About the service:

• Rapkyns Care Centre (known as ‘The Grange’) is a residential care home that provides nursing care and support for up to 41 people with a learning disability and other complex needs, including autism and physical disabilities. There are four ‘units’ each with their own dining area and nurse’s station. At the time of our inspection there were 35 people living at the service.

• Rapkyns Care Centre 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 September 2018 we found one breach of regulation in relation to the safe use of people’s medicines. At this inspection we found this breach continued. We also found six new breaches of regulations relating to person centred care, dignity, consent, safeguarding, governance and staffing.

• The service was registered before the 'Registering the Right Support' guidelines were in place. However, the service was not operating 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 be as independent as they could be with their communication or their activities.

People’s experience of using this service:

• A number of aspects of the service remained unsafe.

• Some people were at risk as some risk assessments were not in place. Some risk assessments were in place but were not effective in reducing the possibility of harm. Staff had not taken steps to keep people safe, such as with behaviours that may challenge others.

• People were not consistently protected from abuse as incidents were not audited to effectively spot trends and reduce the risk of abuse.

• Staff had not consistently been deployed in a safe way. There were too few nurses deployed in the daytime and agency nurses struggled to cover two ‘units’.

• 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. Local health teams had previously identified issues we found at this inspection and no improvement had been made.

• Staff did not have the necessary training they required to carry out their role, such as epilepsy training for emergency medicines, or use of the de-choker device.

• People’s health needs were not being met effectively. Areas such as constipation, epilepsy and people’s swallowing ability were not effectively managed.

• 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’s communication needs were not met in a personalised way.

• People with higher support needs did not have a consistently person-centred range of activities.

• Leadership at the service was not effective. Three previous inspections rated the well led domain as ‘Requires Improvement’. At this inspection the rating has reduced to Inadequate.

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

• We observed some people receiving caring and kind supp

This inspection took place on 11 September 2018 and was unannounced. We returned on the 12 September 2018. The provider was given notice of this date, as we needed to spend specific time with them to discuss aspects of the inspection and to gather further information around medicines.

Rapkyn's Care Centre is a 'care home'. The centre is also known as ‘The Grange’, which we have referred to through the report. 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. The home is registered to provide accommodation and care for up to 41 people with a learning and physical disabilities. At the time of our visit 37 people were residing.

There was a well-established registered manager in post; however, they were on annual leave at the time of our inspection. A registered manager is a person who has registered with the 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 and associated Regulations about how the service is run. The peripatetic manager assisted us in the registered manager's absence. The role of a peripatetic manager supports registered managers in their role and moves from service to service offering advice and guidance.

Services operated by the provider have been subjected to a period of increased monitoring and support by commissioners. As a result of concerns raised about other locations operated by the provider, the provider is currently subject to an ongoing police investigation. Since May 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.

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.

At our last inspection in June 2017 we rated the service good overall. The key question is the service well-led, was rated as ‘requires improvement’. This was because the provider needed to ensure that their systems for monitoring and improving services were embedded and to demonstrate that good practice can be sustained in all key questions, is the service safe, effective, caring, responsive and well-led.

This inspection was brought forward due to information shared with CQC about the potential concerns around the management of people's care needs. This inspection examined those risks. At this inspection we found that the provider had been unable to sustain the rating of Good. Medicines were not always management safely and in line with guidance.

For the key question is the service well-led, this continues to be rated as ‘requires improvement.’ Medicines were not always being managed safely, consequently the provider has not been able to sustain good in the key question, is the service safe? We have also made a recommendation that the provider should review its policy for disposal of medicines waste.

The Grange was designed, built and registered before the guidance was published regarding Registering the Right Support and other best practice guidance. This guidance states that people with learning disabilities and autism using a service should be able to live as ordinary a life as any citizen. We found, the provider was not able to demonstrate they were working

The inspection took place on 26 June 2017 and was unannounced.

