Archived: Beech Lodge

Updated 26 August 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 and a medicines inspector on the first day, and two inspectors and an inspection manager on the second day.

Service and service type

Beech 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 registered with the Care Quality Commission. This means that they and the provider are legally responsible 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 information we held about the service. We considered the information that had been shared with us since the last inspection by the provider, the local authority and other partner agencies and health and social care professionals. We used all of 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.

During the inspection-

We spoke with four people who used the service and two relatives about their experience of the care provided. We spoke with twelve members of staff including the provider, registered manager, assistant manager, senior care workers, care workers and the chef. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience 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 a variety of records relating to the management of the service, including policies and procedures which we reviewed.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We looked at care records and quality assurance records. We spoke with some relatives and staff.

Updated 26 August 2021

About the service

Beech Lodge is a residential nursing home providing personal and nursing care to 40 people with learning disabilities, physical disabilities and a range of neurological conditions such as autism. The service comprises of three separate buildings: Beech Lodge, Oak Lodge and Redwood House. At the time of this inspection Redwood House was not being used and did not form part of this inspection, and only one person was living in Oak Lodge. The service is located in a rural setting and is purpose built to provide ground floor accommodation for people with complex health needs and disabilities. At the time of this inspection 21 people were living at the service.

Beech 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

There was unsafe monitoring and management of risks around epilepsy, constipation, medicines, and behaviours that may challenge others. People were not being protected from abuse or neglect and we raised safeguarding concerns for some people at Beech Lodge.

Staff did not always have the correct training and competencies to support people with their needs. Medicines were not being managed safely and audits for medicines did not highlight issues we found.

The provider had acted to manage infection risks during the Covid-19 pandemic. Additional infection prevention and control measures in line with Department of Health and Social care guidelines had been put in place to ensure people's safety. During our inspection the service was clean, and staff had access to and wore appropriate personal protective equipment. Relatives told us the service was clean and well looked after with no bad odours.

There was a lack of sustained learning when things went wrong. Previous concerns around person centred care and people’s independence were still present at this inspection. There was a lack of good governance, and systems to drive improvements were not effective despite input from partner agencies such as the local safeguarding team and health team.

The culture in the service was poor and we saw examples of care and support that were not respectful or promoted independence, such as turning a TV off without asking people who were watching it. One relative told us they were worried about their loved one and kept visiting to check on them.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

Based on our review of Safe and Well led the service was not able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right support:

• Model of care and setting did not maximise people’s choice, control and independence.

• The service was rural and located in private grounds. Opportunities for people to access the community were limited.

Right care:

• Care is not person-centred and did not promote people’s dignity, privacy and human rights.

• People did not receive person centred support. For example, activities were in groups and not personalised.

• Staff did not always know when people may be in pain or distress.

Right culture:

• Ethos, values, attitudes and behaviours of leaders and care staff did not ensure people using services lead confident, inclusive and empowered lives

• The service did not have a positive culture and people were not supported to be as independent as they could. Some people were left for long times without engagement.

Rating at last inspection and update.

The last rating for this service was Inadequate (published 23 March 2021).

After the last inspection where we found breaches of regulation, the provider completed an action plan to show what they would do and by when to improve. At this inspection not enough improvement had been made and the provider was still in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

We carried out an unannounced comprehensive inspection of this service on 12, 13 and 15 October 2020. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve person centred care, dignity and respect, safe care and treatment, good governance, and staffing.

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 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 stayed at Inadequate. 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 Beech Lodge on our website at www.cqc.org.uk.

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 will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to person centred care, dignity and respect, safe care and treatment, safeguarding, good governance and 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 continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures:

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.