This inspection took place on 20 August 2018 and was unannounced. We also returned on the 21 August 2018. The registered manager was given notice of the second date, as we needed to spend specific time with them to discuss aspects of the inspection and to gather further information.

The inspection was prompted in part by information of concern raised by partner agencies. This was following an investigation in August 2018 of an incident which a person using the service died in 2016. This incident is not currently subject to a criminal investigation. However, the information shared with the Care Quality Commission (CQC) about the incident indicated potential concerns about the management of risk of how epilepsy and other specific health conditions was assessed and planned for. This inspection examined those risks.

Stanhope Lodge is a 'care home'. 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. Stanhope Lodge is registered to provide accommodation and care for up to 28 people with a learning disability and/or challenging behaviour and other complex needs. At the time of our visit 20 people were residing.

The service comprises a number of units providing accommodation for between one and eight people in each unit. One unit provides short breaks for people and includes two emergency beds for people requiring immediate care and support. Rowan and Beech units form an area known as ‘The Hostel’. The other units: Peartree, Sycamore, Holly Cottage, Cherry Cottage, Ash and Willow are part of an ‘Intensive Support Unit’ (ISU). People have access to gardens surrounding the home.

A registered manager was 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.

At the last inspection in December 2015 the service was rated Good. At this inspection we found that the provider had been unable to sustain the rating of Good as we identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also found one breach of the Care Quality Commission (Registration) Regulations 2009. You can see what action we have asked the provider to take at the end of the full version of this report.

At the last inspection in December 2015 we found the provider was meeting the regulations, but there was a lack of quality audit systems in place in two areas and no specific system in place to monitor the quality of care delivered. We asked the provider to make improvements to these areas.

At this inspection we found the provider had taken steps to improve the two areas lacking quality monitoring and oversight, which related to ensuring medicines were managed safely and checks made to ensure that areas were cleaned thoroughly and effectively. However, the provider continued to not have an effective system for monitoring how the quality of care was assessed, planned and delivered. At our last inspection we found this had not impacted people’s safety. At this inspection we found risk assessments provided incomplete information about people’s risks and insufficient information and guidance for staff on how to mitigate risks.

The provider had also not notified CQC of relevant incidents of notifiable events when necessary.

The care 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.

Health and safety

The inspection took place on 1 December 2015 and was unannounced.

Stanhope Lodge is situated on the edge of a residential housing estate on the outskirts of Worthing. It is registered to provide accommodation and care for up to 28 people with a learning disability and/or challenging behaviour and other complex needs. The provider refers to people using the service as ‘customers’. The service comprises a number of units providing accommodation for between one and eight people in each unit. One unit provides short breaks for people and includes two emergency beds for people requiring immediate care and support. Rowan and Beech units form an area known as ‘The Hostel’. The other units: Peartree, Sycamore, Holly Cottage, Cherry Cottage, Ash and Willow are part of an ‘Intensive Support Unit’ (ISU). People living in the ISU require a minimum of 1:1 support by staff. There is a mixture of communal areas, such as living rooms and kitchens, whilst other units are self-contained and offer individual accommodation with sitting rooms, kitchens and bathrooms for people living there. People have access to a range of garden and courtyard areas.

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.

People were supported by staff who understood how to identify, assess and manage their risks safely. Staff were trained in safeguarding adults at risk and knew what action to take in the event of abuse taking place. Effective reporting systems were in place in relation to the management of incidents and accidents and measures were in place to prevent reoccurrence. Generally, premises were managed safely, although a lack of investment by the provider meant that some areas of the service were in need of redecoration or refurbishment. There were sufficient numbers of staff on duty at all times to support people safely and the provider followed safe recruitment practices. People’s medicines were managed safely by trained staff.

Staff received care from staff who had been trained in a wide range of areas and new staff followed an induction which included the Care Certificate, a universally recognised qualification. There were a number of training opportunities on offer to staff who had access to the local authority’s learning gateway on line. Team meetings were held and people’s care was reviewed. Staff had a good understanding of the Mental Capacity Act 2005 and associated legislation under the Deprivation of Liberty Safeguards and put this into practice. People were supported to have sufficient to eat and drink and to maintain a healthy lifestyle. They had access to a range of health and social care professionals. People were encouraged to personalise their rooms and to choose how they wanted their rooms furnished.

People were cared for by kind and caring staff who understood them well. People’s likes and dislikes, choices and preferences were taken account of and staff demonstrated they met people’s needs in line with these. As much as they were able, people were able to express their views and to be involved in decisions about their care. Relatives were also involved and attended annual care reviews. People were treated with dignity and respect.

People received personalised care that responded to their needs. Many people were out during the day, either attending a day centre or pursuing an activity in the community. A wide range of activities was available to people. Care plans provided comprehensive information about people’s care needs. Where people exhibited challenging behaviour, support plans provided advice and guidance to staff on how this should be managed. The provider had a complaints policy in place and complaints were responded to in line with this policy and to the satisfaction of the complainant.

People and their relatives were asked for their views about the service through an annual questionnaire and were positive about Stanhope Lodge overall. People received person-centred care and staff responded to people’s needs in a personalised way. Staff understood the importance of being open and honest with people and their relatives and had a good understanding of the vision and values of the home. The registered manager was involved in all aspects of the service and supported staff effectively. There was a range of audit systems in place for kitchen management and analysis of accidents and incidents, but there was a lack of audits in cleaning, medicines and quality of care.

We used a number of different methods to help us to understand the experiences of people using the service as the people had complex needs which meant that they were not able to tell us their experiences in detail.

There were sixteen permanent people and eleven short-stay living at the home at the time of the inspection. During our visit we observed staff talking to people with respect and compassion and assisting them in making choices. We found that people attended a local day centre regularly and undertook other activities.

We read in care records that every person had a personalised care and support plan that was suitable to their needs and reviewed regularly and that people were involved with these. We saw that there were regular meetings where people's views were listened to and valued. Through observation we saw people being offered choice as to what they wanted to do and how their room's were decorated. We saw that regular audits of the service were completed by the provider ensuring that people who used the service benefited from a service that constantly monitored its quality of care provided.

Staff told us that they felt they had adequate training and were well supported in order to carry out their role and to meet the needs of the people in the home. We found that safeguarding training had been received by all staff and that their responsibility was well understood.

We used a number of different methods to help us understand the experiences of people using the service, because the people using the service had complex needs which meant they were not able to tell us their experiences in great details.

We observed that staff asked people about how and when they wanted their care and support. This indicated that people were involved in planning their care on a daily basis.

People living at the service told us that they were happy in their home and that staff listen to them and that they liked the food.

During our inspection we observed that people’s bedrooms had been personalised and adapted to meet their individual needs.

We spoke with staff and staff demonstrated an understanding of the safeguarding procedures and the different forms of abuse.

During our inspection we saw that people were provided with a choice of suitable and nutritious food and drink.

Although there were a number of systems to regularly assess and monitor the quality of services the provider may wish to note that there was no tool in place for overall monitoring of quality assurance which showed that they regularly assessed and monitored the quality of services provided.

Risk assessment reviews and records were inconsistent for example the provider had a monthly review record in place however reviews had not been held monthly, reviews ranged from two to three monthly.

People had limited capacity to talk with us and explain about life in the home. However, one person was able to tell us that they were happy living in the home, that care and support was offered according to their wishes and that all people were encouraged to be involved in the community including daycentres, colleges , churches and leisure activities. We were told people like to go on holidays.

A relative spoke very highly about home and told us that it compares very favourably with other homes he has known.