Forest Hospital

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

This means we looked for evidence that patients’ care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence. At our last inspection we rated this key question requires improvement. The service was in breach of legal regulation in relation to safe care and treatment (regulation 12). At this inspection and assessment, the rating has changed to good. The service made improvements and was no longer in breach of regulations in relation to physical health observations. Patients’ needs were assessed using a range of assessment tools. The service worked well across teams and services to support patients. The service supported patients to manage their health and wellbeing. There were effective approaches to monitor patients’ care and treatment and their outcomes. Patients’ capacity and ability to consent was taken into account.

However, patients did not always receive care, treatment and support in line with good practice standards. Risks relating to patients’ physical health were not consistently monitored or reviewed.

We have not awarded this service a score for Effective.

Find out about when we will not publish a key question score and what we look at when we assess Effective.

The evidence showed a good standard. The service made sure patients’ care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

Patients’ needs were assessed using a range of assessment tools to ensure their needs were reflected and understood. Pre‑admission processes were thorough and ensured that the service could meet each patient’s needs effectively. Information gathered prior to admission included clinical history, behavioural presentation, physical health needs, and environmental considerations. We reviewed 9 care records, and all demonstrated staff completed comprehensive assessments of patients’ needs. Staff used a range of assessment tools including HoNOS and Waterlow scores.

Nurses and HCAs worked together with patients and their families to complete detailed, personalised care plans that reflected patients’ individual needs and preferences.

The evidence showed some shortfalls. The service did not always deliver patients’ care and treatment with them, including what was important and mattered to them.

Patients did not always receive care, treatment and support in line with good practice standards. Risks relating to patients’ physical health were not always consistently monitored or reviewed. In one care record, staff had not completed a routine physical health check within the past two months, and in another, the hospital passport had not been reviewed for over a year. We reviewed 3 patients’ physical health care plans. Although staff assessed patients’ physical health needs, we were not assured appropriate plans were always in place to address the identified needs. Staff recorded that a patient had type 1 diabetes but did not include any details on what to do in the event of the patient experiencing hyperglycaemia (high blood sugar) or hypoglycaemia (low blood sugar). The nurse advised the patient would know what to do. However, we raised this with the provider and they updated the care plan whilst we were on site. These omissions meant there was a risk that changes in patients’ health needs might not always be recognised or responded to in a timely way

The provider’s systems ensured that staff were up to date with national legislation, evidence-based good practice and required standards. Staff carried out patient observations safely and in accordance with the provider’s policy. Staff demonstrated a thorough understanding of their responsibilities and completed observations consistently and accurately to promote patients’ safety and wellbeing. There was effective oversight of observation practice, which supported safe decision‑making and timely escalation when required. This reflected a clear improvement since the last inspection.

Patients’ nutrition and hydration needs were met in line with current guidance. We saw the menu offered a good choice of options and was presented like a restaurant menu. Patients could access additional food throughout the day and drinks at any time. We saw food and fluid charts were in place for patients, where required. These were reviewed in the morning meeting we observed.

Mental Health Act

• The provider reported 92% of staff received training in the Mental Health Act.
• Staff were trained in and had a good understanding of the Mental Health Act, the Code of Practice and the guiding principles.
• Staff had easy access to administrative support and legal advice on implementation of the Mental Health Act and its Code of Practice. Staff knew who their Mental Health Act administrators were.
• The provider had relevant policies and procedures that reflected the most recent guidance.
• Staff had easy access to local Mental Health Act policies and procedures and to the Code of Practice.
• Patients had easy access to information about independent mental health advocacy.
• Staff explained to patients their rights under the Mental Health Act in a way that they could understand, repeated it as required and recorded that they had done it.
• Staff requested an opinion from a second opinion appointed doctor when necessary.
• Staff stored copies of patients' detention papers and associated records (for example, Section 17 leave forms) correctly and so that they were available to all staff that needed access to them.
• The service displayed a notice to tell informal patients that they could leave the ward freely.
• The Mental Health Act team did regular audits to ensure that the Mental Health Act was being applied correctly.

