Forest Hill

Forest Hill provides personal and nursing care for up to 55 people. People are accommodated in two separate units within one building. The Portland Suite (downstairs) provides personal and nursing care for adults with mental health needs. The Memory Lane community (upstairs) provides personal and nursing care for older people living with dementia. At the time of our inspection, there were 53 people living at Forest Hill.

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

People were not always protected from the risk of abuse. Relatives had mixed views about whether their family members were cared for safely. There were times when there was not enough staff to meet people’s needs safely. People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Areas of the service were not clean or maintained well. There were not enough domestic staff to keep the building clean. People did not always receive their prescribed medicines at the prescribed times. Information in people’s care plans was not consistently kept up to date.

The provider had not ensured systems and processes to assess risk and monitor quality were sufficient and effective in driving improvements. There was a lack of robust oversight of the quality of care. The governance systems did not support staff to identify themes of concern and take appropriate action to maintain safe care in a consistent way.

The provider’s checks and audits did not identify that people were not consistently involved in planning and reviewing their care. The provider did not always act on feedback received from health and social care professionals in a timely manner to reduce risks to people.

Staff we spoke with demonstrated good knowledge of people’s needs, but said they did not always have enough time to read people’s care plans. People were not always involved in reviews of their care, particularly where they were less able to communicate their needs.

Relatives had mixed experiences of communication from the provider about aspects of their family members’ care. The provider had not taken steps to ensure that people were given information about their care and support in ways which were accessible for them.

Risks associated with the service environment were assessed, but the provider did not always ensure those risk were mitigated.. The provider had a system in place for regular checks on all aspects of the environment. People’s needs were assessed, and any risks associated with their health conditions documented. Accidents and incidents were reviewed and monitored to identify trends and to prevent reoccurrences.

People's needs, and choices were assessed in line with current legislation and guidance in a way that helped to prevent discrimination. People were supported by staff to access healthcare services when required. People were supported and encouraged to have a varied diet that gave them enough to eat and drink.

People and relatives spoke positively about the staff who provided support. Staff were caring and showed that they enjoyed the work they do.

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 Outstanding (published 21 November 2017).

Why we inspected

The inspection was prompted due to concerns received about infection control, cleanliness and how people were safeguarded from the risk of abuse. 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. This included checking the provider was meeting COVID-19 vaccination requirements.

We have found evidence that the provider needs to make improvements. You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Forest Hill on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches of regulations in relation to safeguarding service users from abuse and improper treatment, staffing, premises and equipment and good governance.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Forest Hill provides personal and nursing care for up to 53 people. People are accommodated in two separate units within one building. The Portland Suite provides personal and nursing care for up to 21 adults with mental health needs. The Memory Lane community provides personal and nursing care for up to 32 older people living with dementia. At the time of our inspection, there were 53 people living at Forest Hill.

The service had a registered manager at the time of our inspection visit. 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 people who lived in the service told us that they felt safe and very well cared for. They believed that staff were committed to caring for them to a high standard and knew what support they needed to be well looked after. People felt safe, and were protected from the risk of abuse and avoidable harm. People’s care needs were assessed and recorded, and risks identified. Risk assessments and care plans set out what staff should do to reduce the risk of avoidable harm. Staff demonstrated how to balance managing risks associated with people’s health needs, with promoting people’s independence. Accidents and incidents were monitored and reviewed, and action was taken to reduce the risk of harm reoccurring.

People were happy and had positive relationships with staff who provided their care. They were cared for by sufficient numbers of staff who were skilled, experienced and knowledgeable about people’s individual needs. Staff had clear and consistent guidance about how to meet people’s individual needs. Care plans were regularly reviewed with people who were fully involved; these were updated to meet their changing needs and preferences. People were also supported by staff in a caring way, which ensured they received support with dignity and respect. Staff promoted people’s independence and people were active citizens of their local community and had grown in confidence and were proud of their achievements.

The provider took action to ensure that potential staff were suitable to work with people needing care. Staff received supervision and had checks of their knowledge and skills. They also received regular training in a range of skills the provider felt necessary to meet the needs of people at the service.

The systems for managing medicines were safe. People had medicines available when they needed them and in accordance with prescribing instructions. Staff worked in cooperation with health and social care professionals to ensure that people received appropriate healthcare and treatment in a timely manner.

People and their relatives confirmed that staff sought permission before offering personal care. Appropriate arrangements were in place to assess whether people were able to consent to their care. Where people lacked capacity to make decisions for themselves, the provider took appropriate steps to ensure decisions about care were in people’s best interests, and their rights were upheld. The provider was meeting the legal requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DOLS).

People felt cared for by staff who treated them with kindness, dignity and respect. The support people received was tailored to meet their individual needs. People, their relatives, and staff felt able to raise concerns or suggestions in relation to the quality of care. The provider had a complaints procedure to ensure that issues with quality of care were addressed. The provider also sought views from people, relatives and staff in order to take action to improve the quality of the service.

We saw many examples of positive and caring interactions between people and staff. Staff went out of their way to make people feel that they mattered, and that they got the support they needed to maintain control of their lives. People were able to express their views openly and staff listened to what they said and took action to ensure their decisions were acted on.

The service was led by a passionate and committed registered manager. People, relatives and staff all said the registered manager was open, supportive and had excellent management skills. In turn the registered manager felt they were extremely well supported by the provider. Systems were in place to monitor the quality of the service provided and ensure people received safe and effective care. These included seeking and responding to feedback from people in relation to the standard of care. Regular checks were undertaken on all aspects of care provision and actions were taken to improve people’s experience of care. There was an open and inclusive culture within the service, and staff had clear guidance on the standards of care expected of them.

People who used the service said, 'Yes I like it here, I am happy with the care and the support.' Another person said, 'It's alright here but I would rather be at home.' Family members spoke very positively about the service. One family member said, 'The care is absolutely marvellous.' Another family member said, 'The care is wonderful, I can't fault it, it's like a weight has been lifted.'

Family members told us that they had been involved in their relatives move to the home. Where people were assessed as lacking capacity best interest decisions had been made. Staff gave people choices and respected their privacy and dignity.

People's needs were assessed and person centred care plans were developed. Individual risk assessments were undertaken and control measures put in place. Family members told us that they felt their relatives were happy, content and safe.

Systems were in place for cleanliness and infection control. We saw cleaning schedules, checklists and housekeeping audits.

Staffing levels were maintained and staff received appropriate training. Family members told us that staff responded quickly when people needed assistance. Staff told us they felt they had the skills, knowledge and experience to meet people's needs.

A complaints procedure was in place. No complaints had been received at the time of our visit.

We found that staff knew how to protect people and what to do if an allegation of abuse was made.

People told us the food was good and they had plenty of choice. The menus we saw supported this.

Due to the complex needs of the people who used the service we undertook a period of observation to help us understand their experiences. We saw the interactions between staff and people were very positive. People were occupied in meaningful activity and this varied according to the person's likes and dislikes.

A relative told us that their relative had been through an unsettled period. Their behaviour had become difficult. They said this had been managed well and a medication review had resulted in positive changes. They said their relative was now content.

We saw that staff were trained to administer medication safely. Records had been completed correctly. Medication was stored and ordered in the correct manner.

A relative said 'the staff are very attentive and caring to me as well. I visit any time and they are always the same. The place is spotlessly clean." They said 'The staff on reception are very welcoming and helpful.'

Another relative said 'I haven't got a single complaint all the years my relative has been here.' They said they were confident that if they did, it would be listened to and addressed.