The inspection took place on 10 July 2018 and was unannounced.

The provider and its associated locations have been subject to a period of increased monitoring and support by commissioners. Investigations are ongoing by the local authority, police and partner agencies at some of the provider’s locations. Our inspection did not examine specific incidents and safeguarding allegations which have formed part of these investigations. 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 Nursing Home provides nursing and personal care for up to 60 people living with a learning disability, physical disability or complex health condition. Accommodation is provided in two buildings on the same site and comprises the main building, Rapkyns Nursing Home, and a smaller building, Sycamore Lodge. At the time of this inspection, Rapkyns Nursing Home was empty, so this inspection is solely about what we found at Sycamore Lodge. Sycamore Lodge is a home that provides residential care and support for up to 10 people with a learning disability and/or autism, with some challenging behaviours. At the time of our inspection, nine people were living at the home. Accommodation is provided on one level. Communal areas include a lounge area and dining room, with access to gardens and grounds. All rooms have en-suite facilities. For the purpose of this report we have referred to the home as Sycamore lodge.

We carried out an unannounced comprehensive inspection at Rapkyns Nursing Home in June/July 2017 and a focused inspection in December 2017, where it was awarded a rating of ‘Requires Improvement’ in all domains and overall. Whilst much of the evidence resulting in breaches of regulations related to the main building at Rapkyns Nursing Home rather than Sycamore Lodge, the registration covers both locations/buildings, and therefore the rating applies to both. As a result of this inspection, the overall rating for Rapkyns Nursing Home (and the service known as Sycamore Lodge) remains at ‘Requires Improvement’.

The last manager at Rapkyns Nursing Home de-registered with the Commission in August 2017. A new manager took over in August 2017 and at our inspection in December 2017, we were informed they had commenced the registration process. However, the manager currently in post at Sycamore Lodge commenced the process of registering with the Commission in May 2018. Therefore, there has been no registered manager since August 2017. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered person’. 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.

Sycamore Lodge, which comes under the registration of Rapkyns Nursing Home, is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided and both were looked at during this inspection.

Sycamore Lodge has not been operated and developed in line with the values that underpin the Registering the Right Support and other best practice guidance. Sycamore Lodge was designed, built and registered before the guidance was published. However, the provider has not developed or adapted Sycamore Lodge in response to changes in best practice guidance. Had the provider applied to register Sycamore Lodge today, the application would be unlikely to be granted. The model 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.

At the last inspection, we found people did not receive safe care and tr

We undertook an unannounced focused inspection of Rapkyns Nursing Home on 7 and 8 December 2017.

We undertook a comprehensive inspection of Rapkyns Nursing Home in July 2017 where we identified three breaches of legal requirements and judged the service to be 'Requires Improvement' in all domains. The breaches of legal requirements related to gaps in staff training, supervision and appraisal, a lack of personalised care and ineffective quality monitoring systems. The provider submitted an action plan which detailed the steps that would be taken to achieve compliance.

We brought forward this focussed inspection of Rapkyns Nursing Home due to an increase in concerns raised by partner agencies about risk and quality at the service highlighted by routine monitoring visits and safeguarding alerts raised. At this inspection we focussed on the ‘Safe’ and ‘Well-Led’ domains only and checked whether improvements planned by the provider to meet legal requirements in these areas had been undertaken.

The service had 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. 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.

At this inspection the team inspected the service against two of the five questions we ask about services: is the service safe and is the service well led. We were unable to improve the ratings for these Key Questions as we found a continued breach of Regulations. We also identified new risks to people living at the home regarding their care and treatment. Therefore the service remains at ‘Requires Improvement’ in these areas and overall.

Rapkyns Nursing Home is a care home that provides both nursing and residential care for up to 60 people. 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.

Rapkyns Nursing Home accommodated people across two separate units. Rapkyns Nursing Home supported people living with Huntington’s Disease. Sycamore Lodge provided care to younger people with a learning disability and/or autism. At the time of this inspection there were 30 people living in Rapkyns Nursing Home and nine people resided at Sycamore Lodge. People had access to communal areas within the home and Sycamore Lodge bedrooms were complete with en-suite facilities. Sycamore Lodge was adapted to meet the need of people who also had complex physical needs and was fitted with overhead hoisting equipment throughout.

Sycamore Lodge has not been operated and developed in line with the values that underpin the Registering the Right Support and other best practice guidance. Sycamore Lodge was designed, built and registered before this guidance was published. However the provider has not developed or adapted Sycamore Lodge in response to changes in best practice guidance. Had the provider applied to register Sycamore Lodge today, the application would be unlikely to be granted. The model 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.

These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service should be able to live as ordinary a life as any citizen, but this was not always the case for people. Sycamore Lodge is geographically isolated on a campus within the provider's own care village setting. Most people’s social engagement and activities took pl

This unannounced inspection was carried out on 8 June and 11 July 2017.

