We carried out a review of the data available to us about Stanhope Lodge on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Stanhope Lodge, you can give feedback on this service.
Stanhope Lodge is a residential care home providing personal care to people with a learning disability and/or Autistic people. The service accommodates people across nine buildings, each of which has separate adapted facilities. People have access to gardens surrounding the service.
The service was registered for the support of up to 28 people. At the time of this inspection 17 people were using the service.
People’s experience of using this service and what we found
We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.
This was a targeted inspection which considered systems and processes to safeguard people from the risk of abuse and staff recruitment. Based on our inspection of safeguarding from the risk of abuse and recruitment we found:
Right Support:
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. People knew who to tell if they experienced something, they were not comfortable with. People and staff, we spoke with knew about abuse and how to report it.
Right Care: People were taken seriously when they did raise concerns and were supported to understand what might happen next. Concerns were reported to the correct agencies, for example the police, local authority safeguarding team and CQC. Investigations were undertaken and outcomes shared appropriately.
Right Culture: The ethos, values, attitudes and behaviours of leaders and care staff ensure people had staff that were appropriately recruited and trained to identify abuse.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection The last rating for this service was good (published 10 September 2019).
Why we inspected
We undertook a targeted inspection to follow up on specific concerns which we had received about the service. The concerns were about safeguarding people from the risk of abuse and safe recruitment of staff. A decision was made for us to inspect and examine those risks.
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 COVID-19 and other infection outbreaks effectively.
We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe section of this full report.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Stanhope Lodge on our website at www.cqc.org.uk.
Follow up
We will continue to monitor information we receive about the service, which will help inform when we next inspect.
We found the following examples of good practice.
Stanhope Lodge had been able to respond quickly to the pandemic, making full use of the layout of the site. There was a building at the main entrance which had been set aside for staff to change clothes and put on personal protective equipment on arrival. The reception had created an external welcome area where temperatures were taken and all visitors were risk assessed. Staff worked in individual cottages on the site which reduced the risk of cross infection.
The provider had installed Wi-Fi and routers to allow people to keep in contact with families and friends as well as giving access to on-line activities during the pandemic. The training and education of the staff and supported people had been inclusive and individual. This had resulted in supported people being comfortable with staff wearing face masks. People were now able to wear their own masks to go shopping.
Further information is in the detailed findings below.
Stanhope Lodge is a residential care home providing personal care to people with a learning disability and/or challenging behaviour and other complex needs. The service accommodates people across nine buildings, each of which has separate adapted facilities. People have access to gardens surrounding the service.
The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.
The service was registered for the support of up to 28 people. 18 people were using the service. This is larger than current best practice guidance. However. the size of the service having a negative impact on people was mitigated by the building design fitting into the residential area and the other large domestic homes of a similar size. There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home. Staff were discouraged from wearing anything that suggested they were care staff when coming and going with people.
People’s experience of using this service and what we found
The Secretary of State has asked the Care Quality Commission (CQC) to conduct a thematic review and to make recommendations about the use of restrictive interventions in settings that provide care for people with, or who might have, mental health problems, learning disabilities and/or autism. Thematic reviews look in-depth at specific issues concerning quality of care across the health and social care sectors. They expand our understanding of both good and poor practice and of the potential drivers of improvement.
As part of the thematic review, we carried out a survey with the provider at this inspection. This considered whether the service used any restrictive intervention practices (restraint, seclusion and segregation) when supporting people. The service used some restrictive intervention practices as a last resort, in a person-centred way, in line with positive behaviour support principles. Where interventions were used the registered manager agreed to record where lessons could be learnt to reduce the likelihood an incident would occur again.
The service supported people to learn new skills and maintain their independence. People planned and took part in activities that met their needs and preferences and they were supported to follow their interests.
There was a visible person-centred culture at the service. Staff had a clear understanding of people's needs and had developed positive relationships with them and their family members. Staff were very supportive and sensitive when supporting people to follow their diverse wishes and preferences.
One person described themselves as a “very happy man.” A relative fedback, ‘The staff that support [person] are so dedicated to him nothing is too much trouble, they are always trying to improve and introduce new ideas in to his accommodation and daily routine, so his quality of life is more fulfilled and interesting.’
The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensured people who used the service can live as full a life as possible. This had resulted in exceptional achievements and outcomes that included control, choice and independence for people. People planned for activities that met their needs and preferences and they were supported to follow their interests.
The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.
Risks to people had been assessed to ensure their needs were safely met. One person said, “I am very safe.” The service had procedures in place to reduce the risk of infections. A relative fedback, ‘The service provided is extremely safe, they take into account every aspect of [person’s] needs making it a priority in ensuring he is safe throughout the day.’
