Forge House Services Limited

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.

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 nine people living at the home.

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

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.

Right Support:

People were supported to have maximum possible choice and control of their lives and staff sought to support them in the least restrictive way possible and in their best interests. Work was required to ensure ongoing improvement.

People were at reduced risk from harm. Risk management had improved. Further work was required to ensure improved practice was embedded and consistent.

People lived in a home where most environmental risks had been identified and were being addressed. Additional risks identified by inspectors were addressed following our visit.

Further work was required to ensure staff were provided with sufficient clear guidance to support people safely.

Incidents were reviewed with trends and learning identified to prevent from re-occurring. Incidents were being reported to other outside agencies.

People were protected from the risks associated with cross infection.

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

Right Care:

Improvements had been made since the last inspection to ensure people received personalised care and support which was built around people's needs and preferences. Work was required to ensure ongoing improvement.

People's care and support plans had been reviewed and reflected people's individual needs. Work was required to ensure care plans reflected peoples goals, aspirations and achievements.

People's needs and preferences to avoid social isolation were being met. Group activities within the home had reduced and individual activities within the community increased. Work was required to ensure ongoing improvement.

Right Culture:

Person centred care had improved. Further work was required to ensure improved practice was embedded and consistent.

Routines and practices within the home had changed. People had increased control over their lives because of the change of ethos, values, attitudes and behaviours of the management and staff.

People were now supported by staff to be involved in decisions about their care and support. Staff used individual communication methods to enable people to express themselves The provider had a system for seeking feedback about the quality of the service from people who used the service.

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 November 2022)

Why we inspected

We undertook this targeted inspection to check whether the Warning Notice we previously served 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 has not changed following this targeted inspection and remains Inadequate.

We use targeted inspections to follow up on Warning Notices or to check concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

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 that the service can respond to COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Forge House on our website at www.cqc.org.uk

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified a continued breach in relation to person centred care and risk management at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Special Measures:

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'. This means we will keep the service under review and, if we do not propose to cancel the provider's registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

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 nine people living at the home.

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

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 lived in a service impacted by the death of a long-standing member of the management team. People and staff were being supported with this.

Based on our review of the key questions safe, effective, caring, responsive and well led. The service was not able to demonstrate they were fully meeting the underpinning principles of Right support, right care, right culture.

Right Support:

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Where people lacked capacity to make decisions, the provider failed to put in place documents to support decision making. Not all restrictions were considered when looking at the least restrictive options for individual people. Some internal doors were kept locked to all people without considering how the risks for each individual person could be safely supported.

People did not have outcome focused support plans. People were not supported to agree plans with clear steps that would support them to develop skills and interests or support their sensory needs to enable people to cope with their environment.

People were not always enabled to access specialist health and social care support where appropriate. Staff did not always support people to lead decisions about their own health.

Risk management was poor. A lack of support plans and assessments in place meant people's needs were not identified, assessed or managed effectively. Staff were not provided with enough clear guidance to support people safely. A failure to monitor incidents meant there were missed opportunities to avoid and reduce reoccurrence.

Right Care:

Care was not always person-centred or designed to promote people's dignity, privacy and human rights.

People's care and support plans did not reflect people's individual needs and aspirations. People's strengths, levels of independence and quality of life was not always accounted for when planning and reviewing their care, and people were not involved in this process. People's care and support did not consistently focus on their quality of life or follow best practice.

People were not provided with opportunities to try new activities tailored to them that enhanced and enriched their lives. We observed people participated in group activities facilitated within the home rather than pursuing their own individual interests or seeking opportunities for volunteering or employment.

People were not always protected by a service that had safeguarding systems in place to report and respond to accidents and incidents. We found instances where safeguarding concerns had not been reported to CQC, or local safeguarding authorities. Leadership was not effective and did not identify that people were put at risk or subject to potential abuse.

There was a core team of staff who knew people's needs and were kind and caring.

Right Culture:

People did not lead inclusive and empowered lives because the ethos, values, attitudes and behaviours of the management and staff did not promote this. People were supported by staff who did not understand best practice in relation to the wide range of strengths, impairments or sensitivities people with a learning disability and/or autistic people may have. This meant people did not receive empowering care that was tailored to their needs.

There were indicators of a closed culture. There was a failure to identify and mitigate institutionalised practices and risks associated with closed cultures so that people received support based on transparency, respect and inclusivity. A number of restrictive practices were found, and the routines within the home were not always personalised to individual people. The service had not been supported by the provider to ensure they were aware of and implementing current best practice and guidelines.

