This comprehensive inspection took place on 21 and 22 March 2018; the first day was unannounced.

Forge House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Forge House provides accommodation with personal care for up to 11 people with learning disabilities. Some adaptations on the ground floor have been made to meet the needs of people who may also have a physical disability. The home is situated close to the centre of Cullompton. At the time of our unannounced inspection there were nine people living at Forge House.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

At the last inspection, in January 2016 the service was rated 'Good' overall and in four domains but the safe required improvement. This was because an incident had not been referred to the local authority safeguarding team. Poor moving and handling practices had been adopted by staff on one occasion. This was an isolated incident. At this inspection we found improvements had been made. Incidents had been reported appropriately to local safeguarding team and new equipment had been purchased to ensure any moving or handling was carried out safely.

At this inspection the rating for the service was ‘Good’ overall and ‘Good’ in all domains. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Why the service is rated ‘Good’

The service had a registered manager in post at the time of our inspection. 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.

Medicines were safely managed however we noted the temperature within the medicines cabinet was sometimes above that recommended. Immediate action was taken to address the temperature of the medicines cabinet to ensure it remained within the recommended range. People were protected from the risks of abuse because staff were trained in recognising and reporting any safeguarding concerns. Employment checks were completed to ensure staff were suitable for their role before they started working with people. There were enough suitably skilled, qualified and experienced staff to support people safely. Risks to people’s individual health and wellbeing were assessed and actions were in place to reduce risk without impacting on people’s rights.

People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible.

People’s individual and diverse needs were being met. The service continued to assess, plan for and meet people’s individual changing needs. People were involved in making decisions about their daily care and support. Suitably trained and supported staff ensured people were supported to maintain their health and to obtain specialist healthcare advice when their health needs changed. People were offered a healthy and varied diet.

People received personalised care and support specific to their needs, preferences and diversity. They were engaged in a variety of activities and were supported to spend time in the local community or visiting places of interest. They were supported to enjoy individual interests and hobbies.

There were regular opportunities for people, and people that matter to them, to raise comp

An adult social care inspector carried out this inspection. The focus of the inspection was to answer five key questions: Is the service safe, effective, caring, responsive and well-led?

Before our inspection we reviewed all the information we held about the home. We examined previous inspection reports and notifications received by the Care Quality Commission.

On the day of our visit we were told that there were nine people living at Forge House. We spoke to five people living at the home, spent time observing the care people were receiving, spoke to four members of staff, which included the registered manager, looked at three people’s care files in detail, a selection of the home’s policies and procedures and quality assurance systems.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

Is the service safe?

The service was safe because people were protected from harm. We spoke with staff about their understanding of what constituted abuse and how to raise concerns. They demonstrated a comprehensive understanding of what might constitute abuse and knew where they should go to report any concerns they may have. For example, staff knew how to report concerns within the organisation and externally such as the local authority, police and Care Quality Commission.

Care plans included considerations of the Mental Capacity Act (2005) and staff demonstrated an understanding of the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards (DoLS) and how they applied to their practice. We found the location to be meeting the requirements of the Mental Capacity Act (2005). People’s human rights were therefore properly recognised, respected and promoted.

People’s individual risks were identified and the necessary risk assessments were conducted. This meant when staff were accessing information about a person’s needs through their risk assessments, they would be able to determine how best to support them in a safe and therapeutic way.

Is the service effective?

The service was effective because people were spending their time relaxing in the lounge, playing their keyboard and accessing the local community with staff support. People did not appear rushed and the home was relaxed and homely. Comments included: “I like living here” and “I like swimming and going to church.” During our visit, we saw that people appeared relaxed and contented.

Care plans were up-to-date and were written with clear instructions. They were broken down into separate sections, making it easier to find relevant information, for example, health needs, personal care, communication, anxiety management, activities and eating and drinking. We saw evidence of multi-professional visits and appointments, for example GP, psychiatrist, speech and language therapist, optician and dentist. These records demonstrated how other health and social care professionals had been involved in people’s care to encourage health promotion and ensure the timely follow up of care and treatment needs.

Is the service caring?

The service was caring because we saw how staff were observant to people’s changing moods and responded appropriately. Throughout the inspection, we observed staff communicated appropriately with people, and we saw the relationships between staff and people in the home were positive.

Throughout our visit we saw staff involving people in their care and allowing them time to consent to care through the use of individual cues, such as looking for a person’s facial expressions, body language and spoken word. People’s individual wishes were acted upon, such as how they wanted to spend their time.

Is the service responsive?

The service was responsive because people’s likes and dislikes were being taken into account. This demonstrated that when staff were assisting people they would be able to know what kinds of things they liked and disliked in order to provide appropriate care and support.

People had access to activities that were important to them and had been supported to maintain relationships with their friends and relatives.

Care files included personal information and identified the relevant people involved in their care. The care files were presented in an orderly and easy to follow format, which staff could refer to when providing care and support to ensure it was appropriate. Relevant assessments were completed and up-to-date, from initial planning through to on-going reviews of care. Files included a history of people’s pasts, which provided a timeline of significant events which had impacted on them at these times and how they impact on them now.

Is the service well-led?

The service was well-led because people’s views and suggestions were taken into account to improve the service. The registered manager informed us that questionnaires had been sent to people’s relatives and health and social care professionals so their views would be known.

Comments included: “I think Forge House provides an excellent service” and “X is very well cared for and seems happy here.”

We saw that a range of audits were carried out. These were conducted on an ongoing basis to monitor the quality and safety of the service provided. Areas covered included the overall environment, safety considerations, care plans and medicines management. Where changes were needed these were followed up by the registered manager. For example, additional supervision for staff to improve practice.

