Forest Brow Care Home

Forest Brow Care Home is a residential care home providing accommodation and personal care to up to 32 people. The service provides support to older people, some of whom were living with dementia. At the time of our inspection there were 18 people using the service. Accommodation was set in one adapted building over three floors.

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

The provider had worked to make significant improvements to the service since our last inspection, which means they were now meeting the requirements of regulations. Additional work was required for the provider to demonstrate that they were meeting the characteristics of good in all the key questions we looked at. However, at this inspection we found that people were not at risk of harm and work was in progress to address the issues found.

The provider had made improvements to their medicines management systems and processes. However, further improvements were required in some areas such as auditing to make processes more robust. The provider had increased the number of permanent staff in place and was working towards ensuring all staff deployed overnight had the required skills and training. People were protected from the risk of suffering abuse or coming to avoidable harm. There were effective systems in place to analyse incidents and put measures in place to reduce the risk of recurrence.

Since our last inspection, there was a new management team in place. People, relatives’ and staff were positive about the management and told us they were confident in their ability to manage the service. The manager and nominated individual had a good understanding of their role and regulatory requirements. There had been lots of positive engagement with people, relatives and staff who told us they felt listened to and respected. We received positive feedback from health and social care professionals about the provider’s efforts to improve the quality of the care since our last inspection.

The provider had made improvements to ensure that staff received appropriate training and support in their role. Some care plans contained contradictory information, specifically around eating and drinking, but staff mitigated any risks through their knowledge of people’s needs. Care records were not always completed accurately, with some staff citing issues with recording systems as contributing factors towards this. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People and relatives told us they were happy with the care provided. They told us that staff were caring, committed and empathetic. They said the provider had made significant improvements in increasing the number of permanent staff, which had a positive effect on the atmosphere at the service and consistency of care. They told us they felt consulted about their care and were treated with dignity and respect.

People told us they received personalised care in line with their needs. The provider had made significant improvements to help ensure that people were busy and active throughout the day. This included organising structured activities or events and spending informal time with people talking and reminiscing. There were systems in place to help ensure people were responded to appropriately when they had concerns or complaints.

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 inadequate (published 4 January 2023). We issued warning notices in relation to breaches in regulations 12, 13 and 17 and identified other breaches in regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. We subsequently inspected the service (published 7 March 2023) to check whether the provider had made improvements in relation to regulations 12 and 13. We found that the provider was in breach of these regulations and further improvement was required.

This service has been in Special Measures since 22 December 2022. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures. At this inspection the service has been rated requires improvement.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Forest Brow is a residential care home providing accommodation and personal care to up to 32 people. The service provides support to older people, some of whom were living with dementia. At the time of our inspection there were 24 people using the service.

The care home accommodates people in one adapted building over three floors.

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

People's medicines were not being properly and safely managed. There was a lack of stock control and monitoring, lack of auditing and lack of training. Risks related to people’s health and safety were not always safely managed, this included risks related to safe moving and handling of people and fire safety.

There were no incident reporting processes in place, which increased the risk of potential safeguarding not being identified.

The provider and the manager had taken actions to ensure that the environment was cleaner, however further work was needed to ensure good infection control processes were being followed in line with guidance.

People told us they were happy and felt well cared for by staff.

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 inadequate (published 04 January 2023) and there were breaches of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations.

Why we inspected

We undertook this targeted inspection to check whether the Warning Notices we previously served in relation to Regulation 12 and 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met in relation to specific concerns we had about people’s safety, safeguarding, infection control and medicines management. We did not review whether the Warning Notice for Regulation 17 in relation to governance had been met as the provider and the manager still have further time to meet the requirements of this regulation. Regulation 17 will be reviewed at the next inspection. The overall rating for the service has not changed following this targeted inspection and remains inadequate.

We use targeted inspections to follow up on Warning Notices or to check concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Forest Brow Care Home on our website at www.cqc.org.uk.

