We carried out an unannounced inspection at Forest Care Village on 26 June 2018. At the last inspection on 05 December 2017, we asked the provider to make immediate improvements in some areas of the care and support people received. These areas were around risk management for people, safeguarding systems and processes, nutrition, consent to care, personalised care, dignity and governance systems. This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.Following our inspection on 05 December 2017 we were informed by the local authority that Environmental Health officers had served a Hygiene Emergency Prohibition Notice on Forest Care Village due to an infestation of cockroaches. At this inspection we found that this notice had been lifted and the cockroach infestation had been eradicated.
Forest Care Village is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
Forest Care Village is registered to provide personal and nursing care for up to 178 people aged 18 and over with a range of complex health and care needs. At the time of our inspection 120 people were using the service.
Forest Care Village spreads across three floors and accommodates people in separate units, each of which have separate adapted facilities. Three of the units specialise in providing care to people living with dementia whereas in the remaining four units people have nursing needs.
There was a manager in post who had registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC 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.
At this inspection we found that significant improvements were made and although some areas were still developing and improving, however, people received personalised care and support which was safe and protected them from the risk of harm.
Following the inspection on 05 December 2017 we shared our findings with the Local Authority and Clinical Commissioning Group (CCG). The different funding authorities and local commissioning group worked closely with the provider and the registered manager providing support to empower Forest Care Village staff and to monitor improvements as part of their quality improvement process. There were regular service improvement meetings where different health and social care professionals gave feedback following their visits and assessments carried out at the home to the provider and register manager. A manual handling specialist had observed staff’s practices and provided training. The CCG had allocated two nurses two days a week to observe and empower staff employed by the home to develop their skills further in recognising people`s changing health needs. At the time of this inspection the support from the different external professionals was recently withdrawn except for PEG specialist nurses who were training and assessing staff`s competencies in the management of percutaneous endoscopic gastrostomy (PEG)`s. PEG is an endoscopic medical procedure in which a tube is passed into a patient's stomach through the abdominal wall, most commonly to provide a means of feeding when oral intake is not adequate.
The provider reviewed their governance systems and developed this further to ensure that this was effective in identifying areas in need of improvement without the permanent support from the local authority. The provider has transitioned to electronic care planning which meant that staff could access people`s records from their hand-held devices and they updated the records when they delivered support to people.
People told us that they felt safe living in the home. Staff demonstrated they had the knowledge to identify potential abuse and also the process for reporting concerns. We saw notices and information displayed throughout the service informing people, staff and visitors how to report concerns and relevant contact numbers for external safeguarding authorities. Referrals to local safeguarding authorities and CQC were done in a timely manner.
There were adequate staff on duty to support people in a timely way. Call bells were responded to within a couple of minutes and people confirmed staff responded when they requested help. We reviewed rotas and saw that adequate staff were deployed to assist people safely.
People’s individual risks were assessed and where risks were identified, measures were put in place to help reduce and mitigate those risks. Staff demonstrated a good knowledge about people and could tell us how they mitigated risks to people`s well-being.
People who lived with specific health conditions had care plans in place to address this area of their needs and staff had guidance on how to maximise people`s health. People`s end of life care needs were assessed and plans were in place to evidence that people`s wishes, likes and dislikes were considered when staff created care plans. Staff could tell us what people liked and how they wished to be cared for.
Infection control measures were in place. Staff were observed to use personal protective equipment, including the use of gloves and aprons while supporting people with personal care. People’s medicines were managed safely in most cases. Medicines were stored safely and administered by trained staff.
Staff felt supported by the registered manager and unit managers and were encouraged to have their say about any concerns they had in how the service operated. Staff attended regular meetings and discussed issues that were important to them. They also had regular supervisions where their performance and development were reviewed. Staff told us they received training and support to carry out their roles effectively. Recruitment processes were robust and ensured that the staff employed were suitable to work in this type of care settings.
Electronic care plans were well developed, personalised and regularly reviewed. However not all the features this care planning system offered were developed to full capacity at the time of the inspection. Not every person we spoke with were aware of their care plans or the content of it, however they told us they had or were waiting for a review of their care needs.
People were asked for their consent to the day to day care and support they received from staff. We observed staff assisting people and communicating with them and asking for their involvement in the task. People told us and we observed that staff protected their dignity and privacy.
The principles of the Mental Capacity Act 2005 (MCA) were followed by staff and where Deprivation of Liberty Safeguards (DoLS) authorisations were in place with conditions listed on the restrictions to people`s freedom plans were in place to meet these and keep people safe.
People were positive about the care and support they received and told us staff were kind and caring. People were supported to engage in a range of arts, crafts, and hobbies that were of interest to them. There were singalong musical events, sporting events and outside entertainers visited the home. People were also supported to attend community events. People who were less able to engage in social activities had an identified need for staff to spend meaningful moments with them outside the care delivery, however we saw that some of these moments were not completed. This area of the service was still improving to ensure that people in their bedrooms were not at risk of isolation.
People told us they liked the food provided to them and they had enough choices. People`s dietary needs were met and we found that staff referred people to specialist support in case they were at risk of malnutrition.
After the previous inspection there was extensive support provided by the Local Authority, CCG and other partner agencies involving deployment of their own qualified staff to help the provider identify where they needed improvements and agreed actions were put in place to improve the quality and safety of the care provided to people. This support was recently withdrawn and the registered manager and the provider were yet to prove that the service could sustain the improvements achieved.
Systems had been developed to identify shortfalls and address these areas as needed. Communication through the management team had been improved. There were monthly clinical and quality meetings to discuss all areas of the service, internal audits completed and any incidents that had occurred. This enabled the management team to review previous and ongoing action plans to help ensure they were effective. Lessons were learned following incidents.
The registered manager effectively monitored the quality of the care provided to people and they were regularly walking the floors helping, coaching and mentoring staff. Regular surveys carried out evidenced that people were feeling positive about the changes in the home.There were regular relatives and residents meetings organised and a `you said, we did` poster to evidence when people requests were fulfilled, however there were some people who told us that they were disappointed that not all the issues they brought up in meetings were actioned.