The service had safeguarding and whistleblowing policies and procedures in place and staff had a clear understanding of these procedures. Appropriate recruitment checks had taken place before staff started work and there were enough staff available to meet people's care and support needs. People's medicines were managed safely.
People's care and support needs were assessed before they started to use the service. Staff had the skills, knowledge and experience to support people appropriately. Staff were supported through induction, training and regular supervision. People were supported to maintain a healthy balanced diet and had access to health care professionals when they needed them.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.
People and their relatives (where appropriate) had been consulted about their care and support needs. The service had a complaints procedure in place. There were procedures in place to make sure people had access to end of life care and support if it was required.
The registered manager had worked in partnership with health and social care providers to plan and deliver an effective service. The provider took people and their relatives views into account through satisfaction surveys. Staff enjoyed working at the service and said they received excellent support from the registered manager.
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
The last rating for this service was requires improvement (published 12 September 2018) and there were three breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.
Why we inspected
This was a planned inspection based on the previous rating. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Stanhope Lodge on our website at www.cqc.org.uk.
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.
The inspection was prompted in part by information of concern raised by partner agencies. This was following an investigation in August 2018 of an incident which a person using the service died in 2016. This incident is not currently subject to a criminal investigation. However, the information shared with the Care Quality Commission (CQC) about the incident indicated potential concerns about the management of risk of how epilepsy and other specific health conditions was assessed and planned for. This inspection examined those risks.
Stanhope 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. Stanhope Lodge is registered to provide accommodation and care for up to 28 people with a learning disability and/or challenging behaviour and other complex needs. At the time of our visit 20 people were residing.
The service comprises a number of units providing accommodation for between one and eight people in each unit. One unit provides short breaks for people and includes two emergency beds for people requiring immediate care and support. Rowan and Beech units form an area known as ‘The Hostel’. The other units: Peartree, Sycamore, Holly Cottage, Cherry Cottage, Ash and Willow are part of an ‘Intensive Support Unit’ (ISU). People have access to gardens surrounding the home.
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.
At the last inspection in December 2015 the service was rated Good. At this inspection we found that the provider had been unable to sustain the rating of Good as we identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also found one breach of the Care Quality Commission (Registration) Regulations 2009. You can see what action we have asked the provider to take at the end of the full version of this report.
At the last inspection in December 2015 we found the provider was meeting the regulations, but there was a lack of quality audit systems in place in two areas and no specific system in place to monitor the quality of care delivered. We asked the provider to make improvements to these areas.
At this inspection we found the provider had taken steps to improve the two areas lacking quality monitoring and oversight, which related to ensuring medicines were managed safely and checks made to ensure that areas were cleaned thoroughly and effectively. However, the provider continued to not have an effective system for monitoring how the quality of care was assessed, planned and delivered. At our last inspection we found this had not impacted people’s safety. At this inspection we found risk assessments provided incomplete information about people’s risks and insufficient information and guidance for staff on how to mitigate risks.
The provider had also not notified CQC of relevant incidents of notifiable events when necessary.
The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.
Health and safety audits were completed as needed and checks made on the safety of equipment, electrical installations and gas safety. Staff had been trained to recognise the signs of potential abuse and knew what action to take. Safe recruitment practices were in place. Medicines were managed safely. People were protected by the prevention and control of infection and lessons had been learnt when things had gone wrong.
Staff we spoke with understood the requirements of the Mental Capacity Act (MCA). Staff completed training in a range of areas including safeguarding, moving and handling, first aid, health and safety. New staff followed the Care Certificate, a nationally recognised qualification. Staff meetings took place monthly and records confirmed this. Staff received monthly supervision and annual appraisal and told us they felt supported in their roles. People's nutrition and hydration needs were catered for. People received support from a range of healthcare professionals and services. People had benefited from the accommodation being adapted, designed and decorated in a way that met their needs and expectations.
Staff had a good understanding of person-centred care. A range of activities was organised for people at the home. Complaints were managed in line with the provider’s policy. People and their relatives knew who to talk with if they had any concerns or wished to make a complaint.
There was a range of quality audits in place completed by the management team. These were up-to-date and completed on a regular basis. Accidents and incidents were reported and monitored to identify any patterns or trends. People and their relatives were asked for their views about the service and actions taken where needed. Staff we spoke with felt supported by the management and leadership of the home.
At the time of our inspection the quality assurance manager and registered manager gave us a detailed list of actions that would be taken to address the issues and concerns we found at inspection.
The inspection took place on 1 December 2015 and was unannounced.
