The inspection took place on 23 and 24 May 2018. This was a comprehensive inspection and it was unannounced.

Services operated by the provider had been subject to a period of increased monitoring and support by commissioners. As a result of concerns raised, the provider is currently subject to a police investigation. We used the information of concern raised by partner agencies to plan what areas we would inspect and to judge the safety and quality of the service at the time of the inspection. Between May 2017 and May 2018, 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.

Forest Lodge is a care home that provides nursing and residential care. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided and both were looked at during this inspection.

Forest Lodge is registered to provide nursing and accommodation for up to 73 people. People cared for were older people who needed nursing care, some people had complex health needs and/or some people were living with dementia. At the time of our inspection there were 56 people living at the home. Accommodation is provided across three units Ash, Cedar and Beech. Eight people shared bedrooms and the rest were of single occupancy. People shared communal areas such as a large lounge and dining room.

A registered manager was in post who was not present during the inspection. 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.

On one occasion the service did not demonstrate the correct action was taken after an incident involving a person had occurred. This included any routine health checks to ensure harm had not been caused. We found inconsistencies with how risks were being managed, by the service, on behalf of people.

Staff were not always adequately trained to assist them in carrying out their role and responsibilities safely and effectively. We found there was an offensive odour related to urine incontinence in some communal areas. We recommended the provider reviews how many staff were deployed at night time as their was a lack of information available about how decisions were made about how many staff were needed to meet people's needs.

Group activities were offered to people. However, personalised activities and stimulation were not always provided. We observed caring approaches used by staff when supporting people. However, some aspects of the service were not consistently caring.

Systems were not always effective in measuring and monitoring the quality of the service provided. There were ineffective systems in place to drive continuous improvement.

People's consent to care and treatment was gained in line with the requirements of the Mental Capacity Act 2005. People were supported to have choice and control of their lives and for staff to support them in the least restrictive way possible; the policies and systems in the service supported this practice. Staff received supervisions and appraisals and they found the registered manager’s approach supportive.

People were provided choices on a daily basis regarding what food they ate and clothes they wore. Complaints were managed effectively. The provider sought feedback from people and their relatives regarding the care received.

The registered manager had sought information about the new Key Lines of Enquiry (KLOE) which the Commission introduced from 1 November 2017. They were keen to improve the quality and safety of care provided to people living at the home.

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This inspection took place on 5 & 6 December 2016. It was unannounced. There were 56 people living at Forest Lodge when we inspected. People cared for were This inspection took place on 5 and 6 December 2016. It was unannounced. There were 56 people living at Forest Lodge when we inspected. People cared for were mainly older people who needed nursing care and were living with dementia. People had a range of care and treatment needs, including stroke, heart conditions, breathing difficulties, diabetes and arthritis. Many people needed support with all of their personal care, eating and drinking and mobility needs. Some of the people were living with behaviours which may challenge others.

Forest Lodge is a large house which had been extended. People’s bedrooms were provided over two floors, with a passenger lift in-between. There were sitting rooms and a dining room on the ground floor. Forest Lodge was situated in its own grounds, which were shared with other services, also owned by the provider. This group of services were situated in a rural area near Uckfield in East Sussex. The provider for the service was SHC Rapkyns Group Limited, who own a range of services across south east England.

Forest Lodge had a registered manager. 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.

The last inspection took place on 3 and 9 November 2015. At that inspection we found the service required improvement. This was because the service was not always safe, responsive or well led, due to people’s assessments and care plans not always reflecting all of their needs. This was a breach of Regulation 12 of the HSCA 2014 Regulations and we required that the provider take action to address this. The provider and registered manager had met the requirements of this regulation. People now had relevant assessments and care plans, which outlined how their risk was to be reduced and care and treatment needs met.

At this inspection, the provider’s systems for audit required improvement because their audits had not identified there was a lack of consistency across the home in people’s care plans and documentation. The provider’s other systems for audit were effective, including receiving and acting on feedback from relevant persons.

People’s medicines were managed in a safe way and there were full records about supporting people with their medicines. All medicines were securely stored. People received the support they needed to enable them to eat and drink what they wanted. They could choose where they ate their meals. Staff were available to support people who needed assistance with eating and drinking.

People said there were enough staff on duty to support them. Staff were available to respond quickly to people when they needed assistance. Staff were recruited in an effective way, to ensure they were safe to care for people.

