The inspection took place on 4 and 5 October 2016.

Forest Manor Care Home is registered to provide accommodation for 40 people who require nursing or personal care. At the time of the inspection there were 40 people using the service.

On the day of our inspection there was a registered manager in place. 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 were safe living at the service because staff knew how to recognise and report any incidents of harm. Staff were confident that the registered manager would deal with any concerns that they reported. Systems were in place for staff to identify and manage risks and respond to accidents and incidents.

Staffing levels were adequate to meet people’s needs. Staff received an induction, training and supervision and felt supported by the management team. Staff were recruited through safe recruitment practices.

Medicines were safely administered and stored.

People were asked for their consent before care and support was provided. However, mental capacity assessments were not always in place where needed. The registered manager applied the principles of Deprivation of Liberty Safeguards (DoLS), so that people’s rights were protected.

People received sufficient to eat and drink and their nutritional needs were catered for.

People’s healthcare needs had been assessed and were regularly monitored. The service worked well with visiting healthcare professionals to ensure they provided effective care and support.

Staff were kind, caring and respectful towards the people they supported. Staff were aware of people's support needs and their personal preferences.

People and/or their relatives were involved in the development and review of their care plans. People had access to independent advocacy services should they have required this support. People's independence privacy and dignity were promoted and respected by staff.

People received care and support that was personalised and responsive to their individual needs.

People were supported to participate in activities, interests and hobbies of their choice. The complaints policy was accessible for everyone.

Staff understood the values and vision of the service and had a clear understanding of their roles and responsibilities. The management team was supportive and approachable towards people, relatives, external professionals and staff.

People and their relatives were involved or had opportunities to be involved in the development of the service. There were systems in place to monitor and improve the quality of the service provided.

We used a number of different methods to help us understand the experiences of people using the service, because the people using the service had complex needs which meant they were not all able to tell us their experiences. We spoke to the relatives of two people, who told us they found the care provided was “Very good,” and “Exceptional. “

We looked at the records for a person who had decisions made for them by others and found that records did not reflect that the provider had acted in accordance with legal requirements.

We looked at the care plans and risk assessments for three people who used the service. These reflected good practice, identifying risks to people’s health and recording how the risks were to be managed.

We observed how people spent their time each day and what the arrangements for their social and recreational activities were. The systems in place took account of people’s individual needs and supported their wellbeing.

We looked at nutrition and hydration assessment records and care delivery records which showed people who used the service were supported to have adequate nutrition and hydration.

We undertook a brief tour of the premises and checked cleaning records that showed the environment was well managed and clean and there were systems designed to assess the risk of and to prevent and control the spread of a health care associated infection.

We found that people's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. A relative told us, “My relative receives the care he needs, staff know him well and they give him extra portions of food. Another relative told us, “Things have considerably improved here, the team leader has organised the staff and they have more time to spend with people.” The majority of people we spoke with told us they were happy with the care being provided. One person told us, “I decided to stay here, I like it and the staff talk to me about my care plans. They always accommodate my wishes”.

We saw a feedback letter from a relative. This told us that the person's relative had recently received end of life care at the home. The letter described that they felt they had received care, kindness and love during difficult times. The staff team put in time and effort into caring for their relative and keeping them comfortable and that they should be proud of the improvements that had been made over the last year.

We found that the provider had made improvements to the service following our last inspection in February 2012. The manager had improved the care planning documentation, admission assessments and incident analysis, which protected people's health and welfare. Quality assurance systems were in place and provided the manager with the information they needed to maintain compliance and continue to develop the service.

We spoke with six people who used the service and asked them about their experience of the care they received at Forest Manor, everyone made positive comments about their experience with care and support. One person told us, “I have my wound care done every day and they always do it well. I have to say, it’s very good here, I’m looked after properly.” Another person told us, “I feel safe here, there are some very good nurses.”

People who use the service told us that they felt respected and involved in planning their care at Forest Manor. Following risk assessment people had no restrictions on their freedom and found staff supported their independence.

One person told us that they had been living at Forest Manor for six months and they were full of praise for the staff team. This person said they felt very lucky to be living there and felt that staff supported them in a way that respected their individuality and needs.

We saw that staff respected and valued the views of people who use the service. Staff supported people safely and gave them time and encouragement to speak about their experiences. We found that people were being empowered and their voices listened to, when influencing how the home was run.