Enforcement and recommendations

We have identified the provider failed to fully address the action we told them to following our last inspection. There were continued breaches in relation to safe care and treatment and safeguarding at this inspection.

Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Forest Brow is a residential care home providing accommodation and personal care to up to 32 people. The service provides support to older people, some of whom were living with dementia. At the time of our inspection there were 29 people using the service. The care home accommodates people in one adapted building on three floors.

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

People told us “I feel very safe. I’m not threatened in any way” and “I’m content. I’m fed and I’m independent. I don’t get bossed about here.” We received mixed feedback from relatives including, “We are very pleased with the care shown to [relative]” and “[Relative] is well cared for, but it is not the same place as before” and “Over the last year, due to the changes at the care home, we are not as confident as we were that we always have full insight into our [relative’s] care.”

On our inspection we found systems to oversee the quality and safety of the service were not effective throughout all levels of management. The provider did not maintain effective oversight of the service to support the registered manager to meet their responsibilities around providing good quality care.

Systems to identify and mitigate risk were not effective. Medicines were not managed safely. Risks related to the premises were not always safely managed, this included risks related to fire safety. Staff recruitment checks were completed for permanent staff however they were not always completed for agency staff. Further work was needed to ensure good infection control processes were being followed. Lessons were not always learnt when incidents occurred to reduce the risk of re-occurrence.

Systems and processes to safeguard people from the risk of abuse were not effective. The provider did not always report allegations of abuse in line with safeguarding requirements. This resulted in an increased risk of harm to people.

We found the principles of the Mental Capacity Act 2005 (MCA) were not always followed, for example in relation to the use of bed rails. People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible, and in their best interests; the policies and systems in the service did not support this practice.

Staff did not always receive training or training updates in line with their role. There were significant numbers of staff who required or were overdue updates in key areas relevant to their role, such as medicines; mental capacity; moving and handling; fire; safeguarding adults; first aid, infection control, deprivation of liberty safeguard (DoLS), food hygiene; dementia; end of life care and health and safety.

Some areas of the environment needed updating to ensure it met the needs of people. The home environment did not reflect dementia friendly best practice to best meet people’s needs.

People's assessments and care plans were not always accurate or complete. People's care was not always personalised. Further work was required to reduce the risk of people experiencing social isolation through personalised activities.

Staffing was heavily reliant on agency staff and feedback from relatives included, “There is not enough, lots of agency” and “Staff are young and inexperienced from what I see”. Feedback regarding permanent staff included, “We find the current permanent care team to be very kind and considerate to the residents” and “Day-to-day staff are lovely”.

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 Good (published 3 October 2019)

Why we inspected

We undertook this inspection as part of a random selection of services rated Good and Outstanding.

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 COVID-19 and other infection outbreaks effectively.

The overall rating for the service has changed from good to inadequate based on the findings of this inspection.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to dignity and respect, need for consent, safe care and treatment, safeguarding service users from abuse and improper treatment, good governance, staff training, fit and proper persons employed and failure to submit appropriate statutory notifications to CQC.

Please see the action we have told the provider to take at the end of this report. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is inadequate and the service is therefore in special measures. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions of their registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Forest Brow is a residential care home providing personal care to 32 people aged 65 and over at the time of the inspection. The service can support up to 32 people. The care home accommodates people in one adapted building on three floors.

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

People and relatives told us they felt the service was safe. The risks to people were assessed and minimised and people were protected from the risk of abuse. People were supported to take their medicines as required and there were suitable systems for ensuring the home was clean and equipment was safe for use.

Systems around assessing, monitoring and minimising risk were evident. People's care records contained risk assessments and care plans reflected these risks. Staff were aware of safeguarding issues and how to report concerns. People were supported by staff who had been safely recruited and subject to checks. Medicines were managed in line with national guidance. The home was maintained in a clean and tidy manner.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Quality assurance systems were in place and based upon regular, scheduled audits, which identified any action required to make improvements. This meant the quality of service people received was monitored on a regular basis and, where shortfalls were identified they were acted upon.

