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Forest Lodge Requires improvement

Reports


Inspection carried out on 2 December 2019

During a routine inspection

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 49 people were using the service. Care and support was 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.

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

People and their relatives spoke highly of the service. Comments included, “I am as happy as I can be here, yes I feel safe as everything is made to make you feel safe here,” and “Perfectly safe here, I watch and listen and formulate, I have never seen anything to worry me or I would be doing something about it.” Risks associated with people’s care were not however, consistently safe. Where people displayed behaviours which challenged, robust guidelines and risk assessments were not always in place. The risks around restrictive practice were not regularly reviewed and documentation to monitor people’s behaviour were not accurately completed.

Quality assurance frameworks were in place; these were not consistently effective in driving improvement or identifying shortfalls. Forest Lodge has been in continuous breach of regulations since May 2018 and internal quality assurance frameworks have failed to drive and sustain improvements. Accurate documentation was not consistently maintained. Links and engagement with the local community required strengthening.

People were not always supported to have maximum choice and control of their lives. The application of the Mental Capacity 2005 was inconsistent and people’s capacity to consent to specific decisions had not always been assessed. The provision of activities required further development. Activities were not consistently meaningful or tailored to people's needs. The care planning process required further development to ensure people's social and emotional needs were understood and met. The risks associated with social isolation had not always been assessed or mitigated. We have made a recommendation for improvement. Further work was required to ensure information about people's care and treatment was always made available in the most accessible way.

Staff felt supported and had access to a range of training. People's nutritional needs were met, and people spoke highly of the food provided. Risks associated with catheter care, skin integrity and dehydration were managed well. People had ongoing access to healthcare professionals and staff recognised and responded well to signs that a person's health might be deteriorating. Advanced decision care plans were in place and the registered manager was working with staff, people and relatives to make these care plans more personalised.

People told us they felt safe living at Forest Lodge. Relatives also confirmed that they felt confident leaving their loved one in the hands of staff. Systems were in place to determine staffing levels and safe recruitment practices were operated. People told us that staff responded promptly to their care needs. People and staff spoke highly of the registered manager and the registered manager was compassionate about ensuring people received high quality care

The provider employed a team of dedicated housekeepers. Staff had access to personal protective equipment (PPE) and the service presented as clean and tidy. People and their relatives told us staff were kind and caring, listened to them and respected their choices. People were encouraged to be involved in their day to day care and be as independent as pos

Inspection carried out on 8 May 2019

During a routine inspection

About the service: Forest Lodge is a residential care home that provides personal and nursing care to people aged 65 and over and people with dementia. At the time of the inspection 54 people were using the service.

Forest Lodge is owned and operated by the provider Sussex Healthcare. Services operated by Sussex Healthcare have been subject to a period of increased monitoring and support by local authority commissioners. Due to concerns raised about the provider, Sussex Healthcare is currently subject to a police investigation. This does not include Forest Lodge but the investigation is on-going and no conclusions have yet been reached.

People’s experience of using this service:

Risks to people were not always assessed, monitored and managed safely.

People were not always kept safe from risk of abuse.

Medicines were not always managed safely.

There were not always enough suitably qualified, competent, skilled and experienced staff deployed to meet people’s needs.

Adequate cleaning to combat odours caused by incontinence was not taking place.

Lessons were not always learnt and improvements made when things had gone wrong at the service.

People and those acting lawfully on their behalf had not always given consent before being provided with support.

Conditions on authorisations to deprive a person of their liberty were not always being met appropriately.

People’s needs and choices were not always assessed so staff did not always know or understand how to deliver support for them to achieve effective outcomes.

People did not always receive personalised care that was responsive to their individual needs, including support with meaningful activities within the service and the wider community.

Information about people’s care and treatment was not always made available in the most accessible way for people.

Quality assurance and governance systems were not operating effectively. Staff and management were not supported to understand or fulfil their responsibilities and ensure that quality performance and risks were understood and managed.

There were safe recruitment practices.

Staff had regular training, updates and supervisions.

People and their relatives told us staff were kind and caring, listened to them and respected their choices.

People were encouraged to be involved in their day to day care and be as independent as possible.

Complaints were managed and responded to appropriately.

We have recommended that the provider seeks advice and considers how to improve the design and adaptation of the home and outside spaces, to better meet the needs of people and promote the independence of people.

This inspection identified continued breaches of Regulations 9, 12, 15, 17, 18 and breaches of regulation 11 and 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Rating at last inspection: We last inspected Forest Lodge on 23 and 24 May 2018. The report was published in August 2018 and then re-published to include information about enforcement action on 24 January 2019. The service was rated Requires Improvement.

Why we inspected: This inspection took place on 8 and 9 May 2019 and was a scheduled and planned inspection based on the previous rating.

