Heartland Manor

Forest Oaks is a residential care home providing personal and nursing care to up to 46 people. The service provides support to older people and younger adults. At the time of our inspection there were 37 people using the service.

Forest Oaks provides residential and nursing care to people in two separate wings of a purpose-built care home. There were three floors accessed by stairs and a passenger lift, providing accommodation and personal care to people needing residential care, and a wing for people who needed nursing care. There were various communal areas which included a large restaurant style dining room, lounge areas and an activity room. There was also a garden accessible from communal areas and some bedrooms.

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

People were cared for by staff trained in safeguarding who were confident concerns shared would be acted on. Risks were assessed to minimise potential harm to people and the premises were well maintained with regular servicing and checks taking place of equipment.

Staff were safely recruited and completed an in-depth induction. We received mixed feedback about staffing levels however these were increased during our inspection.

Medicines were safely managed, and an electronic medicines administration record had recently been introduced. The premises were very clean with no malodours.

There had been several changes to the manager over recent years that staff found unsettling. A new manager commenced in post on the first day of our inspection and the addition of team leaders was planned to reduce pressure on registered nurses.

The CEO and an interim manager had been overseeing the service which staff told us gave stability. The registered manager was based at another of the providers services.

Robust auditing ensured the service was safe and compliant and learning was taken and shared from accidents and incidents.

Positive working relationships had been forged with health and social care professionals and in the local community.

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 17 October 2018).

Why we inspected

The inspection was prompted in part due to concerns received about staffing levels and a high turnover of managers. As a result, we undertook a focused inspection to review the key questions of safe and well-led only

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 these concerns. Please see the safe and well-led sections of this full report. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service remained good based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Forest Oaks 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.

• Policies and procedures in relation to the management of risks associated with COVID-19 were thorough and updated regularly.

• Staff had received infection prevention and control training and adhered to good practice in relation to the use of personal protective equipment (PPE).

• There were arrangements in place for visiting families and health professionals to safely visit people living at the service.

• The provider was aware of and had appropriately used zoning and cohorting measures when required to keep people safe.

We were assured that this service met good infection prevention and control guidelines.

This unannounced comprehensive inspection took place on 5 and 7 September 2018.

Forest Oaks is registered to provide accommodation, care and support for up to 46 older people. 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. Forest Oaks is a purpose built residential and nursing home which is located in Brockenhurst and is managed by the Wilverley Association, a charitable organisation. At the time of our inspection there were 34 people living at the home.

The home had a variety of bright, comfortable communal areas where people could spend time with their family, friends or enjoy some quiet time on their own. The communal gardens were well maintained and allowed people easy access to get outside to enjoy the environment in warmer weather.

There had recently been a change in the management team employed at the home. Although the home did not have a registered manager in post, there was a manager in the process of becoming registered who had been employed at the service since July 2018. 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.

Our previous inspection of the home, carried out in August 2017, identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These included people not always receiving appropriate person-centred care, inconsistent completion of people's care and support records, a lack of governance, a lack of training for staff and staff not receiving adequate supervision and support. At this inspection we found the provider had made many improvements to ensure all of the regulations were met. These improvements included a total revision of how people’s care and support records were compiled, an extensive staff training, support and supervision programme and introduction of a programme of robust quality assurance and monitoring systems to ensure the management team had clear oversight of all areas within the home.

People told us they were well cared for and said they felt safe living at the home. Staff were aware of what constituted abuse and the actions they should take if they suspected abuse. Relevant checks were undertaken before new staff started working at the service which ensured they were safe to work with vulnerable adults.

Staff had the right skills and training to support people appropriately. The provider had implemented a structured programme of training that covered all core training requirements as well as additional training courses that staff may require for further development. Staff had completed or were in the process of completing The Care Certificate, which is a nationally recognised set of standards for health and social care workers.

There were enough staff available on each shift to care for people safely and well. Staff felt well supported by the management team and received regular supervision sessions. Staff told us they worked well as a team; they said, “There is always someone I can ask for advice…there are enough staff around so we can care for people well. People get excellent care here.”

Pre-admission assessments were completed prior to people moving into the home. People’s risks were assessed, and plans developed to ensure care was provided safely. Accidents and incidents were monitored to ensure any trends were identified so action could be taken to safeguard people.

Medicines were handled appropriately and stored securely. Medicine administration records (MAR) were signed to indicate people’s prescribed medicines had been given.

People were referred to health care professionals as required. If people needed additional equipment to help them mobilise and keep them safe and comfortable this was readily available.

