Forrester Court

At the last inspection on 12 and 15 December 2016, we asked the provider to take action to make improvements in relation to maintaining safe staffing levels and good governance and this action has been completed.

Forrester Court 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. Forrester Court provides care and support for up to 113 people who require nursing and personal care. There were 98 people using the service when we visited. There are three floors within the building and each floor consists of two units. Three of the home’s units are for people who have nursing needs, two of the units are for people with residential care needs, some of whom have early onset dementia and the remaining unit is home to those with palliative care needs.

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

There were enough suitably trained staff scheduled to work during our inspection and prior to this. The provider operated safer recruitment practices by carrying out appropriate pre-employment checks.

Care staff were appropriately inducted and received ongoing training and support through supervisions and appraisals to conduct their roles safely.

The provider identified and appropriately managed the risks to people’s safety. Where incidents occurred, the provider had a good system in place to record and learn from these to minimise the risk of a reoccurrence.

People told us they felt safe within the home. The provider operated a transparent safeguarding process to keep people safe.

Good infection control practices were operated throughout the building. There was a dedicated sluice on each unit for the hygienic removal of disposables such as incontinence pads.

People were supported to maintain a healthy diet. Care records contained a good level of detail about people’s health and nutritional needs. Kitchen staff were also aware of people’s nutritional requirements and offered people choices with their meals.

People were supported with their healthcare needs. People’s care records contained a good level of detail about their current needs and care staff assisted them to access external healthcare professionals when needed.

People using the service and their relatives were involved in decisions about their care and how their needs were met.

The organisation had good systems in place to monitor the quality of the service. Feedback was obtained from people through monthly residents and relatives meetings as well as annual questionnaires and we saw feedback was actioned as appropriate. There was evidence of further auditing in many areas of care and action was taken to rectify any issues identified as a result.

There were good systems in place for the safe management and administration of medicines. Staff had completed medicines administration training within the last year and were clear about their responsibilities.

Staff a good understanding of their responsibilities under the Mental Capacity Act 2005. Mental capacity assessments were completed when needed and we saw these in people’s care files. Authorisation had been sought and obtained from the local authority where staff felt it was in a person’s best interests to deprive them of their liberty.

People told us care staff were caring and our observations supported this. Care staff demonstrated they knew people’s likes and dislikes in relation to their care and demonstrated an understanding of people’s personal circumstances. Care staff respected people’s privacy and dignity and people’s cultural and religious needs were met. People’s end of life care needs were sought and followed.

People knew how to make complaints and there was a complaints policy and procedure in place.

The service employed five activities coordinators who delivered a varied activities programme. People’s feedback was sought in relation to the activities on offer and the timetable was altered in accordance with people’s views.

At the last inspection on 10, 11 and 12 July 2014, we asked the provider to take action to make improvements in relation to delivering person centred care and this action has been completed.

Forrester Court provides care and support for up to 113 people who require nursing and personal care. There were 102 people using the service when we visited. There are three floors within the building and each floor consists of two units. Three of the home’s units are for people who have nursing needs, two of the units are for people with residential care needs, some of whom have early onset dementia and the remaining unit is home to those with palliative care needs.

There was no registered manager 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 a 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 had left two weeks prior to our inspection and had been replaced by another manager within the organisation. This manager had started working at the service on the first day of our inspection.

There were not enough staff scheduled to work on the first day of our inspection and prior to this. We reported this to the manager who scheduled extra staff to work the next day and assured us they would maintain this level of staffing.

People were supported to maintain a balanced, nutritious diet. People at risk of malnutrition had appropriate assessments conducted and were referred to the community dietitian as appropriate. Advice was implemented by care staff and the kitchen staff who were also aware of people’s dietary needs. People were supported effectively with their other healthcare needs and were supported to access a range of healthcare professionals. However, care plans were not always updated to reflect people’s current needs in respect of their dietary needs.

People using the service and their relatives were involved in decisions about their care and how their needs were met.

