Forest Place Nursing Home

Forest Place Nursing Home provides accommodation for persons who require nursing or personal care to up to 90 people in one adapted building. The service provides support to older people, and people living with dementia. At the time of our inspection there were 63 people using the service across 3 units, [Meadway, Stradbroke and Amberley] each of which has separate adapted facilities.

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

Suitable arrangements were in place to keep people safe. Procedures were followed by staff to safeguard people and staff understood these processes. Risks to people were identified and managed to prevent people from receiving unsafe care and support. Medicine arrangements ensured people received their prescribed medication and staff’s practice was safe.

Staffing levels met people’s care and support needs. Recruitment procedures were followed to ensure the right staff were employed to care for vulnerable individuals. People were protected by the providers arrangements for the prevention and control of infection. Arrangements were in place for learning and making improvements.

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.

People received a good level of care and support that met their needs and preferences. Staff had a good knowledge and understanding of people's specific care and support needs and how they wished to be cared for and supported. People were supported and had their social care needs met. Suitable arrangements were in place to assess and monitor the quality of the service provided. People, relatives, and staff were positive regarding the management of the service.

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 January 2023]. 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 improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out an unannounced focused inspection of this service on 22 November 2022, 25 November 2022, and 7 December 2022. Breaches of legal requirements were found relating to Regulation 9 [Person centred care] and Regulation 17 [Good governance].

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

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 Requires Improvement to Good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Forest Place Nursing Home on our website at www.cqc.org.uk.

Follow up

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

Forest Place Nursing Home is a nursing home providing accommodation for persons who require nursing or personal care to up to 90 people. The service provides support to older people, some of whom are living with dementia. At the time of our inspection there were 67 people using the service.

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

People’s records did not always contain all the information staff needed to enable them to provide safe care, charts were not always completed fully, and people’s medicines were not always stored safely.

The service had enough staff and they knew how to raise concerns about people's safety.

Staff wore appropriate personal protective equipment (PPE) and reported incidents.

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.

People’s care plans did not always contain enough information for staff to provide care in a person-centred way. People did not always receive care from staff who communicated with them in ways they could understand, and they were not always supported to follow their interests and take part in activities.

People’s families felt involved in their care.

The provider did not have effective processes for monitoring the safety and quality of the service or to ensure people received person-centred care.

Staff told us they felt supported in their role and people’s families were kept informed about their health and wellbeing.

The service worked well with other professionals.

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 (21 September 2021) and there were breaches of regulation. 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. The service remains rated requires improvement. This service has been rated requires improvement for the last six consecutive inspections.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection. We received concerns in relation to risk assessments, management of incidents and complaints and lack of person-centred care. As a result, we undertook a focused inspection to review the key questions of safe, responsive and well-led only.

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 remained requires improvement based on the findings of this inspection.

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

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Forest Place Nursing Home on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to person-centred care and managers’ oversight of the service at this inspection.

Please see the action we have told the provider to take at the end of this report. Following the inspection, we issued a warning notice setting out for the provider the actions we required them to take within a set timeframe.

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 Place Nursing Home is a residential care home providing personal and nursing care for up to 90 people aged 65 and over. At the time of the inspection 58 people were living in the service, some of whom were living with dementia.

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

People did not always receive care which reflected their individual preferences or supported them to achieve good outcomes. People’s relatives told us they did not always feel the provider communicated positively or involved them in decisions in the service.

The provider did not have robust safety and quality monitoring processes in place. People’s care records were not always up to date or completed appropriately, and the provider’s management checks had not identified these gaps in recording.

People were kept safe from the risk of harm. Staff knew people well and knew how to raise any concerns about people’s safety. Staff were safely recruited and there were sufficient staff available to meet people’s needs.

People received their medicines as prescribed and staff had clear information about how people liked to be supported with their medicines. Staff were knowledgeable about people’s health needs and the provider had sought support from other health professionals as appropriate to support people’s needs.

Staff wore appropriate personal protective equipment (PPE) and told us they knew how to minimise people’s risk of infection through safe infection prevention and control processes.