The manager was aware of their responsibilities in regard to the Deprivation of Liberty Safeguards (DoLS). These safeguards aim to protect people living in care homes and hospitals from being inappropriately deprived of their liberty. These safeguards can only be used when there is no other way of supporting a person safely. Staff had an understanding of the Mental Capacity Act 2005 (2005) and how it applied to their work.

Staff spoke knowledgeably about the practices they used to ensure people’s dignity and privacy was protected. People received personalised care from staff who were responsive to their needs and knew them well. Staff created a calm, friendly, professional atmosphere which resulted in an open and honest culture in the home.

People knew how to make a complaint and felt confident they would be listened to if they needed to raise concerns or queries. The provider sought regular feedback from people and changes were made if required.

People told us that although the service had gone through a lot of staff changes, they felt it was well led, with a clear management structure in place. Relatives told us they were made to feel welcome at any time and felt fully involved and consulted in the care of their relative.

The provider had put robust systems in processes in place drive the improvement of the safety and quality of the service.

Forest Oaks is a purpose built residential and nursing home for up to 46 people which is located in the centre of Brockenhurst and is run by the Wilverley Association. The Wilverley Association (the provider) is a charitable organisation run by a board of Trustees who meet on a regular basis to discuss and decide on all issues concerning Forest Oaks and their other nearby service. At the time of our inspection there were 38 people living at the home.

The home is arranged over three floors which are accessed by both stairs and a lift. The Loriston-Clarke Wing on the ground floor provides care for up to 16 people who have more complex nursing needs. The Hindson Wing provides general residential and nursing care for up to 29 people.

The home has a number of communal sitting areas, a dining room, a hair salon and a garden with outdoor seating areas. The home has both external and internal CCTV for security and to provide reassurances people living at the home that the environment is safe. The internal CCTV is in the communal areas only and people living at the home have been consulted about and given consent to its use.

The service did not have 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 and associated Regulations about how the service is run. Since our last inspection, 2 new managers had been appointed, but both had left after a short time in the post. In the interim, the service had been supported by senior staff appointed by the provider. This had been an unsettling time for staff and morale had been low. A new manager had recently been appointed and at the time of the inspection had been in post for six weeks.

Following our last inspection, improvements had been made to ensure there were sufficient numbers of staff deployed in the home at all times to meet people’s needs safely. Some people felt more could still be done to increase the staffing levels to improve further the responsiveness of staff. Moving forward, the provider planned further improvements aimed at introducing a more flexible workforce with more staff being rostered at times when observations or call bell analysis showed people’s need for support was greatest. The manager told us it was planned to have this in place by October 2017.

Improvements had also been made to ensure that notifications about important events which happened within the service were submitted to Care Quality Commission (CQC).

However, we found some areas for improvement. Whilst staff were caring and compassionate, people did not always receive appropriate end of life care.

Staff had not been receiving regular supervision or completing the Care Certificate in a timely manner. The training programme needed to be more robust.

The provider had not ensured there were effective systems in place to ensure compliance with the Regulations and to assess, monitor and improve the quality of care provided.

People’s records still did not consistently contain sufficient information about their needs and how these should be met or about people’s preferred daily routines. This had also been a concern at our last inspection.

Recruitment checks needed to be more robust. The provider was not able to demonstrate that appropriate risk assessments had been undertaken regarding the decision to recruit a member of staff currently under investigation by their professional regulator.

Improvements were needed to ensure that all of the risks to people were appropriately managed.

Medicines requiring refrigeration were not being stored appropriately. People were not always receiving their medicines as prescribed. Staff were not consistently recording when topical creams had been applied.

Staff understood how to recognise and respond to abuse. People were encouraged to express their choices and these were respected. People's human rights were protected as the leadership team understood the requirements of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS).

People told us the quality of food provided was improving. People received a choice of meals and were supported appropriately to eat and drink.

People told us they were cared for by kind and caring staff who respected their choices, their privacy and dignity and encouraged them to retain their independence.

People told us they were able to raise any issues or concerns and felt these would be dealt with promptly.

People and staff told us they had a growing confidence in the new leadership of the service.

Plans were in place to suspend new admissions to the home to allow for a period of time during which the management team could oversee the delivery of improvements and a leadership and competency based training programme.

We found three breaches 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 this report.

