The Care Quality Commission
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Forge House Care

Overall: Requires improvement read more about inspection ratings

Victory House, Suite B1, Quayside, Chatham Maritime, Chatham, Kent, ME4 4QU (01634) 671404

Provided and run by:
Forge House Care Ltd

All Inspections

11 May 2022

During an inspection looking at part of the service

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

About the service

Forge House Care is a supported living service providing personal care to 32 people who had a learning disability and/or autism at the time of the inspection.

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

Right Support

People were not always supported to make decisions following best practice in decision-making. People were not supported appropriately to understand their rights regarding their tenancy and support.

Staff focused on people’s strengths and promoted what they could do, so people had a fulfilling and meaningful everyday life. People were supported to do as much as they could themselves, enhancing their independence, while at the same time being supported to stay safe.

The service worked with people to plan for when they experienced periods of distress so that if they had to have restrictions to keep them safe it was only when there was no other alternative.

Staff enabled people to access specialist health and social care support in the community to make sure they could continue to lead a healthy and fulfilling life.

Right Care

Staff understood how to protect people from poor care and abuse. The service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it.

The service had enough appropriately skilled staff to meet people’s individual needs and keep them safe. People could communicate with staff and understand information given to them because staff supported them consistently and understood how they communicated.

People’s care and support plans reflected their range of needs and this promoted their safety, wellbeing and enjoyment of life.

Right culture

People were not given the opportunity to exercise their right to choose who supports them in their own home. A supported living service is required to register with CQC to provide ‘personal care’, not ‘accommodation with personal care’. For this to apply there should be separate legal agreements for the accommodation and the personal care. People did not have separate agreements for their care and their housing, both were part of a single package of care, which restricted their right to choose.

People received safe care and support because trained and well supported staff and specialists could meet their needs and wishes.

Staff evaluated the quality of support provided to people, involving the person, their families and other professionals as appropriate.

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

Why we inspected

We undertook this inspection due to concerns raised about whether people were receiving safe support. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. At this inspection, we found people were receiving safe support.

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 overall rating for the service has changed to requires improvement, we have found evidence that the provider needs to make some improvement. Please see the safe and well-led sections of this report. This is based on the findings at this inspection.

The last rating for this service was Good (published 1 November 2017)

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.

22 August 2017

During a routine inspection

This inspection took place on 22 August and 01 September 2017 and was announced.

Forge House Care provides care services to adults with mild, moderate or complex learning disabilities, some of whom had additional behaviours that challenged services. The care provided is known as supported living and is delivered to people in their own homes mainly in Medway and Kent and is managed from an office in Chatham. Some people needed intensive 24-hour support packages and others were more independent and needed less staff support. People needed help with day-to-day tasks like cooking, shopping, washing and dressing and help to maintain their health and wellbeing. There were 20 people using the service at the time of our inspection.

This service was rated as Good in all of the domains and had an overall Good rating when we last inspected on 17 September 2015.

There continued to be a registered manager employed at the service. 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 registered manager was also the provider.

People continued to experience care that was caring and compassionate. People spoke about the staff in a positive light regarding their feelings of being safe and well cared for.

Staff were trusted and well thought of by the people using the service.

People continued to have their needs assessed and their care was planned to maintain their safety, health and wellbeing.

Risks were assessed and recorded by staff to protect people. There were systems in place to monitor incidents and accidents.

Staff had received training about protecting people from abuse and showed a good understanding of what their responsibilities were in preventing abuse.

The provider had updated their policies since we last inspected in line with published guidance and practice in social care.

Procedures for reporting safeguarding concerns were in place. The registered manager knew how and when they should escalate concerns following the local authorities safeguarding protocols.

The provider had processes in place to monitor the delivery of the service. People’s views were obtained through one-to-one meetings, meetings with people’s families and meetings with social workers. The provider also carried out an annual staff survey. However, the provider had not collated all of the data to analyse their performance and quality. We have made a recommendation about this.

Staff training covered both core training like first aid and more specialised training. They also understood the Mental Capacity Act 2005 and how to support people’s best interest if they lacked capacity.

Staff continued to have good levels of support and supervision to enable them to carry out their roles.

Staff continued to be recruited safely and had been through a selection process so that they were fit to work with people who needed safeguarding.

Staff had been trained to administer medicines safely and staff spoke confidently about their skills and abilities to do this well.

People were pleased that staff encouraged them to keep healthy through eating a balanced diet and drinking enough fluids. Care plans were kept reviewed and updated.

There were policies in place so that people would be listened to and treated fairly if they complained.

The management team and staff were committed to the values of the organisation and they took these into account when delivering care and support.

People were happy with the leadership and approachability of the service’s registered manager, the provider and the management team.

17 September 2015

During a routine inspection

The inspection was carried out on 17 September 2015, and was an announced inspection. The provider was given 48 hours’ notice of the inspection as we needed to be sure that the office was open and staff would be available to speak with us.

Forge House Care is a domiciliary care agency which provides supported living services, to younger adults who are living in their own homes. People had a variety of complex needs including mental and physical health needs and behaviours that may challenge.

At the time of the inspection, the service was providing support to 25 people, four of who received personal care. The agency operated the service mainly in Chatham and the surrounding areas.

The service is run by the provider who is also the 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.

The agency had suitable processes in place to safeguard people from different forms of abuse. Staff had been trained in safeguarding people and in the agency’s whistleblowing policy. Staff were confident that they could raise any matters of concern with the provider, the deputy manager, or the local authority safeguarding team. Staff were trained in how to respond in an emergency (such as a fire, or if the person collapsed) to protect people from harm.

Staff were trained in the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS). Staff understood the processes to follow if they felt a person’s normal freedoms and rights were being significantly restricted.

The agency provided sufficient numbers of staff to meet people’s needs and provided a flexible service. The agency had robust recruitment practices in place. Applicants for post were assessed as suitable for their job roles.

All staff received induction training which included essential subjects such as maintaining confidentiality, moving and handling, safeguarding people and infection control. They worked alongside experienced staff and had their competency was assessed before they were allowed to work on their own. Refresher training was provided at regular intervals. Staff had been trained to administer medicines safely.

Staff followed an up to date medicines policy issued by the provider and they were checked against this by the training manager. Staff were trained to meet people’s needs and were supported through regular supervision and an annual appraisal so they were supported to carry out their roles.

The provider and deputy manager involved people in planning their care by assessing their needs on their first visit to the person, and then by asking people if they were happy with the care they received. The provider and deputy manager carried out risk assessments when they visited people for the first time. Other assessments identified people’s specific health and care needs, their mental health needs, medicines management, and any equipment needed. Care was planned and agreed between the agency and the individual person concerned. Some people were supported by their family members to discuss their care needs, if this was their choice to do so.

People were supported with meal planning, preparation and eating and drinking. Staff supported people, by contacting the office to alert the provider and deputy manager to any identified health needs so that their doctor or nurse could be informed.

People said that they knew they could contact the provider or the deputy manager at any time, and they felt confident about raising any concerns or other issues. The provider or deputy manager carried out spot checks to assess care staff’s work and procedures, with people’s prior agreement. This enabled people to get to know the provider and deputy manager.

The agency had processes in place to monitor the delivery of the service. As well as talking to the provider or deputy manager at spot checks, people could phone the office at any time, or speak to the senior person on duty for out of hours calls. People’s views were obtained through meetings with the person and meetings with families of people who used the service. The provider checked how well people felt the agency was meeting their needs.

Incidents and accidents were recorded and checked by the provider or deputy manager to see what steps could be taken to prevent these happening again. Risks were assessed and the steps taken to minimise them were understood by staff. Managers ensured that they had planned for foreseeable emergencies, so that should they happen, people’s care needs would continue to be met.

People felt that the service was well led. They told us that managers were approachable and listened to their views. The provider and deputy manager of the service provided good leadership.