We inspected Forest Dene Residential Care Home on 31 October 2018. The visit was unannounced, which meant that the service did not know we were visiting. Forest Dene Residential Care Home 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. The home is registered to provide support to a maximum of 40 people. At the time of the inspection there were 38 people using the service.

At the last inspection in June 2016 the service was rated Good. At this inspection we found the service remained Good.

There was a registered manager in post who was available throughout the 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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Although people and relatives told us they felt there were enough staff, we found that some people did not receive appropriate care during breakfast time. We recommend that the registered manager reviews their staffing level to ensure that there are enough staff to cover for the disruption caused by the works going at the service.

People were supported by staff who were caring, kind, and respectful to their needs. Staff ensured people had choices of care and support whilst ensuring their privacy and dignity.

The staff recruitment processes were safe. New staff were appropriately checked before they started work at the service.

Staff received support, supervision and training to ensure they were effective in their roles.

Pre-admission assessments were completed for people before they were admitted. This ensured that people were admitted only if the service was appropriate to their needs.

Each person had a risk assessment, which identified possible risks and how to manage them.

Care plans were person-centred. Each person had a care plan, which identified their needs and how they should be supported.

People were protected from the risk of abuse because there was an adult safeguarding policy, and staff had appropriate training.

The service supported people to make their own decisions and worked within the principles of the Mental Capacity Act 2005 (MCA).

Staff encouraged and supported people to make their own decisions about their care. The registered manager understood their responsibilities under the MCA and the Deprivation of Liberty Safeguards (DoLS).

The management of medicines was safe. There were systems in place to store, administer, record and audit medicines

People were satisfied with the food provided at the service. People's nutritional needs were well managed and people received diets appropriate to their needs.

Staff worked in partnership with other professionals to ensure people had access to health care service.

People were supported to participate in social activities and events provided inside and outside the service.

The service had a complaints procedure and people were confident that their concerns could be investigated and resolved by the registered manager.

The service had end of life care policy, which ensured people's preferences, wishes and needs were respected when they were dying.

There was a clear management structure which ensured various aspects of the service were audited, feedback was sought and improvements were made to the service.

The inspection was unannounced and took place on 9 May 2016. The service was meeting legal requirements at our last inspection in July 2014.

Forest Dene Residential Care Home provides personal and respite care to 38 people, some of whom may be living with dementia. On the day of our visit there were 38 people using the service.

There was a registered manager in place who showed us around on the day of the visit. 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.

People told us they were safe and secure living at Forest Dene. Staff were aware of how to recognise and report abuse and had attended appropriate training.

Medicines were stored, handled and administered safely by staff who had been assessed as competent. Where required, appropriate advice and guidance was sought to ensure medicines were administered safely.

People were supported to eat a balanced diet. We observed staff prompting people to eat and drink and saw that hot and cold drinks were readily available.

Advice from other professionals such as the GP, dietitian and therapist was sought and incorporated into people’s care plans. People told us they had access to a GP when required and some had visits from the district nurses for specified daily or weekly treatment.

Staff were aware of and had attended training on the Mental Capacity Act and were aware of how this applied in daily care delivery. Staff were aware of the need to follow appropriate guidance in order to ensure that where people lacked capacity best interest’s decisions were made. They told us they always waited for people’s consent before delivering care.

Staff were supported by means of regular meetings, supervision and annual appraisals. We saw evidence that staff had the opportunity to discuss any issues and identify any further training or support they required to enable them to support people effectively.

There were robust recruitment policies and practices in place which included relevant checks to ensure only staff that had provided appropriate references, proof of ID and had undergone criminal checks would work with people. A comprehensive induction when staff started and an annual training program for existing staff was in place to ensure staff kept up to date practice and delivered care safely.

Care, including activities, was planned together with people and their relatives when they first started to live at Forest Dene and this was reviewed regularly to ensure it reflected people’s current needs. People’s life history, likes and dislikes, and their social, emotional and physical needs were outlined so staff had clear guidelines on how to effectively support them.

People were aware of the procedure to follow if they wanted to make a complaint or raise a concern. The complaints process was displayed at the main entrance clearly outlining the three stage processes for all to refer to. We found complaints were investigated, acknowledged and responded to in accordance with the service’s policy.

People were treated with dignity and respect. Staff addressed people by their preferred name and responded to call bells in a timely manner.