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 11 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 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 Nursing Home provides nursing and personal care for up to 60 people who are living with a learning disability, physical disability or complex health condition. The home also specialises in supporting and treating people living with Huntington’s disease. Accommodation is provided in two buildings on the same site, Rapkyns Nursing Home and Sycamore Lodge. Young adults and older people reside at the home.

At the time of the inspection there were 35 people living in the main building (two of whom were in hospital during our inspection) and nine people living in Sycamore Lodge.

We carried out an unannounced comprehensive inspection of this service on 16 May 2016 where it was awarded a rating of ‘Good’ in all domains and overall. As a result of this inspection, the overall rating of this service has changed from ‘Good’ to ‘Requires Improvement’.

On the first day of our inspection, a registered manager was in post. When we returned for the second day of inspection, the registered manager had resigned their post and interim arrangements had been put in place for the management of the service. A new manager had been recruited, but had not taken up their post at the time of this inspection. 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.

Whilst systems were in place to assess, monitor and improve the quality of the service, these were not always effective, as they had not identified the breaches of regulation we found at the time of our inspection. The lack of supervision for some staff meant that staff may not always have understood what was expected of them. Staff did not always keep clear records relating to people’s fluid intake where this was needed and there was a lack of guidance for staff on one person’s specialised footwear. There was evidence of improvements having been made in accurate record keeping, but further work was still needed.

There were gaps in training for some staff who had not completed all the mandatory training including, moving and handling, safeguarding vulnerable adults and mental capacity. Some staff had not completed all the required training to ensure they carried out their roles effectively. Supervisions had not been held regularly or in line with the provider’s guidelines. Some staff had not received supervision at all in 2017 or had an annual appraisal within the last 12 months. This put people at risk of receiving care from staff whose competency had not been assessed recently.

People did not always receive personalised care that was in line with their preferences, although these were recorded in their care plans. Staff had not been deployed in such a way as to ensure, for exam

The inspection took place on 16 and 19 May 2016 and was unannounced.

Rapkyns Nursing Home provides nursing and personal care for up to 60 people who are living with a learning disability or physical disability. Rapkyns Nursing Home provides accommodation in two buildings on the same site, Rapkyns Nursing Home and Sycamore Lodge. At the time of our inspection, there were 37 people living at Rapkyns Nursing Home and ten people living in Sycamore Lodge. Rapkyns Nursing Home specialised in supporting and treating people who have Huntington’s Disease. The provider and staff were engaged with wider Huntington’s Disease links and research. The aim of which was to improve the lives of people using their service but also to find treatment solutions to help others living with the disease.

There was no registered manager in place at the time of the inspection. However, a new manager had been appointed in March 2016 and had begun the process of applying for registration.. 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 the service had their own bedroom and en-suite bathroom. In both buildings, there was a communal lounge and separate dining room on the ground floor where people could socialise and eat their meals if they wish. The buildings shared transport for access to the community and offers the use of specialist baths, spa pool and physiotherapy. The service had weekly GP visits, 24-hour nurse support, a multi-sensory room and a social and recreational activities programme. The service could accommodate relatives who wished to visit their family.

Risk assessments and care plans contained information on people's preferred routines, likes, dislikes and medical histories. However, we identified six risk assessments and care plans that did not include guidance for health conditions, which had been identified. This meant that people were at risk of not receiving the care and treatment they needed. We brought this to the managers attention at the time of our visit. The manager reviewed and updated these risk assessments and care plans before our visit concluded. We were satisfied that people were not at risk from receiving treatment.

Staff worked closely with community health professionals and therapists to maximise people's well-being. People felt safe at Rapkyns Nursing Home and had positive and caring relationships with the staff who supported them.

People were protected against avoidable harm and abuse. Good systems were in place for reporting accidents and incidents and the service was responsive to people's individual needs.

Staff enjoyed working at the service and felt well supported in their roles. They had access to a wide range of training, which equipped them to deliver their roles effectively. Staff completed an induction course based on nationally recognised standards and spent time working with experienced staff before they were allowed to support people unsupervised. This ensured they had the appropriate knowledge and skills to support people effectively. Records showed that the training, which the provider had assessed as mandatory was up to date. Staff told us that they felt supported and received training to enable them to understand about the needs of the people they care for. People and their relatives felt the staff had the skills and knowledge to support people well.

There were sufficient numbers of staff on duty to keep people safe and to meet people's needs. We saw that staff recruited had the right values, and skills to work with people who used the service. Staff rotas showed that the staffing levels remained at the levels required to ensure all peoples needs were met and helped to keep people safe.

Pol

This was an unannounced inspection which took place on 02 and 03 March 2015.

