The inspection took place on 30 and 31 October 2017. The first day of the inspection was unannounced, however the second day of the inspection was announced and the registered manager, staff and people knew to expect us. Forest View is a residential service providing accommodation for up to 60 older people, some of whom are living with dementia and who may require support with their personal care needs. On the day of the inspection there were 59 people living at the home.
Forest View is situated in Burgess Hill, West Sussex and is one of a group of services owned by a national provider, Shaw Healthcare Limited. It is a purpose built building with accommodation provided over two floors which are divided into smaller units comprising of ten single bedrooms with en-suite shower rooms, a communal dining room and lounge. There are also communal gardens. The home also contains a day service facility where people can attend if they wish, however this did not form part of our inspection.
The home had a registered manager. A registered manager is a ‘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 home is run. The management team consisted of the registered manager, a deputy manager and team leaders.
We previously carried out an unannounced comprehensive inspection on 14 July 2015 and the home received a rating of ‘Good’.
At this inspection, people were provided with sources of entertainment and stimulation through planned group activities and external entertainers. One person told us, “There’s plenty to do. I like the Bingo and music. I like watching my TV”. Some efforts had been made to provide more meaningful activities for people that were based on their hobbies and interests before they had moved into the home. For example, a knitting club had been introduced which a small number of people enjoyed. However, in the main, there was a lack of meaningful occupation and stimulation to occupy peoples' time and staff did not always have sufficient time to interact and engage with people.
Peoples’ needs and preferences were assessed when they first moved into the home and on-going reviews took place to ensure that the care people were receiving was meeting their current needs. Care plans were person-centred, however, although relatives were informed of any changes or updates in peoples’ care, feedback from them was that they were not always involved in the on-going reviews that took place and that sometimes they were not provided with sufficient explanation about any changes in the care their relatives received. When this was raised with the registered manager they told us that this was something that they wanted to improve and develop.
The staff team consisted of permanent staff as well as the use of temporary staff to ensure that the home was sufficiently staffed to meet peoples’ physical care needs. However, the skills and level of understanding of the temporary staff differed to that of the permanent staff. Measures had been taken to ensure that temporary staff worked alongside more experienced staff to enable the sharing of knowledge and skills. Nevertheless, temporary staff lacked understanding about the content of peoples’ care plans and information that was specific to their care needs. A comment by a healthcare professional echoed this, they told us, “We feel that there is in general poor communication to staff and that information about people isn’t shared effectively”.
The provision of activities to promote more meaningful occupation for people, the need to ensure that there is an increased level of interaction, staff engagement and stimulation from staff to support people to participate in pastimes that they enjoy, as well as the need to increase the involvement of people and their relatives in the on-going review of peoples' care, are areas of concern.
Regular audits of the systems and processes within the home and of the care people received, took place to ensure that people were receiving the type of care they had a right to expect. When improvements needed to be made these were highlighted and timely action taken to ensure that things improved. However, although effective in most areas, this had failed to identify the shortfalls in practice that meant that people were not always supported in a person-centred way.
People, relatives and healthcare professionals told us that staff were kind and caring and observations showed that some positive relationships had developed. Comments from relatives included, “I think the carers are amazing, so patient. It gets a thumbs up from us. It has a good reputation out and about” and “We are happy for my relative to stay here. The carers are professional and dedicated, wonderful”. A healthcare professional told us, “Some staff are excellent and take a very proactive approach to care. They recognise individual peoples’ needs and endeavour to provide the best possible care”.
Peoples’ consent was gained before supporting them. The registered manager was aware of the legislative requirements when a person lacked capacity and had worked in accordance with these. People were treated with respect and dignity and their right to privacy was maintained. Staff were aware of the importance of supporting people in a sensitive manner and information that was held about people was kept in locked cabinets to ensure that confidentiality was maintained. People, dependent on their needs, were able to stay at the home until the end of their lives. Plans to ensure that people received good end of life care were in place and records and observations showed that peoples’ wishes and needs were respected at this time.
People told us that they felt safe, comments included, “Yes I feel safe; I can lock the door if I want” and “I feel safe here, more than I did at home”. Risks to peoples’ safety were regularly assessed and appropriate care was provided to ensure that people received safe care. People were able to take risks and observations showed people independently walking around the home using their mobility aids. People were protected from the risk of harm and abuse as they were cared for by staff who had undertaken the relevant training and who knew what to do if they were concerned about a person’s welfare. People had access to external healthcare services if they were unwell as well as having access to medicines if required. People and relatives told us that people were happy with the food that was provided, that they enjoyed the meals and were provided with choice. Comments included, “You tell them what you want, there’s sandwiches in the evening. There’s plenty of drinks” and “It’s very good”.
People and relatives were able to share their views and ideas through regular residents’ and relatives’ meetings as well as annual surveys and actions had been taken in response to peoples’ feedback. There was a complaints policy in place and complaints had been dealt with in a timely manner. People, relatives and staff were complimentary about the leadership and management of the home. Comments from staff included, “The manager is very approachable”, “I think things have really improved since the manager came. Everyone works well as a team” and “I’ve worked in a lot of care homes and nursing homes and this is by far the best. It’s a very warm and friendly place and the management have a lot to do with that”. There was a friendly, welcoming atmosphere and people and staff appeared at ease. Staff were encouraged and able to share their views and were kept informed about changes that occurred within the home through regular handover and staff meetings.
We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have asked the provider to take at the back of the full version of the report.