Forest Court Nursing Home is a purpose built nursing home and reablement unit, accommodating up to 80 older persons, including people who are living with dementia.

The inspection was unannounced and was carried out on 17 and 18 August 2016.

There was a registered manager in place at the home. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run.

People told us they felt safe living in the home and that care was delivered in a safe manner. Staff and the registered manager had received safeguarding training and were able to demonstrate an understanding of the provider’s safeguarding policy and explain the action they would take if they identified any concerns.

The risks relating to people’s health and welfare were assessed and these were recorded along with actions identified to reduce those risks in the least restrictive way. They were personalised and provided sufficient information to allow staff to protect people whilst promoting their independence.

People were supported by sufficient staff who had received an induction into the home and appropriate training, professional development and supervision to enable them to meet people’s individual needs.

There were suitable systems in place to ensure the safe storage and administration of medicines. Medicines were administered by staff who had received appropriate training and assessments. Healthcare professionals, such as chiropodists, opticians, GPs and dentists were involved in people’s care when necessary.

Staff followed legislation designed to protect people’s rights and ensure decisions were the least restrictive and made in their best interests.

Staff developed caring and positive relationships with people and were sensitive to their individual choices and treated them with dignity and respect. People and their families were encouraged to express their views and be involved in making decisions about their care and support.

People were supported to have enough to eat and drink. Mealtimes were relaxed and staff supported people in a patient and friendly manner.

There was a programme of activities for mental and social stimulation and staff were working on extending this for people who were cared for in bed.

The service was responsive to people’s needs and any concerns they had. Care and treatment plans were personalised and focused on individual needs and preferences.

People were encouraged to provide feedback on the service provided both informally and through an annual questionnaire.

The registered manager demonstrated an open and inclusive style of leadership. Staff understood their roles and responsibilities and there were clear lines of accountability within the service.

There were systems in place to monitor quality and safety of the home provided. Accidents and incidents were monitored, analysed and remedial actions identified to reduce the risk of reoccurrence.

At the previous inspection on 4 June 2014 we found the provider had not taken proper steps to ensure that people were protected against the risks of receiving care or treatment that was inappropriate or unsafe, by means of the planning and delivery of care in such a way as to meet people's individual needs and ensure their safety and welfare. Most people had clear care plans that reflected the support they received. However, there was not an effective system in place to ensure that care and treatment was always planned and delivered in line with people's individual needs.

At this inspection we gathered evidence against the outcome for care and welfare to answer the questions: is the service safe and is the service effective?

We looked at records and spoke with the Registered Manager and six members of staff. We also spoke with the Deputy Director of Operations.

Below is a summary of what we found. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

We found reviews had been completed or were on-going and the records updated to reflect people’s current needs. Some out of date information had been removed from the files to help ensure that they did not contain conflicting guidance. New assessments were recorded where people’s needs had changed. For example, where one person’s overall condition had changed, there was a specific support plan in place and recently reviewed assessments of their range of needs. These demonstrated that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare.

Is the service effective?

The provider and manager had taken action to make sure there was an effective system in place to ensure that care and treatment was planned and delivered in line with people's individual needs. Daily diary notes completed by care staff showed that the care being delivered reflected the guidance in each person’s care and support plans. For example, regular position changes, monitoring and encouraging fluid intake, and night time checks.

We saw that people were referred to external health professionals appropriately. Care staff were clear about their responsibilities for recording and reporting their observations to the nursing staff if appropriate. A nurse we spoke with demonstrated a detailed knowledge of the needs of people being cared for in the unit.

Our inspection of 27 November 2013 found that, whilst there was a choice and sufficient quantities of suitable and nutritious food and hydration, people were at risk of not always being supported to be able to eat and drink sufficient amounts to meet their needs. There were not enough qualified, skilled and experienced staff to meet people's needs. People were not protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were not maintained. The provider wrote to us in January 2014 and told us the measures that were being taken to address the issues.

At this inspection we looked at these areas to check the progress the provider had made. At the time of this inspection there were 63 people using the service. We spoke with 10 people who use the service, five relatives, the manager, clinical deputy manager and 11 staff.

We considered our inspection findings to answer questions we always ask;

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well led?

This is a summary of what we found –

Is the service safe?

The service is safe because there were enough qualified, skilled and experienced staff to meet people's needs. Staff we spoke with were aware of those people who needed support and encouragement to eat and drink sufficient amounts. This helped to ensure that people were protected from the risks of inadequate nutrition and dehydration.

The provider had taken steps to help ensure that people were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained. These improvements will need to be embedded in practice and sustained.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications had needed to be submitted, proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made, and how to submit one. The manager was aware of recent changes to the legislation and was awaiting further guidance from the provider organisation.

Is the service effective?

Most people had clear care plans that reflected the support they received. However, there was not an effective system in place to ensure that care and treatment was always planned and delivered in line with people’s individual needs. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to the planning and delivery of care in such a way as to meet people’s individual needs and ensure their safety and welfare.

Is the service caring?

The majority of people we spoke with commented positively about the care they received. One person told us "“I am well looked after” and another person said “The staff are kind”. Both told us they felt safe living in the home. Another person said “I am well looked after. They can’t do enough for me”, and “I am happy and safe and they are so good to me”. Another person commented “I am very happy indeed, it is like a four star hotel. Everyone is very helpful and nothing is too much trouble”. A relative told us “This home is excellent” and “We tell everyone how good it is”.

