Forest View

We found the following examples of good practice.

People were isolated in accordance with government guidance. Staff understood the impact of isolation on people’s wellbeing and thought of creative ways to address this. One-to-one time was utilised to talk to people or offer therapeutic activities such as hand massage or painting their nails in people's rooms. The registered manager purchased additional magazines and puzzle books for people to use. For those that wanted, radios were provided for people who did not have a television in their room and televisions were available to borrow.

We observed all staff within the home wearing face masks. Staff wore personal protective equipment (PPE) as required. Staff had undertaken refresher training in infection prevention and control, the correct use of PPE and their handwashing competence revisited. Staff told us they felt confident in the use of PPE and the processes in place for managing stock and PPE disposal during the outbreak.

People living with dementia who found it difficult to isolate were supported by staff who had done all they could to promote social distancing. People were supported to maintain good hand and personal hygiene. Staff increased observation of people to ensure communal spaces they had visited could be frequently cleaned to reduce the risk of cross contamination.

Staffing pressures as a result of the outbreak were managed effectively. The registered managers system for the booking and deployment of agency staff ensured that agency staff working across multiple homes during the outbreak was minimised and reduced the potential risk of COVID-19 transmission.

The home was clean and hygienic and there were cleaning schedules in place for people’s rooms and communal spaces. We observed cleaning taking place during the inspection in line with best practice guidance. ‘High touch’ areas were regularly cleaned, and cleaning records reviewed daily to ensure schedules had been met and any concerns could be addressed. There were robust laundry systems in place to ensure contaminated laundry was kept separate from other laundry and was washed at a suitable temperature to reduce the risk of the spread of infection. During the outbreak the registered manager had adjusted the shift times of housekeeping staff to manage the increased amount of laundry and promote safe IPC practices.

All people living at the service had received both doses of a coronavirus vaccine and all but three had received their booster. For those that had not yet received their booster, dates for a health professional home visit to administer these had been arranged.

The provider had a range of policies to support their working practices which were regularly reviewed and updated in accordance with current government guidance. Policies included a COVID-19 standard operating procedure, admissions and isolation policies, visiting and vaccination requirements and quality assurance / audit tools.

Forest View is one of a group of homes owned by a national provider, Shaw Healthcare Limited. It is a residential 'care home' which can accommodate up to 60 people in one adapted building. Most people living at the home were living with dementia, and some people had disabilities associated with older age and frailty. At the time of the inspection there were 57 people living in the home.

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

Since our last inspection it was evident the managers of the service and the staff had made improvements which had raised the standard of care people received and the overall governance of the home. Some improvements were still required to ensure the provider was always working in accordance with government and best practice guidance to keep people safe and ensure people consistently received person centred care.

People did not always receive care in line with their assessed needs and preferences or had their communication needs fully considered. Staff did not always have detailed guidance to respond to people and ensure they were supported in the most effective way. Some information had been adapted to ensure people received information in a way they could understand, but work in this area remained ongoing.

People were protected from avoidable harm as risks to people’s health and safety were identified and assessed. People and their relatives told us they felt safe and were cared for by staff who knew them well. Medicines were managed safely and people received their medicines as prescribed. Accidents, incidents and safeguarding concerns were reported and investigated as required and actions taken to prevent reoccurrence. People were protected from the risk of abuse and staff were aware of their safeguarding duties and how to report concerns.

People received a comprehensive assessment and felt involved in discussions about their care. This included planning for end of life care and support. People were encouraged to engage in activities that were of interest to them and develop meaningful relationships.

People and their relatives told us staffing levels had improved and there were enough staff with the appropriate skills and training to meet their needs. Staff were recruited safely and received supervision where opportunities to develop and feedback about their practice were discussed.

People were treated with kindness, dignity and respect. Staff interactions with people were warm and caring. One relative told us, “The staff are brilliant, very talkative, they keep me informed always have time to sit and talk and they are always happy. I couldn’t wish for nicer staff; they are like family.”

People were observed in a homely environment adapted for their needs and were supported to drink enough and maintain a balanced diet. 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 and their relatives were complimentary about the service and the management team. The service had a positive culture and embraced continuous learning and improving care. Quality assurance and monitoring systems had been revised and updated to improve managerial oversight of people’s care and keep people safe.

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 17 February 2020) and there were multiple breaches of regulation. After the last inspection the provider was served a warning notice and completed an action plan to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider had met the requirements of the warning notice. The provider was no longer in breach of regulations.