The organisation had good systems in place to monitor the quality of the service. Feedback was obtained from people through monthly residents and relatives meetings as well as annual questionnaires and we saw feedback was actioned as appropriate. There was evidence of auditing in many areas of care but these did not identify the issues identified in relation to care plans and understaffing.

There were good systems in place for the safe management and administration of medicines. Staff had completed medicines administration training within the last year and were clear about their responsibilities.

Staff demonstrated a good knowledge of their responsibilities under the Mental Capacity Act 2005. Mental capacity assessments were completed as needed and we saw these in people’s care files. Where staff felt it was in a person’s best interests to deprive them of their liberty, applications were sent to the local authority for Deprivation of Liberty Safeguards authorisations to ensure this was lawful.

Staff demonstrated an understanding of people’s life histories and current circumstances and supported people to meet their individual needs in a caring way.

Recruitment procedures ensured that only staff who were suitable, worked within the service. There was an induction programme for new staff, which prepared them for their role. Staff were provided with appropriate training to help them carry out their duties and received regular supervision.

People who used the service gave us good feedback about the care workers. Staff respected people’s privacy and dignity and people’s cultural and religious needs were met.

People using the service felt able to speak with the management team and provide feedback on the service. They knew how to make complaints and there was a complaints policy and procedure in place. Care staff gave excellent feedback about the deputy manager and the rest of the management team.

People were encouraged to participate in activities they enjoyed and people’s participation in activities was monitored. People’s feedback was obtained to determine whether they found activities or events enjoyable or useful and these were used to further develop the activities programme on offer. The activities programme covered five days a week and included a mixture of one to one sessions and group activities. At the time of our inspection the service was running a specific Christmas activities timetable which included Christmas carol singing, a visit to see some of London’s Christmas lights and church visits.

We found two breaches of regulation in relation to staffing and good governance. You can see what action we told the provider to take at the back of the full version of the report.

On the days of our visits there were 107 people living at the home. From conversations with people who used the service the overall impression was that people were happy with the care they received. People who used the service told us "staff are really kind and caring" and "work very hard." Family members told us "the place is very nice" and "I put my trust in the people here."

People had care plans in place and risk assessments had been completed. Care plans were not always signed and therefore it was difficult to ascertain whether or not people, their family members and/or advocates had been fully involved in the care planning process. There was also some evidence that indicated care plans were not always being adhered to and that recommendations were not always followed.

There were activities on offer such as coffee morning sessions, church services, nail painting and hairdressing appointments. However, these activities did not appear to extend to those who were confined to their beds and we observed a significant number of people alone in their rooms and not engaged in any form of activity.

The provider had systems in place to ensure that the quality of the home was monitored. However, it was sometimes difficult to see where learning had taken place and where recommendations and suggestions had been acted upon following quality assurance exercises.

Most of the people we spoke with told us they would make a complaint to the manager if they had any reason to do so. There was a complaints policy in place and this information was available to people in the reception area.

We found that people were happy living at Forrester Court and their relatives found the staff supportive, caring and told us they would speak with the managers if they had a concern about their family member. We saw that families were encouraged to visit and be involved in care and did so.

People expressed their views and were involved in making decisions about their care and treatment. This included initial assessment and care planning. People were supported in promoting their independence. There was a range of activities provided daily. People's diversity, values and human rights were respected and families reported that their relatives were treated with respect. Two examples were, 'I come in most days. The staff know what my relative likes and doesn't like. She's safe here and that makes it better for me' and 'I've no worries about leaving my relative here'.

Staff understood their responsibilities with regard to safeguarding the people in their care. They had undertaken training appropriate to their roles. In general there were enough staff to care safely for the people at the home. However more staff, particularly nurses, would enable people to receive more attention, especially when they were being cared for in bed. Nurses would then not be disturbed when they were required to concentrate on tasks, such as giving medication, if there was another nurse on duty at those times.

Care records were managed safely and were up to date. These included daily logs, for example of fluids taken and food eaten. People were assisted to eat their meals and a range of nutritious food was provided by the on-site kitchen staff.