Forest Care Home

Updated 19 May 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This was a comprehensive inspection that took place on 16 April 2018 and was unannounced. The inspection team consisted of one inspector, an assistant inspector, a specialist advisor who was a registered nurse in dementia nursing care and an Expert-by-Experience. An Expert-by-Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

We used information the provider sent us in the Provider Information Return. This is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make.

The inspection was also informed by other information we had received from and about the service. This included previous inspection reports and statutory notifications. A notification is information about important events, which the provider is required to send us by law. We also sought feedback from the local authority, who commission services from the provider and Healthwatch.

On the day of the inspection, we spoke with one person who used the service and two visiting relative’s for their views. Due to the needs of people, it was not possible to obtain verbal feedback from many people about their views. We observed care and support in communal areas of the service and used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

During the inspection, we spoke with the registered manager, regional director, clinical development nurse, nurse, chef, housekeeper and three care staff. We looked at all or parts of the care records of seven people, along with other records relevant to the running of the service. This included how people were supported with their medicines, quality assurance audits, training information for staff and recruitment and deployment of staff, meeting minutes, policies, procedures, and arrangements for managing complaints. We also spoke with a visiting pharmacist.

Updated 19 May 2018

We inspected this service on 16 April 2018. The inspection was unannounced.

Forest Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single packages under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Forest Care Home is a nursing home that accommodates up to 20 people living with early onset dementia with complex needs. On the day of our inspection, 17 people were living at the service.

The service had a registered manager at the time of 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At the previous inspection in January 2016 we identified some improvements were required in three key areas we inspected; ‘Safe’, ‘Effective’ and 'Well-led'. This resulted in the service having an overall rating of 'Requires Improvement'.

During this inspection we checked to see whether improvements had been made, we found further improvements were required in ‘Safe’ but improvements had been made in the other key areas.

Some shortfalls were identified in the management of medicines. Risks had been assessed and planned for and these were monitored for changes. However, inconsistencies were identified in the guidance provided to staff about managing people’s needs associated with their anxiety that affected their mood and behaviour.

Staffing levels were assessed and monitored and were short on the day of the inspection but this was an unusual occurrence. The deployment of staff needed reviewing to ensure people’s safety at all times. Safe staff recruitment checks were carried out before new staff commenced.

The service was found to be clean and improvements were being made to the cleaning schedules to ensure these followed best practice guidance. Accidents and incidents were recorded, monitored and reviewed for any themes and patterns. Documentation did not always show post action and monitoring. Staff were aware of their responsibility to protect people from avoidable harm and had received safeguarding training.

Staff received an induction and ongoing training and support. Staff were knowledgeable about people’s health conditions. People had their needs assessed, planned and monitored. People received a choice of meals and their nutritional needs were known, understood and met by staff.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Where people lacked mental capacity to consent to their care and support, assessments to ensure decisions were made in their best interest had not always been consistently completed. However, this was addressed by the provider in implementing improved documentation. Where people had a DoLS authorisation with a condition, this had been met. People were supported to access primary and specialist health services.

Staff were aware of people’s needs, routines and what was important to them. Staff were kind, caring, and they supported people ensuring their privacy, dignity and respect was met. Independence was encouraged and supported. Information about independent advocacy services was available.

Staff had information to support them to understand people’s needs, preferences and diverse needs. People received opportunities to participate in meaningful activities. The provider’s complaint policy and procedure had been made available to people who used the service, relatives and visitors. The registered manager had plans to meet with people and or their relatives to discuss their end of life wishes and to review their care and treatment.

Systems and processes were in place to monitor and improve the quality and safety of the service. An action plan was in place to drive forward continued improvements. People who used the service and their relatives received opportunities to share their experience about the service.