Why we inspected

In August 2021 a call was held with the managers of the service using our Direct Monitoring Approach (DMA) to check whether the warning notice had been met. The leadership team provided assurances there were no emerging or ongoing risks that had not been identified or addressed by the provider. However, in order to gain further assurances that the provider was now compliant with the regulations, this inspection was carried out to corroborate evidence collated during the DMA call and 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.

The last rating for this service was Requires Improvement (published 17 February 2020). The service remains rated Requires Improvement. This service has been rated Requires Improvement for the last four consecutive inspections.

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

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 our re-inspection programme. If we receive any concerning information we may inspect sooner.

Forest View is situated in Burgess Hill, West Sussex and is one of a group of homes owned by a national provider, Shaw Healthcare Limited. It is a residential ‘care home’ for up to 60 people some of whom are living with dementia, physical disabilities, older age and frailty. At the time of the inspection there were 53 people living in the home.

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

The provider’s values were not always demonstrated through their systems and processes. There was a lack of person-centred care to ensure people were treated as individuals. There was mixed feedback about the leadership and management of the home. Some staff were complimentary about the management team. Others felt unsupported by them. They told us that when issues were raised these were not always listened to or acted upon. Quality assurance processes had not always identified concerns found at inspection. There were concerns that the provider had not made enough improvement to ensure that the concerns found at the previous inspection, as well as those identified at the provider's other services within the Sussex area, were addressed and resolved. We continued to have concerns about the quality of care people received which had decreased since the last inspection. The provider was working alongside health and social care professionals to help improve staff’s understanding and the quality of care that people were provided with.

The provider had not always considered people’s assessed needs when allocating and deploying staff. People, relatives and staff told us that there was insufficient staffing to meet people’s needs and our observations and findings confirmed this. Medicines management was not always safe, and people did not always have their medicines administered according to prescribing guidance. Some people at risk of falls had not always been adequately assessed and staff had not always worked in accordance with the provider’s policy to ensure that when one person had experienced falls, they were appropriate monitored to ensure their condition did not worsen. There was good oversight of people’s hydration and nutrition to ensure they maintained good health. People were not always safeguarded from abuse as one person was not always receiving support to meet their needs. Following the inspection, CQC made safeguarding referrals to the local authority for them to consider as part of their safeguarding duties. When there had been other concerns about people's safety, the management team had liaised with external health and social care professionals. People were protected from the risk of infection and staff ensured good infection control was maintained. Incidents were used as opportunities to learn and improve practice.

We observed most people spent extended periods of time without interaction or stimulation with others. People and staff told us that staffing levels did not enable staff to spend time with people to meet their social and emotional needs and our observations showed that there were sometimes missed opportunities for interaction. The provider was receiving support from external professionals to help ensure that people’s needs were appropriately planned for and met. People had received appropriate end of life care to maintain their comfort. We have made a recommendation that the provider seeks guidance and advice about appropriate and stimulating environments for people living with dementia.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems did not support this practice. The provider lacked oversight and consideration of the skills staff might need to support people’s specific needs, such as when people were living with dementia. People had access to external health care professionals and were supported to maintain their health. People had access to sufficient food to ensure they received a balanced diet.

People’s privacy and dignity was not always maintained, and they did not always receive respectful care. Most observations showed that staff were kind and caring and people spoke fondly of the staff that supported them. People told us that staff were kind and caring and they were complimentary about staffs’ compassionate nature. Staff knew people well and they were considerate and caring.

Rating at last inspection and update

The last rating for this home was Requires Improvement. (Published 10 January 2019). There were two breaches of regulation in relation to people’s safety and the leadership and management of the home. The provider completed action plans after the last inspection to show what they would do and by when to improve. At this inspection, we found the provider had not always complied with their action plans and not enough improvement had been made. The provider was still in breach of regulations. The home remains rated Requires Improvement and has been rated Requires Improvement at the last three consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to people’s safety, safeguarding people from improper treatment, staffing, the promotion of person-centred care and privacy and dignity and the leadership and management of the home. 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 continue to monitor the intelligence we receive about this home. 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 the local authority to monitor progress. We plan to inspect in line with our re-inspection programme. If we receive any concerning information we may inspect sooner.

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

Forest View is situated in Burgess Hill in West Sussex and is one of a group of homes owned by a national provider, Shaw Healthcare Limited. Forest View is registered to accommodate 60 people. At the time of the inspection there were 56 people accommodated in one adapted building, over two floors, which were divided into smaller units comprising of ten single bedrooms with en-suite shower rooms, a communal dining room and lounge. These units provided accommodation for older people with associated healthcare conditions as well as those living with dementia.

The home had a registered manager. A registered manager is a ‘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. The management team consisted of the registered manager and team leaders. An operations manager also regularly visited and supported the management team.

