12 May 2022
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.
As part of this inspection we looked at the infection control and prevention measures in place. This included checking the provider was meeting COVID-19 vaccination requirements. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.
This inspection took place on 17 and 21 February 2022. The first day of our inspection was unannounced and was carried out by one inspector. The second day of our inspection was carried out by two inspectors.
Service and service type
Forest Hill is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Forest Hill is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
This inspection was unannounced.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and the local clinical commissioning group about the service. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all of this information to plan our inspection.
During the inspection
During the inspection we spoke with five people who used the service, 14 relatives, and observed how care and support was given generally. We spoke with nine care staff, including nurses, and three staff involved in activities, maintenance and catering. We spoke with the deputy manager and the provider’s divisional director for hospitals and complex care services. We looked at a range of records including nine people’s care and activity records and how medicines were managed for people. We also looked at staff training, and the provider’s quality auditing system.
We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.
After the inspection
Following the inspection visit we asked the provider to give us additional evidence about how the service was managed, which they sent to us.
12 May 2022
About the service
Forest Hill provides personal and nursing care for up to 55 people. People are accommodated in two separate units within one building. The Portland Suite (downstairs) provides personal and nursing care for adults with mental health needs. The Memory Lane community (upstairs) provides personal and nursing care for older people living with dementia. At the time of our inspection, there were 53 people living at Forest Hill.
People’s experience of using this service and what we found
People were not always protected from the risk of abuse. Relatives had mixed views about whether their family members were cared for safely. There were times when there was not enough staff to meet people’s needs safely. People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.
Areas of the service were not clean or maintained well. There were not enough domestic staff to keep the building clean. People did not always receive their prescribed medicines at the prescribed times. Information in people’s care plans was not consistently kept up to date.
The provider had not ensured systems and processes to assess risk and monitor quality were sufficient and effective in driving improvements. There was a lack of robust oversight of the quality of care. The governance systems did not support staff to identify themes of concern and take appropriate action to maintain safe care in a consistent way.
The provider’s checks and audits did not identify that people were not consistently involved in planning and reviewing their care. The provider did not always act on feedback received from health and social care professionals in a timely manner to reduce risks to people.
Staff we spoke with demonstrated good knowledge of people’s needs, but said they did not always have enough time to read people’s care plans. People were not always involved in reviews of their care, particularly where they were less able to communicate their needs.
Relatives had mixed experiences of communication from the provider about aspects of their family members’ care. The provider had not taken steps to ensure that people were given information about their care and support in ways which were accessible for them.
Risks associated with the service environment were assessed, but the provider did not always ensure those risk were mitigated.. The provider had a system in place for regular checks on all aspects of the environment. People’s needs were assessed, and any risks associated with their health conditions documented. Accidents and incidents were reviewed and monitored to identify trends and to prevent reoccurrences.
People's needs, and choices were assessed in line with current legislation and guidance in a way that helped to prevent discrimination. People were supported by staff to access healthcare services when required. People were supported and encouraged to have a varied diet that gave them enough to eat and drink.
People and relatives spoke positively about the staff who provided support. Staff were caring and showed that they enjoyed the work they do.
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 Outstanding (published 21 November 2017).
Why we inspected
The inspection was prompted due to concerns received about infection control, cleanliness and how people were safeguarded from the risk of abuse. A decision was made for us to inspect and examine those risks.
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. This included checking the provider was meeting COVID-19 vaccination requirements.
We have found evidence that the provider needs to make improvements. 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 Forest Hill on our website at www.cqc.org.uk.
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 of regulations in relation to safeguarding service users from abuse and improper treatment, staffing, premises and equipment and good governance.
Please see the action we have told the provider to take at the end of this report.
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.