Stanhope Lodge is situated on the edge of a residential housing estate on the outskirts of Worthing. It is registered to provide accommodation and care for up to 28 people with a learning disability and/or challenging behaviour and other complex needs. The provider refers to people using the service as ‘customers’. The service comprises a number of units providing accommodation for between one and eight people in each unit. One unit provides short breaks for people and includes two emergency beds for people requiring immediate care and support. Rowan and Beech units form an area known as ‘The Hostel’. The other units: Peartree, Sycamore, Holly Cottage, Cherry Cottage, Ash and Willow are part of an ‘Intensive Support Unit’ (ISU). People living in the ISU require a minimum of 1:1 support by staff. There is a mixture of communal areas, such as living rooms and kitchens, whilst other units are self-contained and offer individual accommodation with sitting rooms, kitchens and bathrooms for people living there. People have access to a range of garden and courtyard areas.
There was a registered manager 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.
People were supported by staff who understood how to identify, assess and manage their risks safely. Staff were trained in safeguarding adults at risk and knew what action to take in the event of abuse taking place. Effective reporting systems were in place in relation to the management of incidents and accidents and measures were in place to prevent reoccurrence. Generally, premises were managed safely, although a lack of investment by the provider meant that some areas of the service were in need of redecoration or refurbishment. There were sufficient numbers of staff on duty at all times to support people safely and the provider followed safe recruitment practices. People’s medicines were managed safely by trained staff.
Staff received care from staff who had been trained in a wide range of areas and new staff followed an induction which included the Care Certificate, a universally recognised qualification. There were a number of training opportunities on offer to staff who had access to the local authority’s learning gateway on line. Team meetings were held and people’s care was reviewed. Staff had a good understanding of the Mental Capacity Act 2005 and associated legislation under the Deprivation of Liberty Safeguards and put this into practice. People were supported to have sufficient to eat and drink and to maintain a healthy lifestyle. They had access to a range of health and social care professionals. People were encouraged to personalise their rooms and to choose how they wanted their rooms furnished.
People were cared for by kind and caring staff who understood them well. People’s likes and dislikes, choices and preferences were taken account of and staff demonstrated they met people’s needs in line with these. As much as they were able, people were able to express their views and to be involved in decisions about their care. Relatives were also involved and attended annual care reviews. People were treated with dignity and respect.
People received personalised care that responded to their needs. Many people were out during the day, either attending a day centre or pursuing an activity in the community. A wide range of activities was available to people. Care plans provided comprehensive information about people’s care needs. Where people exhibited challenging behaviour, support plans provided advice and guidance to staff on how this should be managed. The provider had a complaints policy in place and complaints were responded to in line with this policy and to the satisfaction of the complainant.
People and their relatives were asked for their views about the service through an annual questionnaire and were positive about Stanhope Lodge overall. People received person-centred care and staff responded to people’s needs in a personalised way. Staff understood the importance of being open and honest with people and their relatives and had a good understanding of the vision and values of the home. The registered manager was involved in all aspects of the service and supported staff effectively. There was a range of audit systems in place for kitchen management and analysis of accidents and incidents, but there was a lack of audits in cleaning, medicines and quality of care.
There were sixteen permanent people and eleven short-stay living at the home at the time of the inspection. During our visit we observed staff talking to people with respect and compassion and assisting them in making choices. We found that people attended a local day centre regularly and undertook other activities.
We read in care records that every person had a personalised care and support plan that was suitable to their needs and reviewed regularly and that people were involved with these. We saw that there were regular meetings where people's views were listened to and valued. Through observation we saw people being offered choice as to what they wanted to do and how their room's were decorated. We saw that regular audits of the service were completed by the provider ensuring that people who used the service benefited from a service that constantly monitored its quality of care provided.
Staff told us that they felt they had adequate training and were well supported in order to carry out their role and to meet the needs of the people in the home. We found that safeguarding training had been received by all staff and that their responsibility was well understood.
We observed that staff asked people about how and when they wanted their care and support. This indicated that people were involved in planning their care on a daily basis.
People living at the service told us that they were happy in their home and that staff listen to them and that they liked the food.
During our inspection we observed that people's bedrooms had been personalised and adapted to meet their individual needs.
We spoke with staff and staff demonstrated an understanding of the safeguarding procedures and the different forms of abuse.
During our inspection we saw that people were provided with a choice of suitable and nutritious food and drink.
Although there were a number of systems to regularly assess and monitor the quality of services the provider may wish to note that there was no tool in place for overall monitoring of quality assurance which showed that they regularly assessed and monitored the quality of services provided.
Risk assessment reviews and records were inconsistent for example the provider had a monthly review record in place however reviews had not been held monthly, reviews ranged from two to three monthly.
A relative spoke very highly about home and told us that it compares very favourably with other homes he has known.