audits at manager and provider level, as well audits by external companies. Action plans were in place to monitor progress. Whilst we saw that these had been used to improve the service in many areas, they had not identified some concerns, such as the absence of staff appraisal.

The service was well-led in most areas and people felt able to approach the manager. A change in the management of the service was planned. We recommend that the management arrangements for the service be confirmed at the earliest opportunity to ensure clear accountability and oversight.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we have told the provider to take at the back of the full version of the report.

The inspection took place on 14 and 15 September 2015 and was an unannounced inspection.

Orchard Lodge provides personal and nursing care for up to 33 people with learning and physical disabilities, including two respite places. Most people have complex mobility and communication needs. Orchard Lodge is made up of two purpose built bungalows, Orchard Lodge which consisted of two units and Boldings Lodge. At the time of inspection, there were 29 people living at the service.

At the last inspection, on 3 November 2014, we asked the provider to take action to improve the way that they established and acted in accordance with people’s best interests and to ensure staff received regular training and appraisal. The registered manager wrote to us at the end of March 2015 to confirm that they had addressed these issues. At this visit, we found that the actions had been completed.

The service has 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. While often based at the service, the registered manager had been working for the provider in a different role for over a year. An acting manager was in post. The provider informed us during our visit that a new manager had been appointed and was due to start in post in October 2015.

Following our last inspection, the service received a rating of ‘requires improvement’. From April 2015 services have been required to display performance ratings. The provider had failed to do this, which meant that people using the service and relatives may not have been informed of our findings.

The lack of clear management had an impact on the day to day running of the service. Many of the staff were feeling demoralised due to staff absence, vacancies and a lack of clear direction. They did not feel that they were being listened to. One said, “We raise it (their concerns) but no matter what we raise they are not acting on it”. Suggestions raised by staff and feedback received from people or their relatives had not always been acted upon in a timely fashion. Actions identified in audits had not been consistently followed up or completed.

People enjoyed good relationships with the staff who supported them. Staff were able to communicate with people and understand their choices. We found, however, that people were not facilitated by staff to use communication systems and to initiate communication. They relied on staff making suggestions that fitted with their wishes. We have made a recommendation around how people are supported with communication.

People were involved in a variety of activities. This included in-house activities such as craft or music and trips out to local attractions or towns. Some people attended day centre services or college. We found that records relating to people’s activities had improved since our last visit but that some outings were curtailed due to staff vacancies, including for a driver.

Since our last visit, the registered manager had taken action to address breaches in the regulations. Where people lacked capacity to consent to decisions that restricted their freedom, assessments had been made in accordance with the provisions of the Mental Capacity Act 2005. This included best interest meetings and applications to the local authority under the Deprivation of Liberty Safeguards (DoLS). This meant that any restrictions were assessed and authorised as being required to protect the person from harm. Staff appraisals had taken place and an improved system for monitoring the status of staff training had been introduced. Staff were satisfied with the training on offer. They told us that there were opportunities to further their knowledge and to develop professionally.

People felt safe at the service and were treated respectfully by staff. Staff understood local safeguarding procedures and knew what action to take if they suspected someone had been harmed or was at risk of harm. There were enough staff on duty to keep people safe. Risks to people’s safety had been assessed and reviewed. Any accidents or incidents had been recorded and reviewed in order to minimise the risk in future. People received their medicines safely and at the right time.

The premises were purpose built and well-equipped. People were able to access physiotherapy services via the in-house team. There were weekly GP visits and people were able to access other healthcare professionals as needed. Monitoring records were generally detailed but some contained gaps which suggested additional support may have been required to meet the person’s health needs. In some cases, these did not appear to have been acted upon by staff. People were happy with the choice of food on offer and were supported to eat and drink if needed.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of the full version of the report.