Rapkyns Nursing Home provides support and accommodation for a maximum of 60 people within two buildings. The main building provides support which can include nursing care to people with neurological conditions, specifically with Huntington’s Disease. The other building known as Sycamore Lodge provides support to people, which does not include nursing care. The majority of people who live in Sycamore Lodge have a learning disability and/or autism. Some people also had physical disabilities. At the time of the inspection there were 38 people living in the main building, many of whom required a high level of nursing care. There were nine people living in Sycamore Lodge.

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 and associated Regulations about how the service is run.’

People told us that there were, on the whole, enough staff on duty to support people at the times they wanted or needed. The provider had a formal dependency assessment tool for deciding staffing levels for each person who lived at Rapkyns Nursing Home. However, this was not being consistently used when deciding safe staffing levels. Despite this we observed that on the day of our inspection there were sufficient staff on duty.

Medicines were managed safely at Rapkyns Nursing Home. There were systems in place to ensure that medicines had been stored, administered, audited and reviewed appropriately. At times in Sycamore Lodge care staff administered medicines. There was no written guidance regarding this practice that helped ensure nurses employed at the home followed The Nursing and Midwifery Council guidance: Standards for medicines management.

People said that they would speak to staff if they were worried or unhappy about anything. Staff had received safeguarding training and were aware of their responsibilities in relation to safeguarding.

Risks to people’s safety were assessed and actions taken to reduce reoccurrence where possible. Staff were able to describe how they supported people who were living with neurological conditions or learning disabilities and who at times needed support with behaviours.

Equipment was available in sufficient quantities and used where needed to ensure that people were moved safely and staff were able to describe safe moving and handling techniques. In Sycamore Lodge bedrooms included ceiling tracking that could be used to move people from their bedrooms to their ensuite bathrooms.

People said that they were happy with the medical care and attention they received and we found that people’s health and care needs were managed effectively. Assessments and care plans were detailed and informative and could be used to monitor that people were receiving effective treatment. National Institute for Health and Care Excellence (NICE) guidelines were being followed for effective wound care management.

People said that the food at the home was good. Staff assisted people when required and offered encouragement and support. The chef manager was knowledgeable about the dietary needs of people.

Staff were sufficiently skilled and experienced to care and support people to have a good quality of life. An external healthcare professional who had delivered training to staff informed us, “All members of staff seemed keen to work with the Integrated Response Team (IRT) and embraced our intervention. I delivered three training sessions to staff members (manager, nurses and carers). These were all well attended and there was good interest and engagement from the staff: they were keen to embrace new ideas and to relate them to residents in their care”. A training programme was in place that included courses that were relevant to the needs of people who lived at Rapkyns Nursing Home. Staff received support to understand their roles and responsibilities through supervision and an annual appraisal.

Rapkyns Nursing Home was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS). These safeguards protect the rights of people by 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. Mental capacity assessments were completed for people and their capacity to make decisions had been assumed by staff unless there was a professional assessment to show otherwise. This was in line with the Mental Capacity Act (2005) Code of Practice which guided staff to ensure practice and decisions were made in people’s best interests.

People said that they were treated with kindness and respect. A relative said, “Staff treat him (family member) as an individual. They are very obliging and patient with him”. Staff knew what people could do for themselves and areas where support was needed. In Sycamore Lodge care plans and support focused strongly on independence and relationships.

People’s privacy and dignity was promoted. Staff understood the importance of respecting people’s rights. People were routinely listened to and their comments acted upon. Staff were seen spending time with people on an informal, relaxed basis and not just when they were supporting people with tasks.

People said that the home took appropriate action in response to changes in people’s needs. Care plans were in place that provided detailed information for staff on how to deliver people’s care. Care records were person-centred, meaning the needs and preferences of people or those acting on their behalf were central to their care and support plans.

In the main, people said that they were happy with the choice of activities on offer. An activity programme was in place that included film club, sensory stimulation, external entertainers, arts and crafts and a weekly outing. People in the main building and Sycamore Lodge were able to make use of the swimming pool and gym located in the grounds near the home. People’s religious and cultural needs were met.

People said that the home was well-led and that management was good. The registered manager had recently taken on an additional role as an area manager for the provider. The registered manager was supported by two deputy managers to run Rapkyns Nursing Home. A deputy was based in both of the buildings that form Rapkyns Nursing Home and had specific responsibilities within these. Both deputies said that they were fully supported by the registered manager to undertake their roles and responsibilities. A variety of tools were used to obtain and act on feedback from people.

The registered manager showed a commitment to improving the service that people received by ensuring her own personal knowledge and skills were up to date. A range of quality assurance audits were completed by the manager and the members of the provider’s quality assurance team to help ensure quality standards were maintained and legislation complied with. The latest health and safety report showed that the overall health and safety score for the home had improved from 82% to 87%. The provider had reviewed its incident monitoring system in order that trends could be identified and action taken at service level and across the provider’s other locations. The registered manager told us, “Staff have improved at looking at possible causes, preventative. It’s really helpful as it identifies patterns that may have been missed before”.