Foresters Nursing Home

Foresters Nursing Home is a care home providing accommodation and nursing care for up to 30 people living with dementia and people living with a physical disability. The care home is a two storey building with en-suite bedrooms and communal facilities. At the time of the inspection 26 people were receiving care.

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

People received their medicines in line with their prescribed needs. Where there had been medicine errors these had been identified, investigated and appropriate action taken by the registered manager.

People's care records were detailed, person centred and contained comprehensive risk assessments and care plans.

There were systems to identify when people needed safeguarding and staff understood their responsibilities to keep people safe.

People and relatives told us they felt safe and were happy with the care they received.

People were protected from the risks of COVID-19 by effective infection control procedures. Staff had training in relation to COVID-19 and had access to sufficient supplies of personal protective equipment (PPE). The registered manager and provider ensured that staff were kept up to date with infection control procedures that reflected current government guidance.

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.

There was improved governance and oversight of risks and of people’s care and support. People and staff were positive about the management of the home.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update:

The last rating for this service was requires improvement (published 19 March 2021) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

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.

The overall rating for the service has changed from requires improvement to 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 Foresters Nursing Home 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.

Foresters Nursing Home is a care home providing accommodation and nursing care for up to 30 people living with dementia and people living with a physical disability. The care home is a two storey building with en-suite bedrooms and communal facilities. At the time of the inspection 27 people were receiving care.

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

The service was not always well- led. The provider’s governance systems were not consistently effective to identify shortfalls, maintain continuous improvement and ensure compliance with regulations.

The provider was not able to evidence they were always responsive to the risks associated with the COVID-19 pandemic. Regular checking of people’s temperatures could not be evidenced. Staff practices in wearing of masks and recording their temperatures needed to be improved. During and following the inspection we were given assurances by the provider of action to be taken and how improvements in these areas would be implemented. We have written to the provider to emphasise the concerns and the improvements required, We will monitor their action plan to be assured of the improvements made.

Medicines were not always managed safely with people not always receiving their medicines as prescribed.

Care plans were not always up to date and did not therefore always contain accurate information about people’s care and support needs. Records to evidence the care and support provided were not always in place or maintained to evidence how staff had supported people to have their individual needs met.

The management were aware of shortfalls in staff training. Recent training had been impacted due to the COVID-19 pandemic. Improvement was needed where a member of staff who led shifts had shortfalls in their training over a longer period time.

Staffing levels were sufficient to meet people’ needs.

People felt safe living at the home and staff were aware of their responsibility to keep people safe.

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 26 September 2019).

Why we inspected

We received concerns in relation to the management of medicines, infection control and the meeting of people’s care needs. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

the inspection, we received further information of concern regarding the care provided to people. We took this additional information into account as part of the inspection.

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 coronavirus and other infection outbreaks effectively.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

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 Foresters Nursing Home 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. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to keeping people safe and ensuring good governance of the service at this inspection.

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 for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Foresters Nursing Home is a nursing home providing personal and nursing care to 26 people aged 65 and over at the time of the inspection. The service can support up to 30 people.

Foresters nursing home is situated in a rural location. It is in an adapted building with bedrooms available over three floors. There were lounges and dining areas on two floors with access by lifts and stairs.

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

People were cared for by staff who knew how to keep them safe and protect them from avoidable harm. Sufficient, knowledgeable staff were available to meet people's needs. People received their medicines regularly and systems were in place for the safe management and supply of medicines. Incidents and accidents were investigated, and actions were taken to prevent recurrence. The premises were free from odour, and staff followed infection control and prevention procedures.

People's needs were assessed, and care was planned and delivered to meet legislation and good practice guidance. Care was delivered by staff who were well trained and knowledgeable about people's needs and wishes. People enjoyed the meal time experience, and relatives and friends were welcome to share this experience. 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.

People were cared for by staff who were caring. The atmosphere within the home was friendly and welcoming and staff were considerate towards people they cared for. People and their relatives felt involved and supported in decision making. People's privacy was respected, and their dignity maintained.

People were supported by staff who had the guidance and knowledge about how to meet peoples needs and support them as an individual. People had some interesting things to do and the registered manager was improving how people spend their time. Complaints were investigated, and outcomes acknowledged and improvements made when needed.

People's concerns were listened to and action was taken to improve the service as a result. The registered manager and her management team were open, approachable. Systems were in place to improve the quality of care provided. The new registered manager had improved the culture at the home and was taking positive actions to benefit people living at the home.

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 on 9 January 2017) insert date last report published in brackets.

Why we inspected

This was a planned inspection based on the previous rating.

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.

