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Inspection on 05/05/10 for Forest Court Nursing Home

Also see our care home review for Forest Court Nursing Home for more information

This inspection was carried out on 5th May 2010.

It is an annual review prepared by CQC after examining previous reports and information from the provider. At the time of this report, CQC judged the service to be Good.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

Annual service review Name of Service: Forest Court Nursing Home The quality rating for this care home is: The rating was made on: two star good service 2 3 0 2 2 0 0 9 A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection We do an annual service review when there has been no key inspection of the service in the last 12 months. It does not involve a visit to the service but is a summary of new information given to us, or collected by us, since the last key inspection or annual service review.   Has this annual service review changed our opinion of the service?   No You should read the last key inspection report for this service to get a full picture of how well outcomes for the people using the service are being met. The date by which we will do a key inspection: Name of inspector: Janice Patrick1 Date of this annual service review: 3 0 0 3 2 0 1 0 Annual Service Review Page 1 of 9 Information about the service Address of service: Bradley Court Road Mitcheldean Glos GL17 0DR 01989750775 01989750348 Telephone number: Fax number: Email address: Provider web address:   www.bupa.co.uk BUPA Care Homes (CFC Homes) Ltd Name of registered provider(s): Name of registered manager (if applicable) Miss Emma-Jayne Colbourne Conditions of registration: Category(ies) : dementia mental disorder, excluding learning disability or dementia Conditions of registration: Number of places (if applicable): Under 65 Over 65 49 49 0 0 The maximum number of service users who can be accommodated is 49 The registered person may provide the following category of service only: Care Home with Nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following categories: Dementia (Code DE) Mental Disorder, excluding learning disability or dementia (Code MD) Have there been any changes in the ownership, management or the No service’s registration details in the last 12 months? If yes, what have they been: Date of last key inspection: Date of last annual service review (if applicable): Brief description of the service Forest Court is a large building situated on high ground outside the town of Mitcheldean in the Forest Of Dean. There are extensive gardens with an enclosed area Annual Service Review Page 2 of 9 2 3 0 2 2 0 0 9 that provides a safe and sheltered garden for people to enjoy. There is plenty of parking with level access into the home. This care home specialises in the care of the older person who has dementia and who requires nursing care. There are qualified nurses on duty at all times and all staff have experience or have appropriate training in this specialist area of care. The home provides single bedrooms. There are large communal areas and wide corridors for people to walk freely in. Daily activities are available and family and visitors are welcome to visit at any time. Public transport goes as far as the town of Mitcheldean. Fees range from eight hundred pounds to nine hundred pounds per week, these vary depending on the size of bedroom. The majority of people receive funding of some sort due to their very specialised needs. Fees exclude, Chiropody (foot care), toiletries, hairdressing and papers/magazines. Information on the home can be found in the front hall or can be supplied on request. Annual Service Review Page 3 of 9 Service update since the last key inspection or annual service review: What did we do for this annual service review? We looked at the information that we have received, or requested, since the last key inspection. This included: 1.The annual quality assurance assessment (AQAA) that was sent to us 25th January 2010. This is a self-assessment that focuses on how well the outcomes are being met for the people using the service. It also gave us some numerical information. 2.We have drawn on the findings of the most recent key inspection report of 23rd February 2009, which stated that Forest Court provides a good standard of care. 3.We also took into account what the organisation has told us about things that have happened to the service, these are called notifications and are a legal requirement. These have been forwarded appropriately and any safeguarding incidents, that we have been aware of, have been managed correctly. 4.There have been no complaints brought to our attention since the last inspection. 5. We have been kept informed of incidents that have required investigation and of referrals made by the home to the local County Councils safeguarding adults team. This Annual Service Review has been completed with the use of questionnaires, seeking the views of peoples representatives, staff and visiting professionals. What has this told us about the service? The key inspection of 23 February 2009 provided us with the following information about Forest Court: Prospective new residents could be re-assured that there would be a full assessment of their needs. Residents were treated with respect and dignity. The homes main aim was to support people to make choices and maintain their freedom but at the same time, keep them safe. The homes aim was still to care for people with the minimum of medication particularly during episodes of challenging behaviour. The staff were good at recognising that family members/friends that have a relative/friend with dementia sometimes need a lot of support for a long period of time. There were good arrangements in place to ensure people ate well. It was a well managed home which had a welcoming atmosphere and the environment was safe, well maintained and clean. Many residents and families spoke positively about the home and the staff who provided the care. Residents were having their health and personal needs supported. People could expect their complaints to be listened to and acted upon. There had not been a high volume of complaints and any concerns were being addressed. There were policies and procedures in place to help safeguard people from abuse but some staff needed better awareness of these procedures in order to improve peoples protection. The home had a good quality assurance system in place which was helping to identify any shortfalls. Annual Service Review Page 4 of 9 One requirement was made at the last inspection. This was to: Ensure that records of care were being maintained at all times, including nursing records relating to wound care and pressure relief care. Some important recommendations were made which included: Making arrangements for senior staff in particular to have a clear understanding of the safeguarding adults procedures, early on in their employment at the home. For the company to recognise that ongoing training in subjects such as dementia care and other related subjects was important and to make arrangements for this to be delivered locally. To consider providing two nurses on each shift when successful recruitment had taken place. To review and make sure that care was really being delivered in a person centred way and according to the care plan. The manager has sent the AQAA to us. This has provided us with the following information: Everyone has their needs assessed before they move into the home, appropriate and helpful information is made available. Some staff have been trained to handle out of hours inquiries from people interested in the home for their relative. The home continues to review all care plans which are kept up to date. There is an established quality audit system in place to ensure this is being achieved. Care plans continue to focus on peoples equality and diversity as well as their health and personal care needs. The home now wishes