We carried out an unannounced inspection at Forest Care Village on 26 June 2018. At the last inspection on 05 December 2017, we asked the provider to make immediate improvements in some areas of the care and support people received. These areas were around risk management for people, safeguarding systems and processes, nutrition, consent to care, personalised care, dignity and governance systems. This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

Following our inspection on 05 December 2017 we were informed by the local authority that Environmental Health officers had served a Hygiene Emergency Prohibition Notice on Forest Care Village due to an infestation of cockroaches. At this inspection we found that this notice had been lifted and the cockroach infestation had been eradicated.

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

Forest Care Village is registered to provide personal and nursing care for up to 178 people aged 18 and over with a range of complex health and care needs. At the time of our inspection 120 people were using the service.

Forest Care Village spreads across three floors and accommodates people in separate units, each of which have separate adapted facilities. Three of the units specialise in providing care to people living with dementia whereas in the remaining four units people have nursing needs.

There was a manager in post who had registered with the Care Quality Commission (CQC). 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.

At this inspection we found that significant improvements were made and although some areas were still developing and improving, however, people received personalised care and support which was safe and protected them from the risk of harm.

Following the inspection on 05 December 2017 we shared our findings with the Local Authority and Clinical Commissioning Group (CCG). The different funding authorities and local commissioning group worked closely with the provider and the registered manager providing support to empower Forest Care Village staff and to monitor improvements as part of their quality improvement process. There were regular service improvement meetings where different health and social care professionals gave feedback following their visits and assessments carried out at the home to the provider and register manager. A manual handling specialist had observed staff’s practices and provided training. The CCG had allocated two nurses two days a week to observe and empower staff employed by the home to develop their skills further in recognising people`s changing health needs. At the time of this inspection the support from the different external professionals was recently withdrawn except for PEG specialist nurses who were training and assessing staff`s competencies in the management of percutaneous endoscopic gastrostomy (PEG)`s. PEG is an endoscopic medical procedure in which a tube is passed into a patient's stomach through the abdominal wall, most commonly to provide a means of feeding when oral intake is not adequate.

The provider reviewed their governance systems and developed this further to ensure th

We carried out a responsive comprehensive unannounced inspection at Forest Care Village on 05 December 2017. This inspection was in response of the concerns the Care Quality Commission (CQC) received from members of the public and local funding authorities. At our last inspection on 30 November 2016 we found the service was meeting the required standards. At this inspection we found that there were serious failings from staff and management to ensure people received care and support in a safe and effective way. Following our visit to the service we were informed by the local authority that Environmental Health officers had served a Hygiene Emergency prohibition Notice on Forest Care Village due to an infestation of cockroaches.

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

Forest Care Village is registered to provide personal and nursing care for up to 178 people aged 18 and over with a range of complex health and care needs. At the time of our inspection 161 people were using the service.

Forest Care Village spreads across three floors and accommodates people in separate units, each of which have separate adapted facilities. Three of the units specialise in providing care to people living with dementia whereas in the remaining four units people have nursing needs.

There was a manager in post who had registered with the Care Quality Commission (CQC). 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.

People who were able to talk to us told us that they felt safe living in the home. However seven people and two relatives felt there were not enough staff to meet their needs in a timely way and also that the agency staff working in the home were not knowledgeable about their needs which had impacted on their dignity and general well-being. Some staff also told us they were rushed and felt under pressure to complete tasks not having time to spend with people. We observed staff working in a task led way. For example, asking people to finish their meals in a hurry or moving people without giving people time to actively participate in the process.

Risks to people`s well-being and health were not always identified, assessed or mitigated in a way to reduce them. Where people were assessed as requiring a fortified diet to help reduce the risk of malnutrition they were not provided this by the kitchen staff who were not aware of people’s needs. Where people had pressure relieving equipment in place to help prevent the development of pressure ulcers the checks carried out by staff did not effectively identify faults or wrong settings on air mattresses. There was a risk that this shortfall had contributed to people developing pressure ulcers.

