The inspection took place on 14 August 2018 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 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.

Woodhurst 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. Woodhurst Lodge is registered to provide accommodation and nursing care for up to 10 people with physical disabilities, learning disabilities and a range of neurological conditions and/or acquired brain injury. At the time of the inspection there were nine people living at the home. The home is located in a rural setting and is purpose built to accommodate the needs of people with complex physical disabilities and neurological conditions.

The home has a registered manager and they were present throughout the 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.

The last inspection on 19 July 2017 identified three breaches of the Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider had completed an improvement plan following the last inspection to show what they would do, and by when, to improve the key questions of is the service effective, caring, responsive and well-led, to at least good. At this inspection on 14 August 2018 there had been improvements in some areas of practice to address the identified breaches. However, in the key questions of responsive and well -led, it remained that some areas of practice required further improvement.

Woodhurst Lodge has not been operated and developed in line with the values that underpin the Registering the Right Support and other best practice guidance. Woodhurst Lodge was designed, built and registered before this guidance was published. However, the provider has not developed or adapted Woodhurst Lodge in response to changes in best practice guidance. Had the provider applied to register Woodhurst Lodge 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 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. Woodhurst Lodge is a large clinical setting rather than a small-scale homely environment. Woodhurst Lodge is geographically isolated in a rural area. For some people, there were limited opportunities to have meaningful engagement with the local community. Most people's social engagement and activities took place at Woodhurst Lodge.

Whilst improvements had been made to ensure that people’s social needs were met this was not consistent for everyone. Some people were not receiving the stimulation and social engagement that they needed to improve their quality of life. We ident

This inspection took place on 19 July 2017 and was unannounced.

The inspection was planned due to a previous rating of ‘Good’ published for Woodhurst Lodge in July 2015. However since that inspection, services operated by the provider had been subject to a period of increased monitoring and support by commissioners. Woodhurst Lodge had been the subject of one safeguarding concern about a person not receiving care as planned with their funding authority. 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.

Woodhurst Lodge is registered to provide accommodation and nursing care for up to 10 people with a range of neurological conditions and/or acquired brain injury. At the time of our inspection, the home was at full capacity. Communal areas include a dining room, sitting room, multi-sensory room, and spa facility. All rooms have en-suite wet room facilities and overhead tracking hoists. Woodhurst Lodge has extensive grounds which are accessible to people living at the home. The home is purpose-built and located in a rural setting, but within easy reach of the A23.

At the last inspection, the service was rated Good overall and in each domain, apart from Responsive, which was rated Requires Improvement. The rating of Requires Improvement was because there had been a change in the provision of activities which limited the opportunities for people to be involved in activities and spend time out in the community. 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.

At the time of our inspection, the registered manager had recently transferred to one of the provider's other homes as manager, but had not cancelled their registration at Woodhurst Lodge. 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 provider told us that a new manager had been recruited and was due to take up their post in September.

Staff had not always completed the training needed, and as required by the provider, to ensure their competency in providing support to people.

Care was not delivered in a personalised way and staff took little account of people’s documented interests when arranging activities. Care was not person-centred and staff did not always obtain people’s agreement when interacting with them. Care delivered by staff to people was task focused. People’s likes, dislikes and preferences were recorded in their care plans, but these were not taken into consideration when staff supported people.

Systems were not robust or effective in identifying the issues we found at inspection that have resulted in breaches of regulation. No system was in place to show how people were involved in developing the service and no formal feedback was obtained from relatives.

People were safe living at Woodhurst Lodge. The majority of staff had been trained to recognise the signs of potential abuse and knew what action to take if they suspected abuse was taking place. Risks to people were identified, assessed and managed appropriately.

The inspection took place on 19 May 2015 and was an unannounced inspection.

Woodhurst Lodge provides accommodation and nursing care for up to 10 people. The home is purpose built and well-equipped. It caters for people with long-term health needs including neurological conditions and acquired brain injury. At the time of our visit there were nine 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 told us that they were happy living at Woodhurst Lodge. They enjoyed the company of staff and received support in accordance with their individual wishes and preferences. In recent months the home had been without an activity coordinator or driver. Although provision had been made for people who wished to attend specific events, there had been fewer activities and outings on offer.

Staff had received training in neurological conditions and felt equipped to deliver support to the people living at Woodhurst Lodge. Staff spoke highly of the training offered by the provider and were encouraged to undertake additional qualifications. There was a system of regular supervision and appraisal to support staff in their professional development. Staff felt supported and were able to speak freely with the registered manager if they had suggestions or concerns.

There was an open and friendly atmosphere at the home. People appeared relaxed and visitors were warmly welcomed. Relatives spoke of the staff skill in understanding people’s non-verbal communication and anticipating their needs. People had been involved in planning their care and support and were involved in decisions relating to their care and treatment. 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).

There were enough staff on duty to meet people’s needs and to keep them safe. 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 received a choice of food and specific requests were cheerfully accommodated. Staff monitored people’s food and fluid intake to ensure that they received balanced nutrition and enough to drink.

Staff were quick to respond to changes in people’s needs and the service worked collaboratively with external healthcare professionals. Prompt action was taken to ensure that people received appropriate support.

The registered manager had a system to monitor and review the quality of care delivered and was supported by monthly visits from a representative of the provider. In addition, external audits of the service had been commissioned by the provider. The registered manager received regular feedback from people, their relatives, staff and visitors about the running and quality of the service. This included direct feedback and regular meetings. Where improvements had been identified, action plans were in place and used effectively.