Enforcement: We imposed conditions on the provider’s registration, due to repeated and significant concerns about the quality and safety of care at several services they operate. The conditions are therefore imposed at each service operated by the provider, including Forest Lodge.

The conditions mean that the provider must send to the CQC, monthly information about incidents and accidents, unplanned hospital admissions and staffing. We will use this information to help us review and monitor the provider’s services and actions to improve, and to inform our inspections.

Follow up: The overall rating for this service is inadequate. This means the service has been placed in Special Measures. Services in special measures are kept under

Inspection carried out on 23 May 2018

During a routine inspection

The inspection took place on 23 and 24 May 2018. This was a comprehensive inspection and it was unannounced.

Services operated by the provider had been subject to a period of increased monitoring and support by commissioners. As a result of concerns raised, the provider is currently subject to a police investigation. We used the information of concern raised by partner agencies to plan what areas we would inspect and to judge the safety and quality of the service at the time of the inspection. Between May 2017 and May 2018, we have inspected a number of Sussex Health Care locations in relation to concerns about variation in quality and safety across their services and will report on what we find.

Forest Lodge is a care home that provides nursing and residential care. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided and both were looked at during this inspection.

Forest Lodge is registered to provide nursing and accommodation for up to 73 people. People cared for were older people who needed nursing care, some people had complex health needs and/or some people were living with dementia. At the time of our inspection there were 56 people living at the home. Accommodation is provided across three units Ash, Cedar and Beech. Eight people shared bedrooms and the rest were of single occupancy. People shared communal areas such as a large lounge and dining room.

A registered manager was in post who was not present during the 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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

On one occasion the service did not demonstrate the correct action was taken after an incident involving a person had occurred. This included any routine health checks to ensure harm had not been caused. We found inconsistencies with how risks were being managed, by the service, on behalf of people.

Staff were not always adequately trained to assist them in carrying out their role and responsibilities safely and effectively. We found there was an offensive odour related to urine incontinence in some communal areas. We recommended the provider reviews how many staff were deployed at night time as their was a lack of information available about how decisions were made about how many staff were needed to meet people's needs.

Group activities were offered to people. However, personalised activities and stimulation were not always provided. We observed caring approaches used by staff when supporting people. However, some aspects of the service were not consistently caring.

Systems were not always effective in measuring and monitoring the quality of the service provided. There were ineffective systems in place to drive continuous improvement.

People's consent to care and treatment was gained in line with the requirements of the Mental Capacity Act 2005. People were supported to have choice and control of their lives and for staff to support them in the least restrictive way possible; the policies and systems in the service supported this practice. Staff received supervisions and appraisals and they found the registered manager’s approach supportive.

People were provided choices on a daily basis regarding what food they ate and clothes they wore. Complaints were managed effectively. The provider sought feedback from people and their relatives regarding the care received.

The registered manager had sought information about the new Key Lines of Enquiry (KLOE) which the Commission introduced from 1 November 2017. They were keen to improve the quality and safety of care provided to people living at the home.

At

Inspection carried out on 5 December 2016

During a routine inspection

This inspection took place on 5 & 6 December 2016. It was unannounced. There were 56 people living at Forest Lodge when we inspected. People cared for were This inspection took place on 5 and 6 December 2016. It was unannounced. There were 56 people living at Forest Lodge when we inspected. People cared for were mainly older people who needed nursing care and were living with dementia. People had a range of care and treatment needs, including stroke, heart conditions, breathing difficulties, diabetes and arthritis. Many people needed support with all of their personal care, eating and drinking and mobility needs. Some of the people were living with behaviours which may challenge others.

Forest Lodge is a large house which had been extended. People’s bedrooms were provided over two floors, with a passenger lift in-between. There were sitting rooms and a dining room on the ground floor. Forest Lodge was situated in its own grounds, which were shared with other services, also owned by the provider. This group of services were situated in a rural area near Uckfield in East Sussex. The provider for the service was SHC Rapkyns Group Limited, who own a range of services across south east England.

Forest Lodge had a registered manager. 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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The last inspection took place on 3 and 9 November 2015. At that inspection we found the service required improvement. This was because the service was not always safe, responsive or well led, due to people’s assessments and care plans not always reflecting all of their needs. This was a breach of Regulation 12 of the HSCA 2014 Regulations and we required that the provider take action to address this. The provider and registered manager had met the requirements of this regulation. People now had relevant assessments and care plans, which outlined how their risk was to be reduced and care and treatment needs met.

At this inspection, the provider’s systems for audit required improvement because their audits had not identified there was a lack of consistency across the home in people’s care plans and documentation. The provider’s other systems for audit were effective, including receiving and acting on feedback from relevant persons.

