This inspection took place on 15 and 17 August 2017. The first day of our inspection visit was unannounced. Forest Hill was last inspected in March 2015 and was rated as Good. This service has a history of being compliant with regulations inspected by the Care Quality Commission.

Forest Hill provides personal and nursing care for up to 53 people. People are accommodated in two separate units within one building. The Portland Suite provides personal and nursing care for up to 21 adults with mental health needs. The Memory Lane community provides personal and nursing care for up to 32 older people living with dementia. At the time of our inspection, there were 53 people living at Forest Hill.

The service had a registered manager at the time of our inspection 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.

The people who lived in the service told us that they felt safe and very well cared for. They believed that staff were committed to caring for them to a high standard and knew what support they needed to be well looked after. People felt safe, and were protected from the risk of abuse and avoidable harm. People’s care needs were assessed and recorded, and risks identified. Risk assessments and care plans set out what staff should do to reduce the risk of avoidable harm. Staff demonstrated how to balance managing risks associated with people’s health needs, with promoting people’s independence. Accidents and incidents were monitored and reviewed, and action was taken to reduce the risk of harm reoccurring.

People were happy and had positive relationships with staff who provided their care. They were cared for by sufficient numbers of staff who were skilled, experienced and knowledgeable about people’s individual needs. Staff had clear and consistent guidance about how to meet people’s individual needs. Care plans were regularly reviewed with people who were fully involved; these were updated to meet their changing needs and preferences. People were also supported by staff in a caring way, which ensured they received support with dignity and respect. Staff promoted people’s independence and people were active citizens of their local community and had grown in confidence and were proud of their achievements.

The provider took action to ensure that potential staff were suitable to work with people needing care. Staff received supervision and had checks of their knowledge and skills. They also received regular training in a range of skills the provider felt necessary to meet the needs of people at the service.

The systems for managing medicines were safe. People had medicines available when they needed them and in accordance with prescribing instructions. Staff worked in cooperation with health and social care professionals to ensure that people received appropriate healthcare and treatment in a timely manner.

People and their relatives confirmed that staff sought permission before offering personal care. Appropriate arrangements were in place to assess whether people were able to consent to their care. Where people lacked capacity to make decisions for themselves, the provider took appropriate steps to ensure decisions about care were in people’s best interests, and their rights were upheld. The provider was meeting the legal requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DOLS).

People felt cared for by staff who treated them with kindness, dignity and respect. The support people received was tailored to meet their individual needs. People, their relatives, and staff felt able to raise concerns or suggestions in relation to the quality of care. The provider had a complaints procedu

On the day of our inspection there were fifty two people living at the home. We spoke with two people who used the service, two family members, two members of staff and the manager. We also made observations during our visit and sampled three care records.

People who used the service said, “Yes I like it here, I am happy with the care and the support.” Another person said, “It’s alright here but I would rather be at home.” Family members spoke very positively about the service. One family member said, “The care is absolutely marvellous.” Another family member said, “The care is wonderful, I can’t fault it, it’s like a weight has been lifted.”

Family members told us that they had been involved in their relatives move to the home. Where people were assessed as lacking capacity best interest decisions had been made. Staff gave people choices and respected their privacy and dignity.

People’s needs were assessed and person centred care plans were developed. Individual risk assessments were undertaken and control measures put in place. Family members told us that they felt their relatives were happy, content and safe.

Systems were in place for cleanliness and infection control. We saw cleaning schedules, checklists and housekeeping audits.

Staffing levels were maintained and staff received appropriate training. Family members told us that staff responded quickly when people needed assistance. Staff told us they felt they had the skills, knowledge and experience to meet people’s needs.

A complaints procedure was in place. No complaints had been received at the time of our visit.

People told us they were happy and the staff were good. One person said “I’ve been here for years and have seen lots of changes. It's good.”

We found that staff knew how to protect people and what to do if an allegation of abuse was made.

People told us the food was good and they had plenty of choice. The menus we saw supported this.

Due to the complex needs of the people who used the service we undertook a period of observation to help us understand their experiences. We saw the interactions between staff and people were very positive. People were occupied in meaningful activity and this varied according to the person's likes and dislikes.

A relative told us that their relative had been through an unsettled period. Their behaviour had become difficult. They said this had been managed well and a medication review had resulted in positive changes. They said their relative was now content.

We saw that staff were trained to administer medication safely. Records had been completed correctly. Medication was stored and ordered in the correct manner.

A relative said “the staff are very attentive and caring to me as well. I visit any time and they are always the same. The place is spotlessly clean." They said “The staff on reception are very welcoming and helpful.”

Another relative said “I haven’t got a single complaint all the years my relative has been here.” They said they were confident that if they did, it would be listened to and addressed.

We performed the unannounced inspection on 31 March 2015 and 01 April 2015. Forest Hill is a purpose built care home located in Worksop. There are 53 beds and care is provided for 32 people who have dementia and for 21 adults who have mental health needs, and the associated challenges. On the day of our inspection 26 people were using the service. The service is provided across two floors with a passenger lift connecting the two floors.

The service had a manager in place at the time of our inspection who was in the process of registering with the commission and have since been registered with the commission. The previous registered manager left the service in February 2015 and the manager commenced their employment in January 2015. This provided the manager with support throughout the transitional period. 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.

People were protected from the risk of abuse and 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.

People received their medicines as prescribed and the management of medicines was safe.

Staffing levels were sufficient to support people’s needs and people received care and support when required.

People were encouraged to make independent decisions and staff were aware of legislation to protect people who lacked capacity when decisions were made in their best interests. We also found staff were aware of the principles within the Mental Capacity Act 2005 (MCA) and had not deprived people of their liberty without applying for the required authorisation.

People were protected from the risks of inadequate nutrition. Specialist diets were provided if needed. Referrals were made to health care professionals when needed.

People who used the service, or their representatives when appropriate, were encouraged to contribute to the planning of their care.

People were treated in a caring and respectful manner and staff delivered support in a relaxed and considerate manner.

People who used the service, or their representatives when appropriate, were encouraged to be involved in decisions and systems were in place to monitor the quality of service provision. People also felt they could report any concerns to the management team and felt they would be taken seriously.