Lady Forester Residential & Day Care Centre

Lady Forester Residential and Day Care Centre is a residential care home providing accommodation and personal care to a maximum of 14 people. The service has an adjoining day care centre which can be accessed by people living at the home and by the wider community. The service provides support to older people and at the time of our inspection there were 12 people using the service.

The home is run as a charity and the board of trustees act as the provider of the organisation.

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

Since our last inspection, the provider had made improvements in all areas of the service, including the governance of the home and these improvements were ongoing. Significant improvement was seen in the environmental issues we identified at our last inspection. Further time was needed to ensure the improvements and new systems were fully effective, embedded in all staffs’ practice and able to be sustained.

Overall management of people’s medicines had improved. The systems which monitored medicines however, needed further improvement.

The provider’s governance systems, although improved did not always identify and capture where there were concerns and so required improvement.

People's risks associated with their care had been reviewed and guidance for staff was improved upon. People’s care plans were more specific and person centred. This was an area of continued improvement.

People were supported to have 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 an increased oversight at the service by the provider and new nominated individual, who was at the home daily. The management team were open and they recognised further improvements were required at the service. The provider had an ongoing improvement and action plan were in place.

Staff understood how to protect people from harm and followed safe hygiene practices to prevent and control infection. People were supported by enough staff who had been safely recruited. The provider had systems in place to make sure lessons could be learnt from accidents, incidents and when things went wrong.

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 inadequate (published 26 April 2023). Breaches in regulations relating to safe care and treatment, staff training and recruitment and governance were identified. We took enforcement action after the last inspection and imposed 2 conditions onto the provider’s registration.

At this inspection we found significant improvements had been made but these needed to be embedded into everyday practice. We found the provider remained in breach of some of the regulations. The provider continues to meet the conditions and sends us monthly action plans as per the conditions on their registration.

This service has been in special measures since 9 March 2023. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in special measures.

Why we inspected

We undertook this focused inspection to check the provider now met their legal requirements. This report only covers our findings in relation to the key questions safe and well-led. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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 inadequate to requires improvement based on the findings of this inspection.

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 Lady Forester Residential & Day Care Centre on our website at www.cqc.org.uk.

Enforcement

At our last inspection we idnetified a breach in relation to staff training. We did not look at this as part of this inspection.

We have identified a continued breach in relation to the 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 from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Lady Forester Residential and Day Care Centre is a residential care home providing accommodation and personal care to a maximum of 14 people. The service has an adjoining day care centre which can be accessed by people living at the home and by the wider community. The service provides support to older people and at the time of our inspection there were 11 people using the service.

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

People were at risk of harm because the provider had failed to take action to reduce environmental risks, including fire risks. People’s medicines were not managed or stored safely. Recruitment checks on new staff did not fully comply with the regulations to make sure staff were suitable to work at the home. The provider had not kept up to date with current government guidance for COVID-19 and had not ensured their own policies were followed for infection control and recruitment.

Staff had not received regular training to support them in their roles and to help them understand their responsibilities. Staff had not understood or acted upon unsafe temperature readings for the medicine and kitchen fridge, and for hot water readings. This had potential to cause people harm

People’s care plans needed improvement to ensure they reflected their health needs and were personalised for each person. The provider needed to ensure staff knew what was in people’s care plans and understood the observations they completed.

The provider had not demonstrated respect towards people because they had not kept the environment safe for them. There was no evidence of the provider having oversight of the service and driving the improvement needed.

There was a continued failure by provider to establish effective governance systems and they had not complied with previous actions we told them to take.

People were supported to have access to healthcare professionals. People spoke positively about the food they received, and their nutritional needs and preferences were met. People had access to healthcare services as required.

People were supported by enough staff. People were supported to spend their time how they wanted to and to be involved in activities if they wished to. People’s end of life wishes were recorded. The provider had systems in place to respond to complaints.

The registered manager worked in partnership with health and social care agencies and there was involvement with the local community to help benefit people.

Despite our findings at this inspection, the feedback we received from people was positive and they told us they felt cared for by staff.

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 and update

The last rating for this service was requires improvement (published 24 October 2022) 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 the provider remained in breach of regulations.

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.

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 Lady Forester Residential and Day Care on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified continued breaches in relation to environmental risks, medicines, staff recruitment, staff training and the governance of the home at this inspection. As a result of these we have taken enforcement action and imposed 2 conditions onto the provider's registration.

Follow up

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Lady Forester Residential and Day Care Centre is a residential care home providing accommodation and personal care to a maximum of 14 people. The service has an adjoining day care centre which can be accessed by people living at the home and by the wider community. The service provides support to older persons and at the time of our inspection there were 13 people using the service.

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

The provider had not established effective governance systems and had not followed up on previous recommendations. An action plan has since been developed and external relationships were being built to help the service improve.

Risks to people’s safety were not always considered and action was needed to improve key areas. For example, fire safety and the management of medicine errors. The required recruitment checks also needed to increase to include a full employment history.

We found limited evidence of the provider using the mental capacity act. However, we observed people being supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. We will check on our next inspection that the policies and systems in the service support this practice.