Staff had not placed people's wishes, needs and rights at the heart of everything they did. There was a lack of information about preferences to support people with these. People were not always involved in planning their care. People were not leading inclusive and empowered lives.

The provider failed to ensure staff received appropriate training and support to understand people's individual needs and provide enabling support to people. The support people received was not in line with current best practice guidelines.

Risk assessments in place were not encouraging positive risk taking for people, were not evaluated and measured at regular intervals to assess their effectiveness.

The provider failed to develop effective governance and quality assurance system to assess the quality and safety of the support people received. There were a lack of audits and actions taken when things went wrong. Actions were not always documented, and it was unclear if actions were completed. This meant improvements were not always made to improve the care people received.

There were minimal internal quality assurance systems and processes to audit or review service

performance and the safety and quality of care. Where checks and audits were carried out, they had not always identified or prevented issues occurring or continuing at the service. Where issues had been identified, the registered manager and provider had not always ensured actions were taken to maintain, or improve the quality and safety of the support being delivered at the service.

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 good (Published 19 May 2018).

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. We discussed this with the registered manager who gave assurances they were committed to making improvements for people. We undertook this inspection to review improvements following this.

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.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have found evidence that the provider needs to make improvements. Breaches of legal requirements were found in relation to providing safe care to people, premises, recruitment, staff training, person centred care, safeguarding, consent to care, dignity and respect and good governance.

Please see the action we have told the provider to take at the end of this report. Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider and request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the local authority and provider to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Special Measures

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'. This means we will keep the service under review and, if we do not propose to cancel the provider's registration, we will re-inspect within 6 months to check for significant improvements

If the provider has not made enough improvement within this timeframe, and there is still a rating of

inadequate for any key question or overall rating, we will take action in line with our enforcement

procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it, and it is no longer rated as inadequate for any of the five key questions, it will no longer be in special measures.

Forge House Services 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 nine people living at the home.

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

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture. This was a targeted inspection, so our judgements are based solely on issues regarding consent to care and treatment and how people receive personalised care that is responsive to their needs.

Right Support

People were usually supported to have maximum choice and control of their lives and staff usually supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. Where people were unable to make decisions, the staff acted in their best interests.

Staff supported people in accordance with their known likes and dislikes. However, there were limited opportunities for people to try new things or set goals. The acting manager had started to introduce new activities to the home. They gave assurances these could be tailored to individuals.

Right Care

People could take part in activities at the home and in the local area. The staff did not always give people opportunities to try new activities that enhanced and enriched their lives.

People were not always fully involved in planning their care and support. Staff regularly reviewed care plans and created daily activity plans but did not always involve people who lived at the home or their representatives.

Right Culture

The new acting manager was committed to creating a more person-centred approach to care to make sure everyone received support which met their individual needs and wishes.

Staff turnover was very low, which supported people to receive consistent care from staff who knew them well.

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 good (Published 19 May 2018)

Why we inspected

We undertook this targeted inspection to check on specific concerns we had about how people gave their consent to care and treatment and how person-centred care was provided. The overall rating for the service has not changed following this targeted inspection and remains Good.

We use targeted inspections to follow up on Warning Notices or to check concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

We found no evidence during this inspection that people were at risk of harm from these concerns. However, we noted that some improvements could be made to person centred care and how people are supported to make choices. Please see the Effective and Responsive sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Forge House Services Limited on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

The staff were following up to date infection prevention and control guidance to help people to stay safe.

The provider provided training to ensure staff knew how to keep people safe during the COVID-19 pandemic.

Staff supported people to occupy themselves whilst maintaining their safety. Staff were providing additional one to one activities for people.

Staff helped people to stay in touch with family and friends through phone and video calls. The registered manager was communicating with people their family members, and staff members regularly to make sure everyone had an understanding of precautions being taken, and how to keep people safe.

There was an infection control lead at the service. Regular audits ensured care staff were aware of their responsibilities in regard infection control, and the importance of working effectively together to ensure national guidance was followed.

We were assured that this service met good infection prevention and control guidelines as a designated care setting.

Further information is in the detailed findings below.

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 complaints, concerns and compliments. People had no complaints about the service.

Good management and leadership continued to be demonstrated. People knew the registered manager well and were invited to share their views of the service. The registered manager had developed a system to ensure regulars checks of the quality of the service were undertaken to make sure people’s needs were met safely and effectively.

Further information is in the detailed findings below.

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.

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.

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.