There were concerns about the provider’s oversight and overall ability to maintain standards and to continually improve the quality of care. Areas of improvement that were found as part of this inspection had not been identified or acted-upon by the provider’s own quality assurance audits. The provider had not learned from inspections of their other services and had not shared this learning to ensure that improvements were made across all their services. There have been consistent themes in relation to staff understanding of and the implementation of the Mental Capacity Act 2005 as well as timely access to medicines for people who have Parkinson’s disease. Feedback about the leadership and management of the home as well as the approachability of the registered manager and the provider was not positive. Records did not always provide sufficient guidance to staff to inform their practice. Some, had not been completed in their entirety to confirm staff’s practice and provide assurance that people had received the necessary support. These were areas of concern.

Not all people received their medicines in a timely way. Three people were living with Parkinson’s disease that required their medicines to be given at specific times. Records showed that these people had not always had their medicines according to the prescribing guidelines. People were not supported in a person-centred way, in relation to their access to medicines, to ensure that their condition was well-managed. Not all risks to people’s safety had been identified or mitigated. Not all chemicals or items that had the potential to cause people harm if ingested, had been stored securely. These were areas of concern.

People were not always supported to have maximum choice and control of their lives. Staff did not always support them in the least restrictive way possible. The policies and systems in the home did not always support this practice. This was identified as needing to improve.

The provider had not always ensured that people’s communication needs were met. They had not always documented people’s communication needs to inform staff’s practice. Resources and information were not always adapted to help people to access information or understand the information that was available to them. We have recommended that the provider seeks advice from a reputable source in relation to providing information for people to meet their communication needs.

People told us that they felt safe. One person told us, “It’s safe. If I need any help they help me in a nice way and the staff say we’re here to help you”. There was sufficient and suitable staff to meet people’s needs. Staff knew who to report concerns to if they were worried about people’s wellbeing.

Infection control was maintained.

People’s needs were assessed and reviewed on an on-going basis. People were supported to maintain their health. They received support from external healthcare professionals when required. People received appropriate end of life care to ensure their comfort.

People told us that they enjoyed the food. Comments included, “The food is nice. The meals are lovely”. People’s had access to nutrition and hydration to meet their needs. Communal areas, as well as private spaces, enabled people to spend time on their own or with others.

People and relatives were involved in decisions related to the running of the home. They could make complaints and knew how to do this. People told us that they were content living at the home and spoke with fondness about some of the staff that supported them. One person told us, “The staff are very nice and I class them as my friends”. People’s privacy and dignity was maintained.

The overall rating for this home is Requires Improvement. This is the second time that the home has been rated as Requires Improvement. We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

Forest View is a residential service providing accommodation for up to 60 older people, some of whom are living with dementia and who may require support with their personal care needs. On the day of the inspection there were 59 people living at the home.

Forest View is situated in Burgess Hill, West Sussex and is one of a group of services owned by a national provider, Shaw Healthcare Limited. It is a purpose built building with accommodation provided over two floors which are divided into smaller units comprising of ten single bedrooms with en-suite shower rooms, a communal dining room and lounge. There are also communal gardens. The home also contains a day service facility where people can attend if they wish, however this did not form part of our inspection.

The home had a registered manager. A registered manager is a ‘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. The management team consisted of the registered manager, a deputy manager and team leaders.

We previously carried out an unannounced comprehensive inspection on 14 July 2015 and the home received a rating of ‘Good’.

At this inspection, people were provided with sources of entertainment and stimulation through planned group activities and external entertainers. One person told us, “There’s plenty to do. I like the Bingo and music. I like watching my TV”. Some efforts had been made to provide more meaningful activities for people that were based on their hobbies and interests before they had moved into the home. For example, a knitting club had been introduced which a small number of people enjoyed. However, in the main, there was a lack of meaningful occupation and stimulation to occupy peoples' time and staff did not always have sufficient time to interact and engage with people.

Peoples’ needs and preferences were assessed when they first moved into the home and on-going reviews took place to ensure that the care people were receiving was meeting their current needs. Care plans were person-centred, however, although relatives were informed of any changes or updates in peoples’ care, feedback from them was that they were not always involved in the on-going reviews that took place and that sometimes they were not provided with sufficient explanation about any changes in the care their relatives received. When this was raised with the registered manager they told us that this was something that they wanted to improve and develop.

The staff team consisted of permanent staff as well as the use of temporary staff to ensure that the home was sufficiently staffed to meet peoples’ physical care needs. However, the skills and level of understanding of the temporary staff differed to that of the permanent staff. Measures had been taken to ensure that temporary staff worked alongside more experienced staff to enable the sharing of knowledge and skills. Nevertheless, temporary staff lacked understanding about the content of peoples’ care plans and information that was specific to their care needs. A comment by a healthcare professional echoed this, they told us, “We feel that there is in general poor communication to staff and that information about people isn’t shared effectively”.

