Archived: White Lodge

Updated 26 January 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 22 November 2017 and was unannounced. The inspection team consisted of two inspectors.

Although this comprehensive inspection had been planned, the inspection plan was informed, in part, by concerns that had been raised about the quality and safety of locations operated by this provider. A number of safeguarding and quality concerns in relation to the provider, Sussex Health Care, are the subject of a police investigation and safeguarding enquiries although none of these concerns relate to White Lodge specifically. As a result this inspection did not examine the circumstances of the specific allegations made about the registered provider. However, the information of concern shared with the Commission indicated potential concerns about staff training, delivery of person-centred care and good governance. Therefore we examined those themes in detail as part of this inspection.

Before the inspection we reviewed the information we held about the service. We used information the provider sent us in the Provider Information Return. This is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make. We also looked at reports from previous inspections and statutory notifications submitted by the provider. Statutory notifications contain information providers are required to send us about significant events that take place within services.

During the inspection, people were unable to share their experiences with us due to their complex communication needs. In order to understand their experiences of using the service we observed staff carrying out care and support and the way they interacted with people.

We spoke with the senior staff team which consisted of the deputy manager, the area manager for the service and the Head of Quality from the provider’s organisation. We also spoke with three members of staff who were care support workers. We looked at three people’s care records, four staff files, medicines administration records (MARs) for three people and other records relating to the management of the service.

After the inspection we spoke with five relatives of people using the service. The provider also wrote to us to provide information we asked for during the inspection. This included proof of servicing of the gas heating system, proof of water hygiene checks, the improvement plan for the environment, details of the interim management arrangements for the service and confirmation of the deep clean of the environment and epilepsy training arranged for staff.

Updated 26 January 2018

This inspection took place on 22 November 2017 and was unannounced. The last Care Quality Commission (CQC) comprehensive inspection of the service was carried out in July 2015. At that inspection we gave the service an overall rating of ‘good’.

Since that inspection, services operated by the provider had been subject 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 a police investigation. There have been no specific safeguarding or criminal allegations made about White Lodge. However, we used the information of concern raised by partner agencies about this provider to plan what areas we would inspect and to judge the safety and quality of the service at the time of the inspection. 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.

White Lodge is a ‘care home’. People in care homes receive accommodation and 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. White Lodge accommodates eight people with a learning disability in one adapted building. At the time of this inspection seven people were using the service.

The service had a registered manager in post. 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 2008 and associated Regulations about how the service is run. At the time of this inspection the registered manager was absent from the service. The provider had put arrangements in place to ensure there was adequate day to day management of the service in the registered manager’s absence. They had also increased their monitoring of the service to check that these arrangements remained appropriate.

Some aspects of the service had deteriorated since our last inspection, resulting in the overall rating for the service changing from ‘good’ to ‘requires improvement.’ Staff had not received all the support they needed to deliver effective care to people. They were not provided with training to meet the specialist needs of people using the service. Staff had supervision (one to one meetings) with senior staff to help them improve their working practices and the quality of support provided to people However they told us the frequency of these meetings could be improved.

Systems in place to assess, monitor and review the quality and safety of the service, were not always effective. The provider had not identified or addressed issues we found about some aspects of the service. They had not used learning from recent inspections of other Sussex Health Care locations to improve working practices at White Lodge. However checks of other aspects of the service had been undertaken to ensure these areas continued to be well managed and safe. The provider had plans to address some of the shortfalls we found but it was too early at this time to judge how these would lead to improved outcomes for people.

Some parts of the environment were clean and hygienic. However some areas of the environment would have benefited from additional and more thorough cleaning. There was a lack of personalisation in communal areas such as the living and dining room, but people’s rooms had been decorated and personalised to their preference. The provider had continued to maintain a servicing programme of the premises and the equipment used by staff to ensure those areas of the service covered by these checks did not pose unnecessary risks to people. After our inspection the provider arranged for a deep clean of the environment to be undertaken. They also sent us their plan for repairs, redecoration and refurbishment across the whole of the environment.

The quality of records maintained by the service was variable. Although most records were current and accurate, some of the information the service held about people on their records needed to be updated. Records maintained of staff supervision meetings were minimal and would not have supported senior staff to review how effective staff were when supporting people.

Opportunities for people to have their social and physical needs met were mixed. Some people undertook a wide range of activities daily. However people who did not go out regularly were not always appropriately stimulated and engaged when at home. The area manager told us training for staff would be provided in how to offer and deliver appropriate activities to people at home.

Staff knew how to protect people from the risk of abuse or harm. They followed guidance to minimise identified risks to people in the home and community. There were enough staff at the time of this inspection to keep people safe. The provider had adequate arrangements in place to check the suitability and fitness of any new staff.

Staff ensured that people ate and drank sufficient amounts to meet their needs, monitored their health and wellbeing and supported them to access healthcare services when they needed to. People’s medicines were managed safely and people received them as prescribed. Staff adhered to the Mental Capacity Act 2005 (MCA). People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Staff were kind, attentive and respected people’s dignity and right to privacy. They were aware of people’s communication methods and how they expressed themselves. They supported people to undertake tasks and activities aimed at encouraging and promoting their independence.

People and their relatives were involved in planning and reviewing the care and support people required. People had a current care plan which was regularly reviewed and updated in line with any changes to their needs. Staff respected people’s individual differences and supported them with any religious or cultural needs. People were supported to maintain relationships with the people that mattered to them and there were no unnecessary restrictions placed on family and friends when visiting the service.

People’s views had been sought about how some aspects of the service could be improved. These had been used to tailor mealtimes to people's preference. Relatives had mixed satisfaction levels with the service but said senior staff were responsive when dealing with their concerns. The provider maintained appropriate arrangements to deal with people’s concerns or complaints if they were unhappy with any aspect of the support provided.

At this inspection we found the provider in breach of legal requirements with regard to staffing and good governance. You can see what action we told the provider to take with regard to these breaches at the back of the full version of the report.