Archived: Forder Lane House

Forder Lane House is a residential care home providing personal and nursing care to 22 people aged 65 and over at the time of the inspection. The service can support up to 25 people.

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

The provider had made improvements to the service following our last inspection in July 2019.

Risks to people were now assessed and managed safely. Risks were monitored regularly, and daily checks were made to ensure people were receiving the care they needed to mitigate risk.

Risks associated with premises safety had been addressed and maintained to ensure the environment was safe for people. The provider had taken steps ensure people were safe from the risks from falling from a height.

Improvements had been made to the provider's quality assurance system which was used effectively to identify any shortfalls. When areas for improvement had been found we saw that swift action had been taken to address them.

There was clear managerial and provider oversight of the service to ensure systems in place were being followed and used to drive improvement at the service. Staff and relatives were very positive about the interim management team.

Staff followed appropriate infection control practices to prevent cross infection. However, not all staff had received training about risks related to Covid 19, including handwashing and use of personal protective equipment (PPE). This was addressed immediately.

The provider had systems in place to safeguard people from the risk of abuse and staff knew how to respond to possible safeguarding concerns. Medicines were managed safely.

During the inspection we observed there were sufficient numbers of staff to meet people's needs. Safe recruitment procedures were in place.

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 requires improvement (9 September 2019).

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

Why we inspected

This was a planned inspection based on the previous rating.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Forder Lane House is a residential care home providing accommodation and personal care for up to 25 people. At the time of the inspection there were 25 people living at the service.

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

Risks associated with people's individual health and care needs were assessed and guidance was available for staff on how to minimise known risks to keep people safe. However, people were not always protected from risks associated with their environment and equipment used to minimise risk was not always set correctly in order to reduce the risk of skin damage. Where some risks had been identified, it was unclear what action had been taken to mitigate those risks and keep people safe.

There were systems in place to check the quality of the service. However, internal audits and processes failed to identify or address the issues we found at this inspection. The management team understood their responsibility to be open and honest when things had gone wrong. They welcomed our inspection feedback and took immediate action in response to the issues we found.

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. However, we made a recommendation to the provider about ensuring records relating to best interests decisions were completed in compliance with the Mental Capacity Act 2005.

People felt safe living at the service and safeguarding procedures were in place to protect people from harm. Staff were recruited safely, and enough staff were on duty to provide safe care during our visit.

People and relatives spoke positively about the level of care they received. People were encouraged to be independent. Care was provided in a dignified way and people's right to privacy was respected.

Staff received training to ensure they had the skills and knowledge they needed to perform their roles. Staff told us they felt supported by the managers and received regular supervisions.

People were involved in their own care planning and could contribute to the way in which they were supported. People and their family were involved in reviewing their care and making any necessary changes.

A process was in place which ensured people could raise any complaints or concerns. Concerns were acted upon promptly and lessons were learned through positive communication.

The home was visibly clean throughout. All equipment had been serviced and maintained. Weekly and monthly health and safety checks were completed.

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 24 January 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to safe care and treatment and good governance 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 for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

A manager was employed to manage 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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People told us they were cared for by staff who knew them well. Comments included, “Staff are really caring, really good.” Staff spoke about people with respect and compassion and had received training to meet people’s needs. Staff were supported in their role by an ongoing programme of supervision, appraisal and competency checks; they also told us they received sufficient support from senior staff whenever they needed it.

People told us they felt safe using the service. There were risk assessments in place to help reduce any risks related to people’s care and support needs. Staff had received training in how to recognise and report abuse and were confident any allegations would be taken seriously and investigated to help ensure people were protected.

People were kept safe by suitable staffing levels and we observed unhurried interactions between people and staff. This meant people’s needs were met in a timely manner. Recruitment practices were safe. Checks were carried out prior to staff commencing their employment to ensure they had the correct characteristics to work with vulnerable people.

People had their healthcare needs met. For example, people had their medicines as prescribed and on time. People were supported to see a range of health and social care professionals including social workers, chiropodists, district nurses and doctors.

People told us they enjoyed the food and mealtimes were a positive experience. People told us meals were of sufficient quality and quantity and there were always alternatives on offer for them to choose from. People were involved in planning the menus and their feedback on the food was sought. Where people had specific needs or wishes relating to food, these were catered for.

The registered manager and staff had attended training on the Mental Capacity Act 2005 (MCA).

Staff were knowledgeable about the Mental Capacity Act and how this applied to their role.

People, and where appropriate, their family members, were involved in planning their care and staff sought their consent prior to providing them with assistance. People’s care plans reflected their needs and wishes and were updated regularly.

There was a positive culture within the service. The registered manager had clear values about how they wished the service to be provided and these values were shared by the whole staff team. Staff talked about providing a homely atmosphere for people and respecting people’s individual choices.

There was a management structure in the service which provided clear lines of responsibility and accountability. A registered manager was in post who had overall responsibility for the service. They were supported by other senior staff who had designated management responsibilities. People told us they knew who to speak to and any changes or concerns were dealt with swiftly and efficiently.

Feedback received by the service and outcomes from audits were used to aid learning and drive improvement across the service. The manager and staff monitored the quality of the service by regularly undertaking a range of regular audits and speaking with people to ensure they were happy with the service they received. People and their relatives told us the management team were approachable and included them in discussions about their care and the running of the service.