Staff knew how to ensure people were protected against risk of abuse. All staff were aware of their responsibilities where people lacked capacity. People had clear individual assessments in relation to their capacity. The registered manager had ensured relevant referrals were made to the local authority under the Deprivation of Liberty Safeguards (DoLS).

All people had relevant care plans, including where people had complex healthcare, nursing and treatment needs. People also had clear care plans about living with dementia, these were followed by staff. Where people needed support from external professionals, such as the tissue viability nurse (TVN) or speech and language therapist (SALT), the home ensured referrals took place promptly and professionals’ directions were followed.

People and their relatives said staff were caring. Throughout

This inspection took place on 3 and 9 November 2015. It was unannounced. There were 59 people living at Forest Lodge when we inspected. People cared for were mainly older people who needed nursing care and were living with dementia. People had a range of care and treatment needs, including stroke, heart conditions, breathing difficulties, diabetes and arthritis. Many people needed support with all of their personal care, eating and drinking and mobility needs. Some of the people were living with behaviours which may challenge others.

Forest Lodge is a large house which had been extended. People’s bedrooms were provided over two floors, with a passenger lift in-between. There were sitting rooms and a dining room on the ground floor. Forest Lodge was situated in its own grounds, which were shared with other services, also owned by the provider. This group of services were situated in a rural area, north west of Uckfield in East Sussex. The provider for the service was SHC Rapkyns Group Limited, who own a range of services across south east England.

Forest Lodge had a registered manager. 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.

Forest Lodge had been registered with the CQC for a period of time under a different provider, before this inspection. The home was registered by the current provider, SHC Rapkyns Group Limited, in November 2014, so this was the first inspection of the service since their new registration.

Some ways of ensuring the safety of people were not effective. This included the safety of people who used bed rails and people who may be at risk of trips and slips. There were systems to ensure the safety of people in other areas, including where people were at risk of falling, choking and had mobility needs.

People did not have care effectively planned and delivered for all areas of their care and treatment. This included where people showed high blood sugar levels, where people had small wounds and for some people who were at high risk of pressure damage. Care plans were in place for other areas, including where people may be at risk of low blood sugar levels, had large wounds and experienced behaviours which may challenge others.

Where people needed to be given their medicines in a disguised way (known as covert administration), there was a lack of care planning to ensure all registered nurses supported people consistently. Where people were given medicines ‘as required’ (PRN), care plans did not include relevant information known about by staff. There was also a lack of records to enable audit of covert administration of medicines and the effectiveness of PRN medicines for people. Other systems to ensure safe management of medicines were in place. All medicines were stored in a secure way and registered nurses appropriately supported people when giving them their medicines.

The provider’s audits did not identify a range of relevant areas, including systems for ensuring the privacy and dignity of people where they shared double rooms, the cleanliness of certain pieces of equipment and ensuring all staff moved people in a safe way. Other systems were audited effectively by the provider, including fire safety and response times when people used their call bells.

People and their relatives said they felt safe in the home. Staff knew about how to ensure people were protected against risk of abuse. All staff were aware of their responsibilities where people lacked capacity. The manager had ensured relevant referrals were made to the local authority under the Deprivation of Liberty Safeguards (DoLS).

People and their relatives said staff were caring. They said the home’s systems supported people’s independence and promotion of choice. Staff ensured people’s privacy and dignity in their day to day care and treatment.

People commented favourably on care and treatment provided at the end of people’s lives, so that people’s care at those times was person-centred and as pain-free as possible.

People said there were enough staff on duty to support them. Staff were available to respond quickly to people when they needed assistance. There were systems to ensure staff were recruited in an appropriate way. Staff were trained in their roles and regularly supervised to ensure they could provide effective care and treatment to people.

Where people needed support from external professionals, such as a dietician or speech and language therapist (SALT), the home ensured referrals took place promptly and professionals’ directions followed.

People received the support they needed to enable them to eat and drink what they wanted. They could choose where they ate their meals. Staff were available to support people who needed assistance with their diet and fluid intake.

The home employed a range of activities staff. A range of activities were provided to people to suit their diverse needs. People were fully supported in participating in activities as they wished.

People said they could raise issues with managers when they needed to. They felt confident action would be taken if they did this. People and staff commented on the support they received from the registered manager and the senior managers for the provider. People said the home was well managed and supportive of their needs.

During the inspection we found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

You can see what action we told the provider to take at the back of the full version of the report.