Archived: The Old Forge

At the time of our inspection there were four people living in the home. 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.

The inspection took place on the 1 and 2 December 2015 and was carried out as part of our schedule of comprehensive inspections.

Staffing levels were not sufficient to meet people’s needs. As a result risks associated with eating and swallowing were not managed in line with professional guidance. Sufficient staff were not always provided to ensure people who required two staff for moving and handling could have their personal care needs met and access to activities were limited.

Risk assessments were in place, however some risk assessments lacked details on how specific risks were to be managed and risk assessments were not in place for all identified risks.

Systems were in place to manage infection control, however staff practice did not always promote safe working practices to prevent the risks of cross infection. The kitchen was under refurbishment and therefore out of use. As a result the laundry room and sink was being used on a temporary basis to wash dishes. There was no risk assessment in place to manage the risks of cross infection associated with this. Discussions had taken place regarding potential risks and staff were aware of what they needed to do to prevent cross infection.

Improvements were required to recruitment practices. We have made a recommendation to address this.

Food and fluid intake was monitored but accurate records were not maintained of the total amounts required and taken. We have made a recommendation to address this.

Mental capacity assessments took place and decisions on people’s care and treatment were made in line with legislation. Deprivation of liberty safeguards (DoLS) had been approved by the local authority. However the home failed to obtain copies of the approved applications and inform the Commission in a timely manner.

Staff were kind, caring and gentle in their approach. They offered people choices and engaged with them. However we saw limited use of aids, objects of reference and signing to communicate with people as was outlined on their communication diaries. We have made a recommendation to address this.

Relatives told us staff were kind, caring and gave an example where they felt staff had gone the extra mile.

Care plans were in place. They were not person centred and were not updated to reflect change in people’s needs. They showed no evidence of people’s involvement in them.

The range of activities on offer was limited and activities did not take place regularly. We have made a recommendation to improve access to more person centred activities for people.

Staff were suitably inducted, trained, supervised and appraised. They told us they worked well as a team and felt the home was well led and managed. They found the registered manager and support lead to be accessible and approachable. However we found the registered manager was responsible for managing two locations with not enough staff to enable them to do it effectively.

Medicines were safely managed. Systems were in place to audit the service but the audits failed to address the issues we found at this inspection.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

We looked at everyone's care records, five staff files, the providers policies and quality assurance records. We requested information from a medical practitioner.

We found that people's views and experiences were taken into account in the way the service was provided and delivered in relation to their care. We saw that people were treated with dignity and respect and appeared relaxed and happy.

We found that staff had an understanding of the needs of people who used the service. People experienced care and support that met their needs. People were encouraged to remain as independent as possible and to participate in a range of activities and outings. We observed that people only had partial access to the garden due to their mobility needs. The registered manager assured us that steps would be taken to improve the access.

People were protected from the risk of abuse.

We found that there was an effective recruitment process in place to ensure that staff had the skills to meet people's needs.

The provider monitored the quality of the service and had made improvements where needed.

During our observation we saw staff interacted well with people when they were supporting them. We saw the staff were knowledgeable about people's needs and preferences and found staff were respectful and maintained people's dignity, privacy and independence.

We observed people who used the service needs being assessed and care being planned and delivered in line with individual care plans. A complaints procedure was available in a user friendly format and was clearly explained to people who used the service, records were maintained to confirm this was done.

We looked at a 'Thank You' letter from a relative of one of the people who used the service, praising the quality of the service and highlighting the commitment from the team to provide an excellent service.

People who used the service were comfortable with staff and we saw a nomination from a parent to a care worker to acknowledge exceptional support and care received by a person who uses the service.