Archived: The Old Forge

Updated 22 May 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 11, 12 and 13 April 2018 and was unannounced. The inspection was carried out by one inspector.

Prior to the inspection we reviewed the information we held about the service, this included notifications we had received from the provider. Notifications are changes or events that occur at the service which the provider has a legal duty to inform us about. We had not asked the provider to complete a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We covered these areas during our inspection.

During the inspection we spoke with six staff members including the regional manager, two assistant managers, the service manager and two support workers. During our visit we were not able to speak with the people who were present in the service due to communication difficulties. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us. Following the inspection we spoke with two relatives of people living in the service and one local authority professional.

We reviewed documents associated with two people’s care and their medicines. We examined records associated with the employment of three staff. We read records related to health and safety, incidents and accidents and audits connected to the running of the service.

Updated 22 May 2018

This inspection took place on the 11, 12 and 13 April 2018 and was unannounced. We made two recommendations following our previous inspection in February 2017. These related to staffing levels and activities for people.

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

The care service has not been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. The values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen. We found that people were not able to be included in their local community due to its geographical location and the lack of transport and staffing. At the time of our inspection, two people were living in the service.

The service did not have a registered manager in place. The previous manager deregistered with the Care Quality Commission (CQC) in January 2018. 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.

People’s relatives spoke positively about the care being provided within the service. We observed staff who cared for people in a respectful and kind way. We saw positive relationships had been formed between staff and the people they cared for.

The provider had failed to monitor the quality of the management in the home and this had resulted in a lack of progress concerning the expected improvements from our previous inspection in February 2017. There were still not enough staff available to meet people’s needs and to keep them safe. Activities were not regularly available outside of the home. This prevented people from accessing their local community and placed them at risk of social isolation.

We identified breaches to Regulation 12 of the Health and Social Care Act 2008. This was because personal emergency evacuation plans did not accurately reflect people’s needs and did not give clear and consistent guidance to staff on how to evacuate the service safely. Furthermore, the fire emergency plan was not up to date. Risks related to the care being provided and the environment had not always been mitigated. When risks were identified, appropriate action was not always taken to minimise the risk.

In addition, there were gaps and inaccurate records alongside a lack of managerial oversight. This placed people at risk of receiving inappropriate or unsafe care. Insufficient staff members meant people did not always receive the care they required at the time they needed it. Staff were not always trained in the areas needed to carry out their role.

People did not always receive food that was safe for them to eat. Professional advice was not always followed.

Medicines were administered appropriately, and records reflected this. Staff understood how to protect people from the risk of infection. Recruitment records contained the relevant checks and staff had received training in how to protect people from the risk of abuse. 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 at the service supported this practice. We have made a recommendation to ensure staff were trained in Mental Capacity Act and were following the best interest process. We found this was not always happening.

There was a lack of care reviews taking place with people and their representatives. Although we found some good practice in relation to how people were assisted to communicate, we also found guidelines were not being followed. We have made a recommendation about the Accessible Information standard.

We found this was not a well-managed service. There was a lack of management presence, with no clear reason given. The service manager was managing two services, but appeared to spend little time at The Old Forge. The senior staff were clearly struggling to manage the service, and management support had been slow to respond. A lack of management oversight meant the service had not operated to an acceptable level. Where areas of the service had been identified as requiring improvement these had not been acted upon in a timely way.

We found senior staff were not aware of the requirements related to the Duty of Candour. We have made a recommendation about this.

We found a number of 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.