Staff told us they felt supported in their role. The registered manager had introduced regular staff meetings to encourage feedback and shared lessons learnt with staff to drive improvements in the service.

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 (published 18 March 2021).

Why we inspected

We received concerns in relation to safeguarding people from the risk of abuse and the management of safeguarding allegations. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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 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.

We have found evidence that the provider needs to make improvement. Please see the well-led section of this full report.

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified a breach in relation to people receiving personalised care which reflects their preferences.

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

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.

We found the following examples of good practice:

Staff supported people in a personalised way to keep in touch with their friends and family members.

There was a dedicated staff team set up to work in the designated areas for people who were discharged to the service with a positive COVID-19 test. The designated area had a separate entrance and facilities.

The provider had considered in detail how to minimise the spread of infection when they planned the designated unit, such as selecting wipe-clean furniture.

We were assured that this service met good infection prevention and control guidelines as a designated care setting.

Forest Place Nursing Home is a residential care home providing personal and nursing care for up to 90 people over the age of 65 years, with nursing and/or dementia related needs. There were 55 people living at the service at the time of our inspection.

There had been significant changes to the property since our last inspection. The Kingfisher unit had closed, and people had moved into purpose-built units, which included a new reception, training rooms and parking facilities.

In total the service had the potential to accommodate 120 people, however the provider had not yet requested to register the additional units, and the top floor was not yet in use.

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

The provider and registered manager had responded positively to feedback from the last inspection. Significant changes had been made, including an extensive building and refurbishment programme. As a result, people’s experience of living at Forest Place Nursing Home had improved and staff were enabled to provide safer care.

The provider had supported the registered manager to develop systems to promptly and effectively pick up and resolve concerns. This had improved the understanding and management of risk, in particular around key areas of concern at our last inspection, such as safeguarding and pressure care. There was an excellent culture of learning and continual development.

There were enough staff to support people safely and the team was well organised. The registered manager was passionate about enabling staff to develop their skills and understand their role in the service.

People continued to receive medicines safely and as prescribed. We were assured that this service met good infection prevention and control guidelines.

People received personalised care from motivated staff who knew them well and supported them to achieve positive outcomes. 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.

Relatives were largely positive about the care their family members received, though they described some anxiety because contact was affected by the COVID-19 pandemic. All staff worked hard to communicate and engage with relatives. We had positive feedback about how well the electronic systems supported this contact and communication.

All the professionals we contacted gave us positive feedback and told us they had good working relationships with staff and management which promoted people’s wellbeing.

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 06 January 2020). The provider completed an action plan after the last inspection to show what they would do and by when to improve the governance at the service. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We undertook this focused inspection to check the provider 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.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has therefore remained requires improvement. This is based on the findings at this 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 coronavirus and other infection outbreaks effectively.

We also looked to see whether the infection prevention and control at the service met the required standard for it to be used as a designated care setting, to facilitate safe hospital discharges during the COVID-19 pandemic.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Forest Place Nursing Home on our website at www.cqc.org.uk.

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.

About the service

Forest Place is a residential care home providing personal and nursing care for up to 90 people over the age of 65 years, with nursing and/or dementia related needs. There were 52 people accommodated at the time of our inspection.

Forest Place is made up of two adapted buildings on one site. Maple is spread across three floors. Kingfisher, the older of the two buildings, originally the old cottage hospital for Epping, has two floors; the upper floor was closed. The provider was building a purpose designed new building in the same grounds which will eventually replace Kingfisher. The provider was looking to the end of January 2020 for completion of the new building.

There was 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.

Peoples experience of using this service and what we found

Since our last inspection managerial oversight had lapsed. Governance systems were not run effectively to monitor the quality and safety of the service and give a correct overview. This led to incidents not being reported correctly or investigated properly.

The local authority safeguarding, and quality improvement teams have monitored and supported the service through regular visits and training. Formal systems have since been put in place to record, review and check incidents, and make sure action is taken to address the situation, protect people and prevent further occurrences. The number of incidents has now reduced.

The provider was developing a new management team to support the registered manager and they had appointed a new home manager. We viewed this appointment of an experienced person in care to be a positive step, bringing stability, support and guidance to the staff team. Although only in post for just a few weeks prior to this inspection, clear governance, management and accountability arrangements were already appearing.

