Archived: Forde Park Care

We carried out an unannounced comprehensive inspection of this home on 25 January 2016 to see if the provider had taken action to address concerns from a previous inspection in May 2015. We found actions had been taken to respond to the previous concerns identified. However, we identified concerns relating to staff not always taking sufficient action to obtain prescribed medicines and not always identifying potential risks. We also identified a repeated concern relating to people not always being treated with dignity and respect. We served warning notices on the provider and then registered manager for breaches of Regulations 12 and 10 of the Health and Social Care Act 2008 (Regulated Activity) Regulations 2014. We gave the provider until 16 May 2016 to meet the legal requirements of the regulations.

Following the inspection the provider told us what changes they intended to make. The provider sent us an action plan telling us what actions they had taken to improve, and worked with the local authority’s quality teams to improve standards at the home.

We carried out this focused inspection on 5 October 2016. This report only covers the findings in relation to the warning notices. You can read the report from our last comprehensive inspection in January 2016, by selecting the 'all reports' link for Forde Park Care on our website at www.cqc.org.uk.

There was not a registered manager in post at the time of this inspection, however a new manager had been employed and they had made application to CQC to be registered. 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.

At this inspection in October 2016 we found the manager and the provider had worked hard to improve the service. A lot of improvements had been made and the issues previously identified had been rectified. We found sufficient action had been taken to meet the requirements of the warning notices, although improvements were required in relation medicine recording systems such as paper medicines administration records (MAR). With this in mind the rating for the key question, is the service safe, remains unchanged. The manager took immediate action in response to our feedback to ensure systems for managing medicines were completely safe.

We have made a recommendation about the management of medicines.

At our previous inspection in January 2016, the key question, is the service caring, was rated as ‘Requires Improvement’ as we identified the provider was not meeting the regulations in relation to people being treated with dignity and respect. Improvements had been made and the issues previously identified had been rectified. We found sufficient action had been taken to meet the requirements of the warning notice and with this in mind we have changed the rating of this domain to 'Good'.

The manager had taken action to ensure staff spoke with people in a respectful manner and to tackle poor interactions. