This unannounced inspection took place on 26 November 2018. Forest View is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Forest View is situated in Burgess Hill in West Sussex and is one of a group of homes owned by a national provider, Shaw Healthcare Limited. Forest View is registered to accommodate 60 people. At the time of the inspection there were 56 people accommodated in one adapted building, over two floors, which were divided into smaller units comprising of ten single bedrooms with en-suite shower rooms, a communal dining room and lounge. These units provided accommodation for older people with associated healthcare conditions as well as those living with dementia.

The home had a registered manager. A registered manager is a ‘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. The management team consisted of the registered manager and team leaders. An operations manager also regularly visited and supported the management team.

There were concerns about the provider’s oversight and overall ability to maintain standards and to continually improve the quality of care. Areas of improvement that were found as part of this inspection had not been identified or acted-upon by the provider’s own quality assurance audits. The provider had not learned from inspections of their other services and had not shared this learning to ensure that improvements were made across all their services. There have been consistent themes in relation to staff understanding of and the implementation of the Mental Capacity Act 2005 as well as timely access to medicines for people who have Parkinson’s disease. Feedback about the leadership and management of the home as well as the approachability of the registered manager and the provider was not positive. Records did not always provide sufficient guidance to staff to inform their practice. Some, had not been completed in their entirety to confirm staff’s practice and provide assurance that people had received the necessary support. These were areas of concern.

Not all people received their medicines in a timely way. Three people were living with Parkinson’s disease that required their medicines to be given at specific times. Records showed that these people had not always had their medicines according to the prescribing guidelines. People were not supported in a person-centred way, in relation to their access to medicines, to ensure that their condition was well-managed. Not all risks to people’s safety had been identified or mitigated. Not all chemicals or items that had the potential to cause people harm if ingested, had been stored securely. These were areas of concern.

People were not always supported to have maximum choice and control of their lives. Staff did not always support them in the least restrictive way possible. The policies and systems in the home did not always support this practice. This was identified as needing to improve.

The provider had not always ensured that people’s communication needs were met. They had not always documented people’s communication needs to inform staff’s practice. Resources and information were not always adapted to help people to access information or understand the information that was available to them. We have recommended that the provider seeks advice from a reputable source in relation to providing information for people to meet their communication needs.

People told us that they felt safe. One person told us, “It’s safe. If I need any help they help me in a nice way and the staff say we’re here to help you”. There was sufficient and suitable staff to meet people’s needs. Staff knew who to report concerns t

The inspection took place on 30 and 31 October 2017. The first day of the inspection was unannounced, however the second day of the inspection was announced and the registered manager, staff and people knew to expect us.

Forest View is a residential service providing accommodation for up to 60 older people, some of whom are living with dementia and who may require support with their personal care needs. On the day of the inspection there were 59 people living at the home.

Forest View is situated in Burgess Hill, West Sussex and is one of a group of services owned by a national provider, Shaw Healthcare Limited. It is a purpose built building with accommodation provided over two floors which are divided into smaller units comprising of ten single bedrooms with en-suite shower rooms, a communal dining room and lounge. There are also communal gardens. The home also contains a day service facility where people can attend if they wish, however this did not form part of our inspection.

The home had a registered manager. A registered manager is a ‘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. The management team consisted of the registered manager, a deputy manager and team leaders.

We previously carried out an unannounced comprehensive inspection on 14 July 2015 and the home received a rating of ‘Good’.

At this inspection, people were provided with sources of entertainment and stimulation through planned group activities and external entertainers. One person told us, “There’s plenty to do. I like the Bingo and music. I like watching my TV”. Some efforts had been made to provide more meaningful activities for people that were based on their hobbies and interests before they had moved into the home. For example, a knitting club had been introduced which a small number of people enjoyed. However, in the main, there was a lack of meaningful occupation and stimulation to occupy peoples' time and staff did not always have sufficient time to interact and engage with people.

Peoples’ needs and preferences were assessed when they first moved into the home and on-going reviews took place to ensure that the care people were receiving was meeting their current needs. Care plans were person-centred, however, although relatives were informed of any changes or updates in peoples’ care, feedback from them was that they were not always involved in the on-going reviews that took place and that sometimes they were not provided with sufficient explanation about any changes in the care their relatives received. When this was raised with the registered manager they told us that this was something that they wanted to improve and develop.

The staff team consisted of permanent staff as well as the use of temporary staff to ensure that the home was sufficiently staffed to meet peoples’ physical care needs. However, the skills and level of understanding of the temporary staff differed to that of the permanent staff. Measures had been taken to ensure that temporary staff worked alongside more experienced staff to enable the sharing of knowledge and skills. Nevertheless, temporary staff lacked understanding about the content of peoples’ care plans and information that was specific to their care needs. A comment by a healthcare professional echoed this, they told us, “We feel that there is in general poor communication to staff and that information about people isn’t shared effectively”.

The provision of activities to promote more meaningful occupation for people, the need to ensure that there is an increased level of interaction, staff engagement and stimulation from staff to support people to participate in pastimes that they enjoy, as well as the need to increase the involvement of people and their relatives in the on-going review of peoples' care, are areas of concern.

