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Inspection on 15/04/09 for Forest House

Also see our care home review for Forest House for more information

This inspection was carried out on 15th April 2009.

CQC found this care home to be providing an Adequate 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.

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

What the care home does well

The home provides a comfortable and homely environment with plenty of communal space and also a secure and spacious rear garden. The home is well situated to access local facilities. The home has a motivated staff team who understand the needs of the people living in the home and promote choice and inclusion. People are provided with opportunities to develop their independence skills. Staff have completed various training courses relevant to their roles and are supported to complete NVQ training.

What has improved since the last inspection?

The service has begun implementing a system of health action planning

What the care home could do better:

The home needs to ensure the staff rotas are organized in a way that best meets the needs of the people living in the home. The home needs to become a non-smoking environment. The home needs to ensure that all records are appropriately stored and that communal areas are not used in a way that could breach confidentiality.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Forest House Church Square Newnham Road Blakeney Gloucestershire GL15 4AA     The quality rating for this care home is:   one star adequate service 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 assessment of the service. We call this a ‘key’ inspection. Lead inspector: Simon Massey     Date: 2 1 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 24 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 24 Information about the care home Name of care home: Address: Forest House Church Square Newnham Road Blakeney Gloucestershire GL15 4AA 01594516825 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) : forest.house@craegmoor.co.uk Parkcare Homes Ltd care home 8 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: Date of last inspection Brief description of the care home 8 Forest House is registered to provide care for up to eight adults with a learning disability. The service is operated by Parkcare Homes, which is a subsidiary of the Craegmoor Healthcare group. The home is in the small village of Blakeney in the Forest of Dean. The building is a renovated and refurbished stone cottage. Whilst this gives the home character, it also means that there are some low ceilings and doorways, fairly steep staircases and steps to many of the rooms on the ground floor. The home provides 24 hour staffing. All service users have single rooms, some with ensuite facilities. There is a communal lounge, smoking area and dining room. Outside there is a patio, outbuildings and stepped access to the garden. People who may move to the home and those involved in their care are offered information about the service including copies of the Statement of Purpose and Service Users Guide. Fee levels were reported to range between approximately #600 to #1200 per week, with a base fee of #1026 at the time of the inspection. Care Homes for Adults (18-65 years) Page 4 of 24 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: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This inspection was conducted over two days. The inspector met with the acting manager and deputy manager, various care staff and also all of the people living at the home were observed or spoken with. Records relating to care planning, staff training and recruitment, medication administration and storage were examined. An inspection of the environment was also carried out. Care Homes for Adults (18-65 years) Page 5 of 24 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 set out 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 Adults (18-65 years) Page 6 of 24 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 7 of 24 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, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. 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 the person 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 Statement of Purpose and the admissions process ensures the home will have the capacity to meet the needs of people moving into the service. Evidence: There have been no admissions since the previous inspection. This process was inspected at last inspection and found to be satisfactory. The home has a Statement of Purpose and Service User Guide in place that meets the requirements and provides clear and accessible information to prospective service users and their families. Care Homes for Adults (18-65 years) Page 8 of 24 Individual needs and choices 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 needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. 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. A framework exists for care planning and risk assessment, although there is still some potential for improvement in order to make the approaches more person-centered. People are encouraged to make choices and decisions about their lives. Evidence: All service users have care plans in place which are to a large extent person centered and contain dates which identify that they have been reviewed. However there has been little updating or changing of some of the plans. Staff explained how the plans are reviewed and how they reflect the needs and wishes of the service users. Greater clarity and evidence could be provided over the reviewing process and also some greater detail over short, medium and longterm goals for people. Some service users spoken with demonstrated a good awareness of their plans and their role in planing and reviewing. The personal files contain a wide range of information covering all aspects of care and support and there was evidence that information is correctly recorded and where Care Homes for Adults (18-65 years) Page 9 of 24 Evidence: appropriate monitoring of appointments and behaviors is being completed. Service users gave examples of how they make choices about activities and daily routines and are supported to do this by the care staff. Examples of this were also seen during the inspection visit. Care Homes for Adults (18-65 years) Page 10 of 24 Lifestyle 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 can take part in activities that are appropriate to their age and culture and 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 and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. 