Forest Edge

About the service

Forest Edge is a residential care home providing accommodation and personal care to up to 32 people. The service provides support to older people who may be living with dementia, sensory loss, physical disabilities, or mental health conditions. At the time of our inspection there were 21 people using the service.

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

Relatives told us their loved ones were safe. However, we could not be assured risks associated with people’s needs were always assessed appropriately or managed. When people had unwitnessed falls no post falls observations were completed. Records showed incidents were not always investigated fully to keep people safe. More robust governance systems needed to be in place to monitor and improve the quality of the service provided.

The provider had not notified CQC of all significant events in line with the requirements of the provider’s registration. We viewed 3 reportable incidents that should have been reported to CQC.

Relevant recruitment checks were conducted before staff started working at the service to make sure they were of good character and had the necessary skills. However, we did find more robust procedures for checking full employment histories were required.

Medicines administration records (MAR) confirmed people had received their medicines as prescribed. However, we found some concerns in relation to recording when prescribed creams were applied. The service has since put in some measures to improve medicines.

The home was clean, and measures were in place for infection prevention and control. We were assured that infection prevention and control practices were in line with current guidance. The home had recently gone through a refurbishment programme to improve the home.

Staff had received training in safeguarding adults and knew how to identify, prevent, and report abuse. There were enough staff to keep people safe. People were supported with their nutritional needs. People received varied meals including a choice of fresh food and drinks. Staff knew people well and treated people with kindness and compassion.

Staff worked collaboratively with health and social care professionals to support people with their healthcare needs. There was a system in place to allow people to express any concerns or complaints they may have.

Staff received regular support and one to one sessions or supervision to discuss areas of development and to enable them to carry out their roles effectively. Training had improved and we received praise from staff about the training. Activities took place both inside the home and outside the home. Staff felt supported by management and enjoyed working at the service and felt staff morale was positive. Staff we spoke with were enthusiastic about their jobs and showed care and understanding for the people they supported.

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.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was inadequate (published 06 December 2022). The provider completed an action plan after the last inspection to show what they would do and by when to improve.

This service has been in Special Measures since 30 November 2022. During this inspection the provider demonstrated improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from inadequate to requires improvement based on the findings of this inspection.

We have found evidence the provider needs to make improvements. Please see the safe and well led sections of this full report.

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 Edge on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified a repeated breach of regulation 12 safe care and treatment. There was an additional breach of Regulation 18, due to not sending in notifications as required, 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 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.

Forest Edge is a residential care home providing accommodation and personal care to up to 32 people. The service provides support to older people who may be living with dementia, sensory loss, physical disabilities or mental health conditions. At the time of our inspection there were 24 people using the service.

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

This was a targeted inspection to follow up a warning notice served at the previous inspection about how well led the service was. We use targeted inspections to follow up on Warning Notices or to check concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

Based on our inspection of safe and well led, we found improvements had been made and the warning notice had been met to ensure improvements were made in specific areas to evidence compliance with the regulations.

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 inadequate (published 06 December 2022). The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At the last inspection we served warning notices in respect of good governance. At this inspection we found improvements had been made and the provider had met the warning notices in full.

Why we inspected

We undertook this targeted inspection to check whether the Warning Notice we previously served in relation to Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. The overall rating for the service has not changed following this targeted inspection and remains inadequate.

We use targeted inspections to follow up on Warning Notices or to check concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

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.

Enforcement

The provider remains in breach of regulations found at the last inspection. These relate to staffing and training, medicines, premises, person centred care, mitigating risks to people and making decisions for people who lack capacity or have fluctuating capacity.

Special Measures

The overall rating for this service is 'Inadequate' and the service remains in 'special measures'. This means we will keep the service under review and, if we do not propose to cancel the provider's registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of

inadequate for any key question or overall rating, we will take action in line with our enforcement

procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions of their registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect. 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.

