We inspected this service on 16 April 2018. The inspection was unannounced.

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

Forest Care Home is a nursing home that accommodates up to 20 people living with early onset dementia with complex needs. On the day of our inspection, 17 people were living at the service.

The service had a registered manager at the time of our inspection. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At the previous inspection in January 2016 we identified some improvements were required in three key areas we inspected; ‘Safe’, ‘Effective’ and 'Well-led'. This resulted in the service having an overall rating of 'Requires Improvement'.

During this inspection we checked to see whether improvements had been made, we found further improvements were required in ‘Safe’ but improvements had been made in the other key areas.

Some shortfalls were identified in the management of medicines. Risks had been assessed and planned for and these were monitored for changes. However, inconsistencies were identified in the guidance provided to staff about managing people’s needs associated with their anxiety that affected their mood and behaviour.

Staffing levels were assessed and monitored and were short on the day of the inspection but this was an unusual occurrence. The deployment of staff needed reviewing to ensure people’s safety at all times. Safe staff recruitment checks were carried out before new staff commenced.

The service was found to be clean and improvements were being made to the cleaning schedules to ensure these followed best practice guidance. Accidents and incidents were recorded, monitored and reviewed for any themes and patterns. Documentation did not always show post action and monitoring. Staff were aware of their responsibility to protect people from avoidable harm and had received safeguarding training.

Staff received an induction and ongoing training and support. Staff were knowledgeable about people’s health conditions. People had their needs assessed, planned and monitored. People received a choice of meals and their nutritional needs were known, understood and met by staff.

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 in the service supported this practice. Where people lacked mental capacity to consent to their care and support, assessments to ensure decisions were made in their best interest had not always been consistently completed. However, this was addressed by the provider in implementing improved documentation. Where people had a DoLS authorisation with a condition, this had been met. People were supported to access primary and specialist health services.

Staff were aware of people’s needs, routines and what was important to them. Staff were kind, caring, and they supported people ensuring their privacy, dignity and respect was met. Independence was encouraged and supported. Information about independent advocacy services was available.

Staff had information to support them to understand people’s needs, preferences and diverse needs. People received opportunities to participate in meaningful activities. The provider’s complaint policy and procedure had been made available to people who used the service, relatives and visitors. The registered manager had plans to meet with people and or their relatives to discuss their end of life wishes and to review the

We carried out an unannounced inspection of the service on 17 January 2017.

Forest care centre is registered to provide accommodation for up to 20 persons, who require nursing or personal care for adults with early onset dementia, with complex needs and associated behaviours that challenge. All rooms are on ground level, single occupancy with en-suite facilities. On the day of our inspection 15 people were living at the service.

A registered manager was in post who had been registered since September 2016. 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.

Staff understood how to identify and report allegations of abuse. Risks associated to people’s needs had been in the main assessed for, but risk plans were variable in detail and guidance for staff. The internal and external environment people lived in was safe.

People’s emergency evacuations plans lacked specific detail and did not consider people’s mental health needs.

There was a system used to review and monitor people’s dependency needs. There were sufficient staff available to meet people’s needs and safety. Staff recruitment for a clinical lead and an additional nurse was ongoing but plans were in place to manage these vacancies in the short-term. Staff had been appropriately recruited; checks had been completed in relation to safety and suitability before they commenced their employment.

People received their prescribed medicines safely. Some inconsistencies were found with the recording of medicines prescribed to be taken as and when required. People’s preferences of how they preferred to take their medicines were not recorded. The daily stock control of medicines was found to have some gaps. An eye drop medicine were found not to be dated when opened and a cream not in use had not been removed to confirm it had been discontinued.

The principles of the Mental Capacity Act 2005 were understood by staff and had been applied appropriately. Some people experienced periods of heightened anxiety that could result in behaviours that were challenging to themselves and others. Staff had limited information and guidance available about how to support people effectively at these times.

Staff training was ongoing and areas identified that required improvements such as catheter care training and cardiopulmonary resuscitation [CPR] was in the process of being completed. Staff had received infrequent opportunities to discuss their work and development needs. This was being addressed and improvements were underway.