People’s medicines were managed in a safe way and there were full records about supporting people with their medicines. All medicines were securely stored. People received the support they needed to enable them to eat and drink what they wanted. They could choose where they ate their meals. Staff were available to support people who needed assistance with eating and drinking.

People said there were enough staff on duty to support them. Staff were available to respond quickly to people when they needed assistance. Staff were recruited in an effective way, to ensure they were safe to care for people.

Staff knew how to ensure people were protected against risk of abuse. All staff were aware of their responsibilities where people lacked capacity. People had clear individual assessments in relation to their capacity. The registered manager had ensured relevant referrals were made to the local authority under the Deprivation of Liberty Safeguards (DoLS).

All people had relevant care plans, including where people had complex healthcare, nursing and treatment needs. People also had clear care plans about living with dementia, these were followed by staff. Where people needed support from external professionals, such as the tissue viability nurse (TVN) or speech and language therapist (SALT), the home ensured referrals took place promptly and professionals’ directions were followed.

People and their relatives said staff were caring. Throughout

Inspection carried out on 3 and 9 November 2015

During a routine inspection

This inspection took place on 3 and 9 November 2015. It was unannounced. There were 59 people living at Forest Lodge when we inspected. People cared for were mainly older people who needed nursing care and were living with dementia. People had a range of care and treatment needs, including stroke, heart conditions, breathing difficulties, diabetes and arthritis. Many people needed support with all of their personal care, eating and drinking and mobility needs. Some of the people were living with behaviours which may challenge others.

Forest Lodge is a large house which had been extended. People’s bedrooms were provided over two floors, with a passenger lift in-between. There were sitting rooms and a dining room on the ground floor. Forest Lodge was situated in its own grounds, which were shared with other services, also owned by the provider. This group of services were situated in a rural area, north west of Uckfield in East Sussex. The provider for the service was SHC Rapkyns Group Limited, who own a range of services across south east England.

Forest Lodge had a registered manager. 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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Forest Lodge had been registered with the CQC for a period of time under a different provider, before this inspection. The home was registered by the current provider, SHC Rapkyns Group Limited, in November 2014, so this was the first inspection of the service since their new registration.

Some ways of ensuring the safety of people were not effective. This included the safety of people who used bed rails and people who may be at risk of trips and slips. There were systems to ensure the safety of people in other areas, including where people were at risk of falling, choking and had mobility needs.

People did not have care effectively planned and delivered for all areas of their care and treatment. This included where people showed high blood sugar levels, where people had small wounds and for some people who were at high risk of pressure damage. Care plans were in place for other areas, including where people may be at risk of low blood sugar levels, had large wounds and experienced behaviours which may challenge others.

Where people needed to be given their medicines in a disguised way (known as covert administration), there was a lack of care planning to ensure all registered nurses supported people consistently. Where people were given medicines ‘as required’ (PRN), care plans did not include relevant information known about by staff. There was also a lack of records to enable audit of covert administration of medicines and the effectiveness of PRN medicines for people. Other systems to ensure safe management of medicines were in place. All medicines were stored in a secure way and registered nurses appropriately supported people when giving them their medicines.

The provider’s audits did not identify a range of relevant areas, including systems for ensuring the privacy and dignity of people where they shared double rooms, the cleanliness of certain pieces of equipment and ensuring all staff moved people in a safe way. Other systems were audited effectively by the provider, including fire safety and response times when people used their call bells.

People and their relatives said they felt safe in the home. Staff knew about how to ensure people were protected against risk of abuse. All staff were aware of their responsibilities where people lacked capacity. The manager had ensured relevant referrals were made to the local authority under the Deprivation of Liberty Safeguards (DoLS).

People and their relatives said staff were caring. They said the home’s systems supported people’s independence and promotion of choice. Staff ensured people’s privacy and dignity in their day to day care and treatment.

People commented favourably on care and treatment provided at the end of people’s lives, so that people’s care at those times was person-centred and as pain-free as possible.

People said there were enough staff on duty to support them. Staff were available to respond quickly to people when they needed assistance. There were systems to ensure staff were recruited in an appropriate way. Staff were trained in their roles and regularly supervised to ensure they could provide effective care and treatment to people.

Where people needed support from external professionals, such as a dietician or speech and language therapist (SALT), the home ensured referrals took place promptly and professionals’ directions followed.

People received the support they needed to enable them to eat and drink what they wanted. They could choose where they ate their meals. Staff were available to support people who needed assistance with their diet and fluid intake.

The home employed a range of activities staff. A range of activities were provided to people to suit their diverse needs. People were fully supported in participating in activities as they wished.

People said they could raise issues with managers when they needed to. They felt confident action would be taken if they did this. People and staff commented on the support they received from the registered manager and the senior managers for the provider. People said the home was well managed and supportive of their needs.

During the inspection we found one breach 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.