This focused inspection took place on 4 and 5 February 2019 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 reached. 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 February 2019, we have inspected a number of Sussex Health Care locations in relation to concerns about variation in quality and safety across their services and have reported on what we found.

This inspection took place due to information shared with CQC about concerns around the management of people's care needs. However, this inspection did not examine the specifics of those incidents and focused on what the care experience was for all people living at The Granary. At the inspection we rated the Key Questions ‘Safe’, ‘Effective’ and ‘Well-led’.

No risks, concerns or significant improvement were identified in the remaining Key Questions through our ongoing monitoring or during our inspection activity so we did not inspect them. The ratings from the previous comprehensive inspection for these Key Questions were included in calculating the overall rating in this inspection.

The Granary is a care home that provides nursing and residential care. 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.

The Granary provides nursing and personal care for up to 41 people who may have learning disabilities, acquired brain injury and other neurological conditions. Most people had complex mobility and communication needs. At the time of our inspection there were six people living at The Granary and one person receiving short term care. The Granary provides accommodation across four ground floor units: Walnut, Pine, Yew and Alder. Each unit has a separate living room, dining room and kitchenette. At the time of this inspection, people were accommodated in Walnut and Alder, the other two units, which could accommodate 10 people each, were unoccupied. Rooms were of single occupancy and had en-suite facilities.

There was no registered manager at the time of this inspection. 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. A new manager had been employed since December 2018 and had applied to become the registered manager.

The Granary has not been operated and developed in line with all the values that underpin the Registering the Right Support and other best practice guidance. The Granary was designed, built and registered before this guidance was published. However, the provider has not developed or adapted The Granary in response to changes in best practice guidance. Had the provider applied to register The Granary today, the application would be unlikely to be granted. The model and scale of care provided is not in keeping with the cultural and professional changes to how services for people with a learning disability should be operated to meet their needs. People with learning disabilities using the service should be able to live as ordinary a life as any citizen.

At the last inspection in September 2018, the service was found to be in breach of legal requirements and was given a rating of 'Requires Improvement'. Th

This inspection took place on 21 September 2018 and was unannounced.

The Granary is a 'care home'. People in care homes receive accommodation and nursing or personal care as 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. The home is registered to provide accommodation and care for up to 41 people with an acquired brain injury or neurological condition, learning and physical disabilities. At the time of our visit 11 people were living at the home, including one person who was staying for a short break.

The Granary provides accommodation across four ground floor units: Walnut, Pine, Yew and Alder. Each unit has a separate living room, dining room and kitchenette. At the time of this inspection, people were accommodated in Walnut and Alder, the other two units, which could accommodate 10 people each, were unoccupied. Rooms were of single occupancy and had en-suite facilities.

At the time of our inspection the service did not have a registered manager in post. The last registered manager left in July 2018. 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 of the Health and Social Care Act 2008 and associated regulations. The acting manager assisted us with the inspection. The provider had put measures in place to ensure the service had adequate management support whilst they were recruiting a new manager.

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.

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 the last inspection on 7 and 11 December 2017 the service was rated requires improvement. The report was published in March 2018. At that inspection we identified five regulatory breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was due to the provider failing to ensure that staff received the training they needed to meet the needs of people. Some staff did not have regular supervisions as defined by the provider's policy. The provider had failed to ensure that care and treatment was provided to people with the consent of the relevant person. People were not treated with dignity and respect at all times. The provider had failed to ensure that people using the service had care or treatment that was personalised specifically for them. The provider did not have effective systems in place to assess, monitor and improve the quality and safety of the services provided in the carrying on of the regulated activity.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve each of the key question's to at least good.

At this inspection, we found although improvements had been made the registered provider remained in breach of one of the five previous breaches of Regulation. People were supported to access a wide range of activities, which included involvement and use of the local and wider community. However, people’s interests were not fully reflected in their weekly activity time

The inspection took place on 7 and 11 December 2017 and was unannounced. This is the first inspection since the service was registered with the Commission in July 2015, but was dormant until it was opened to new service users in December 2016.

Since the registration of The Granary, services operated by the provider had been subject to a period of increased monitoring and support by commissioners. The Granary had been the subject of three safeguarding concerns about a person not receiving care in line with their health needs, a risk of injury posed by a person’s equipment and an allegation of physical abuse. 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 December 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.

The Granary is a care home that provides nursing and residential care. 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.

The Granary is registered to provide nursing and accommodation for up to 41 people with an acquired brain injury or neurological condition. At the time of the inspection, 9 people were living at the home, including one person who was staying for a short break. The Granary provides accommodation across four ground floor units: Walnut, Pine, Yew and Alder. Each unit has a separate living room, dining room and kitchenette. At the time of this inspection, people were accommodated in Walnut, the other three units, which could accommodate 10 people each, were unoccupied. Rooms were of single occupancy and had en-suite facilities.

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.

Staff did not complete specific training to enable them to understand acquired brain injury or neurological conditions that affected people living at The Granary. Staff did not receive supervisions in line with the provider’s policy, which stated these should be completed three times a year.

People’s consent to care and treatment was not always gained in line with the requirements of the Mental Capacity Act 2005. Where people had been assessed as lacking capacity to make specific decisions, processes were not followed to ensure decisions taken were in people’s best interests.

Systems were not effective in measuring and monitoring the quality of the service provided. Where actions were identified, these had not always been completed. There were ineffective systems in place to drive continuous improvement. Monitoring records were not always completed consistently.

People were not always treated with dignity and respect, for example, how they were supported at mealtimes and how staff referred to people's personal care needs in a communal setting.

Care records did not always reflect that people received personalised care that met their needs. Some care plans relating to people’s specific areas of need lacked detailed information and guidance for staff on how to support people in a responsive way, for example, in expressing sexuality. Activities were organised but did not take account of people’s identified interests and pr