People who lived with specific health conditions had no care plans in place to address this area of their needs and staff had no guidance on how to maximise people`s health. People`s end of life care needs were not assessed, there were no plans in place to evidence that people`s wishes, likes and dislikes were considered when staff created care plans. Staff could not tell us what people liked and how they wished to be cared for.

People who came to harm because of the measures in place to mitigate risks were ineffective had not been referred to local safeguarding authorities. This meant that further actions had not always been implemented to keep people safe. Staff were knowledgeable about signs and symptoms of abuse and their responsibilities to report. However we noted instances when staff had reported concerns to their m

The inspection took place on 30 November 2016 and was unannounced. At our last inspection on 1 and 6 July 2015 we found the service was not meeting the required standards at that time. This was in relation to an accurate, complete and contemporaneous record in respect of each service user, including a record of care and treatment provided to the service user and of decisions taken in relation to the care and treatment had not been maintained. However, at this inspection the provider had made the required improvements.

Forest Care Village provides accommodation; personal and nursing care for up to 178 people aged 18 and over with a range of complex care needs. At the time of our inspection 161 people were using the service.

There was a manager in post who had registered with the Care Quality Commission (CQC). 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.

People who used the services at Forest Care Village, their relatives and professionals involved with people’s care and support gave us positive and complimentary feedback about the service and said that they had no concerns about the care and support that people received.

People told us they felt safe living at Forest Care Village. People had health care and support plans in place to help staff know how they liked their needs to be met. Risks to people’s safety and welfare had been identified and support had been planned to enable people to live as safely as possible whilst enjoying a variety of opportunities for engagement and stimulation. There were appropriate numbers of staff available to meet people’s care and support needs.

Staff members understood their roles and responsibilities and were supported by the registered manager and unit managers to maintain and develop their skills and knowledge. People enjoyed a varied healthy diet and their health needs were catered for.

The atmosphere at Forest Care Village was welcoming and there was a comfortable rapport between the staff and people who used the service. People’s relatives were encouraged to be involved in developing people’s support plans and to visit the home at any time. Staff treated people with compassion, promoted their dignity and treated them with respect.

There was an open culture at the home, people’s relatives and staff told us that they were completely comfortable to speak with the registered manager if they had a concern. The provider had arrangements in place to regularly monitor health and safety and the quality of the care and support provided for people who used the service.

We visited the home on three occasions and we spoke to people who lived in all the different parts of the home. We were told that the home had improved and that the staff had a better understanding of the English language and therefore communications were easier. People told us that staff appeared to be trained to carry out their care. The staff we spoke with told us that generally they felt that they were well managed and leadership was provided by the home's manager. However some staff told us that one of the unit managers did not offer support and guidance and that on many occasions when they sought assistance the unit manager's door was closed with a 'do not disturb' sign on it. Staff told us that they found this very difficult and often had to get support from other unit managers. They said that this caused a delay in caring for the person.

We looked at how people were cared for and we found that care plans were up to date and gave staff good instructions on how to care for people. Medicines were stored, administered and recorded as prescribed. The management of the home had systems in place that ensured all aspects of the service and care offered to people were regularly audited and action plans drawn and implemented to address any anomalies found.

People we spoke with told us they were satisfied with the way the service managed their medicines.

During this inspection a team of inspectors visited Forest Care Village Elstree and Borehamwood on 20, 21 and 24 September 2012. We were accompanied by two ‘experts by experience’, a specialist advisor in Acquired Brain Injury, a specialist advisor in Mental Health, and a pharmacy inspector from CQC.

We spoke with more that 35 people who lived at the home and their relatives, and we carried out a period of close observation, watching the care of the people in this home who had a dementia or memory loss and were unable to communicate with us.

We observed that people looked clean and well cared for, and interactions between staff and the people they supported were relaxed and respectful. We found that care was administered in a manner that promoted people’s dignity, choice and independence

People that we spoke with during this three day inspection told us that they were involved in the planning of their care, and were treated well by staff. People made references to being given choices and consulted about different aspects of life in this home. They spoke about the improvements they had seen over the past few weeks in the home, and we received many positive comments such as. “I really like this place it is my home now. I like the staff, they are really helpful and I have lots of friends here.” And “I like everything about it, this place saved my life.”

