Forest Home

Forest Home is a residential care home providing personal care and accommodation for up to 39 people. The service provides support to older people and people living with dementia. At the time of our inspection there were 36 people using the service in 1 adapted building, with 1 wing specialised in providing care to people living with dementia.

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

There was a lack of robust management oversight in some areas of the home. Some quality assurance monitoring was undertaken however, this was not always effective as the shortfalls found at inspection had not been identified through this monitoring. Medicine management was not always robust, however, concerns identified at the inspection were addressed by the manager immediately with support from the GP.

People’s care records, care plans and risk assessments would benefit from further detail to help and support staff to provide personalised and consistent care. Some practice in the home did not always promote people’s dignity and privacy, we have made a recommendation about promoting and respecting people’s dignity.

Some areas of the home were tired and in need of refurbishment. The manager advised this was taking place gradually. The home lacked dedicated storage facilities and consequently easily became cluttered and therefore harder to maintain good Infection Prevention Control (IPC) practice. Some staff training was not up to date or in place. For example, diabetes awareness and some refresher training, whilst it had been booked, was overdue. The manager demonstrated this training had now been booked prompted by the inspection.

People told us they felt safe and staff said they knew how to report concerns. People, relatives and staff said there were enough staff deployed to meet people’s needs. People’s relatives told us, and we saw in records and through our observations, that changes to people’s health were identified and managed. People had access to food, drink and call bells throughout our inspection. We saw there were records kept of fluids consumed, these checked daily by the manager to satisfy themselves people were receiving adequate hydration.

People and relatives said they were treated with care, kindness, dignity, and respect. Staff had a good knowledge and understanding of people's specific care and support needs and how they wished to be cared for and supported. The relationship between staff and people using the service was positive.

The provider had a complaints policy and procedure in place. People, and those important to them, could raise any concerns and complaints easily. People and relatives said they felt the service was able to meet people’s individual needs.

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 (published 08 July 2017).

Why we inspected

This inspection was prompted by a review of the information we held about this service. 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.

Enforcement and Recommendations

We have identified breaches in relation to medicines management and monitoring and oversight 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 from the provider to understand what they will do to improve the standards of quality and safety. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

The registered manager and staff team worked tirelessly to provide safe care, despite experiencing significant challenges during a COVID-19 outbreak. This involved personal sacrifice and commitment to the people they supported.

The provider had built an attractive visiting pod and specialist cleaning equipment to support safe visiting.

There were good working relationships with local health professionals. This included effective arrangements to ensure staff had the necessary skills to take on additional tasks when external professionals had reduced their visits, to minimise the risk of infection.

The registered manager supported the wellbeing of people, families and staff affected by COVID-19 in a personalised and practical manner.

There was a registered manager in post. 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.

When we inspected this service in February 2015, there was a breach of Regulation 13 HSCA 2008 (Regulated Activities) Regulations 2010 Management of medicines. During this inspection the stock balances for some of the regularly prescribed medications did not tally with the records. At this inspection we found the provider had taken action to address these concerns.

The administration of medicines was safe. Staff had been trained in the administration of medicines and had up to date policies and procedures to follow. Their competency was checked regularly. However, on the day of inspection we identified a medication error, the registered manager was alerted and followed the medication error procedure that included checking with the GP that the person was not at risk. Following this inspection the registered manager sent us full details of the actions they had taken.

Only senior staff are responsible for administering medication but this error had not been identified. We have made a recommendation about the management of some medicines.

People were cared for by staff who had a good understanding of protecting people from the risk of abuse and who understood how to meet peoples care needs safely. Staff knew their responsibility to report any concerns and were confident that action would be taken to protect people .

Individual and environmental risks relating to people's health and welfare had been identified and assessed to reduce those risks. Regular safety checks were carried out on the environment and equipment.

New staff received induction training to provide them with the skills to care for people. Staff files showed staff had undertaken sufficient training to meet the needs of people and they were supervised regularly to check their competence. Supervision sessions also gave staff the opportunity to discuss their work and identify any necessary training.

People needs were met promptly. Both relatives and staff said that there were sufficient staff numbers to meet people's needs and we saw staff responding to people in a timely way. People's rights and freedoms were respected by staff.

People who lived at Forest Home had access to healthcare professionals and appointments were documented with outcomes implemented in care plans. We found staff had responded promptly when people had experienced health problems.

The registered manager had received training and understood the requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards, which meant they were working within the law to support people who may lack capacity to make their own decisions.

We found the service was caring. People told us staff were kind and patient. We observed staff were warm and friendly when they interacted with people.

Quality assurance systems were in place to drive improvements. People and relatives were encouraged to give their views about the service. A complaints procedure was available and people knew who to speak to if they had a concern.

People told us the food was well cooked and there was plenty of it. One person said, 'the deserts are lovely.'

At our previous inspection we had concerns regarding people giving their consent, some aspects of care planning and safeguarding arrangements. The service has addressed all these concerns and we have found them compliant for each of these outcomes. Further information is in this report.

We found that the service was meeting the personal, emotional and healthcare needs of people who used the service. The environment was maintained safely, care plans were well documented and up to date and the service carefully sought the person's consent about how they wished their care to be delivered.

We found that staff were supervised and trained appropriately to carry out their role effectively. Medication was being administered safely to people and managed effectively.

We found that consent had not always been recorded within people's care plans and that people's nutritional and dietary needs had not been fully assessed. We also found that the service did not always meet the personal, emotional and healthcare needs of the people who used the service.

We found that the service had failed to follow the correct procedure for reporting allegations of abuse which had placed people at risk of harm and abuse.