Forest Place Nursing Home

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

The service is not effective. We identified a breach of regulation around how the service applied the principles of the Mental Capacity Act and Deprivation of Liberty Safeguards (DoLS). This means people were deprived of their liberties or had decisions made on their behalf without proper processes first taking place to determine if this was in their best interests. People were not routinely involved in the planning of their care and care records contained contradictory and, in some examples, missing information. The provider had no systems in place to ensure they kept up to date with current best practice guidelines. People’s personal care and clinical needs were not always met appropriately, and some people organised referrals to healthcare professionals themselves.

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Whilst people and their relatives told us they were involved in the planning of their care, this was not always documented which demonstrated it was in line with statutory requirements.

Staff spoken with were aware of their responsibility to assess and review people’s needs in a timely manner. However, staff had received little training or support to document this within peoples care plans. This meant there were gaps in the provider’s ability to demonstrate needs were fully assessed and met.

Care plans were not complete and missed key information to enable staff to review people’s care. For example, a person with uncontrolled diabetes did not have their food or fluid monitored, even though they experienced high blood sugar levels. The electronic care planning system was available to complete a comprehensive and detailed assessment including all areas including but not limited to physical and mental health, well-being, food and fluid monitoring, positional changes to reduce the risk of developing a pressure wound, weights. However, there was missing key information or updates which were overdue for review. This placed service users at potential risk of not having their care needs updated and receiving the care they needed. This resulted in a lack of person-centred care assessments, reflecting people’s personal circumstances, risks and choices. Care was managed in a task driven way. Most people were unaware what was contained within their care plans.

People and relatives told us they were involved in making decisions about their care, however, when we looked at care records, we found this was not the case. For example, decisions around individual people’s capacity and how to care for people in their best interests were made by staff with no communication with the person or their representative.

Staff and managers said they involved people and relatives in making decisions about their care, however, when we looked at care records we found this was not documented. Instead, we found staff had signed off the decisions.

The provider was unable to demonstrate to us how they kept up to date with current best national practice guidelines and standards. Staff had received some mandatory training, but key areas were not included, such as higher level dementia training, skin integrity or mental health. We found they could not demonstrate ongoing learning beyond the basic set of training subjects. This lack of training meant staff were ill equipped to manage people’s day to day needs in the specialist setting that the provider operated. Further development of staff training was required to keep them and people using the service safe and minimise risks to their wellbeing through lack of knowledge and skills.

People told us they were able to access their GP and other healthcare professionals. However, two relatives said that they felt they needed to organise their own referrals to services such as the dentist and occupational therapy.

The home manager told us they worked across a range of teams and services to support people and referrals were made when needed. However, people did not always receive the healthcare support from external professionals that they needed to maintain and promote their health and welfare. Referrals required to seek advice and support from healthcare professionals were not always made. Examples included a person sustaining bruising from the bed rail where staff had failed to give 5 doses of a person’s medicines.

Healthcare professionals told us they had raised concerns about areas such as falls management, people left in bed through the day, pressure care, continence care and support for people living with dementia. They told us that up until the point of this assessment, little changes had been seen. However, since our visit to the service, and with the changes in the management team, there had been a noticeable improvement with health professionals commenting that since the CQC site visit they had seen some improvements.

The guidance for staff in people’s care plans was not always up to date, accurate and in some examples, not completed at all. There was a risk that people could receive inappropriate care which did not meet their current care needs. Where there were identified risks and a care plan in place, there was little information to show how this was monitored to check people were improving. For example, interventions when there were a number of falls in a period for people or an increase in the frequency of behaviours caused by agitation or distress. There was no monitoring of these incidents so that concerns could be escalated and advice sought to agree changes to minimise risks.

The provider did not always support people to manage their health and wellbeing as independently as they could. For a number of people cared for in bed, staff did not always maximise their independence, choice or control. People were therefore not supported to live healthier, independent lives, or manage their future needs for care and support.

The home manager told us that they regularly monitored people’s care to manage their health and wellbeing. However, as highlighted in other areas of this report we found that this was not being managed, reviewed or monitored effectively.

People’s care records were incomplete, not accurately recorded, or not monitored. We found examples where people were not having their food intake recorded when there were concerns around weight loss or diabetes. We saw positional charts showed excessive delays in relieving pressure on skin areas likely to deteriorate. These had not been identified by the leadership team, as an area for improvement, leaving people at increased risk of harm.

People and their relatives gave mixed views on how staff monitored care needs. For example, one relative said staff had worked well to encourage and support them to maintain their independent walking with a frame. They felt that this had a positive outcome for this person, retaining some of their independence. However, this experience was not consistent across the care home. For example, we also received feedback which expressed frustration that staff were not assisting a person out of bed, after a physiotherapist assessed them and advised staff, they could be out of bed for short periods daily.

Senior staff told us they regularly monitored people’s care to manage their health and wellbeing. However, the provider did not demonstrate this happening effectively. We found there were differences around people’s outcomes based on the complexity of their care needs or the unit they resided on. We shared examples of this with the provider and within this report

The provider did not routinely monitor people’s care and treatment to enable them to identify shortfalls or where improvements could be made. They did not ensure that outcomes were effective, positive and consistent, or that they met both clinical expectations and the expectations of people themselves. There was a lack of monitoring arrangements in place to identify themes and trends. The poor oversight of accidents and incidents did not ensure people were kept safe, or opportunities were identified to improved care experience and outcomes. Care plans and risk assessments were not always reviewed and updated where people's needs had changed. This placed people at risk of receiving care which was not safe for them.

People who were unable to provide consent, for example those living with dementia, were unlawfully restrained or restricted. For example, one person said, “I have a walker but look it's not here near me they've taken it back to my room I don't know why.” This person required this equipment to move from the chair; without it they were restricted to the chair and lounge until staff returned. We also saw other restrictions on people’s ability to consent and choices about how they lived their lives at the service.

Whilst staff were trained in the Mental Capacity Act 2005 and could explain how they supported people who were unable to consent, they failed to recognise the need for mental capacity assessments and best interest decisions for people in relation to close supervision, use of bed rails and restrictions leaving the building.

There were unlawful restrictions placed on people’s freedom without appropriate assessment, consent or best interest decision. We found the culture of the service failed to support the provision of high-quality care and support which was not in line with national policy and good practice guidance for services for people who lacked capacity. This had a significant impact on the quality of life, autonomy and rights of service users. Management and staff did not have a good working knowledge of the principles of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty safeguards (DOLs). Ten people had a carer allocated to them on a 1:1 basis for periods of the day and night. Staff had not assessed whether this was the least invasive option or applied to the local authority to do so. Assessments were not in place which demonstrated this was the most appropriate option. They had not considered this as invasive/restrictive and the need to seek thorough assessment and agreement to ensure people’s rights were protected. The management team stated arrangements were in place for people and staff safety. However, it was also observed that on some occasions staff were not within eyesight of the person despite it being required by the care plan.