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 living in the home are supported to take part in a variety of activities in the home and community and to maintain contact with family and friends, promoting their quality of life. Evidence: All service users have individual routines based around their needs, preferences and interests. records showed that people are supported to pursue hobbies and are supported to do by care staff. Occasional limitations are placed upon this due to the staffing arrangements. These issues are referred to in more detail under the staffing standards. People are supported to maintain contact with families and friends and this is recorded. Care Homes for Adults (18-65 years) Page 11 of 24 Evidence: Some risk assessments were due for review and this should be undertaken. Some service users have keys to the home and are to supported to access the local community independently. The kitchen was well stocked with fresh and frozen produce and people explained how they were supported to be involved with all aspects of food planning and preparation. People were observed cooking their meals and also being involved in other domestic chores around the home. All people spoken to were very positive about the quality and quantity of food. Evidence was also seen that a healthy diet is promoted but that individual choice is respected. Care Homes for Adults (18-65 years) Page 12 of 24 Personal and healthcare support 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 receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people 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. If people are approaching the end of their life, the care home will respect their choices and help them to 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. The healthcare needs of the people living in the home are met and personal care is delivered in a manner that promotes their dignity and well being. Evidence: All service users have health action plans in place, though some needed updating. Records are kept of medical and health appointments and there is guidance for staff relating to personal care where appropriate. People spoken with were positive about how this care was delivered and stated that their privacy was respected by the staff. All medication was appropriately stored and all recording was in order. One minor discrepancy was identified and the reason for this was explained by the staff on duty. Staff are required to undertake training before they administer medication and the records were seen and were up to date. Care Homes for Adults (18-65 years) Page 13 of 24 Concerns, 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. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. 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. Staff training, good relations with people living in the home and a complaints procedure help to promote and maintain a safe environment and help ensure that people can raise concerns if they wish. Evidence: All staff have completed training in adult protection issues and those spoken with were able to demonstrate an awareness of the issues and good practice. Incidents have been correctly recorded and where appropriate bruise or body charts have been completed. People were observed interacting positively and confidently with staff and people interviewed stated they felt able to raise concerns with staff and also said they considered themselves safe in the home. Staff spoken with said they felt able to raise concerns with senior staff if the need arose. The home has a complaints policy and process in place and people were aware of how to access and use this. There are systems in place for checking personal monies and this is done on a regular basis. Care Homes for Adults (18-65 years) Page 14 of 24 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, comfortable, 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. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a comfortable and homely environment but the health of people living in the home is compromised by the provision of an internal smoking area. The confidentiality of records is compromised by having a storage area in the communal living room. Evidence: The home has an ongoing programme of maintenance and decoration and at the time of this visit all parts of the home were in a good state of repair with some rooms having been recently decorated. People spoken with were positive about their bedrooms and explained how they had been involved in choosing colour schemes and furnishings. All rooms reflected the personal tastes and preferences of the people living there. The home currently has a smoking area for the use of service users within the house. In order to access a toilet and the laundry area people must pass through this area, and also another service was observed spending time in this space. This needs to be reviewed and a more suitable arrangement put into place. The living room for the home is currently also used for the storing of some records and files. This is inappropriate and provides opportunities for potential breaches of confidentiality. The office is upstairs and is not the most practical shape or size for use Care Homes for Adults (18-65 years) Page 15 of 24 Evidence: for meetings and staff recording. It is recommended that the home review these issues and provide more suitable storage space Care Homes for Adults (18-65 years) Page 16 of 24 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, qualified 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. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Motivated and experienced staff provide care and support but this is compromised by unclear staffing guidelines, the lack of appropriate storage space for confidential records, insufficient office space and infrequent staff meetings Evidence: There were sufficient staff on duty at the time of this inspection and the rotas showed that the correct levels were being maintained. However there are a number of considerations which must be taken into account by the home when compiling the rota, which include the staffing mix and the male to female ratio of staff. At times there are occasions when some activities cannot be undertaken due to the limitations of the staffing arrangements. The acting manager explained these considerations, or guidelines, but there were no written policies on this in place. It appears that to some extent the rotas are organized around the needs of the staffing group and not the people living in the home. Written guidelines need to be put in place and the home needs to ensure that there are sufficient staff on duty to support community based activities. This is particularly relevant to the home when considering its location, which means that many activities will require the use of of the homes vehicle, or the use of public transport. Greater flexibility of staffing will better help the meeting of needs, and leadership and direction needs to be provided on this by the management of the Care Homes for Adults (18-65 years) Page 17 of 24 Evidence: home. Good relations were observed between staff and the people living in the home and several people made positive comments about the care staff and the support they provided. Staff appeared knowledgeable about the needs of people but some questioned the homes ability to meet the needs of one person, who has increasing physical care needs. There appeared to be lack of leadership and guidance on this issue and this needs to be provided by the management of the home. The majority of staff have completed their NVQ training and have also undertaken a range of training provided by the Provider. All were up to date with the required statutory training, though the monitoring and organizing of this could be better organized. There had been a period of limited supervisions taking place but records showed that recently these have been happening more frequently. There have also only been two staff meetings in five months and these need to be convened more regularly, and also at times when all staff can attend. Recruitment records were checked and found to be in order with the necessary checks being undertaken and recorded. As mentioned in the environment standards, there are some limitations placed on staff due to the lack of appropriate office space. Staff were observed completing recording in the living room, and also there were occasions when staff were observed discussing client issues in communal areas, which is inappropriate. It is recommended that the home review its use of office space and storage of confidential records. One outcome from this should be that staff have the space to discuss issues and record information without breaching confidentiality and also within a more appropriate and professional location. Staff spoken with, and observed, appeared motivated towards providing good care and support and were also knowledgeable about promoting choice, social inclusion and developing a person centered approach to care planning and the delivery of the service. Care Homes for Adults (18-65 years) Page 18 of 24 Conduct and management of the 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 have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because 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. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards of care and outcomes for people living in the home are generally being maintained but a permanent registered manager providing strong leadership is required to build on and consolidate improvements identified at the previous inspection. Evidence: At the time of this inspection there was an acting manager in post but subsequent to the completion of the site visit the Commission were informed that another person had been appointed to the post and that an application would be subsequently submitted. Comments from staff and service users evidenced that the acting manager was approachable and evidence was seen that choice and client involvement in the running of the home was being promoted and supported. The Commission was concerned however by the lack of regular staff meetings and some lack of leadership on the issues of the staffing rotas and the concerns expressed by staff in relation to the meeting of the needs of one person who it is perceived by some staff has increased needs are difficult to meet. The home is in needs of strong leadership in respect of Care Homes for Adults (18-65 years) Page 19 of 24 Evidence: these issues. All required safety checks have been completed and recorded and all environmental risk assessments were up to date and in place. The Provider has completed regular regulation 26 inspections and reports and the copies have been supplied to the home. There has also been a quality assurance audit completed and the report with action points has been supplied to the home. Care Homes for Adults (18-65 years) Page 20 of 24 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 Adults (18-65 years) Page 21 of 24 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 33 18 The home must ensure that 22/07/2009 at all times there are sufficient staff working as are appropriate for the the health and welfare of service users. The staffing rota should be organized to meet the needs of the service users and the guidelines for staffing arrangements should be clear and transparent. 2 37 8 The Provider must appoint and register a manager The home has not had a permanent manager for several months and this situation needs to be addressed. 22/07/2009 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 Care Homes for Adults (18-65 years) Page 22 of 24 1 32 Guidance or reminders should be provided to staff about confidentiality of information in regard to comments made in the report. The home should review its guidelines for compiling staff rotas and produce written guidelines that are transparent and understood by all staff The home should have regular staff meetings 2 33 3 33 Care Homes for Adults (18-65 years) Page 23 of 24 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. 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