People, relatives and staff were happy and felt the home was being well run. People were supported by a team of staff who were happy in their jobs and well-supported by their managers.

Leadership was visible and promoted good teamwork. People, professionals and staff spoke highly about the management and staff had a clear understanding of their roles and responsibilities. The registered manager and staff team worked together in a positive way to support people to achieve their own goals and to be safe.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Good. (Report published 22 February 2017).

Why we inspected

This was a planned inspection based on the previous rating.

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.

At our previous inspection of October 2013, the service met all the regulations we inspected.

There was a registered manager in post as required. A registered manager is a person who has registered with the CQC 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 and associated Regulations about how the service is run.

Staff identified and managed risks to people’s health and safety. Staff followed guidance in place to manage the risks whilst respecting their rights. The registered manager monitored incidents and accidents and had put plans in place to prevent a recurrence. The lack of proper storage at the service meant that some equipment was not always stored appropriately. This could be unsafe for people with reduced mobility or who were at risk of falls.

People received the support they required with their medicines. Staff knew how to protect people from abuse. The provider used a safe process to recruit suitable staff. There were sufficient numbers of appropriately skilled staff on duty to meet people's needs.

Staff received training and support that enabled them to plan and deliver people’s support safely and competently. The registered manager carried out regular supervision and appraisal and took action to address any knowledge and skills gaps.

People gave consent to care and treatment. Staff supported people in line with the principles of the Mental Capacity Act 2005. People’s rights were upheld. Staff appropriately supported people whose freedom was authorised to be restricted under the Deprivation of Liberty Safeguards. The registered manager involved people, relatives and healthcare professionals to help people to make decisions that were in their best interest.

People had sufficient food and drink and enjoyed the meals provided at the service. Staff made referrals to healthcare professionals about people’s dietary needs and monitored their food and fluid intake as required. People accessed the healthcare services they required for advice, treatment and support.

Staff treated people with dignity and respect and provided their care and support in a caring and compassionate way. Staff knew people well and understood their communication needs.

People took part in activities they enjoyed at the service and in the community. Staff encouraged people to try new things based on their individual interests, hobbies, preferences and abilities.

Staff assessed and reviewed people’s needs regularly and managed their changing needs in a flexible way. Staff had sufficient guidance on how to deliver people’s care. People and their relatives, where appropriate were involved in planning for people’s care. People received their care and support as planned.

People and their relative’s views about the service were sought and acted on. People knew how to make a complaint. The registered manager responded and investigated complaints in line with the provider’s procedure.

People, their relatives and staff were positive about the quality of care and support provided at the service. The registered managed used audit systems in place to monitor the quality of the service and addressed shortfalls to develop the service.

There was clear information to guide staff in how people liked to be cared for and supported and this was consistently followed.

There were policies and procedures in place to safeguard people from abuse and people felt confident that any concern they had would be listened to and addressed.

There were robust systems in place to reduce the risk of spread of infection.

The service was well led and people were supported by competent and suitably trained staff who were employed in sufficient numbers to meet their needs.

We looked at the issue of consent to care and treatment by people and their relatives, and found that the provider had processes in place to gain consent, although this was not always been taken up by people or their relatives.

We looked at the care process, and found that people who used the service were happy with their level of care. We found there were proper assessment, care management and risk assessment systems in place and that these were reviewed regularly.

We looked at safeguarding and found that staff had been properly trained this area and felt able to report any instances of abuse if necessary. We were also able to seek clarification on a number of potential safeguarding issues that had been raised prior to our visit.

We looked at staffing and found there were sufficient numbers of properly qualified staff to provide an acceptable level of care, although we identified one particular issue regarding lunchtime staffing.

We looked at how the provider assessed and monitored quality in the service and found it had effective processes for doing this.