The provision of activities to promote more meaningful occupation for people, the need to ensure that there is an increased level of interaction, staff engagement and stimulation from staff to support people to participate in pastimes that they enjoy, as well as the need to increase the involvement of people and their relatives in the on-going review of peoples' care, are areas of concern.

Regular audits of the systems and processes within the home and of the care people received, took place to ensure that people were receiving the type of care they had a right to expect. When improvements needed to be made these were highlighted and timely action taken to ensure that things improved. However, although effective in most areas, this had failed to identify the shortfalls in practice that meant that people were not always supported in a person-centred way.

People, relatives and healthcare professionals told us that staff were kind and caring and observations showed that some positive relationships had developed. Comments from relatives included, “I think the carers are amazing, so patient. It gets a thumbs up from us. It has a good reputation out and about” and “We are happy for my relative to stay here. The carers are professional and dedicated, wonderful”. A healthcare professional told us, “Some staff are excellent and take a very proactive approach to care. They recognise individual peoples’ needs and endeavour to provide the best possible care”.

Peoples’ consent was gained before supporting them. The registered manager was aware of the legislative requirements when a person lacked capacity and had worked in accordance with these. People were treated with respect and dignity and their right to privacy was maintained. Staff were aware of the importance of supporting people in a sensitive manner and information that was held about people was kept in locked cabinets to ensure that confidentiality was maintained. People, dependent on their needs, were able to stay at the home until the end of their lives. Plans to ensure that people received good end of life care were in place and records and observations showed that peoples’ wishes and needs were respected at this time.

People told us that they felt safe, comments included, “Yes I feel safe; I can lock the door if I want” and “I feel safe here, more than I did at home”. Risks to peoples’ safety were regularly assessed and appropriate care was provided to ensure that people received safe care. People were able to take risks and observations showed people independently walking around the home using their mobility aids. People were protected from the risk of harm and abuse as they were cared for by staff who had undertaken the relevant training and who knew what to do if they were concerned about a person’s welfare. People had access to external healthcare services if they were unwell as well as having access to medicines if required. People and relatives told us that people were happy with the food that was provided, that they enjoyed the meals and were provided with choice. Comments included, “You tell them what you want, there’s sandwiches in the evening. There’s plenty of drinks” and “It’s very good”.

People and relatives were able to share their views and ideas through regular residents’ and relatives’ meetings as well as annual surveys and actions had been taken in response to peoples’ feedback. There was a complaints policy in place and complaints had been dealt with in a timely manner. People, relatives and staff were complimentary about the leadership and management of the home. Comments from staff included, “The manager is very approachable”, “I think things have really improved since the manager came. Everyone works well as a team” and “I’ve worked in a lot of care homes and nursing homes and this is by far the best. It’s a very warm and friendly place and the management have a lot to do with that”. There was a friendly, welcoming atmosphere and people and staff appeared at ease. Staff were encouraged and able to share their views and were kept informed about changes that occurred within the home through regular handover and staff meetings.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have asked the provider to take at the back of the full version of the report.

We found that people received care that met their needs and protected their rights. We saw that staff supported people in a way that showed that they understood their needs and how the person preferred their care to be provided. We saw that people were treated with dignity, kindness and respect.

People were protected against the risks associated with medicines because there were robust systems in place to administer medication safely. Medicines were stored securely and records were well maintained.

We found that staff got the training they needed to carry out their roles effectively. Staff told us that they had enough support and training to care for people appropriately.

There were effective systems in place to assess and monitor the quality of the service that people received. The provider carried out regular checks and audits had made improvements where the need for these had been identified.

We were told that people were well looked after. One person who used the service told us that the, "Staff here are all wonderful, they can't do enough for you." Another person told us that there, 'Is always something to do, so I am never bored.' They also told us about entertainment that was arranged in the home and trips out that they could participate in.

The three relatives we spoke with told us that they were involved in the care and welfare of their family member, and discussed care plans with the staff.

We looked at a range of care records. These included initial assessment information, care plans and risk assessments. They were well completed and guided staff in their day to day work. We also looked at medication and training records. These were comprehensive and accurate.

We discussed the provider's quality assurance measures and looked at a number of satisfaction surveys that had just been completed by people who used the service or their relatives. A number of positive comments were seen which included,

'I have visited many times and always been impressed with the attitude of staff'

'I always look forward to my visits, staff bring me up to date'

'Overall it's a wonderful home with wonderful staff'