Forge House

Updated 10 December 2019

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.

Inspection team

The inspection was carried out by one inspector.

Service and service type

Forge House 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.

The service had a manager registered with the Care Quality Commission. The registered manager was also the registered provider. This means that they are legally responsible for how the service is run and for the quality and safety of the care provided. The service also had a manager at Forge House who was responsible for day to day management of the service.

Notice of inspection

This inspection was unannounced the first day and announced the second day. We visited on the second day to gather additional information from speaking with staff, manager and provider.

What we did before the inspection

We reviewed information we had received about the service. This included details about incidents the provider must notify us about, such as abuse or when a person dies. We contacted healthcare professionals such as care managers and health practitioners for feedback on the service. We received no feedback. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all of this information to plan our inspection.

During the inspection

During the inspection, we spoke with four people using the service, a behaviour support therapist, two senior team leaders, one support worker, the manager of Forge House, the registered manager and two directors.

We reviewed a range of records. This included three people's care records and medicines records. We also looked at three staff files including their recruitment and supervision records. We reviewed records relating to the management of the service, quality assurance records and a variety of policies and procedures implemented by the provider.

After the inspection

We spoke with two relatives on the telephone to gain their feedback about the service. We continued to seek clarification from the provider to validate evidence found. We received and reviewed all the documents which included the training data, rota, policies, procedures and other records sent to us in a timely manner.

Updated 10 December 2019

About the service

Forge House provides accommodation and personal care for up to six people aged between 18 and 65 years, who have a learning disability and autism. Forge House Care Ltd is a care organisation based in Chatham. At the time of our inspection, six people were using 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 that 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 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 thematic review, we carried out a survey with the manager at Forge House and the behaviour support therapist at this inspection. The service had a registered manager who was also the registered provider and a manager for Forge House. The registered manager was not available for most part of this inspection. The thematic review considered whether the service used any restrictive intervention practices (restraint, seclusion and segregation) when supporting people.

The service used positive behaviour support principles to support people in the least restrictive way. No restrictive intervention practices were used.

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

Effective governance systems to monitor performance had not been fully embedded into the service. Provider audit systems had not been effective in identifying the areas we found at this inspection and the manager at Forge House did not carry out any audits to check the quality and safety of the service. Records were not always up to date. We have made a recommendation about this.

The registered manager and staff had not spoken with people and their relatives about end of life plans. We found no end of life care plans in place. This is an area for improvement.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

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.

People were safe at Forge House. Staff knew what their responsibilities were in relation to keeping people safe from the risk of abuse. The provider followed safe recruitment practices.

Medicines practice was safe. Medicines records were accurately signed with no gaps in recording. Staff had detailed knowledge of the system in place. The environment was well maintained, and infection control procedures were adhered to.

People were consulted on key issues that may affect them. People’s rights, their dignity and privacy were respected.

People received the support they needed to stay healthy and to access healthcare services. Each person had care plan, which set out how their care and support needs should be met by staff. These were reviewed regularly.

Staff supported people to maintain a balanced diet and monitor their nutritional health.

Staff received regular training and were provided with appropriate support and supervision as is necessary to enable them to carry out their duties.

People knew how to complain and that any concerns would be listened and responded to by the provider. Relatives said they felt able to express concerns and were confident of these being addressed.

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.

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 (Report published on 21 March 2017).

Why we inspected:

This was a planned inspection based on the previous rating.

We have found evidence that the provider needs to make improvements. The provider acted to mitigate some areas of concerns found during the inspection and we will check if this has been effective when we next inspect. Please see the Well led sections of this full report.

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.