Forest Court Nursing Home

Forest Court Nursing Home is a nursing home that also provides short term care for up to 4 weeks to promote the delivery of the Discharge to Assess process. This provides people who have recovered from a hospital stay, no longer needing an acute bed with appropriate care and assessment to enable them to return home or find suitable ongoing care. A number of beds were also provided to people too unwell to be cared for at home but not unwell enough for hospital admission, ‘step up’ beds and was providing nursing and personal care to 68 people at the time of our inspection. The service can support up to 80 people.

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

People enjoyed living at the service and felt safe. However, improvements were required in some areas. 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 that 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 had been applied. The service has since put in measures to improve medicines.

The risks to people were minimized through risk assessments. However, some improvements would benefit people living with diabetes. Staff had received training in safeguarding adults and knew how to identify, prevent and report abuse. There were enough staff to keep people safe. Staff knew people well and treated people with kindness and compassion. The home was clean, and measures were in place for infection prevention and control

There were effective systems in place to monitor and improve the quality of the service provided. Staff felt supported by management and enjoyed working at the service. The provider had an open and honest approach to care delivery and reported accidents and incidents and informed those involved as necessary. However, improvements were required in sending in notifications.

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 requires improvement (published 07 January 2022). 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

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.

Follow up

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

Forest Court Nursing home provides care and support for up to 80 people. At the time of our inspection there were twenty-one people using the service on a permanent basis who may have required nursing care. The remaining 55 people were using the therapy service which was commissioned by West Hampshire Clinical Commissioning Group. The therapy service promotes the delivery of the Discharge to Assess process for individuals who require a short-term placement to identify and arrange provision of care required to maintain their safety and wellbeing. Staff working for therapy team included physiotherapists and occupational therapists. They are employed by Southern Health and are regulated and inspected by our Hospitals directorate.

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

Staff did not always respond to people’s request for care and support.

Staff were not always appropriately deployed to meet people’s needs.

Risks associated with people’s care needs were not always assessed and documented.

People were not always treated with dignity and respect.

The culture within the home was not always person centred or empowering.

Staff were not always effective in their communication when involving people in their care.

Governance systems were not consistently effective in driving improvement.

People, relatives and professionals told us the leadership within the home was approachable and they felt able to raise concerns.

Staff were aware of the possible signs of abuse and knew how to report concerns.

Why we inspected

We received concerns in relation to people not receiving dignity and respect during their care, unsafe staffing levels and poor staff communication. As a result, we undertook a focused inspection to review the key questions of safe, caring and well-led only. 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 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 overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the safe, caring and well-led section in the full report.

We have identified breaches in relation to staffing, dignity and respect and good governance.

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 Court 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.

We found the following examples of good practice.

¿ Information was easily accessible on arrival or before visits to ensure visitors followed guidance, procedures or protocols to ensure compliance with infection prevention control.

¿ Staff wore appropriate personal protective equipment including a mask, gloves and apron when delivering personal care to all people.

¿ There were designated areas for donning/doffing personal protective equipment (PPE).

¿ Safe arrangements were in place to enable staff to appropriately socially distance during breaks.

¿ The service followed national guidelines regarding testing of people before admission to the service. All staff and residents were also regularly tested as part of ‘whole home testing’.

¿ People were assessed daily for the development of a high temperature (37.8°C or above), a cough, as well as for softer signs that might indicate the presence of infection.

¿ All areas of the service were uncluttered to ensure cleaning could take place effectively.

¿ Any staff in high risk groups such as black and minority ethnic (BAME) staff had been risk assessed, and adjustments had been made.

¿ Staff were trained and knew how to immediately instigate full infection control measures to care for people with symptoms to avoid the virus spreading across the home.

¿ People and staff knew how to raise any concerns or complaints around IPC practice if they thought it was unsafe, or not effective, without fear or discrimination.

Forest Court Nursing Home is a care home which currently provides personal and nursing care to 71 people aged 65 and over. The service can support up to 80 people, including people admitted for short stay and reablement and those living with dementia.

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

Staff and managers were committed to continually improving the service and what they could offer people living there. There was a strong person-centred culture which reflected the provider’s values.

