23 May 2018
During a routine inspection
Forward Support Limited 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. Forward Support Limited can provide support to up to ten people with mental health conditions who may also have a forensic history. At the time of our inspection eight people were living in the home. Forward Support Limited is a large house with large communal areas and a separate games room in the garden. Each person had their own bedroom with en-suite bathroom facilities.
There was a registered manager in post. 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 told us they felt safe living in the home. Staff were knowledgeable about safeguarding adults and records showed appropriate action was taken when people were identified as being at risk of abuse and avoidable harm. Risks faced by people living in the home were clearly identified, particularly with regard to the risks of mental health relapse, with clear measures in place to mitigate and escalate these risks. When incidents occurred, the service took effective action to ensure lessons were learnt and improvements made. People told us there were enough staff available to ensure their needs were met. Staff knew about the risks of people’s medicines and records showed they were supported to take medicines as prescribed. During the inspection the provider completed medicines care plans to ensure medicines practice was in line with best practice guidance.
People were involved in comprehensive needs assessments and completed a gradual transition to moving to the home. Care plans did not always reflect the detailed knowledge of staff about how to provide support to people. This was addressed by the service during the inspection. Records showed staff supported people to work collaboratively with other organisations and healthcare services involved in their care and treatment. Staff received the training and supervision they needed to perform their roles. People told us they were supported to eat and drink in line with their personal and cultural needs and preferences. Everyone living in the home had capacity to consent to their care and treatment. Some people were subject to restrictions due to the nature of their needs and staff supported them to understand and comply with these conditions.
People told us they had developed trusting relationship with staff. Staff demonstrated they understood the need to provide emotional support and were able to identify how people expressed their emotional needs. People were supported to practice their religious faith where they wished to do so. The service had taken steps to ensure that people felt safe to disclose their sexual and gender identity. Staff demonstrated how they treated people with respect and we saw staff always communicated with people in a polite and respectful manner.
The home operated a key-working system where each person had a named member of staff who led on ensuring they received the right support. People met with their keyworkers regularly and staff regularly reviewed and updated people’s care plans. Records showed any changes were escalated promptly and effectively with other agencies involved in providing care and treatment. People knew how to make complaints. There was clear information about timescales for response to complaints and how to escalate concerns if people were not happy. People were asked if they wanted to consider their end of life wishes and there was a framework in place to support people at the end of their lives if this became necessary.
The quality assurance and audit systems in place had not identified that medicines plans were not in place, or that care plans did not reflect the knowledge of staff. We have made a recommendation about quality assurance systems. People, staff and external professionals all spoke highly of the registered manager. There was a clear vision for the service with a values base that emphasised the rights and responsibilities of people living in the home. Regular meetings and surveys gave people, staff and relatives the opportunity to be engaged in the development of the service.