People’s nutritional needs had been assessed and planned for and people were supported to maintain their health. Some inconsistencies were identified in relation to the frequency of the monitoring of people’s weights. However, recent weekly meetings had been introduced for key staff to have oversight of people’s changing needs, and the required action to respond effectively to these. Staff worked well with external health professionals and followed recommendations made in supporting people with their health needs.

People were supported by kind, caring and compassionate staff that showed dignity and respect. Some staff were more reserved in their interactions with people. Experienced staff were knowledgeable about people’s needs, preferences and routines.

People had access to independent advocacy information should they have required this support. People and their relatives, if appropriate, were involved in review meetings that discussed the care and treatment provided.

People were supported by staff to participate in activities of interest to them. Staff were responsive to people’s requests for assistance and reacted well to people’s comfort needs.

Systems were in place

We performed this unannounced inspection on 12 August 2015. Forest care centre is run and managed by Barchester Healthcare Homes Limited. The service is registered to provide accommodation for up to 20 persons who require nursing or personal care. On the day of our inspection eight people were using the service.

There was no registered manager in post at the time of our inspection, however there was a person managing the service who was in the process of applying to be registered with us. 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.

When we last inspected the service on 3 and 4 March 2015 we found there were improvements needed in relation to maintaining appropriate staffing levels, the quality of people’s care records and the management and oversight of the service. The provider sent us an action plan telling us they would make improvements in these areas by the end of March 2015. We found at this inspection that this had been completed and the provider had made improvements in line with their action plan.

People were protected from the risk of abuse as staff had a good understanding of their roles and responsibilities if they suspected abuse was happening. The manager shared information with the local authority when needed.

The management of medicines was safe and people received their medicines as prescribed.

Staffing levels were sufficient to support people’s needs. Systems were in place to manage short notice staff absenteeism to ensure people received care and support when they needed it.

People’s choices, likes and dislikes were respected and people were treated in a kind and caring manner.

People were encouraged to make independent decisions when able and staff were aware of legislation to protect people who lacked capacity. We also found staff were aware of the principles within the Mental Capacity Act 2005 (MCA) and had only deprived people of their liberty after obtaining the required authorisation.

People were provided with a varied diet and were protected from the risks of inadequate nutrition. Referrals were made to health care professionals when needed.

People who used the service, or their representatives, were encouraged to contribute to the planning of their care and were involved in decisions about the running of the home.

Effective quality auditing procedures were in place to monitor the quality service provision. The management team were aware of their responsibility for reporting significant events to the Care Quality Commission (CQC).

Systems were in place to aid people residing at the home, or those acting on their behalf, to make complaints and they felt complaints would be taken seriously.

When we carried out an unannounced comprehensive inspection of this service on 03 and 04 March 2015 breaches of legal requirements were found. We took enforcement action against the provider in relation to regulation 9, 10 and11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. These relate to regulation 12. 13 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also found other breaches of regulation but we did not follow these up at this focused inspection as they will be followed up at a later date.

We undertook this focused inspection to check that the provider had made improvements to ensure people were safeguarded from abuse. We also examined the processes for assessing people’s needs to protect them from receiving care or treatment that was inappropriate or unsafe. This report only covers our findings in relation to the aforementioned requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Forest Care Centre on our website at www.cqc.org.uk.

The service did not have a registered manager in place but an acting manager was available who had been in post for approximately six weeks. 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 and associated Regulations about how the service is run.

At this inspection we found improvements had been made in relation to safeguarding people from abuse as they were no longer exposed to inappropriate methods of restraint.

People were protected against the risk of psychological ill treatment and punitive measures to control behaviour was no longer used.

Procedures had been amended to ensure people could maintain their skin integrity and people would receive medical interventions in a timely manner in the event of a medical emergency.

People could be assured their risk of falls would be assessed and fall prevention strategies would be put in place.

Systems were also in place to analyse clinical incidents, such as falls, and information was shared in line with multi-agency safeguarding procedures.

People were in receipt of the required one to one support so staff could be responsive to people’s individual needs. People could participate in meaningful and stimulating activities.