Highly critical report into care of disabled people at Beech Lodge in Horsham published ahead of its closure

In a report released today, the Care Quality Commission (CQC) told Sussex Health Care to protect people using the services at Beech Lodge in Horsham, after rating the service inadequate overall for the second time, following an inspection.

Beech Lodge, in Clemsfold near Horsham, is a residential nursing home for people with learning disabilities, physical disabilities and a range of neurological conditions. It was previously rated inadequate at an inspection in October 2020 and has a history of being rated as requires improvement.

In June, CQC undertook an unannounced focused inspection to check on the progress of improvements that the provider was told to make to the safety and management of the service.

In a statement the CQC said: "Beech Lodge is owned and operated by SHC Clemsfold Group Limited, also known as Sussex Healthcare. Services operated by Sussex Healthcare have been subject to a period of increased monitoring and support by CQC and local authority commissioners. Due to safeguarding concerns raised about the provider, Sussex Healthcare is also currently subject to an investigation by Sussex Police, the investigation is on-going, and no conclusions have yet been reached.

"Beech Lodge has also been subject to additional monitoring and support from CQC and other local agencies to drive improvements to the safety and quality of care. Despite these interventions, the provider hasn’t been able to implement or sustain effective improvements. After this inspection, it was rated inadequate overall and inadequate in respect of safety and leadership for the second time.

"CQC would have taken action at Beech Lodge, however, Sussex Healthcare has taken the decision to close six of its services including Beech Lodge. The other services that will close are Orchard lodge, Beechcroft Care Centre, Kingsmead Lodge and Wisteria Lodge. The Granary will also close its profound and multiple learning disability service however, its acquired brain injury service will remain open. Sussex Health Care plans to close all these service by 30 September 2021."

Debbie Ivanova, CQC’s deputy chief inspector for people with a learning disability and autistic people said: "After our inspection in October, Sussex Healthcare provided us with an action plan outlining how it intended to address our concerns. However, at the time of our recent inspection, this had not been implemented. Instead, our inspectors saw that daily life for people living at Beech Lodge was unacceptable. The culture in the service was poor and we saw examples of care and support that were not respectful or did not promote independence.

“Despite significant support and intervention from local agencies, and CQC producing detailed reports to help focus the provider’s attention on where improvements needed to be made following regulation breaches, we still didn’t see the required improvements at Beech Lodge. It is disappointing that the provider was unable to make or sustain effective improvements to keep people safe.

“People were given little choice over how they spent their time, and there was no respect for their wants, needs and dignity. Inspectors saw staff turning off a television that people were watching without asking. One person was sitting alone in their room and their trousers had slipped down, but nobody came to help. They also had nothing to look at, even though they liked to be sociable, and in their care plan it said it was important to them that they had a sensory stimulation.

“Aside from people’s choices, their safety was also compromised. For example, people were not being supported to eat and drink in a safe way. Some people living at Beech Lodge had guidelines to reduce their risk of choking or inhaling particles of food or fluid into their lungs. But inspectors saw that some people did not receive the support they needed with their meals. One person was coughing repeatedly throughout their meal, but staff continued to support them to eat and did not offer them a drink. This put them at risk of choking.

“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.

“Although we are aware that Sussex Healthcare plans to close Beech Lodge imminently, we will continue to work with the local safeguarding authority and other partners to monitor the service and to ensure people living at Beech Lodge are moved to other homes which are appropriate to their needs.”

Inspectors found the following areas of concern:

- 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. 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.

- People were not being protected from abuse or neglect. Audits and processes to highlight safeguarding concerns had not been effective in identifying shortfalls and protecting people from possible harm. The service had been receiving support from the local authority as part of operational provider concerns under the Sussex Multi-Agency Policy and Procedures for Safeguarding Adults at Risk. However, despite input from different agencies there was no improvement in the protection of people from neglect or abuse.

- There were not enough skilled or competent staff to keep people safe. Despite adding an extra staff member during the daytime, there were still times when people were left with little or no support.

- Staff did not always have the correct training and competencies to support people’s needs. They had not been trained to follow safe and lawful restraint techniques and did not have training in positive behaviour support. Staff also did not always know when people may be in pain or distress.

- There was unsafe monitoring and management of risks around epilepsy, constipation, medicines, and behaviours that may challenge others. This issue was picked up during the previous inspection in October but had not been addressed.

- Leaders and staff did not ensure that people using the service were able to lead confident, inclusive and empowered lives. People were not supported to be as independent as they could be, and some people were left for long periods without any engagement at all.

- Care was 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. The service was rural and located in private grounds and opportunities for people to access the community were limited.

In response, a spokesperson at Sussex Healthcare said: “As an experienced care provider, Sussex Healthcare has been fully committed to providing the best care possible for those we support, but we have been unable to move our complex Profound and Multiple Learning Disability services, including Beech Lodge, forward to a position where we provide consistent, high-quality care.

“The decision to close the services was an incredibly difficult one. Many of the people we support have been with us for a very long time and the impact on them and their families has been our highest concern throughout. Our immediate priority is to ensure that those in our care are supported in their transition into appropriate alternative care. We will also be supporting our hard-working and dedicated staff through the service closure process.”