Forest Place Nursing Home

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Staff and leaders were not trained or knowledgeable about some of the support needs people were living with and protected characteristics were not identified or considered. We identified a breach of regulation because people's dignity was not always maintained.

People’s care plans did not always contain information to enable staff to meet their personal, spiritual, cultural, social or religious beliefs and those we reviewed contained limited basic information about peoples interests and what mattered to them.

There was a lack of planned activities, and most people were not supported to engage in meaningful activities. We observed long periods of isolation for some people especially for people cared for in bed.

People did not have choice or control over their care or wellbeing.

This service scored 46 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People were not consistently at the centre of their care and treatment choices. This meant that people did not always receive person-centred care. Care plans were not reflective of people’s needs or wishes and some had not been developed with people or relatives. Daily records did not demonstrate how people received personal care, for example, where people required support with their personal care in bed.

People were not always involved in decisions relating to their care, for example the use of bed rails or when they could leave the building. Care plans did not always contain information to enable staff to meet their spiritual, cultural, social or religious beliefs and those we reviewed contained limited basic information about peoples interests and what mattered to them.

There were circumstances where people did not have choices or control over their care or wellbeing. For example, people were not free to choose when they see their families was not theirs to make freely and without restriction.

Staff all told us they worked in a person centred manner, listening to people and understanding how they wanted their care to be delivered. One staff member said, “I treat each person as an individual by getting to know their unique needs, preferences, and backgrounds. As I am responsible for writing the care plans and completing MCA assessments, I make sure that each resident’s care is personalised to meet their individual needs and preferences.” However, our observations, and review of care records demonstrated that not all people received care in this manner. The proprietor when made aware of the improvements required in a meeting after our visit said, “We are caring for people as if they are tasks and not caring.”

Systems were not operated to ensure people were always treated with dignity. The provider told us that the manager and unit managers carried out daily walk rounds to identify any shortfalls and make immediate improvements. These had been put into place prior to our visit; however, our observations of people showed these processes were not effectively operated. We saw from the daily records for the people we reviewed that most had not had a bath, or a shower for the two week period before our visit. Those people who were cared for in bed had a bed bath in the morning, sometimes a face wash in the evening. There were gaps in the evening showing people did not always receive that face wash or oral care. The processes in place in the service did not identify this as a concern or explore matters around people’s dignity

People did not provide us with direct examples of their experience of this area. However, our observations and feedback from relatives, professionals and others demonstrated there were some shortfalls in how the provider understood the diverse health and care needs of people and their local communities Therefore care was not always joined-up, flexible or supportive of choice and continuity.

Staff had received training relating to equality and basic training to understand specific needs such as dementia. There was however a lack of training to further develop staff knowledge in areas such as dementia or mental health. The provider’s information included that they were a specialist provider to deliver this type of support. Staff who originated from overseas were not supported to understand the cultural and diverse needs of the people who used the service. People's care as mentioned elsewhere did not always identify people’s specific cultural needs. This was important due to the diverse cultural mix of staff working in the service.

Partners provided feedback that supported the view that a lack of training to develop staff knowledge to better support people as needed and improvements in assessment, review and wellbeing would improve outcomes for people.

Care was provided by a mostly permanent staff team. We observed people and relatives asking for staff by name which suggested continuity was maintained.Staff did fully understand people’s different cultural backgrounds and plans to meet their cultural preferences did not exist or were minimal.For example, there was no planning around people’s religious beliefs and how this may have impacted their life or death. For one family, the lack of planning led to confusion about their relative’s health conditions, the involvement of a coroner and impacts on funeral arrangements. Staff were not aware and did not understand what was needed which was linked to the person’s faith and culture.Systems were not operated to ensure people were always treated with dignity. The provider told us that the manager and unit managers carried out daily walk rounds to identify any shortfalls and make immediate improvements. These had been put into place prior to our visit; however, our observations of people showed these processes were not effectively operated. We saw from the daily records for the people we reviewed that most had not had a bath, or a shower for the two week period before our visit. Those people who were cared for in bed had a bed bath in the morning, sometimes a face wash in the evening. There were gaps in the evening showing people did not always receive that face wash or oral care. The processes in place in the service did not identify this as a concern or explore matters around people’s dignity

We did not look at Providing Information during this assessment. The score for this quality statement is based on the previous rating for Responsive.

Feedback from people, relatives and others showed the provider and management team did not always make it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. This was because regular forums were not made available for those concerns to be raised. Staff did not always involve people in decisions about their care or tell them what had changed as a result.