Clinical audit systems were given a high profile and were in place for monitoring service provision. These showed management had a robust oversight of service quality and everyone's safety.

The provider had a programme of ongoing investment to improve the environment. This included investing in technology and systems to improve both the environment and people’s experiences of care.

People felt safe. Staff had received training in safeguarding and understood the actions they needed to take if they identified any concerns.

Systems were in place to ensure the safe storage and administration of medicines. Medicines were administered by staff who had received appropriate training and assessments. A range of healthcare professionals, such as chiropodists, opticians, GPs and dentists were involved in people’s care when necessary.

People received personalised care in line with their assessed needs and their care plans. Risks were assessed and actions taken to minimise these while promoting independence as far as possible.

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 were supported by staff who had received an induction into the home and appropriate training, professional development and supervision to enable them to meet people’s individual needs.

People were supported to have enough to eat and drink. Attention was paid to people’s hydration needs and a breakfast club had been developed and was also used as a social occasion.

The service was responsive to people’s needs and staff listened to what people said. People were confident they could raise concerns or complaints and that these would be dealt with.

People and their families or other representatives were involved in discussions about their care planning. The provider sought feedback through the use of questionnaires and surveys.

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 26 October 2016).

Why we inspected

This was a planned inspection based on the previous rating.

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.

The inspection was unannounced and was carried out on 17 and 18 August 2016.

There was a registered manager in place at the home. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run.

People told us they felt safe living in the home and that care was delivered in a safe manner. Staff and the registered manager had received safeguarding training and were able to demonstrate an understanding of the provider’s safeguarding policy and explain the action they would take if they identified any concerns.

The risks relating to people’s health and welfare were assessed and these were recorded along with actions identified to reduce those risks in the least restrictive way. They were personalised and provided sufficient information to allow staff to protect people whilst promoting their independence.

People were supported by sufficient staff who had received an induction into the home and appropriate training, professional development and supervision to enable them to meet people’s individual needs.

There were suitable systems in place to ensure the safe storage and administration of medicines. Medicines were administered by staff who had received appropriate training and assessments. Healthcare professionals, such as chiropodists, opticians, GPs and dentists were involved in people’s care when necessary.

Staff followed legislation designed to protect people’s rights and ensure decisions were the least restrictive and made in their best interests.

Staff developed caring and positive relationships with people and were sensitive to their individual choices and treated them with dignity and respect. People and their families were encouraged to express their views and be involved in making decisions about their care and support.

People were supported to have enough to eat and drink. Mealtimes were relaxed and staff supported people in a patient and friendly manner.

There was a programme of activities for mental and social stimulation and staff were working on extending this for people who were cared for in bed.

The service was responsive to people’s needs and any concerns they had. Care and treatment plans were personalised and focused on individual needs and preferences.

People were encouraged to provide feedback on the service provided both informally and through an annual questionnaire.

The registered manager demonstrated an open and inclusive style of leadership. Staff understood their roles and responsibilities and there were clear lines of accountability within the service.

There were systems in place to monitor quality and safety of the home provided. Accidents and incidents were monitored, analysed and remedial actions identified to reduce the risk of reoccurrence.

At this inspection we gathered evidence against the outcome for care and welfare to answer the questions: is the service safe and is the service effective?

We looked at records and spoke with the Registered Manager and six members of staff. We also spoke with the Deputy Director of Operations.

Below is a summary of what we found. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

We found reviews had been completed or were on-going and the records updated to reflect people's current needs. Some out of date information had been removed from the files to help ensure that they did not contain conflicting guidance. New assessments were recorded where people's needs had changed. For example, where one person's overall condition had changed, there was a specific support plan in place and recently reviewed assessments of their range of needs. These demonstrated that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare.

Is the service effective?

The provider and manager had taken action to make sure there was an effective system in place to ensure that care and treatment was planned and delivered in line with people's individual needs. Daily diary notes completed by care staff showed that the care being delivered reflected the guidance in each person's care and support plans. For example, regular position changes, monitoring and encouraging fluid intake, and night time checks.

We saw that people were referred to external health professionals appropriately. Care staff were clear about their responsibilities for recording and reporting their observations to the nursing staff if appropriate. A nurse we spoke with demonstrated a detailed knowledge of the needs of people being cared for in the unit.