The inspection was planned due to a previous rating of ‘Requires Improvement’ published for Rapkyns Care Centre in June 2016. However since that inspection, the service had been subject to a period of increased monitoring and support by commissioners. The service has been the subject of 14 safeguarding investigations and quality concerns 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 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.

Rapkyns Care Centre is a nursing home that provides accommodation, nursing and personal care to 41 adults with learning and physical disabilities. Accommodation is provided in four lodges called Elm Lodge, Ash Lodge, Cedar Lodge and Rowan Lodge, which are all on one site.

There were 40 people living in the four lodges at the time of our visit. In each house, there was a communal lounge and separate dining room on the ground floor, where people could socialise and eat their meals if they wished. The houses shared transport for access to the community and offered the use of specialist baths, a spa pool, physiotherapy, weekly GP visits, 24-hour nursing support, multi-sensory room, social and recreational activities programme and a swimming pool. There was a room allocated for using computers. This was a space for people to contact their relatives through video chat and email. People’s families could visit and stay at the centre in separate accommodation.

During our inspection the registered manager was present. 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 last inspection took place on 11 and 12 April 2016. As a result of this inspection, we identified two breaches of the Health and Social Care Act Regulations associated with how consent was sought where a person may have lacked capacity and how people were not always treated with dignity and respect. We identified one breach of the Registration Regulations due to the registered manager not notifying the Commission regarding an allegation of abuse. We also made a recommendation around how people were supported with communication as people were not helped by staff to use communication systems and to initiate communication. They relied on staff making suggestions that aligned with their wishes.

Following the last inspection, the provider wrote to us to confirm that they had addressed these issues. At this visit, we found people’s capacity to consent to care was properly considered and the home worked in accordance with current legislation relating to the Mental Capacity Act 2005 and the Deprivation of Liberties Safeguards. This included training for all staff on both subjects. We found people looked happy and were relaxed and comfortable with staff. People were supported by staff who understood their needs and abilities and knew them well. Staff were kind and caring towards people and upheld their privacy and dignity at all times. We found the registered manager had notified the Commission of reportable incidences such as alleged abuse, a medication error and serious injury. We observed people communicating with staff using their assessed

This comprehensive inspection took place on 11 and 12 April 2016. The inspection was unannounced.

Rapkyns Care Centre is a nursing home that provides accommodation, nursing and personal care to 41 adults with learning and physical disabilities. Accommodation is provided in four lodges called Elm Lodge, Ash Lodge, Cedar Lodge and Rowan Lodge, which are all on one site.

There were 40 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 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. There was a computer room. This was a space for people to contact their relatives through skype, face book and email. The service could accommodate relatives who wished to visit.

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.

Not all of the people who were using the service were able to tell us about their experiences. We relied on our observations of care and our discussions with staff and those people using the service who were able to speak with us.

Staff were trained and understood the actions required to keep people safe. People had been safeguarded against the risk of abuse by staff who took prompt action if they suspected people were at risk of harm. However the registered manager had failed to notify CQC and the local safeguarding team of an allegation of abuse that had been made.

The Deprivation of Liberty Safeguards (DoLS) protects the rights of people ensuring if there are any restrictions to their freedom and liberty, these have been authorised by the local authority as being required to protect the person from harm. Staff had received training with regard to the Mental Capacity Act 2005 and DoLS. However, the registered manager had failed to notify CQC of DoLS that had been authorised for individuals by the appropriate authority. CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS).

Staff had a good understanding of the Mental Capacity Act 2005 (MCA); however, this was not always demonstrated when best interest decisions had been made for people who were deemed to lack capacity.

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.

Risks associated with people's care and support needs were identified and managed safely to protect them from harm. We observed staff support people safely in accordance with their risk assessments and care plans. Risks affecting people's health and welfare were understood and managed safely by staff. Environmental risks such as hoist equipment, wheelchairs and legionella checks were managed effectively through prompt and regular servicing.

People enjoyed good relationships with the staff that 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 made a recommendation around how people are supported with communication.

The behaviour of the registered manager and members of the senior management team at times did not encourage open communication. The impact of this meant the s