The proprietor and staff told us they listened to people’s views and opinions about their care. They told us there was a complaints procedure in place where people could raise any concerns. Staff spoken with gave examples of where complaints raised had led to some improvement. For example, one staff member said, “After a complaint about long response times, new call bell response protocols were introduced.”

Care records did not demonstrate or provide guidance in people’s care plans where people had specific needs, such a hearing or sight loss, dementia, or reverting back to their first learned language. There was no information as to how staff were to communicate effectively with them. For example, one person’s care plan described the person getting agitated and shouting if they could not understand staff or if staff had a different accent. There was no information for staff about actions that addressed this to meet that person’s communication needs.

The provider did not always make sure that people could access the care, support and treatment they needed when they needed it. Relatives commented that they felt they needed to make their own arrangements to access external professionals such as the dentist.

The management team told us they had good working relationships with other professionals involved in people’s care, such as health care professionals. They told us referrals were made to health care professionals where required, such as if they were concerned about a person’s wellbeing relating to falls, or weight loss.

We received feedback from one visiting professional who told us referrals were being made appropriately. We saw records in a handover book, where staff had made some referrals and these were chased up where required. However, outcomes were not always documented throughout care plans to ensure they reflected the most up to date information about the person and their needs. This could lead to inappropriate care.

Evidence reported elsewhere in this report demonstrates that the provider did not always ensure people could access the care, support and treatment they needed when they needed it. For example, reviews of medicines, mental health support, occupational therapists and external health professionals such as dentists.

Furthermore, due to the inconsistencies in record keeping, incomplete records a lack of checks of care records by management they could not demonstrate systems were in place to address any barriers to accessing care. This included making timely referrals to other agencies or identifying changes in a person’s care needs.

Staff and leaders did not always actively listen to or act on information about people who are most likely to experience inequality in experience or outcomes. This meant people’s care was not always tailored in response to this.

The proprietor acknowledged that systems were not operated effectively to ensure those people likely to experience inequality in experience or outcomes were proactively supported.

People’s care plans were not always kept up to date and were either incomplete or referred to other people due to copy and pasting. There was a lack of evidence to show that people, and their representatives, where appropriate, were included other than when they were initially assessed. There was a lack of evidence to show people were listened to about their experiences to ensure their care plans were tailored to their individual needs and preferences. The proprietor and home manager did not listen to or record information about people who were most likely to experience inequality in experience or outcomes.

There was a lack of analysis and lessons learned, for example in safeguarding and injuries, to learn, improve and identify potential trends and reduce future risks.

Systems were not in place to proactively seek out and respond to the diverse collection of voices within Forest Place to understand the needs of those people most likely to experience inequality. Support was not tailored to incorporate appropriate adjustments for individuals with communication needs or disabilities. The provider had systems in place to involve people in care planning, but these were not consistently followed meaning people were not part of decision making about their care. The provider had not ensured that through effective listening and care planning staff took all reasonable steps to empower disadvantaged groups. During this assessment the provider acknowledged these gaps and began reviewing peoples care needs to reflect communication, diversity, sensory needs, backgrounds and preferences.

We did not receive feedback from people or relatives about future planning and end of life wishes. People were supported to plan for informed decisions about their end of life care. These decisions factored in areas such as clinical care and pain management, however, did not consider people’s personal preferences and choices to ensure a dignified end of life. We have reported elsewhere a family’s poor experience regarding end of life and staff not understanding their cultural preferences.

The provider said that the clinical team worked with the GP and a local hospice who visited the service to support people at the end of their life.

Staff understood the importance of working together to ensure people have a comfortable and dignified end of life but felt that additional training would provide them with more confidence to make those assessments. One staff member said they felt it would be beneficial to have more frequent face-to-face training in areas like syringe driver use, end-of-life care, medication management, phlebotomy. This viewpoint was shared among other staff spoken with.

People had advanced and end of life care plans in place, however these lacked person centred information. For example, the care plans referred to clinical aspects such as monitoring health conditions or to escalate any concerns to health professionals. These also referred to ensure the right equipment was in place, however failed to identify personal factors, such as if people wanted music to be playing, if they wanted their family around them, if they had religious needs or beliefs staff needed to respect.

Staffing levels were not managed to consider whether additional staff were needed for more frequent comfort checks for people who were in their final days or hours of their life, or who may have no family to be with them. Care staff had not received end of life care training which would help them to recognise when a person was nearing the end of their life and how to care for them. The provider could not demonstrate the risk of people dying without dignity and their wishes being met was minimise.