Regular audits of the systems a

The inspection took place on the 14 July 2015 and was unannounced.

Forest View is registered to provide residential care for up to 60 older persons. On the day of our inspection there were 60 people using the service with the majority of people living with dementia. The home is a purposed built dementia friendly home with six units accommodating up to ten people in each with a communal lounge and dining area and spread over two floors. On the ground floor there is access to a maintained garden and patio.

The home had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The experiences of people were very positive. People told us they felt safe living at the home, staff were kind and the care they received was good. One person told us “I feel safe, very much so. There are enough carers on duty and I get my medication at the same time every day”. We observed people at lunchtime and through the day and found people to be in a positive mood with warm and supportive staff interactions.

Medicines were managed safely in accordance with current regulations and guidance. There were systems in place to ensure that medicines had been stored, administered, audited and reviewed appropriately.

People were being supported to make decisions in their best interests. The registered manager and staff had received training in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS).

Accidents and incidents were recorded appropriately and steps taken to minimise the risk of similar events happening in the future. Risks associated with the environment and equipment had been identified and managed. Emergency procedures were in place in the event of fire and people knew what to do, as did the staff.

Staff supported people to eat and they were given the time to eat at their own pace. The home met people’s nutritional needs and people reported they had a good choice of food and drink. Staff were patient and polite, supported people to maintain their dignity and were respectful of their right to privacy. People had access to and could choose suitable social activities in line with their individual interests and hobbies. These included gardening, singing and arts and crafts.

Innovative methods were used that ensured care was delivered in accordance with people’s individual preferences and needs. The service had been designed to help people living with dementia manage their surroundings, retain their independence, and reduce feelings of confusion and anxiety.

People were enabled to participate in activities that were based upon best practice in dementia care. People were actively supported in their care, This promoted positive care experiences and enhanced people’s health and wellbeing.

Throughout the inspection we observed staff treated people with kindness and understanding. Interactions and conversations between staff and people were positive and constant. Staff made time to talk to people. It was clear staff knew people well but equally people were familiar with staff and happy to approach them if they had concerns or worries. One person told us “It’s absolutely perfect, I can’t fault the care here. I can’t say more than that can I”.

Care records were personalised and reflected the individualised care and support staff provided to people. Personal profiles and life histories were used effectively to create personalised care for people with their involvement. Staff were proactive in working with healthcare professionals to obtain specialist advice about people’s care and treatment.

There were clear lines of accountability. The home had good leadership and direction from the management team. Staff felt fully supported by management to undertake their roles. Staff were given regular training updates, supervision and development opportunities. For example staff were offered to undertake additional training and development courses to increase their understanding of needs if people living at the home.

Resident and staff meetings regularly took place which provided an opportunity for staff and people to feedback on the quality of the service. Staff and people told us they liked having regular meetings and felt them to be beneficial, the provider took action in response to feedback received.

The people who used the service had complex needs and many were not able to tell us about their life at the home. We used a number of different methods to help us understand their experiences. These included looking at records, talking to staff and observing care practices. We spoke with four people who used the service. We also received feedback from two visiting professionals and one person’s relative who attended the home on the day our inspection. One person told us “We have a laugh and I have a nice room. I’m getting on well here.”

We found that people received care that met their needs and protected their rights. We saw that staff supported people in a way that showed that they understood their needs and how the person preferred their care to be provided. We saw that people were treated with dignity, kindness and respect.

People were protected against the risks associated with medicines because there were robust systems in place to administer medication safely. Medicines were stored securely and records were well maintained.

We found that staff got the training they needed to carry out their roles effectively. Staff told us that they had enough support and training to care for people appropriately.

There were effective systems in place to assess and monitor the quality of the service that people received. The provider carried out regular checks and audits had made improvements where the need for these had been identified.

During our inspection we spoke with six people who used the service and three family members visiting the service to see their relatives. We also spoke with five members of the staff team.

We were told that people were well looked after. One person who used the service told us that the, "Staff here are all wonderful, they can't do enough for you." Another person told us that there, “Is always something to do, so I am never bored.” They also told us about entertainment that was arranged in the home and trips out that they could participate in.

The three relatives we spoke with told us that they were involved in the care and welfare of their family member, and discussed care plans with the staff.

We looked at a range of care records. These included initial assessment information, care plans and risk assessments. They were well completed and guided staff in their day to day work. We also looked at medication and training records. These were comprehensive and accurate.

We discussed the provider’s quality assurance measures and looked at a number of satisfaction surveys that had just been completed by people who used the service or their relatives. A number of positive comments were seen which included,

'I have visited many times and always been impressed with the attitude of staff'

'I always look forward to my visits, staff bring me up to date'

'Overall it’s a wonderful home with wonderful staff'

People we talked to said there was always a choice of meals, and that they could ask if they wanted something different to what was on the menu.

Surveys carried out by the home show that people find the staff helpful, friendly and professional, and people we talked to felt that staff treated them well.