Forest Oaks is a purpose built residential and nursing home for up to 46 people which is located in the centre of Brockenhurst and is run by the Wilverley Association. The Wilverley Association (the provider) is a charitable organisation run by a board of Trustees who meet on a regular basis to discuss and decide on all issues concerning Forest Oaks and their other nearby service. At the time of our inspection there were 44 people living at the home.

The home is arranged over three floors which are accessed by both stairs and a lift. The Loriston-Clarke Wing on the ground floor provides care for up to 16 people who have complex nursing needs. The Hindson Wing provides general residential and nursing care for up to 29 people. The home does not provide specialist support for people living with dementia or those who might display behaviour which might challenge others.

The service has a number of communal sitting areas, a dining room and a hair salon and a garden with outdoor seating areas. The home has both external and internal CCTV for security and to provide reassurances people living at the service that the environment is safe. The internal CCTV is in the communal areas only and people living at the home have been consulted about and given consent to its use.

The registered manager had left the service the week prior to our 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 and associated Regulations about how the service is run. A new manager had been appointed and was due to start at the service in July 2016. In the meantime, the provider’s compliance manager was providing management support to the service.

Improvements were needed to ensure that there were at all times sufficient numbers of staff deployed to meet people’s needs in a responsive manner. Some people told us they had to wait for support or assistance.

People and their relatives were positive about the care and support they received. Staff knew people well and understood how to meet their individual needs in a person centred way. However, people’s records did not consistently contain sufficient information about their needs and how these should be met or about people’s preferred daily routines.

Notifications had not always been submitted to Care Quality Commission (CQC) when a significant event occurred.

People’s medicines were managed and administered safely, but improvements were needed to ensure more detailed information was available in relation to when ‘as required’ medicines should be given and to support the administration of topical medicines and creams.

Where people lacked the mental capacity to make decisions staff had undertaken mental capacity assessments, but these had not always been completed in line with legislation. Plans were in place to address this.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Where people’s liberty or freedoms were at risk of being restricted, the proper authorisations had been applied for.

Recruitment practices were safe and relevant checks had been completed before staff worked unsupervised.

Staff had a good understanding of risks to people’s health and wellbeing and measures were in place to protect people from risks associated with the environment. People were protected against the risk of abuse and the provider had worked effectively with the local authority to investigate safeguarding concerns.

Staff were supported to carry out their roles and received an induction and ongoing training and supervision.

People told us the quality of food provided was improving. People received a choice of meals and were supported appropriately to eat and drink.

Staff had developed effective working relationships with a number of healthcare professionals to ensure that people received co-ordinated care, treatment and support.

People told us they were cared for by kind and caring staff who respected their choices, their privacy and dignity and encouraged them to retain their independence.

People told us they were able to raise any issues or concerns and felt these would be dealt with promptly.

The registered manager had left the service the week before our inspection, but people, their relatives and staff spoke positively about their leadership of the home. The provider was supporting the service until the new manager started in July 2016.

Systems were in place to monitor the quality and safety of the service.

We found two breaches 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 this report.

We spoke with a nutritionist who visited the home each month. They told us 'staff are keen and listen to our advice.'

Two trustees were undertaking a quality monitoring visit at the time of the inspection, and we spoke with them.

We spoke with the manager, the deputy manager, three healthcare assistants, the activities coordinator, two domestic staff and the chef. Two staff told us 'The residents are lovely, and 'It's the best job I've ever had.'

We reviewed care records for four people. We found that people experienced safe and effective care because their needs were assessed and reviewed.

People could choose from a varied menu and had the support they needed to help them eat and drink.

People were protected from the risks of unsafe use and management of medication because there were effective systems and processes in place.

People using the service benefited from a staff team who were well trained and supported to do their job.

People received safe care, treatment and support because the provider assessed the quality of the service provided.

People's needs were assessed, care was planned and delivered inline with their individual needs.The care plans were developed over time and continual assessments were made to ensure safety and welfare, any identified risks were acted on. Staff were qualified and skilled to meet people's needs and the manager had systems in place to adjust staffing levels to meet these needs. We were told, "we are treated as individuals"

The premises were suitably designed and maintained with a robust policy for ongoing refurbishment. People told us that maintenance issues were dealt with promptly and to their satisfaction. We saw that the service kept comprehensive maintenance and servicing records, staff were aware of emergency procedures and policies. Standard of buildings and premises risk assessments were conducted at regular times by the provider.

We found that there was an effective complaints system available that was understood by the people using the service and the staff, working at the service. People told us that their comments and any complaints were listened to and the manager dealt with them, quickly and efficiently. A person said," At meetings we can raise any issues".