At the time of this unannounced inspection there were nine people with learning disabilities living at Forge House. During the day we spoke with, or observed how seven people were supported. People appeared relaxed and happy. We also spoke with the provider, the manager and three members of staff. We looked at four outcome areas and found two were compliant and two were non-compliant. The provider had already recognised the need to improve systems and told us they plan to carry this out in the very near future.

Since our last inspection changes in the staff team had meant that progress introducing new care planning systems had stalled. We tracked the care of three people by reading their support files and checking all records relating to their care. We found the care plans had not been regularly reviewed or updated, and did not provide sufficient information to ensure staff provided a consistent level of support to meet their needs fully.

We saw how staff used their knowledge and observation skills of those people with limited communication skills to seek their verbal consent and give them choices about the things they wanted to do. However the home had not always considered the legal requirements to provide documented evidence of consent for every aspect of people’s care and treatment.

Medicines were stored and administered safely.

The home generally followed safe and effective recruitment procedures before new staff began working unsupervised in the home. There were weaknesses in the way the home gathered adequate references to show new staff were suitable to work in the home unsupervised.

At the time of this inspection there were nine people living at Forge House. People had limited or no verbal communication skills. We tracked the care provided to four people. This included reviewing their support plans and records of the services they received. We spoke with each person or observed staff interactions with them. We also spoke with the manager, deputy manager and two care workers.

People’s views and experiences were taken into account in the way the service was provided and delivered in relation to their care. People and/or their relatives or representatives had been involved and consulted in drawing up and agreeing their support plan.

People experienced care, treatment and support that met their needs and protected their rights. Procedures were in place to identify possible health problems and to ensure people received appropriate treatment. Support plans were regularly reviewed. Staff communicated effectively with people, understood their needs, and provided support and reassurance to ensure people were happy and fulfilled. There were enough qualified, skilled and experienced staff to meet people’s needs.

People living at Forge House were safe. Staff understood how to protect people from potential abuse. The home was well maintained and suitable for people living there.

The provider had an effective system to regularly assess and monitor the quality of service that people receive.

This inspection took place on 18 November 2011 and lasted six hours. There were nine people living at Forge House on the day of our visit.

During the day we met or observed all of the nine people. They had varying levels of communication abilities. We chose four people living in the home to look at their care needs in greater detail. These people had no verbal communication skills, although from their responses to our questions we found they were generally able to understand what we said. We talked to them, and to the manager of the home and some of the care workers on duty that day, to find out what their daily life was like at Forge House. Following our visit to the home we contacted the relatives of five people living in the home and five health and social care professionals who have been working closely with some of the people living there.

We saw people engaged in activities during the day. We saw care workers supporting people calmly and cheerfully. We saw care workers sitting and talking to people, providing individual attention where necessary. We talked to two care workers who were positive about their jobs and told us they had received a wide range of relevant training and good support from the management team.

The relatives we talked to spoke positively about the home and the care provided. Comments included “Fantastic!”, “Very nice” and (Forge House is) “A role model for other homes”. One parent told us “I am happy on the whole” and “Very caring”, but said there were a few little ‘niggles’. They said that they were confident they could always raise any concerns or suggestions with care workers and the communication from the home was good. They said they were very pleased with the new manager. Relatives said that since the home was purchased by U K Health Care they had seen significant improvements in all areas. They mentioned a few things that still needed attention, including the decoration and furnishings of the main lounge, but recognised that major repairs and upgrading had taken place in other parts of the home in the last two years.

We contacted five health and social care professionals for their comments. We were still waiting for three responses at the time of writing this report, but two professionals spoke positively about the home. They told us they were confident that the care provided by the home was good. They told us that the care workers were confident and able to meet people’s care needs appropriately. They told us that the home manager liaised with them often (and appropriately) and said he was proactive and resourceful around meeting people's needs.

This unannounced inspection took place on 7 January 2016. We returned on 8 and 11 January 2016 as arranged with the registered manager. This inspection was brought forward in response to receiving information of concern about moving and handling practices, failure to report incidences to the local authority safeguarding team, a lack of training for staff to enable them to support someone effectively and people not having a choice of food. We were unable to substantiate these concerns during our inspection, apart from one occasion when poor moving and handling had been adopted by staff and one incident which should have been reported to the local authority. Our last inspection in June 2014 found the service to be meeting all of the Health and Social Care Act 2008 regulations inspected.

Forge House provides accommodation with personal care for up to 11 people with learning disabilities. Some adaptations on the ground floor have been made to meet the needs of people who may also have a physical disability. The home is situated close to the centre of Cullompton. At the time of our inspection there were 10 people living at Forge House.

There was a registered manager in post. 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.

One incident had not been referred to the local authority safeguarding team. At the time of the incident, appropriate measures had been put in place, including the person being checked for injury. Other incidents had been appropriately reported to the local authority in the past.

Poor moving and handling practices had been adopted by staff on one occasion. This was an isolated incident.

People were safe and staff demonstrated a good understanding of what constituted abuse and how to report if concerns were raised. Measures to manage risk were as least restrictive as possible to protect people’s freedom. People’s rights were protected because the service followed the appropriate legal processes. Medicines were safely managed on people’s behalf.

Care files were personalised to reflect people’s personal preferences. Their views and suggestions were taken into account to improve the service. They were supported to maintain a balanced diet, which they enjoyed. Health and social care professionals were regularly involved in people’s care to ensure they received the care and treatment which was right for them.

Staff relationships with people were strong, caring and supportive. Staff were motivated to offer care that was kind and compassionate.

There were effective staff recruitment and selection processes in place. Staffing arrangements were flexible in order to meet people’s individual needs. Staff received a range of training and regular support to keep their skills up to date in order to support people appropriately. Staff spoke positively about communication and how the registered manager worked well with them, encouraged team working and an open culture.

A number of effective methods were used to assess the quality and safety of the service people received.