During our visits to Forest Care Village on 30 July 2012 and 01 August 2012 we found that people looked clean and comfortable and interactions from staff were professional. We spoke with 20 people and/ or their relatives during this inspection, and received mixed comments about the care they received.

One person told us that staff were “very pleasant and knowledgeable” and that they were sensitive and gentle when attending to their personal care or assisting them to move. Their relative added that they the service was being proactive in supporting continued physiotherapy sessions and said that staff were always available and willing to assist with their relatives walking. Another person told us ”Everything is lovely” and that their main concern was about what had been said and written about their home in the press.

However this was not consistent throughout the home, and some people told us that they were not happy with some of the changes that had been made, particularly the change to staff allocation. They felt that they no longer knew the staff, staff were not familiar with their care requirements and that this made it more difficult to talk to them. One person felt that their cultural care needs had not been fully addressed and that there was a lack of flexibility in their care delivery.

People told us that they had seen some improvements, and the management team were more visible and accessible in the home, however they were not confident their comments were always listened to, as poor practices they had reported in some areas of the home had continued.

When we visited Forest Care Village on the 17, 18, 21 and 25 May 2012, we spent time on all of the units in the home, and spoke with many of people who used the service. As some people were unable to communicate with us, we also used a number of different methods including observations, and talking with people’s relatives, to help us understand the experiences of people using the service.

We found that there was some variation in people’s views about the way that care and support was provided in the home. Some of the more able and articulate people felt able to influence the way care was provided to them, however this was not the case for everyone in the home. Some people felt that the level and quality of the care they received was dependent on the number of and the skills of the staff on duty at any one time. Some people commented that not all staff knew how to care for their specific needs, and that they continually had to guide these staff and tell them what was needed and how to do certain things. One person said “they recruit for quantity not quality”.

People had differing views and perspectives on their personal safety in the home. Some people stated that they felt safe and could stand up for themselves to ensure that they received the care they required. One person told us that living in the home had saved their life, however others said they were not always happy with the way in which they were cared for by staff. Some people told us that they often saw staff completely ignore people’s buzzers or calls for help, and that they felt that they needed to advocate on behalf of the less able people around them

Many people told us that when they talked to managers about any concerns that they were not listened to and that little changed. They told us that although they were sometimes asked for their opinions about things, they did not feel that they were listened to, or that their opinions were taken into account by the home’s senior management.

This inspection was carried out on 01 and 06 July 2015 and was unannounced.

Forest Care Village provides accommodation personal and nursing care for up to 178 people aged 18 and over with a range of complex care needs. 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 and associated Regulations about how the service is run.

When we last inspected the service on 26 April 2013 we found them to be meeting the required standards.

The Care Quality Commission (CQC) is required to monitor the operation of the Mental Capacity Act (2005) (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are put in place to protect people where they do not have capacity to make decisions and

where it is considered necessary to restrict their freedom in some way, usually to protect themselves or others. At the time of the inspection applications had been made to

the local authority in relation to people who lived at the service and were awaiting assessment. Staff we spoke with were aware of their role in relation to MCA and DoLS and how people were at risk of being deprived of their liberty.

People told us they felt safe at the home. Staff we spoke with were knowledgeable about keeping people safe and reporting any concerns they may have.

We saw there were sufficient numbers of staff to meet people’s needs, however some people experienced a delay in receiving assistance promptly

Risk assessments were in place for people and were appropriate to their needs.

People’s medicines were not always managed safely as staff had not always ensured an accurate record was maintained for people who had their medicines covertly administered.

Staff we spoke with told us they felt supported by the provider.

People told us that they were asked for their consent and their choices were respected.

People we spoke with gave mixed views about the food at Forest Care Village.

People who used the service, their relatives and professionals were positive about the care staff provided to people.

People felt able to approach staff and the unit manager with any concerns they had and were confident they would be dealt with appropriately.

An accurate, complete and contemporaneous record in respect of each service user, including a record of the care and treatment provided to the service user and of decisions taken in relation to the care and treatment had not been maintained consistently.

The staff and management at Forest Care Village had good working relationship with other organisations and health agencies.