We observed staff supporting people in a calm, caring and respectful manner. For example, we saw staff knocking on doors and asking if they could help with drinks or just looking in and checking how people were. One person had been calling out and we saw a care worker go and sit with them.

Is the service responsive?

The service acted responsively to peoples' changing needs. Staffing levels had been increased since the last inspection and were kept under review. The new care staff were deployed to focus on mealtimes and ensure people using the service had enough to eat and drink. One care worker told us “Having nutritional help frees us up to care”.

We saw records of consultations with general practitioners and other health care professionals, in order to review people's health needs.

Is the service well led?

We found the service was well led and action had been taken to address the issues that were raised in the previous inspection report. We also saw that regular audits of the quality and safety of the service took place and were recorded.

People who use the service, their representatives and staff were asked for their views about their care and support and these were acted on. Meetings of the senior management staff within the service supported the effective organisation and running of the home. One care worker told us the home “Is more organised now”. Another member of staff told us “Things are better”; and “We have a manager who has stayed now”.

We spoke with four people who were using the service and two relatives, the manager, a deputy manager and ten members of the nursing and care staff. We also spoke with the service manager who visited the home during the inspection. There was no registered manager at the time of this inspection.

We saw that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. A person using the service said: “There’s nothing they wouldn’t do for you”. Another person said “I couldn’t be better looked after. I have everything I need”. A relative told us they “Can’t speak highly enough” about the home and that they were “Very happy with the care”.

One person told us that they had “Plenty to eat and drink”. Another person said “The food is absolutely super. We have a menu and choice and it’s always very tasty”. However, we found that people were at risk of not always being supported to be able to eat and drink sufficient amounts to meet their needs. We also found that people were not protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were not maintained.

A person told us that staff were “Very nice” and responded to the call alarm in a reasonable time. Another person said that staff “Come as quick as they can. They don’t keep you waiting”. However, from our observations it was not evident that there were enough staff being deployed to meet people’s needs at all times.

Many of the people using the service were not able to verbally communicate with us. We therefore spent time during our visit observing the care and support being given and how staff interacted with people.

During our visit people were observed being spoken with and supported by staff in a friendly and respectful manner. Staff checked that each person had enough to eat and drink.

People we spoke with told us they were getting the care and support they needed and that staff treated them well. We observed that staff provided people with support when they requested or required it. People confirmed that staff responded promptly when they requested assistance.

One person’s relative told us that they had no concerns about the staff but felt that there had been a lack of leadership in the home, which they had brought to the attention of the management.

We spoke with two people who told us that they found the home clean and tidy. However, we found that some of the fixtures and equipment were not kept clean and there was a lack of effective infection control procedures being implemented.

During the visit we spoke with eight people who use the service. People told us staff treated them well and provided the care that they needed. Five people said there were sufficient staff available to meet their needs. People gave examples of staff answering the call bells promptly and staff being available to respond to requests for assistance. Two people said there were usually enough staff available, but said there were some times that were busy such as early mornings. One person was not able to answer specific questions about staffing but said things were “very good”.

As part of the visit we spoke with people who live there, relatives, and visiting professionals and observed the way staff interacted with people. People told us that staff give them the support and care they need and we observed staff responding to people promptly and in a manner which respected their dignity.

A choice of menu is available at mealtimes and this was confirmed in conversation with people living at the home and observed at meal time. People told us they have plenty to eat and drink. Generally people said they were happy with the quality of food and could have an alternative meal if they do not like the choices on the menu.

People told us that they are offered a range of drinks at regular intervals during the day and have a water jug in their bedrooms which is replenished with fresh water daily. People can choose to have their drinks in their bedrooms or small lounges. One person told us if they wanted a drink at anytime staff would make them one.

People told us they were happy with their bedroom and could personalise the room with their own belongings, such as pictures and small items of furniture to make it feel more homely.

People told us they feel safe in the home and felt confident to talk to the staff and managers if they have any concerns.

People told us that the home is always clean and tidy.

There were mixed views from people we spoke to regarding whether there was enough care staff on duty to meet the needs of people living in the home. Whilst some people who used the service felt there was enough care staff, others disagreed due to the time they had to wait for their personal care needs to be met. As a general rule, professionals who we spoke with felt there was not enough care staff on duty.

At the time of our inspection there was no registered manager employed at Forest Court. The organisation had informed us that a new manager was in post. However, the previous manager had not deregistered with CQC at the time of the inspection; therefore their name still remains on any reports until such time that this information is received.

During this visit we spoke with three of the people who used the service, the manager, deputy manager and seven members of the nursing and care staff. 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 a relative of one person using the service, observed care and support being given and how staff interacted with people. We saw that staff communicated well with people who used the service and responded appropriately if people required assistance.

People said that the service was meeting their needs, staff respected their privacy and dignity and worked in ways that promoted their independence. One person said “they’re good to me” while another said the home was a “very nice place to live”. Another person told us that “staff listen, they want to know how you feel”. People described staff as being “very responsive” and “very willing, nothing’s too much trouble”. One person’s relative told us the care being provided was “top class”.