Archived: Woodhurst Lodge

Updated 8 January 2021

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by two inspectors.

Service and service type

Woodhurst Lodge 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.

The service had a manager employed but did not have a manager registered with the Care Quality Commission (CQC). At the time of this inspection, the manager had applied to CQC to be the registered manager for the service and their application was being processed. This means the provider held sole legal responsibility for how the service is run and for the quality and safety of the care provided.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

Before the inspection we reviewed the information we held about the service and the service provider. We looked at the notifications we had received for this service. Notifications are information about important events the service is required to send us by law. We used all this information to plan our inspection.

The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report. We used all this information to plan our inspection.

During the inspection

We spoke with two people and three relatives about their experience of the care provided. We spoke to nine members of staff including the manager, clinical lead, administrator, activities co-ordinator, care workers, domestic staff, and the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider. Due to some people's complex needs they were unable to tell us about their experiences of the service. We made observations of care to help us understand the experiences of people who could not talk with us.

We reviewed a range of records. This included eight people’s care records and multiple medication records. We looked at two staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We looked at training data and quality assurance records. We continued to receive feedback from health and social professionals who have contact with the service.

Updated 8 January 2021

About the service

Woodhurst Lodge provides nursing and personal care in one building for up to 10 people living with a range of neurological conditions and/or acquired brain injury. At the time of our inspection, eight people were living at the service. The service is in a rural setting and is purpose built to accommodate the needs of people with complex disabilities and neurological conditions. Accommodation is provided on one level. Communal areas include a lounge and dining room, with access to gardens and grounds.

Woodhurst Lodge is owned and operated by the provider Sussex Healthcare. Services operated by Sussex Healthcare have been subject to a period of increased monitoring and support by local authority commissioners. Due to concerns raised about the provider, Sussex Healthcare is currently subject to a police investigation, the investigation is on-going, and no conclusions have yet been reached.

People’s experience of using this service and what we found

Risks to people's health were not consistently managed. People did not always receive safe support in relation to infection prevention and control. People's risk of aspiration was not always documented. Systems used to monitor people's health were not always applied consistently. This meant people could not be assured of receiving appropriate care and treatment and were placed at increased risk of avoidable harm.

Staff training and supervision did not always ensure people received safe care and treatment. There were not adequate processes in place for assessing and monitoring the quality of the services provided and that records were accurate and complete. Systems had failed to identify that people were not always protected from avoidable harm. Safe care practices were not always recorded accurately within people's care records. Lessons learnt were not always identified or translated into practice.

People’s care plans were not always suitably individualised around their needs to ensure they were supported to have maximum choice and control of their lives. People were supported in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. Throughout the inspection we saw people treated with dignity and respect. People and their relatives confirmed this was also their experience.

People were involved in activities and these were specific to peoples interests and wishes. The Covid-19 pandemic had significantly reduced participation in activities outside of the building, however the service had increased the range of meaningful activities that could happen inside the building and grounds. People’s rooms were personalised and the atmosphere in the service was one of calm.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

In December 2018 the Care Quality Commission imposed provider wide conditions on the provider's registration. The conditions are therefore imposed at each service operated by the provider. CQC imposed the conditions due to repeated and significant concerns about the quality and safety of care at several services operated by the provider. The conditions mean that the provider must send to the CQC, monthly information about incidents and accidents, unplanned hospital admissions and staffing. We will use this information to help us review and monitor the provider's services and actions to improve, and to inform our inspections. We carried out an unannounced comprehensive inspection of this service on 13 and 14 August 2019. A breach of legal requirements was found in Regulation 17 (Good Governance). The provider completed an action plan after the last inspection to show what they would do and by when to improve. This service has been rated Requires improvement for the last four consecutive inspections. We will describe what we will do about the repeat Requires improvement in the follow up section below.

Why we inspected

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions, Safe, Responsive and Well-led which contain those requirements. The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has remained Requires Improvement. This is based on the findings at this inspection. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Woodhurst Lodge on our website at www.cqc.org.uk.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

We have found evidence the provider needs to make improvements. Please see the Safe, and Well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.

We have identified one continued breach of the Health and Social Care Act 2008 (Regulated Activities) Regulation 17- Good Governance, and two new breaches in relation to Regulation 12- Safe Care and Treatment and Regulation 18- Staffing.

Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded. Follow up We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.