This inspection took place on 24 November 2016 and was unannounced.

The provider of Foresters Nursing Home is registered to provide accommodation, nursing and personal care for up to 30 people. At the time of our inspection there were 24 people who lived at the home. Bedrooms, bathrooms and toilets are situated over two floors with stairs and passenger lift access to the first floor. People have use of communal areas including lounges, and dining rooms.

There was a registered manager in post, who was on duty 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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People and their relatives told us they felt safe and staff treated them well. Staff were seen to be kind and treated them with respect when meeting their needs. People’s privacy was respected and they were supported to maintain their independence.

Staff had been trained and knew how to identify and report signs of abuse to protect and keep people safe. The provider had arrangements in place to recruit, review and manage staffing levels to meet people’s needs.

Staff had received training and supervision, which supported them to deliver care and support to people in a safe way. People’s medicines were available to them and staff knew how to provide the support people needed to meet their health needs.

People were asked for their permission before staff provided care and support so people were able to consent to their care. Where people were unable to consent to their care because they lacked the mental capacity to do this decisions were made in their best interests.

Staff monitored people’s health and shared information effectively to make sure people received advice from doctors and health professionals to help people stay healthy.

People were happy with the care and support they received. People were offered a variety of opportunities to do fun and interesting past times if they wished to.

Staff understood what was expected of them and were supported through training and discussions with their managers. There was open communication between the provider, registered manager, relatives and staff. Relatives and staff were comfortable to make suggestions for improving people's individual care and were listened to. Regular checks were undertaken on the quality of the care by the provider and registered manager and actions were taken to develop the home further.

Foresters Nursing Home is located in Clent. The home is registered to provide-personal care and accommodation for up to 30 older people. On the day of our inspection there were 23 people living at the home.

Since our last inspection the registered manager had left and a new manager appointed. There was a manager in post who was in the process of applying to CQC to become the registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered providers and registered managers 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.

Although people had care plans in place, we saw some of the information was did not reflect people’s current support requirements. People and their relatives had not had input into their care plans. Therefore staff could not be sure whether they were caring and supported people in the way they preferred.

People were supported to receive their medicines in a timely manner and medicines were stored securely and at the correct temperature.

People were supported to have drinks and snacks throughout the day, People enjoyed the food they received and were positive about the choice the given to them.

People told us they didn’t have enough activities to do. There was little evidence to support people maintain interests and activities of their choice. People who were confined to their rooms were at risk of social isolation.

People’s care files and personal information were not always kept confidential and secure.

People were protected from harm, the manager and care staff knew how to recognise abuse and what action to take if they suspected it. Risks assessments and risk management plans were in place to but not all staff knew where to find the information.

People were provided with care that protected their freedom and promoted their rights. Staff asked people for their permission before care was provided and gave people choices about their support. Where people had not got mental capacity the provider had engaged relatives and best interest meetings to represent people’s wishes.

People knew how to make a complaint or raise a concern and felt happy to discuss it with the manager.

The provider was in the process of a lot of changes due to the change in manager and the systems in place to monitor and improve the quality of the service were not yet embedded. The manager and provider had identified many improvements that were needed and had plans in place to improve the quality of the service.

The manager promoted a transparent and open culture. They recognised the areas for improvement required at the home and had a home development action plan in place to address the issues.

Throughout our inspection we observed staff were kind and caring to people who lived at the home. One person who lived at the home told us: 'I like it here' and: 'They (staff) are nice.' One relative said that they were happy with the service being provided and: 'Staff are doing a good job.'

We saw that people's needs had been assessed by a range of health and social care professionals. The manager had put measures in place to ensure staff checked and monitored people's required drink and food amounts, and that they always recorded these. This meant people's health and care needs were being monitored and met.

Staff knew how to safeguard people from harm and felt confident that if they had to report any abuse, action would be taken to protect people who lived at the home. Staff recruitment procedures also protected people from being cared for by unsuitable staff.

The manager told us about the improvements that were planned for the home environment to ensure that it continued to be a safe and suitable place for people to live.

We found that people who lived at the home and family members were comfortable in raising any complaints that they had.

People were given choice and had access to a varied diet. The people who needed extra support with their eating and drinking got the help they needed to ensure they continued to have adequate food and drink.

The people who used the service who we spoke with all gave us positive feedback about living there. One person said that the staff did, "A good job here'. Another said that, 'We are all happy here".

Staff employed at the service had access to further training and told us that they felt supported by their peers and the registered manager. One staff member said they had, "Plenty of training". Another said they felt it was, "A really supportive environment to work".

There were regular audits of areas of care, and regular feedback was obtained from the people using the service and their relatives.