Forge House Services Limited

Updated 27 May 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

Two inspectors carried out the inspection.

Service and service type

Forge House is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Forge House is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

Following the CQC August 2022 inspection, Forge House was placed in a local authority whole service safeguarding process. They received support from the local authority Quality Assurance and Improvement team, a specialist nurse and occupational therapist and other health and social care professionals. CQC received all the minutes and reports from this process and attended the local authority whole service safeguarding meetings, which were also attended by the provider and registered manager.

Forge House came out of the whole service safeguarding process on 19 December 2022 and are receiving ongoing support from the local authority, Quality Assurance and Improvement team, in a Provider Quality Support Process (PQSP).

We looked at all the information we had received about and from the home, this included the provider’s service improvement plan. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections.

During the inspection

Inspectors visited Forge House on 29 March and 4 April 2023. We spoke with and communicated with 2 people who used the service. Some people we met were not able to verbally communicate with us. Their experiences were captured through observations, interactions they had with staff and their reactions.

We spoke with 10 members of staff including the registered manager, deputy manager and provider’s compliance manager.

We reviewed a range of records. This included 4 people’s care records and a variety of records relating to the management of the service, including policies and procedures were reviewed.

We also sought feedback from professionals involved in the service.

Updated 27 May 2023

About the service

Forge House Services Limited is a residential care home. It is registered to provide personal care and accommodation to up to 11 people. The home specialises in the care of people who have a learning disability. At the time of our inspection there were 9 people living at the home.

Forge House Services Limited is a detached 2 storey building in the market town of Cullompton. The home provides level access to the garden, lounge and dining room, with people’s bedrooms on the ground and first floor.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

People’s experience of using this service and what we found

Right Support:

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Significant improvements had been made since the last inspection. People were enabled to be involved in decision making as they were able, regarding their food choices. People were no longer subjected to restrictive practices regarding a healthy diet for all. Improvements had been made around people’s mealtime experiences which were personalised to each person.

People had their own bedrooms and had access to shared facilities including a garden. People were protected from the risks associated with the spread of infection and were supported to take their medicines safely.

Improvements had been made to the environment with people involved in the decision making. Environmental risks we identified at the last inspection had been addressed and risks associated with fire evacuation had improved.

People were enabled to access specialist health and social care support where appropriate.

Risk assessments had been completed in a person-centred way for all identified risks to people.

People's care and support plans had been rewritten and were more personalised and gave staff clearer guidance to support people safely. Care plans and risk assessments were regularly reviewed and involved relatives and advocates as appropriate. Improvements were needed to ensure care records displayed people’s names, the date they were written and who had written them.

The registered manager had a system to review and investigate accidents from re-occurring. This included looking for trends and identifying any learning to reduce the risk of an incident happening again.

Right Care:

Improvements had been made since our last inspection. The registered manager had reported safeguarding concerns appropriately to CQC, and/or the local safeguarding authorities. Staff understood how to protect people from poor care and abuse. Staff had training on how to recognise and report abuse and they knew how to apply it. The service had enough appropriately skilled staff to meet people's needs and keep them safe.

A lot of work had been undertaken to improve people’s care and support plans to reflect people's individual needs and aspirations. People had care and support plans that were personalised, holistic and reflected their needs and aspirations. Relatives confirmed they were included in decision making about their relative's care.

Staff knew people's needs and were kind and caring. They supported people in a more person-centred way and promoted their dignity, privacy and human rights.

People were supported to eat and drink enough to maintain a balanced diet. Staff involved people in choosing their food and plan their meals. People were observed enjoying the food at the home.

Staff supported people to maintain their health and worked jointly with healthcare professionals to improve outcomes for people.

People were still able to participate in group activities if they chose but were also encouraged to pursue their own individual interests and spending time in their local community.

Right Culture:

Improvements had been made to ensure staff placed people's wishes, needs and rights at the heart of everything they did. Improved information in care records and planning involving people about their preferences enabled staff to have a more consistent approach to support people.

As part of the local authority, Provider Quality Support Process (PQSP). The registered manager had regular input from health and social care professionals. They were responsive to feedback from all areas as they wanted to improve the service.

The registered manager was working with staff to ensure any risks of a closed culture were minimised so that people received support based on transparency, respect and inclusivity.

People received support from staff who knew them well. Staff told us the culture of the service had improved since our last inspection. One staff member said, “Things are much better, everyone is getting more choice and more independence.”

The registered manager and management team took a genuine interest in what people, staff and other professionals had to say. The management team worked directly with people and led by example.

Routines within the home were more personalised to individual people. The registered manager was aware of CQC's framework in relation to inspecting services for people with autism and learning disabilities and was working with staff to ensure support for people followed these principles.

The registered manager and staff team had worked with people to enable them and those important to them to work with staff to develop the service. Relatives and staff confirmed they would be able to raise concerns to enable improvements to be made to the service. Relatives were asked by the provider about their opinions of the service.

Staff were recruited safely and there were enough staff on duty to meet people's needs. People were protected from abuse and poor care. The provider supported staff with training and supervision and appraisals were scheduled. Staff had completed appropriate training to support and understand people's individual needs and provide enabling support to people. The registered manager had scheduled learning disability and autism training for April 2023. People at the service lived with learning disability and autism and this training would assist staff to have a better understanding and be able to support people safely.

The provider had more robust systems in place to monitor the quality of the service to people. There were improved audits being undertaken and actions taken when things went wrong. These actions were added to the provider’s service improvement plan as required.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Inadequate (Published 11 November 2022).

Why we inspected

We carried out an unannounced targeted inspection of this service on 26 May 2022 where we identified some improvements could be made to person centred care and how people are supported to make choices. This inspection was not rated.

We then undertook a full comprehensive inspection in August 2022 and found 9 breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, and 1 breach of Regulation 18 (2) of the Care Quality Commission (Registration) Regulations 2009. We issued the provider with 2 warning notices and 8 requirement notices and rated the service inadequate.

The provider completed an action plan to show what they would do and by when to improve.

We then undertook a targeted inspection to check whether the Warning Notices we had served following the August 2022 inspection, in relation to Regulations 9 and 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, had been met. The overall rating for the service was not changed following that targeted inspection and remained Inadequate.

We undertook this comprehensive inspection to check the provider had followed their action plan and to confirm they now met legal requirements.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance the service can respond to COVID-19 and other infection outbreaks effectively.