Inspection on 14/09/09 for Forest Hill Care Home

This inspection was carried out on 14th September 2009.

CQC found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Forest Hill Care Home 30/09/08

Forest Hill Care Home 28/11/07

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

Extracts from inspection reports are licensed from CQC, this page was updated on 25/11/2009.

Key inspection report Care homes for older people Name: Address: Forest Hill Care Home Forest Hill Park Worksop Nottinghamshire S81 0NZ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home 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 full review a ‘key’ inspection. Lead inspector: Mary OLoughlin     Date: 1 4 0 9 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 26 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: Forest Hill Care Home Forest Hill Park Worksop Nottinghamshire S81 0NZ 01909530531 01909532239 foresthill@barchester.net www.barchester.com Barchester Healthcare Homes Ltd care home 64 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 64. The registered person may provide the following category of service only: Care home with Nursing - Code N To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Dementia - Code DE Date of last inspection Brief description of the care home The home was previously part of Westminster Healthcare Ltd, as part of a reorganisation, the home transferred to an existing operations company called Barchester Healthcare Homes Ltd in January 2007. Forest Hill Care Home is a large, modern purpose built home on two floors. It provides 24 hour nursing care for up to 64 older people care. The home is situated in a quiet residential area north of Worksop town centre and close to Bassetlaw District Hospital. It has two units, one on each of the two floors, which can be accessed by a lift. There Care Homes for Older People Page 4 of 26 3 0 0 9 2 0 0 8 64 0 Over 65 0 64 Brief description of the care home is ample communal space on each floor and all bedrooms are single with en-suite facilities. Landscaped garden, with seating, is available at the front and rear of the building and there is a car park to the rear. The building is wheelchair accessible, with wide corridors and doorways, and level access on each floor. The current weekly fees are £510.00 to £856.00. The Statement of Purpose and Service User Guide and are available in the main entrance area of the home and service users have a copy in their bedroom. Copies of previous inspection reports are available on request. Care Homes for Older People Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The focus of inspections undertaken by the Care Quality Commission(CQC) is upon outcomes for the people using the service and their views on the service provided. This process considers the providers capacity to meet regulatory requirement, minimum standards of practice and focuses on aspects of the service that need further development. Prior to our visit an analysis of all the information we have received about the home since our last inspection was undertaken. We looked at what the manager had told us in the Annual Quality Assurance document(AQAA) and the responses we received from our Have Your Say surveys which we sent to residents at the home. Care Homes for Older People Page 6 of 26 The main method of inspection used was called case tracking, which involves looking at the quality of care received by a number of people living at the home.We use evidence from our observations, from speaking to people about their experience of living at the home, talk to staff about their understanding of peoples needs and the training they receive to support them in their role. Nottinghamshire County Council sent us their Quality Audit report following their visit to the home on 21/07/09 and we used this information to inform our inspection. Care Homes for Older People Page 7 of 26 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 26 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service plans each admission carefully and fully considers the views and wishes of the individual when providing the service. Intermediate care is not provided. Evidence: The manager tells us within the AQAA that they provide a lot of information to anyone interested in coming into the home. The information is in different formats to suit different abilities. During this inspection we saw that the information is readily available in large print and it was easy to understand what facilities and services were available at the home. The 9 residents responding to our surveys told us that they had received enough information about the home to help them make decision about staying there. Care Homes for Older People Page 10 of 26 Evidence: The records we examined reflected that the manager ensures people receive a thorough assessment of their needs and any information held by other agencies is obtained to make sure that the service has the appropriate facilities, skills and equipment to support people before admission is agreed. We also saw how the manager confirms this agreement in writing to prospective residents so they can be assured the home is the right place for them. We have not received any concerns about the way admission is managed in the home the AQAA tells us that of 87 people being admitted over the last 12 months, none of these placements have broken down showing the homes pre-admission assessment to be suitably robust. Care Homes for Older People Page 11 of 26 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have their health monitored, receive their medicines as prescribed and have their dignity upheld by a skilled staff team. Evidence: We received 9 responses to our surveys from residents at the home and we spoke with 4 residents during our inspection, in each case we were told that the staff always make sure that people have the medical treatment they need. We received comments like nothing is too much trouble staff should be commended for the care they give We spoke with an external health care professional who is part of the local primary care team who told us that the staff at the home work well with them, they had no concerns about the service provided and they are working in partnership to develop recognised standards for people in the last year of life, this is a recognised framework that ensures people are regularly reviewed for any changes to their health, so that they can be referred to any appropriate health care agency in a timely way and have their health needs addressed properly. Care Homes for Older People Page 12 of 26 Evidence: We saw 3 care plans that reflected each persons needs. The plans were regularly reviewed and drawn up with the involvement of the person or their representative to make sure that the plans reflected the persons wishes and that they agreed to them. Health risks such as skin breakdown from pressure, nutritional problems and the risk of falling were reviewed each month and we saw that where risks were