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Inspection Summary


Overall summary & rating

Good

Updated 19 May 2018

We inspected this service on 16 April 2018. The inspection was unannounced.

Forest Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single packages under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Forest Care Home is a nursing home that accommodates up to 20 people living with early onset dementia with complex needs. On the day of our inspection, 17 people were living at the service.

The service had a registered manager at the time of our 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At the previous inspection in January 2016 we identified some improvements were required in three key areas we inspected; ‘Safe’, ‘Effective’ and 'Well-led'. This resulted in the service having an overall rating of 'Requires Improvement'.

During this inspection we checked to see whether improvements had been made, we found further improvements were required in ‘Safe’ but improvements had been made in the other key areas.

Some shortfalls were identified in the management of medicines. Risks had been assessed and planned for and these were monitored for changes. However, inconsistencies were identified in the guidance provided to staff about managing people’s needs associated with their anxiety that affected their mood and behaviour.

Staffing levels were assessed and monitored and were short on the day of the inspection but this was an unusual occurrence. The deployment of staff needed reviewing to ensure people’s safety at all times. Safe staff recruitment checks were carried out before new staff commenced.

The service was found to be clean and improvements were being made to the cleaning schedules to ensure these followed best practice guidance. Accidents and incidents were recorded, monitored and reviewed for any themes and patterns. Documentation did not always show post action and monitoring. Staff were aware of their responsibility to protect people from avoidable harm and had received safeguarding training.

Staff received an induction and ongoing training and support. Staff were knowledgeable about people’s health conditions. People had their needs assessed, planned and monitored. People received a choice of meals and their nutritional needs were known, understood and met by staff.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Where people lacked mental capacity to consent to their care and support, assessments to ensure decisions were made in their best interest had not always been consistently completed. However, this was addressed by the provider in implementing improved documentation. Where people had a DoLS authorisation with a condition, this had been met. People were supported to access primary and specialist health services.

Staff were aware of people’s needs, routines and what was important to them. Staff were kind, caring, and they supported people ensuring their privacy, dignity and respect was met. Independence was encouraged and supported. Information about independent advocacy services was available.

Staff had information to support them to understand people’s needs, preferences and diverse needs. People received opportunities to participate in meaningful activities. The provider’s complaint policy and procedure had been made available to people who used the service, relatives and visitors. The registered manager had plans to meet with people and or their relatives to discuss their end of life wishes and to review the

Inspection areas

Safe

Requires improvement

Updated 19 May 2018

The service was not consistently safe.

Some shortfalls were identified in the management of medicines.

Risks had been assessed and planned for, but information available to staff about managing people�s mood and behaviour was limited in places.

Staffing levels were sufficient but the deployment of staff needed reviewing. Safe staff recruitment checks were completed.

Improvements were being made to cleaning schedules to ensure these followed best practice guidance.

Accidents and incidents were recorded, reviewed and analysed for patterns and trends. It was not always clear from documentation of action taken post incident.

Staff were aware of their responsibilities to protect people from avoidable harm.

Effective

Good

Updated 19 May 2018

The service was effective.

The provider used best practice guidance and care was delivered in line with current legislation. People were supported by staff that received an appropriate induction and ongoing training and support.

People�s rights were protected by the use of the Mental Capacity Act 2005 when needed.

People received choices of what to eat and drink and menu options met people�s individual needs and preferences.

People received support with any associated healthcare need they had and staff worked with healthcare professionals to support people appropriately.

Caring

Good

Updated 19 May 2018

The service was caring.

People were cared for by staff who showed kindness and compassion in the way they supported them. Staff were knowledgeable about people�s individual needs.

People had information about independent advocacy services to represent their views if needed.

People�s privacy and dignity were respected by staff and independence was promoted.

Responsive

Good

Updated 19 May 2018

The service was responsive.

People�s individual needs, preferences, routines and what was important to them had been assessed and recorded and were known by staff.

People received a personalised and responsive service and they or their relatives were included in discussions and decisions. People received opportunities to participate in meaningful activities.

A complaints procedure was available that informed people of their rights to make a complaint. Plans were in place to complete reviews and end of life plans with people and or their relative.

Well-led

Good

Updated 19 May 2018

The service was well-led.

The service had an experienced registered manager and relatives and staff were positive of their leadership, and improvements they had made since being in post.

People received opportunities to share their experience about the service.

There were processes in place for checking and auditing safety and quality. The management team had a commitment to continually drive forward further improvements and an action plan was in place to achieve this.

The registration and regulatory requirements were understood and met by the registered manager.