We considered our inspection findings to answer questions we always ask;

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

Our inspection team was made up of two inspectors. This is a summary of what we found. The summary is based on our observations during the inspection, speaking with nine people who lived in the home, five staff who supported them, two relatives, the Registered Manager, the Chief Executive, and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

Medication systems in use meant people had their medicines at the time they needed them and in a safe way. There were enough staff on duty to meet people's needs. The Registered Manager had reviewed the staffing levels and increased the number of care staff on duty during the day to ensure there were enough staff to meet people's needs. Staff told us that staffing numbers had increased. One member of staff said 'A while ago we were short staffed and we felt rushed. Now we have an extra staff member, it's a lot calmer and we have enough staff'. People who used the service and their relatives told us that staff were not rushed and had time to meet their needs. One person commented 'there's always staff about' and 'I certainly feel safe here. The staff are all so obliging'. CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The Registered Manager told us they had not needed to submit any applications. The Registered Manager and senior staff had been trained to understand when an application should be made, and how to submit one.

Is the service effective?

People who lived in the home told us they were happy with the care and support they received. Comments included "The staff couldn't be more helpful, they are just brilliant' and 'Staff always ask me if I want anything, I've never had it so good'. We received feedback from the Local Authority who had recently spoken with a range of healthcare professionals who visited the home. They all confirmed that they were happy with the care provided and had no concerns.

Is the service caring?

People were supported by kind and attentive staff. We saw that staff were patient and went at the person's pace when assisting them with their mobility. They explained what they were doing and why. People who used the service told us that staff were not rushed and had time to meet their needs. Our observations confirmed this. Staff responded to people's requests and people appeared to enjoy the interactions and conversations. We observed people with staff in the dining room laughing and joking. People told us "The staff here are first class' and 'Staff are very good, courteous and we have a good laugh'.

Is the service responsive?

The service carried out assessments to ensure they could meet people's needs before they moved into the home. One relative told us 'the Registered Manager came into the hospital and they were very helpful, with a can do attitude. Everything was put in place. I'm very, very pleased'. People knew how to make a complaint if they were unhappy. The people we spoke with told us they had not needed to make a complaint. They were confident that any issues would be addressed to their satisfaction.

Is the service well-led?

People who lived in the home told us they were asked about the quality of the service. People told us that their comments were listened to and acted upon. People and their relatives told us "You can talk to the manager about anything and they will put things right straight away'; 'no concerns at all, I'm very happy' and 'I can't think of anything that could be better'. Staff told us they had regular contact with the Registered Manager. Staff commented "I'm very happy at the moment'; 'If you have a problem you can speak to management and it gets sorted straight away' and 'The manager is always here and is always approachable'. Staff told us that there had been a number of changes in the past year. Staff members commented 'Record keeping is a lot better than it used to be, a lot more structured' and 'Things are really improving'. This helped to ensure that people received a good quality service at all times.

We spoke with six people who lived at the home and with one relative. We also spoke with eight staff including the provider, the manager, two senior care workers, three care workers, a cleaner and a visiting health professional.

All of the people we spoke with were very positive about the manager of Forder Lane House. One person told us 'The manager treats me with respect.' Another person said the manager 'has been great'. A relative told us 'I've got total confidence in the manager here, she acts on suggestions and takes action.'

Everyone we spoke with at Forder Lane told us that they felt safe at the home, with the manager and with the staff employed at the home.

All of the staff we spoke with were positive about the manager. One care worker told us she was 'a very good, kind and friendly manager'. Another said 'She is brilliant with the residents.' The provider told us 'The manager is very robust and very fair.'

We looked at the manager's staff file and three other staff files. We saw that comprehensive background checks had been made on all of these files. This meant that measures were in place to reduce the risk of unsuitable staff working with vulnerable people.

On the day of our inspection 24 people lived at Forder Lane House. We spoke with five people who lived at the home and a relative of a person who lived there. We also spoke with three care workers, the cook, the deputy manager, the manager and the Chief Executive of the provider company.

People told us that they were treated respectfully by care workers and that they were offered choices in relation to their activities at the home. One person said 'I play the piano, do Tai Chi, enjoy reading or bingo.'

People who lived the home and their relatives were positive about the care delivered at Forder Lane. One person said 'Forder Lane was recommended to me and I am very satisfied with it.'

We found that staff had now received mandatory training appropriate to their roles. Some care workers were also undertaking additional training.

We looked at the quality assurance systems in place to monitor the quality of care delivered. We saw that the provider monitored the service effectively and responded to feedback effectively.

We saw that accurate records were now being kept. These included care records, incidents, communication, maintenance and cleaning records.

People told us they were happy with the care they received. Comments included 'I'm perfectly happy, the staff know exactly what to do to meet my needs'; 'it's a very good home, we're well looked after' and 'when I was ill, they couldn't do enough for me'. We spoke with care staff who were able to tell us how they met people's care needs.

People who lived in the home told us they felt safe and staff knew what to do to meet their needs. Staff knew how to report concerns to ensure people were protected from the risk of harm. We found staff had not completed some areas of training to keep them up to date with current best practice. Staff told us they felt well supported in their job role.

The home had a quality assurance system to assess and monitor the quality of the service. People told us that their comments were listened to and acted upon. People told us "there's nothing to grumble about' and 'you can't fault it".

We found records were not kept in a way that protected people's safety and welfare. Care plans did not contain accurate information. The plans were not written in enough detail to ensure that care staff could follow the instructions.