Forest Edge is a residential care home providing accommodation and personal care to up to 32 people. The service provides support to older people who may be living with dementia, sensory loss, physical disabilities or mental health conditions. At the time of our inspection there were 27 people using the service.

Forest Edge is a care home accommodating up to 32 people in one adapted and extended building. The provider states on its website that it is a service, ‘specialising in the care of those living with dementia, Alzheimer’s and other cognitive impairments.’

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

Staff did not interact with people and lacked an understanding of working with people living with dementia.

We were not assured there was good infection prevention and control practice in the service, some areas would benefit from deep cleaning and other areas were in poor states of repair. Visiting was not taking place in line with government guidance. Visits inside the home had not taken place since before the pandemic.

Medicines were not always safely managed, we found medicines on the floor in a bedroom when we inspected.

Accidents and incidents were recorded however no post falls observations were completed when people had unwitnessed falls or had head injuries.

People’s care were not completely person centred and lacked information such as life histories. Information was not always consistent and was at times contradictory.

People living with dementia were left unsupervised for over half an hour at a time, increasing risks of falls and potential harm from peers. Staff frequently returned people to their seats when they wanted to move about the service and tables were positioned in front of them.

Staff completed training in a range of areas however at least 50% of staff deployed were from an agency who only participated in fire training at Forest Edge. Other training was completed at their agency. In addition, none of the agency staff were participating in supervision when we inspected, one of the agency staff had worked there for seven years without supervision.

The décor and design of the premises did not reflect good practice guidance for a dementia care specialist service. The registered manager did not seek information or advice on how best to support people with dementia.

Staff we spoke with had no understanding of the Mental Capacity Act and records in people’s care files indicated the management team also lacked knowledge of the Act. People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible or their best interests.

People all had the same meals at lunchtime and while the registered manager told us there were other choices, we did not see a list of alternatives, or see staff offer people choices. One person was reported to have eaten and drank well, however we had noted she had not had a drink as she was not given her choice of drink and had eaten one sausage for her meal.

There was a lack of oversight of the service and audits completed did not give a clear insight into the service. The culture of the service was not always person-centred and staff did not spend time with people when they had the opportunity to do so. The provider had positive working relationships with some health and social care professionals. However, they had not made any attempts to develop links with local management groups or forums where they would benefit from sharing good practice and peer support.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 24 November 2020). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

The inspection was prompted in part due to concerns received about Mental Capacity Act assessments and best interest decisions, staffing, and people being vocal and unsettled for long periods without intervention. A decision was made for us to inspect and examine those risks and we undertook a focused inspection to review the key questions of name of safe, effective and well-led only. We also checked to see what progress had been made against breaches of regulation found at the inspection carried out on 24 November 2020. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to inadequate. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well-led sections of this full report. 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 Edge on our website at www.cqc.org.uk.

Enforcement and Recommendations

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 repeated breaches of Regulations 9, 10, 12 and 17. There are additional breaches of Regulations 11, 13, 15 and 18.

Please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. 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.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Forest Edge is a residential care home providing personal care to up to 32 people in one adapted building. At the time of the inspection, staff were caring for 26 people over the age of 65.

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

The registered manager was not following all of the Government guidance aimed at preventing and controlling COVID 19. Infection prevention and control practice, was not always as robust as it should be.

People were mostly supported to have choice and control of their lives and staff supported them in the least restrictive way in their best interests. However, records did not always support this, and best interest decisions were not always in place. Wording in some records of care plans suggested that restrictions to people’s movements were not always being used as a last resort.

Medicines administration records (MAR) confirmed people had received their medicines as prescribed. However, where medicines were prescribed ‘as and when required’, (PRN), there were not always PRN protocols in place.

There were systems in place to monitor the quality and safety of the service provided, however these were not always effective in identifying areas for improvement or where safety had been compromised.

Some of the risks to people had been identified, assessed and appropriate management plans were in place to prevent or reduce the risk occurring. However, we also found examples where this was not the case. Whilst there was a plan in place to manage foreseeable emergencies, this had not been reviewed in light of the COVID 19 pandemic. Fire safety checks were carried out.