At this inspection we looked at these areas to check the progress the provider had made. At the time of this inspection there were 63 people using the service. We spoke with 10 people who use the service, five relatives, the manager, clinical deputy manager and 11 staff.

We considered our inspection findings to answer questions we always ask;

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

This is a summary of what we found '

Is the service safe?

The service is safe because there were enough qualified, skilled and experienced staff to meet people's needs. Staff we spoke with were aware of those people who needed support and encouragement to eat and drink sufficient amounts. This helped to ensure that people were protected from the risks of inadequate nutrition and dehydration.

The provider had taken steps to help ensure that people were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained. These improvements will need to be embedded in practice and sustained.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications had needed to be submitted, proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made, and how to submit one. The manager was aware of recent changes to the legislation and was awaiting further guidance from the provider organisation.

Is the service effective?

Most people had clear care plans that reflected the support they received. However, there was not an effective system in place to ensure that care and treatment was always planned and delivered in line with people's individual needs. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to the planning and delivery of care in such a way as to meet people's individual needs and ensure their safety and welfare.

Is the service caring?

The majority of people we spoke with commented positively about the care they received. One person told us "'I am well looked after' and another person said 'The staff are kind'. Both told us they felt safe living in the home. Another person said 'I am well looked after. They can't do enough for me', and 'I am happy and safe and they are so good to me'. Another person commented 'I am very happy indeed, it is like a four star hotel. Everyone is very helpful and nothing is too much trouble'. A relative told us 'This home is excellent' and 'We tell everyone how good it is'.

We observed staff supporting people in a calm, caring and respectful manner. For example, we saw staff knocking on doors and asking if they could help with drinks or just looking in and checking how people were. One person had been calling out and we saw a care worker go and sit with them.

Is the service responsive?

The service acted responsively to peoples' changing needs. Staffing levels had been increased since the last inspection and were kept under review. The new care staff were deployed to focus on mealtimes and ensure people using the service had enough to eat and drink. One care worker told us 'Having nutritional help frees us up to care'.

We saw records of consultations with general practitioners and other health care professionals, in order to review people's health needs.

Is the service well led?

We found the service was well led and action had been taken to address the issues that were raised in the previous inspection report. We also saw that regular audits of the quality and safety of the service took place and were recorded.

People who use the service, their representatives and staff were asked for their views about their care and support and these were acted on. Meetings of the senior management staff within the service supported the effective organisation and running of the home. One care worker told us the home 'Is more organised now'. Another member of staff told us 'Things are better'; and 'We have a manager who has stayed now'.

We saw that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. A person using the service said: 'There's nothing they wouldn't do for you'. Another person said 'I couldn't be better looked after. I have everything I need'. A relative told us they 'Can't speak highly enough' about the home and that they were 'Very happy with the care'.

One person told us that they had 'Plenty to eat and drink'. Another person said 'The food is absolutely super. We have a menu and choice and it's always very tasty'. However, we found that people were at risk of not always being supported to be able to eat and drink sufficient amounts to meet their needs. We also found that people were not protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were not maintained.

A person told us that staff were 'Very nice' and responded to the call alarm in a reasonable time. Another person said that staff 'Come as quick as they can. They don't keep you waiting'. However, from our observations it was not evident that there were enough staff being deployed to meet people's needs at all times.

During this visit we spoke with three of the people who used the service, the manager, deputy manager and seven members of the nursing and care staff. We used a number of different methods to help us understand the experiences of people using the service, because the people using the service had complex needs which meant they were not all able to tell us their experiences. We spoke to a relative of one person using the service, observed care and support being given and how staff interacted with people. We saw that staff communicated well with people who used the service and responded appropriately if people required assistance.

People said that the service was meeting their needs, staff respected their privacy and dignity and worked in ways that promoted their independence. One person said 'they're good to me' while another said the home was a 'very nice place to live'. Another person told us that 'staff listen, they want to know how you feel'. People described staff as being 'very responsive' and 'very willing, nothing's too much trouble'. One person's relative told us the care being provided was 'top class'.