The provider had a clear vision for the service and the extensive new purpose build of a 60 bedded unit in the grounds of Forest Place was almost at the stage of completion. However, further improvement was needed to bring the rating up to good. We need to be sure quality assurance arrangements and improvement plans are robust, effective and sustainable to improve outcomes for people. Any future development of the service would benefit from this.

Management and staff treated people with kindness and compassion. Positive relationships had developed between people and staff. However, people’s experiences of care varied considerably.

Care records contained insufficient guidance for staff in providing safe care and in supporting people’s wellbeing. Improvements were needed in staff’s understanding of dementia care to enable them to support people and deliver care that is responsive, and person centred. This included staff’s knowledge in managing heightened levels of anxiety and associated behaviour and supporting people to have access to meaningful stimulus and engagement tailored to their level of dementia. Staff had received some element of training in dementia care, but staff did not have a good understanding of how dementia affected people and how they could support people in a safe and responsive way. Staff did not understand people’s social needs.

The new management structure was starting to create a positive and inclusive culture at the service, with a supportive approach, developing strong and productive relationships with the staff team.

Rating at last inspection

The last rating for this service was requires improvement (published 28 April 2019). The provider did not complete an action plan after the last inspection to show what they would do and by when they would do it to improve.

At this inspection enough improvement had not been made and the provider was still in breach of Regulation 17, Good governance. The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections.

Why we inspected

This inspection was brought forward due to information received in relation to an elevated level of unreported injuries of unknown cause. A decision was made for us to inspect and examine those risks and to follow up on action we told the provider to take at the last inspection.

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 work with the local authority to monitor progress. We will return to visit as per re-inspection programme. If we receive any concerning information we may inspect sooner.

People’s experience of using this service:

People experienced compassionate care from kind, dedicated staff who made them feel important and valued. People told us they felt they were treated with respect. However, people who were unable to leave their bedrooms did not always have opportunities to engage with activities and told us they were bored and lonely. While some areas of the home environment were well maintained, and created a pleasant and welcoming atmosphere, the appearance of other areas of the home had deteriorated over time and were cold. There were lots of inconsistencies in how well people’s care needs and preferences were recorded which meant there was a risk that people may not always receive care in line with their needs and preferences. People gave examples where agency staff had not known how to support them properly. While people and relatives told us they found staff and the management team open and approachable, their systems were not operating effectively to improve people’s experience of living in the home.

Rating at last inspection: The service was rated Requires Improvement at its last inspection in October 2017.

Why we inspected: This was a planned inspection based on previous rating.

Enforcement: Please see the ‘action we have told the provider to take’ section towards the end of the report.

Follow up: We will continue to closely monitor the service and require an action plan from them.

At this inspection whilst improvements were noted since our last inspection in relation to complaints, medicines management and enabling people to be involved with making decisions, further improvements were still required pertaining to care planning and ensuring risks were managed appropriately.

Following the inspection there was a serious incident which is subject to a police investigation. The inspection did not examine the circumstances of the incident, however we reviewed all information received and concluded the service had acted appropriately to ensure people using the service were safeguarded and any risks to people’s safety and wellbeing were mitigated.

Forest Place Nursing Home provides accommodation and personal care for up to 90 older people. Some people also have dementia and complex nursing related needs. The premises consist of Kingfisher Unit for people living with dementia and Maple Down and Maple Loft for people living with complex nursing needs. At the time of our inspection the service was undergoing extensive building works to the premises and we were advised that these works would be completed in 2019.

This inspection was completed on 29 and 30 October 2017 and there were 71 people living at the service when we inspected.

A registered manager was 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.

Although a lot of work had been done, further improvements were required to the quality assurance system to drive improvement and ensure that all aspects of the service are clearly monitored for potential risks. This related to people’s care records and risk assessments. Risks had not always identified and mitigated so as to ensure people’s safety and wellbeing. Suitable arrangements were needed to ensure staff followed people’s care and support needs so as to ensure their safety and wellbeing. We did not see any impact on people due to these documentary shortfalls during our inspection and the registered manager was responsive to addressing any concerns noted during our visit.