Staff had received training in safeguarding adults and knew how to identify, prevent and report abuse. There were enough staff to keep people safe.

There were sufficient staff deployed to meet people’s needs and overall, relevant recruitment checks had been conducted before staff started working at the service.

People were supported with their nutritional needs. People received varied meals including a choice of fresh food and drinks. Staff were aware of people’s likes and dislikes.

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 04 March 2020).

Why we inspected

The inspection was prompted in part due to concerns received about infection control, training, the Mental Capacity Act and the leadership team not engaging with local health and social care professionals. 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.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well-led sections of this full report.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection. The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

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 Edge on our website at www.cqc.org.uk.

Enforcement

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.

We have identified breaches in relation to failing to infection control, Mental Capacity Act 2005 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.

Forest Edge is a residential care home providing personal care to 26 people aged 65 and over at the time of the inspection. The care home accommodates up to 32 people in one adapted building.

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

The majority of people commented positively about the care they received. There was a friendly atmosphere in the home and staff supported people in a kind and caring way. People and their families were supported to express their views.

People were mostly supported to have choice and control of their lives and staff supported them in the least restrictive way in their best interests; the policies and systems in the service supported this practice.

The service was mostly responsive to people’s needs and staff listened to what they said. People did not always receive care that was fully personalised. Staff were prompt to raise issues about people’s health and people were referred to health professionals when needed. People could be confident that any concerns or complaints they raised would be dealt with.

We have made a recommendation about the provider researching current best practice in meeting people’s equality and diversity needs.

There were systems and processes in place to protect people from harm. Medicines were managed safely. Staff were trained in how to recognise and respond to abuse and understood their responsibility to report any concerns. There were sufficient numbers of experienced staff to meet people’s needs. Safe recruitment practices were followed to make sure only suitable staff were employed to care for people in the home.

Staff were supported to gain relevant knowledge and skills through an on-going programme of training and supervision. The service worked with other agencies to promote people’s health and wellbeing. People were supported to eat and drink enough to meet their needs.

There were a range of systems in place to assess and monitor the quality and safety of the service. Staff were clear about their roles and responsibilities and felt well supported.

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 14 March 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Following the first day of the inspection we received concerns in relation to the management of people’s care needs. We used this information to focus our inspection on the second day.

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.

Forest Edge is registered to provide accommodation and support for up to 32 older people who may also be living with dementia. On the day of our visit 32 people

were living at the home. The home is located on the edge of the New Forest approximately four miles from Southampton. People’s private bedrooms are on the ground and first floors. There is a passenger lift and stairs to the first floor. The home has a well maintained garden and patio area that people are actively encouraged to use.

The service had a registered manager. 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's safety and wellbeing was promoted by staff. People were encouraged to raise any concerns about their safety. People were involved in decisions about keeping them safe.

Assessments were in place to identify risks that may be involved when meeting people’s needs. Staff were aware of people’s individual risks and were able to tell of the strategies in place to keep people safe.

There were sufficient numbers of qualified, skilled and experienced staff deployed to meet people’s needs. Staff were not hurried or rushed and when people requested care or support, this was delivered quickly.

Medicines were stored and administered safely. Clear and accurate medicines records were maintained. Training records showed that staff had completed training in a range of areas that reflected their job role.

People were encouraged to eat a varied and healthy diet. People's views and suggestions were sought about meals and these were used to plan the meals provided.

People's health was maintained. People saw a range of healthcare professionals as and when required.

People enjoyed positive relationships with staff. People were involved in decisions about their care. People were treated with dignity and respect and their privacy was maintained.

People's individual preferences were known by staff. Staff adapted to meet people's changing needs.

People's opinions, comments suggestions were valued and acted upon. Where complaints had been made, these had been investigated and action taken.

The registered manager had created a positive and inclusive atmosphere in which people's and staff's views mattered.

The registered manager and provider maintained oversight of the quality of care provided to people, and sought to continually improve this.