Foresters Lodge

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence. At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

This service scored 58 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not always make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.

People’s needs were assessed and generally included consideration of their physical, mental, sensory, social and communication needs. However, some care plans did not always contain information about people’s specific health conditions. Managers and staff demonstrated they had systems to assess risk and need. However, these were not always consistent or up to date. Staff described how they used daily oversight processes, including a regular daily meeting to discuss emerging risk. However, assessments and care planning were not always consistently translated into clear, person-centred guidance for staff.

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

Care plans often contained detailed information about people. However, there were multiple inconsistencies about the needs of people who required a modified diet. This included inaccuracies between the International Dysphagia Diet Standardisation Initiative (IDDSI) for food and fluid textures and their descriptors. This meant we could not be assured staff had been given appropriate best practice guidance.

The provider did not always work well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

There was evidence of multi-disciplinary working and professionals described good levels of staff engagement. One professional described the home as very welcoming and said staff were “proactive”, often identifying and dealing with issues before they arrived. Another told us staff were always helpful. However, staff teams did not always work together effectively to plan and deliver consistent care. Staff told us teamwork and communication with each other was variable. One explained how on a daily basis between seniors and team members, “Communication is really poor.” Another told us, “There are staff that pass the room and don’t even reassure the person, they just walk past.” Observations found significant differences in how the service operated on each of the inspection days. This inconsistency indicated teams did not always work together in a reliably coordinated way.

The provider supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support.

People and relatives provided examples of support that promoted wellbeing and appropriate access to healthcare. One relative confirmed, “They [staff] call the GP or whoever is needed.” The service supported and encouraged people to maintain hobbies and community links. For example, 1 person enjoyed gardening projects and had been provided equipment for this. Many people chose to go on outings and staff were responsive to these requests. There was evidence of structured nutrition support for some people, including monitoring or nutrition and fluid targets.

The provider routinely monitored people’s care and treatment to continuously improve it. However, gaps in monitoring meant they did not always ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

The provider had systems in place to monitor people’s outcomes, including audits, risk registers and analysis of issues such as falls, weight, wounds, medicines and DoLS, and leaders demonstrated awareness of key risks at both individual and service level. However, these systems were not consistently effective in identifying concerns early, ensuring timely action or sustaining improvement. We found repeated examples where known risks, including medicines refusals, nutrition and hydration concerns, and constipation, were monitored but not always escalated, reviewed or reflected promptly in care plans, increasing the risk of avoidable harm. Although some improvements were made during the inspection, this highlighted that routine governance arrangements had not reliably driven improvement.

The provider told people about their rights around consent and respected these when delivering person-centred care and treatment.

People were supported to make decisions about their care and staff demonstrated an understanding of consent, routinely explaining care and seeking people’s agreement before providing support. One person confirmed, “Yes, they (staff) ask my permission and tell me what they're going to do.” Relatives also described staff using gentle approaches and respecting refusals, returning later when someone declined care. Where people lacked capacity, assessments and DoLS authorisations were in place and staff showed awareness of individual restrictions.