Minor improvements were required to recruit staff safely in line with the provider’s policies and procedures, to ensure staff received a robust induction and an appraisal of their overall performance.

Systems were in place which safeguarded people who used the service from the potential risk of abuse and harm. Staff understood the various types of abuse and knew who to report any concerns to should the need arise. People living at the service confirmed they were kept safe and had no concerns about their safety. People were confident that their concerns and complaints would be listened to, taken seriously and acted upon.

Appropriate arrangements were in place to ensure people’s medicines were obtained and administered in line with the prescriber’s instructions. Improvements were required in relation to how medicines were securely stored for safekeeping at all times.

The deployment of staff within the service was suitable to meet peoples’ care and support needs. Staff described the management team as supportive and approachable. Arrangements were in place for staff to receive formal supervision at regular intervals.

The service was up to date with the Mental Capacity Act [MCA] 2005 and Deprivation of Liberty Safeguards [DoLS] and people’s capacity to make day-to-day decisions had been considered and assessed. Staff sought consent from people before supporting them with their care.

Although people’s comments about the meals provided were variable, the dining experience for people was positive. People’s healthcare needs were supported and people had access to a range of healthcare services and professionals as required. Staff had a good relationship with the people they supported. People were treated with dignity and supported to maintain their independence where appropriate.

In addition, the Care Quality Commission met with the registered provider on 12 February 2016 to discuss our concerns. During the meeting the registered provider gave us an assurance that things would improve and this was followed by a written improvement plan in April 2016 advising of the provider’s progress in meeting legal requirements.

This inspection took place on 11, 12, 13 and 16 August 2016. A registered manager was not in post at the time of this inspection. 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 registered manager had voluntarily cancelled their registration with us since the February inspection. A new manager was in post and taking steps to progress an application for registration as required.

Forest Place is registered to provide accommodation with nursing and personal care for up to 90 older people. People living in the service may have care needs associated with dementia. The service also offers palliative care. There were 67 people receiving a service on the day of our inspection, including two people who were in hospital.

At this inspection we found that although some areas required further sustained improvement, the majority of improvements had been accomplished. The service had developed more robust quality assurance processes to ensure an improved quality of service provision. However, further work was needed to ensure that processes and systems were embedded and continued to improve the care people received at the service, once the service started to re-admit people. We found that the complaints system had not been operated effectively to show that people’s complaints had been thoroughly investigated, learnt from and responded to.

Medicines management was more robust but some aspects of this, as well as aspects of care planning and individual risk assessments, needed further development. Where people lacked capacity to give consent, assessments had been carried out to ensure their rights were protected; however additional detail was needed to show that suitable people had been involved in the decisions in all cases.

Staff were knowledgeable about identifying abuse and how to report it to safeguard people. Staff recruitment processes were shown to be thorough to safeguard people. People were supported by sufficient numbers of staff that were properly deployed to respond to their need safely.

Staff were effectively trained and were clear on their role and responsibility in providing safe and responsive care. People received support from caring staff and people were treated with dignity and respect, including at the end of their life.

Arrangements were in place to support people to gain access to health professionals and services. People had choices of food and drinks that supported their nutritional or health care needs and their personal preferences.

This inspection took place on 1, 2 and 3 February 2016.

Forest Place Nursing Home is registered to provide accommodation with nursing or personal care for up to 90 people, some of whom may be living with dementia. There were 83 people receiving a service on the day of our inspection.

The overall rating for this service is ‘Inadequate’. This means that it has been placed into special measures by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve.

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will be kept under review and if needed could be escalated to urgent enforcement action.

A registered manager was 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.

People were not protected from the risk of harm. Risk management plans for individual people were either not in place or were inaccurate and so did not support people’s safety. Staff did not use equipment safely to limit people’s risk of injury or take action to protect people from risks in the environment they lived in. Staff knowledge of how to safeguard people varied and staff had not acted to protect people from the risk of harm. People’s medicines were not safely managed. Staff recruitment procedures were not robust to ensure staff were suitable to work with people living in the service. Staff were not always available in sufficient numbers to meet people's needs and to provide them with safe care and support. Improvements were needed to staff deployment to ensure people’s safety was consistently monitored.