to encourage relatives/representatives to be far more involved in the care planning and will be offering quarterly care plan review meetings. Menus have been reviewed and expanded to provide for greater choice. There remains a structured activities programme in place. A further improvement has been the employment of an activities coordinator at weekends. Additional plans are being made for rummage boxes to be placed around the home and for the environment to look less sterile. There has been an overall improvement to the staffs awareness, the clients awareness and advocates in relation to, we think, both complaints and the safeguarding of adults but the AQAA was not specific. The home has had two complaints in the last twelve months; both addressed within the homes stated time frame. The home continues to be kept clean and well maintained. The home complies with all water supply regulations. The kitchen has been awarded five stars by the Environmental Heath Officer (EHO). This means that there are high standards of cleanliness and good maintainers of necessary records. The home has received 3 formal complaints in the last twelve months and the home has made two safeguarding adult referrals to the local County Councils safeguarding team. The home now ensures staff are trained in safeguarding protocols within a month of starting work in the home and all staff have been received an update. The plan for the next twelve months is to ensure all staff receive training in the Mental Capacity Act and Deprivation of Liberty Safeguards and further dementia awareness training. A member of staff has been identified to be the dementia link person for the Annual Service Review Page 5 of 9 home. The home is actively seeking to recruit more nurses, in the meantime regular agency nurses are being used in order to maintain two nurses on each shift. The manager informed us that this is necessary to ensure that people receive the correct supervision and care they require. Numbers of care staff have improved over the last three months. Staff training is up to date and good recruitment practices are being carried out. The home have day to day arrangements in place for immediate and small maintenance issues and health and safety checks. The company have specialist that can be called on for advice and regular audits are carried out and monitored by the companys quality and improvement team. As of 30th November 2009 the home commenced a big programme of refurbishment which will result in better living conditions for those in the home, an ability to keep certain areas of the home more hygienic and the end of shared bedrooms. This refurbishment also includes plans for better access to the secure garden. We are aware that there has been a change of manager in the last year. The homes previous deputy manager is now the new acting manager. This person has applied to the Commission to be the new registered manager of the service. We received six questionnaires back from relatives/advocates. They all confirmed that they had enough information about the home to help them make a decision. Five said the needs of their relative/friend are always met and one said they are usually met. Four agreed that staff help the person to stay in touch with them, one did not respond to this question and one felt it was not applicable. The same responses applied to whether people felt they were kept up to date about their relatives/friends condition. Four agreed their relative/friend always get the support that they would expect them to have, one answered usually and one did not respond to this question. Five people said that the staff always have the right skills and one did not respond. The same response was given for meeting peoples individual needs. Four said that their relative/friend is always supported to live their life in the way they choose (this is within their capabilities) and one answered sometimes and one did not respond to this question. Five people said they knew how to make a complaint and one did not respond. Four said they knew how to raise a concern, one did not answer and one said it was not applicable. One specific comment was made about the activities provided and the person would like their relative to be able to go out into the garden more. They suggested that supervised gardening may be a good activity. One person said the food is excellent and another said we know that ..... is safe, well fed (very), all ..... needs attended to, but more than anything ..... is happy. Another person said my ..... is always treated as an individual, ..... is treated with respect, with patience and with good humour, staffs treatment of the residents and interaction with residents is 10 out of 10. One person felt there was competent administration. Annual Service Review Page 6 of 9 Another person said as a family we are always welcomed and chatted with and listened to. We received six staff questionnaires back. All confirmed that relevant checks were carried out when they were employed, which included a Criminal Record Bureau (CRB) clearance and references. Four agreed that their induction covered all aspects required very well, one felt this had been mostly achieved and one answered partly. They all agreed that they are given appropriate training. All agreed the manager regularly gives them support. Four staff members felt that communication in the team was always good, and two felt it was usually good. Two agreed there were always enough staff on duty and four answered usually. Three staff felt they always had enough skill and knowledge to do their job and two said usually. Specific comments from staff included training is kept up to date as much as possible and help given to staff to increase knowledge of dementia care with day courses. One staff member said under what the home could do better more one to one time with residents. Several commented that the home was a friendly place and one person said I feel this is a good place to work with friendly staff and an approachable manager. Another said kitchen standards are high, just been awarded 5 stars for the third time in a row. This comment refers to the star rating awarded by the Environmental Health Officer indicating that home has a high standard of cleanliness and record keeping. We received one questionnaire back from a visiting health care professional. This person confirmed that the home always makes accurate assessments on people and that they always review and monitor peoples health care needs and seek advice on how to improve someones well being. They confirmed that peoples privacy and dignity is always maintained and peoples diverse needs are always responded to. They agreed that staff always have the correct skills to meet the needs of those they are looking after. They said that any concerns raised by them are always responded to appropriately. This person specifically said under what the home does well that they carry out good pre- admission assessments. They also said that the home allows non residents to settle in and the home is good at seeking advice. What are we going to do as a result of this annual service review? There is no evidence to indicate that standards have fallen at Forest Court. We will continue to monitor all information given to us and future site visits and reviews will be subject to any changes in registration and inspection practice following implementation of the Health and Social Care Act 2008. Annual Service Review Page 7 of 9 Annual Service Review Page 8 of 9 Reader Information Document Purpose: Author: Audience: Further copies from: Annual service review CQC General Public 0870 240 7535 (national contact centre) Our duty to regulate social care services is set out in the Care Standards Act 2000. The content of which can be found on our website. Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a copy of the findings in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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