identified the staff had ensured that appropriate support was in place to reduce or eliminate any risk to the person. The clinical nurse manager was aware of the new laws about how people make decisions that ensure their rights and choices are protected, and informed us that the care plans are in the process of being developed to include best interest pathways. We were also informed within the AQAA that the manager is ensuring that the whole staff team understand what the Mental Capacity Act and Deprivation of Liberty safeguards mean to people in their care. We examined the way medicines were managed and found that they are held securely, recorded safely into the home and administered as the prescription requires. We saw how the supplying pharmacist had undertaken a recent review of medication practices at the home and made a number of recommendations within their report. We identified that some of the issues were being addressed, however we did not see an action plan in place that would show how and when the required improvements were to be made. We saw that some work was still to be completed. Where medicines were a variable dose there was no clear audit trail of how much was being administered on each occasion. We also saw within the Nottinghamshire County Council audit report which told us that they had observed residents being left with their medicines which is not appropriate practice. However, we did not see this practice during our inspection and the manager told us that all staff have been reminded about their responsibilities when administering medicines. The staff training records show that they receive training in the specific needs of people living at the home. The staff we spoke with told us that they can access lots of training to help them undertake their role safely and competently. Part of the training includes how to maintain peoples dignity when carrying out care. When we spoke to residents in the home they told us that the staff respect their privacy and are always polite, knocking on doors before entering, allowing them privacy when being visited and respecting their wishes with personal care. Care Homes for Older People Page 13 of 26 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are lots of activities and events taking place inside and outside of the home and staff recognise the importance of a healthy diet that offers choice and maintains their wellbeing. Evidence: The information provided in the AQAA shows that the manager knows the importance of providing opportunities for people to participate in activities of their choice and in keeping with the individuals abilities. All 9 residents responding to our surveys told us that they had opportunities to participate in activities in the home. The care records we looked at recorded the social and religious needs within a care plan for each person. We saw how each week a list is displayed informing people of the activities available that week. This week there was a planned boat trip to Newark, a sponsored wheelchair push, a church service, a coffee morning held by the Macmillan Nurses and hairdressing. Care Homes for Older People Page 14 of 26 Evidence: The Clinical Nurse manager told us there are two activities workers employed that are involved in collating information on the individual interests of residents and then consulting either through the regular resident meetings or directly with the individual on hobbies and interests to inform different events to suit everyone. We spoke to one resident who chooses not to participate in the homes activities, preferring to lead an independent life that he told us he found fulfilling. He was able to take a taxi and go out to lunch or attend church on a regular basis. He said that he received regular visitors and that the staff always made them welcome, offering drinks and meals whenever they came. He said there were no restrictions on his freedom to choose how he spent his time and told us how the activities workers still came to see him and provided him with books to read because they knew what he liked. He told us that the staff were outstanding, kind and caring and very good to him. We also case tracked a person who spent his time in bed due to illness, he was unable to participate in activities. The staff saw this person at least every hour, attended to his physical needs and ensuring his comfort, this was recorded in his care records. Staff were seen to ensure his comfort, control his pain and communicate with him verbally and hold his hand, reassuring him. He was able to see his television and receive visitors. The survey responses and the residents spoken with during our inspection told us they always enjoyed the food provided at the home. The manager told us in the AQAA that the staff team are trained to assist people to eat safely and we saw how each person is assessed for any nutritional risk including choking risks to ensure that people are kept safe if eating could present problems due to physical illness. We saw how the dining room was well presented and a menu displayed the meals of the day, all of which had a choice of meal. A resident told us how she had been able to invite her family for a party at the home. Staff had arranged the occasion in a private dining room for her. Care Homes for Older People Page 15 of 26 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are robust policies in place to ensure that people are safe and have their concerns addressed appropriately. Evidence: We saw how the manager has ensured that each resident has a copy of the homes complaints procedure within the service user guide and also displays the procedure within the home to make sure that people are informed of what they can do if they have concerns. All 9 survey responses we received from residents said they knew how to make a complaint and felt that staff listened and acted on what they said. The manager also keeps a full record of any complaints she receives with details of the investigations undertaken. We looked at these records and found that there had not been any complaints recorded in the last year. The manager told us in the AQAA that there are appropriate policies in place to ensure that staff know how to report any suspicion of abuse. The Nottinghamshire County Council audit report from July 2009 tells us that all of the staff have received training in how to safeguard people from abuse. We have received one complaint which we referred to the Nottinghamshire County Care Homes for Older People Page 16 of 26 Evidence: Social Services under the safeguarding of adults procedures, however the manager told us that this was resolved through an investigation within the company and she is waiting for the written outcome from the company. The manager notified us of 2 other issues that she referred to social services as part of the safeguarding of adults procedures. The manager told us that both issues had been investigated by the home and showed that she had taken appropriate steps to