Background to this inspection
Updated
27 March 2021
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.
Inspection team
The inspection was carried out by two inspectors.
Service and service type
Forest Lodge is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
This inspection was unannounced.
What we did before inspection
The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. Before the inspection we reviewed the information, we held about the service and the service provider. We looked at the notifications we had received for this service. Notifications are information about important events the service is required to send us by law. We used all this information to plan our inspection. We took this into account when we inspected the service and made the judgements in this report.
During the inspection
We spoke with six people who used the service and four relatives about their experience of the care provided. We spoke with 17 members of staff including the quality manager, registered manager, activities co-ordinator, administrator, nurses, senior care workers, care workers and chefs. We also spoke the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We observed care to help us understand the experience of people who could not talk with us.
We reviewed a range of records. This included nine people’s care records and multiple medication records. We looked at two staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We looked at training data and quality assurance records. We spoke with three professionals who regularly visit the service.
Updated
27 March 2021
About the service
Forest Lodge is a residential care home that provides personal and nursing care to people aged 65 and over and people living with dementia. At the time of the inspection 45 people were using the service. Care and support were provided in one adapted building. The building had three units providing care to people: Beech, Ash and Cedar Unit. Forest Lodge is owned and operated by the provider Sussex Healthcare.
Services operated by the provider had been subject to a period of increased monitoring and support by local authority commissioners. As a result of concerns previously raised, the provider is currently subject to a police investigation. The investigation is on-going, and no conclusions have yet been reached. Forest Lodge is not part of this investigation.
People’s experience of using this service and what we found
Staff had received training and practice development in most areas; however, training had not been sought to cover all people’s more specific needs that are significant but secondary to their diagnosis of dementia. For example, learning disability. The providers quality monitoring systems had failed to identify this issue.
The culture of the service was positive, relatives, professionals and staff were complementary of the management and provider. Improvements had been made to systems and process that monitored the quality of the service being delivered and accuracy of records. Staff knowledge and practice in supporting people living with dementia had improved and the atmosphere in the service was friendly and calm. These improvements needed to be sustained and become fully embedded into practice.
The provider had updated their governance framework, and more support was in place from the provider’s quality team, which the registered manager told us was helpful. The changes to quality monitoring and the transfer from paper based to electronic recording were recent, evidence they will be sustained over time will be reviewed at the next inspection.
Risks to people's safety had been assessed, and people were supported to stay safe. Staff knew how to identify potential harm and report concerns. People received their medicines safely from registered nurses.
People were supported to have maximum choice and control of their lives and staff supported them in their best interests; the policies and systems in the service supported this practice.
We observed people being treated with dignity and respect, staff listened to people’s views and demonstrated in practice their understanding of how to support people in their own reality, whist being aware of how to positively change the course of the conversation if people became anxious.
Staff actively engaged people in activities, which we observed were enjoyed.
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 January 2020) and there were four breaches of regulations. At this inspection we found improvements had been made and the provider was no longer in breach of regulations 12 (Safe Care and Treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, regulation 13 (Systems and processes were not established and operated effectively to prevent abuse of service users) and regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to quality monitoring, the effectiveness of audits. The provider completed an action plan after the last inspection to show what they would do and by when to improve.
The last rating for this service was requires improvement (published January 2020). The service remains rated requires improvement. This service has been rated requires improvement for the last six consecutive inspections.
Why we inspected
We inspected to follow up on breaches found at the previous inspection.
We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.
The inspection was prompted in part due to concerns received about safe eating and drinking support, the administration of medicines and record keeping in relation to bruising and weight. We found no evidence during this inspection that people were at risk of harm from these concerns. Please see the Safe and Well-led sections of this full report.
The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service remains Requires improvement. This is based on the findings at this inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Forest Lodge on our website at www.cqc.org.uk.
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 coronavirus and other infection outbreaks effectively.
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.