Up to date guidance about protecting people’s rights had not been followed so as to support decisions made on people’s behalf and to comply with legislation. Staff did not receive suitable training and support to enable them to meet people’s needs effectively. Staff performance was not suitably monitored and appraised to ensure good practice was in place. We observed poor care practices around supporting people to eat and drink well, with moving and handling of people and with supporting people with anxious and distressed behaviours.

People were not always treated in a caring and respectful way. Records were not always available to guide staff on how to meet people's assessed care needs. People did not always receive the support required to meet their identified individual needs and to support their decisions and choices. People had limited opportunities to participate in social activities and engage in positive interactions.

The service was not well led and there were widespread shortfalls. While people living and working in the service had the opportunity to say how they felt about the home and the service it provided, action plans were not developed to demonstrate that improvements were implemented. Management arrangements to ensure accountability and communication in the service were weak and resulted in a poor care outcomes for people. The provider did not have robust systems in place to monitor and reassure themselves of the quality and safety of the service provided so that timely action plans could be put in in place where needed.

We considered our inspection findings to answer the five questions we always ask: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

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

Is the service caring?

We spoke with eight people who used the service and one close relative. One person said to us, "I am very well looked after here. It's very nice; they treat you well." Another person said, "I have no complaints at all. The staff are always wonderful." One close relative said, "It is an awkward journey for me to get here, but I would not want [my relative] cared for anywhere else as this place is perfect. It's incredible just how kind the staff are."

We observed the care and attention people received from staff. All interactions we saw were patient, respectful and friendly and there was a calm atmosphere throughout the home. People's dignity and independence was respected.

Is the service responsive?

We saw that care plans and risk assessments were informative, kept up to date and regularly reviewed. The manager responded in an open, thorough and timely manner to complaints. Therefore people could be assured that complaints were investigated and action was taken as necessary. Staff told us the manager was approachable and they would have no difficulty speaking to them if they had any concerns about the home.

Is the service safe?

The accommodation was adapted to meet the needs of the people living there, was suited to caring for people with limited mobility and was properly maintained. The home was warm, clean and was personalised to the people who lived there.

People were protected by effective staff recruitment systems. The provider had systems in place that ensured the safe receipt, storage, administration and recording of medicines. There were proper process in place in relation to the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards (DoLS).

Is the service effective?

People we spoke with were satisfied with the care and support they received. No one raised any concerns with us. All of the staff we spoke with were knowledgeable about individual people's care needs, and this knowledge was consistent with the care plans in place.

Is the service well led?

Staff said that they felt well supported by the manager, there was a good team ethic and they were able do their jobs safely. The provider had a range of quality monitoring systems in place to ensure that care was being delivered appropriately by staff, that the service was continuously improving and that people were satisfied with the service they were receiving.

During our inspection on 24 May 2013 it was clear staff had a good relationship and communicated well with people living in the home. We spoke with five people who lived in the home. They all said that they were involved in the planning of their care and gave their consent for any care to be given. One person told us, "It's nice here, the staff are lovely, they always ask me how I like things to be done". All the people we spoke with told us they felt safe and would raise any concerns with the manager.

We observed staff supporting people in a kind and calm manner. Communication was positive and staff spoke respectfully with people.

The home was clean, staff were well trained and there were systems in place to ensure people were protected from infection.

Records relating to both staff and the people who lived at Forest Place Nursing Home were appropriate and were securely stored.

All staff had been trained in the Mental Capacity Act. Staff demonstrated to us that they had knowledge of the people they were caring for, meaning they knew what assistance an individual would require to make a decision or give consent.

Where people were unable to provide a verbal response or tell us about their experiences we saw that staff interacted positively with people, supported them respectfully and explained what they were doing to give reassurance to them. However we saw no evidence that appropriate assessments of the mental capacity of the people had been carried out.

We found that the personalised records of people who live at the home and staff members were not always stored securely when left unattended. We also found that the record of training and updates for all staff showed that the ongoing education in the prevention and control of infection associated with the provision of health and social care had not always happened