ensure that people were kept safe. Care Homes for Older People Page 17 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a clean and well maintained environment that provides the aids and equipment they need. Evidence: We looked at the ground floor accommodation and found that each area was very clean and homely. The 3 people we case tracked had all the required aids and equipment to support them safely and comfortably. Their rooms were very pleasant and contained their personal possessions. The home was spacious with wheelchair access throughout. The bed linen and personal laundry was very well cared for. The manager told us in the AQAA that there is an ongoing programme of refurbishment in the home and that the house keeping team have a record of all cleaning duties and deep cleaning to ensure that all areas are suitably maintained. We know from the information in the AQAA and from looking at staff training records that the manager ensures the staff team have suitable policies and procedures in place that ensure infection is controlled. All 9 people responding to our surveys said that the home was always fresh and clean. Care Homes for Older People Page 18 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are in safe hands at all times by an appropriately recruited and trained staff team. Evidence: We examined the recruitment files for 2 staff and found that the manager ensures that a robust procedure is followed in practice. Staff do not start work until all appropriate checks have been made to ensure they are suitable to work with vulnerable adults. We found that new staff are enrolled on an induction course that ensures they know all they need to know to do their job safely and effectively. The induction is part of the persons professional development, preparing them for entry onto the appropriate health and social care National Vocational Qualification. The manager told us in the AQAA that over 50 of the care staff team are trained to at least National Vocational Level 2 and that they receive regular ongoing training, at least 5 days each year, from the organisations trainer to make sure their skills are kept up to date and that any changes in learning needs is accessed either internally or from external trainers. The staff we spoke to told us they felt the training was very good and it provided them with specific skills to meet the specialist needs of people they care for. Care Homes for Older People Page 19 of 26 Evidence: Of the 9 responses from residents returning our surveys they all felt that their needs were always or usually met and that their was sufficient staff to meet their needs. The AQAA told us that the training of the staff team is something the manager is very proud of and committed to continuously developing. There has been no use of agency staff over the last 2 years, staff turnover is minimal. Care Homes for Older People Page 20 of 26 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager is continuously improving the service and ensures that the home is run in the best interests of the people living there. Evidence: The manager is registered with the commission and has many years experience, she has a recognised training certificate in management. The manager completed the AQAA in the timescale and it gave us a clear picture of the services and improvements made to the home in the last year. The manager told us in the AQAA that she recognises the importance of implementing appropriate safeguards as part of a new legislation around peoples capacity to make decisions. She is ensuring that the staff team are suitably trained in this subject and that each care plan will contain information on how decisions about care and treatment are made to ensure that people have their rights and choices protected. Care Homes for Older People Page 21 of 26 Evidence: The staff spoken to said the manager was approachable and supportive. There are systems in place that ask people about their experiences and views of the care provided at the home. The organisation sends out quality surveys each year and publishes the findings, using this information to inform any improvements to the home. The clinical nurse manager told us that regular meetings are held at the home for both residents and their representatives, this gives people the opportunity to have their say about the home and what is working well or what needs to change. Although the manager reports that many quality audits take place within the home on a regular basis, we did identify shortfalls in the management of medicines which would indicate that the medicine audits are not sufficiently robust. The home does not manage any personal money of residents. Training records show that staff receive training on health and safety issues within the home and the AQAA tells us that all appropriate servicing and checks are undertaken to make sure that the home and equipment is safe. We looked at the records of fire tests and found that these are now undertaken weekly and that the required servicing of the fire equipment has been undertaken this year. We have not received any reports on preventable accidents or incidents in the home over the last year. Training records indicated that the staff team are trained to move and handle people safely and manage fire evacuation and protection. The manager told us that 100 of the staff are trained in first aid to ensure they can deal with any accidents and incidents appropriately. Care Homes for Older People Page 22 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 23 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 You must ensure that action 30/09/2009 is taken to address the recommendations identified in the pharmacy inspection which includes recording the dose administered for any variable dose medicine. To ensure that people receive their medicines safely. 2 9 13 You must complete a self administration assessment for anyone self administering medication. To ensure that people are not left unobserved with medication where risks are identified. 30/09/2009 Care Homes for Older People Page 24 of 26 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 3 3 7 9 Make sure that each persons religious needs are recorded on the admission details form. Care plans should include reference to the recent Mental Capacity Act and associated safeguards. You should complete a regular audit of medication practices within the home linked to the standards required to identify any shortfalls and take appropriate action. A record should be held of the administration of nutritional supplement drinks. Full records of all safeguarding referrals, actions taken by social services and the names of those people investigating, should be recorded to provide a suitable audit trail of all investigations. 4 5 15 18 Care Homes for Older People Page 25 of 26 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 summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 26 of 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!