The evidence showed a good standard. The service worked well across teams and services to support patients. They made sure patients only needed to tell their story once by sharing their assessment of needs when patients moved between different services.

Staff had access to the information they needed to appropriately assess, plan and deliver patients’ care, treatment and support. We observed a morning meeting during our site visit. These meetings take place every weekday morning. Attendees included the hospital director, deputy hospital director, receptionist, HCA’s, nursing staff and domestic staff. Items discussed included staffing, incidents, personal care, food and fluid charts and planned activities for the day.

When patients received care from a range of different staff, teams or services, it was co-ordinated effectively. All patients were registered with the same GP. Staff supported patients to attend external appointments from referrals made by the GP. Patients accessed a community dentist with specialism in providing care to this patient group. Podiatry were on site every 6 weeks. Staff reported an excellent working relationship with the local tissue viability team, who they could refer directly to. The occupational therapy (OT) team were supported to access specialist equipment by a contact at the local acute hospital.

The evidence showed a good standard. The service supported patients to manage their health and wellbeing to maximise their independence, choice and control. The service supported patients to live healthier lives and where possible, reduce their future needs for care and support.

The service was focused on identifying risks to patients’ health and wellbeing early and on supported patients to prevent deterioration. The provider implemented measures in response to our concerns at the previous inspection in relation to identification and monitoring of a deteriorating patient. These included sepsis awareness, National Early Warning Signs (NEWS) and blood pressure training for all staff. Staff completed NEWS charts as required.

Patients were encouraged and supported to make healthier choices to help promote and maintain their health and wellbeing. Staff told us about a patient who enjoyed participating in a physical activity with their family. When they were admitted to the service they had not participated in this activity for years due to a physical health issue that made it difficult. The service implemented measures that enabled the patient to re-engage with this activity and they were participating in the activity once a week with their family.

The evidence showed a good standard. The service routinely monitored patients’ care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of patients themselves.

There were effective approaches to monitor patients’ care and treatment and their outcomes. The provider reported the use of a range of outcome measurements including a wellbeing tool used in monthly ward rounds, Cornell Scale for Depression in Dementia, Pain Assessment in Advanced Dementia, Side Effect scale/checklist for anti-psychotic medication, Adapted Bradford Well-Being Assessment Tool (originally designed to map the experiences of individuals with dementia, it has been adapted across health and social care to track emotional, cognitive, and social well-being over time), Model of Human Occupation Screening Tool (MOHOST), a standardised occupational therapy assessment designed to assess how a patients daily routines, environment, and physical/mental skills impact their ability to engage in everyday activities, and the Allen Cognitive Level Screen (ACLS‑5), a standardised occupational therapy tool used to assess functional cognition and learning potential in adults with suspected cognitive impairment. Staff have 30 minutes protected time each day to explore preferred activities with patients from information collated in ‘getting to know me’ booklets and to explore other actives to help gauge patients’ enjoyment and participation. Staff completed evaluation sheets for patient’s level of engagement and their response during the activity. Staff developed patient engagement booklets alongside this.

The evidence showed a good standard. The service told patients about their rights around consent and respected these when delivering patient-centred care and treatment.

Patients’ capacity and ability to consent was taken into account, and they, or a patient lawfully acting on their behalf, were involved in planning, managing and reviewing their care and treatment. We reviewed patients medicine records. Staff completed an assessment of each patient’s capacity and made a best interest decision in relation to the patient’s treatment, with T3 forms in place where required. Under the Mental Health Act, a T3 Form (Certificate of Second Opinion) is the legal document required to medicate a detained patient who either lacks the capacity to consent to treatment or refuses it. Staff completed a care plan for another patient in relation to administering medicines covertly if the patient was unwilling to take it.