People did tell us they felt safe in the home and staff were positive about how well they worked together and the new management structure. New policies and procedures were being embedded and staff understood the need for change.

Infection and prevention control measures were in place and accident and incident forms were completed but more detailed investigations needed to be recorded. The provider kept families up to date when things happened and had plans to ensure there was increased engagement in the future.

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 11 June 2019)

Why we inspected

We received concerns in relation to the overall governance of the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. We have found evidence that the provider needs to make improvements and the provider has already commenced making those improvements by implementing updated policies and procedures and engaging with agencies who can offer appropriate support.

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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Lady Forester Residential and Day Care Centre 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 as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to the management of risk, ensuring new staff are safely recruited and the need for effective governance systems. Please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Lady Forester Residential and Day Care Centre is a care home is registered to provide regulated activities to 14 people aged 65 and over. The home is in Broseley near Telford. At the time of the inspection 13 people were receiving regulated activities at the home.

People’s experience of using this service:

People and relatives told us safety was always considered. The service had an established process for reporting and responding to abuse. Although people felt safe, we noted we found some aspects of the service were not always safe. We saw good practice was not always considered and implemented to promote safety. We have made recommendations about managing environmental risk and deployment of staffing.

People, relatives, and professionals said they considered the service to be well-led. They said they were assured staff were experienced and appropriately trained. The registered manager understood their roles and responsibilities. We saw evidence of partnership working to develop and maintained a high quality, person-centred service. During the inspection visit we identified some areas for improvement to ensure the service was consistently well-led. We have made recommendations in regard to ensuring paperwork and policies and procedures were accurate and up to date.

We observed activities taking place within the home to keep people occupied and active. The registered manager worked proactively to ensure individual concerns were identified and acted upon before they became a complaint. were confident any complaints would be dealt with effectively and professionally. People told us they were able to make choices about their care and support and said they received care tailored to their needs. Although care was person centred, we found records did not always contain the required information to promote continuity of care and individualised support. We have made a recommendation about this.

People, relatives and a visiting health professional told us people’s health was monitored and said good health was promoted through multi-disciplinary working. 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. We saw processes were in place to ensure consent was achieved before providing care and support, but these were not consistent. We have made a recommendation about this.

People and relatives considered all staff kind and caring. We saw independence, privacy and dignity were promoted and maintained by staff. Staff understood the importance of protecting people’s human rights.

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

Rating at last inspection:

At the last inspection the service was rated good (published 06 December 2016).

Why we inspected:

This was a planned inspection based on the previous rating.

Follow up:

The next scheduled inspection will be in keeping with the overall rating. We will continue to monitor information we receive from and about the service. We may inspect sooner if we receive concerning information about the service.

Lady Forester Residential and Day Care Centre provide accommodation and personal care for up to 14 older people and also offers a respite service. On the day of our inspection the home was fully occupied.

The home had a registered manager who was present for the 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 were supported by staff who knew how to protect them from the risk of abuse and care practices reduced the risk of accidents. People were supported by sufficient numbers of staff who had the skills to support them to take their prescribed medicines.

People received care and support from staff who were trained and who received regular one to one [supervision] sessions. People’s human rights were protected because staff were aware of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards and people’s decisions were respected. People were provided with a choice of suitable meals and had access to drinks at all times. Staff assisted people to access relevant healthcare services when needed.

People were treated with kindness and compassion by staff who were aware of their care and support needs. People were actively involved in planning their care and their privacy and dignity was respected by staff.

People’s involvement in their care assessment ensured they received a service that met their needs. They had access to a variety of social activities and were supported by staff to do the things they enjoyed. People felt confident to share any concerns they had with staff.

People were encouraged to have a say in how the home was run. People and staff felt supported by the managers and the provider’s governance systems were effective to drive improvements.

People told us that they were treated with respect and had their dignity maintained. Comments included, "Everybody's very kind and helpful', and 'I'm happy here'.

Staff had a good understanding of the care needs of individual's living at the home. People were able to participate in discussion and decision-making in connection with their care needs.

We found the home to be clean, and regular checks had been carried out to ensure the required standards of cleanliness and infection control had been maintained.

The provider had effective recruitment procedures in place.

There was a complaints policy and procedure in place. People we spoke with told us they knew who to raise any concerns with and they felt confident their concerns would be addressed.

Staff provided health and social care support well. Community services were accessed to support people when necessary.

People told us that they felt able to raise any issues with the manager or staff should they have any concerns. Staff spoke of their awareness of how to keep people safe from harm. Staff told us about the training that the home had arranged for them to undertake so that they would recognise abuse and how to report it.

People told us that staff were always available when they needed help. People's relatives told us that staff were around and available to talk to when they visited. They said that the staff were friendly and always acted professionally. One person said 'I have been here since *** and I have been happy all the time' and another said 'The staff are very good'.

People we spoke with said their comments were listened to. A visitor said that they would not hesitate to talk to staff if something was wrong. The service's management held regular meetings with the people who use the service to find out what people thought about how their care was delivered.