A single inspector carried out this inspection. The focus of the inspection was to check that the service was keeping confidential records securely. During an inspection on 21/05/14 we saw that in one unit care records were kept in an unlocked cupboard in a communal lounge and could be easily accessed by anyone entering the room. A compliance action was issued as records were not stored securely within the premises.

During this visit we found that the provider had taken appropriate action to ensure that records were being securely stored. A lock had been put on the cupboard door so only staff had access to private and confidential information.

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, staff and carers told us.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

The people we spoke with told us that they felt safe in the home. One of the people we spoke with said “The home is very secure.” Staff had received fire warden training and the people within the home had personal evacuation plans.

There were enough staff on duty to meet the needs of the people living at the home and keep them safe. Staff were able to explain how their training kept the people who used the service safe.

Some records were not stored securely within the premises. We found that care records were being kept in a communal lounge, in a cupboard, in one of the units, files could be easily accessed by anyone entering the room. A compliance action has been set for this and the provider must tell us how they plan to improve.

There were arrangements in place to deal with foreseeable emergencies. This included 24 hour staffing, emergency call alarms and personal evacuation plans.

The Deprivation of Liberty Safeguards (DoLS) are part of the Mental Capacity Act 2005. They aim to make sure that people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom. The staff we spoke with had received DoL’s training and understood their responsibilities in relation to this legislation.

Is the service effective?

People told us that they were happy with the care they received and felt the needs identified when they were referred to the service were being met. One of the people we spoke with said “staff are always asking if we are alright.” We observed staffs interaction with people and saw that they knew them well and appeared to understand their needs. The staff we spoke with told us “we know the people’s need well and the care plans are very detailed if the person is new to us.”

Is the service caring?

People were supported by kind and attentive staff. The staff we saw were caring and patient when supporting people. The people we spoke with said the staff were “caring” and that they “took time” to do things correctly. We observed staffs interaction with people and found that they treated be with dignity and respect and were considerate of their needs.

Is the service responsive?

People’s needs had been assessed before they moved into the home. People told us the service had asked them about their likes and dislikes prior to them moving into the home. We saw activities records that showed people had access to activities that were important to them and had been supported to pursue activities that they enjoyed. We saw that care plans matched what people had told the service they like to do during needs assessments and in referral forms.

Is the service well-led?

The staff we spoke with were aware of the aims and objectives of the home and had a good understanding of the quality assurance processes that were in place. We saw that the service regularly asked people for feedback and act upon what they found. We read the most recent annual customer feedback questionnaire and found that the majority of residents were positive about the service. The questionnaires were used to identify areas for improvement and the homes management had developed improvement targets and plans in response to any issues identified in the surveys. People told us that the management had consulted with them before implementing changes to services the home provides and that their views had been taken into consideration. One example of this we saw was that changes had been made to the menu following feedback from people.

People’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan. People we spoke with told us they were happy with their care. One person said “they come straight away if I need them, I don’t think you could find a better home". Another person told us, ”we go out for walks sometimes, if I want something they get it for me”.

We found that all the bedrooms and communal areas were well maintained and clean. People had added their own pictures and ornaments to suit their personal tastes. The manager told us that rooms were cleaned daily and each day four rooms receive a deep clean. There were enough cleaning staff for the location and there was a documented cleaning programme in place.

There were enough qualified, skilled and experienced staff to meet people’s needs. The manager had completed a document setting out the level of care need for each of the people who lived at Forest Dene.

People’s personal records including medical records were accurate and fit for purpose. The records contained up to date risk assessments. For example people who were at risk from pressure sores were identified and their care plans amended to show the measures the home had taken to reduce the risk. We found that care plans had been locked away in a secure cabinet.

"They look after me well, it is nice to have company. They bring me lots of cups of tea".

"This place is clean, it's spotless here".

"The girls are lovely, they are very helpful. I like it here you know".

(Comments from people using the service).

People told us that they like living at Forest Dene and it is a friendly place. People told us that the staff are supportive and the premises are comfortable and hygienic. We were told that there is a varied range of activities and entertainments, and the food is tasty.

During this inspection we did not see any visitors to the home.

People told us that Forest Dene is a friendly and homely place to live. People told us that the staff are very supportive, and that they like living in an area that offers pleasant facilities for visits to local shops and cafes.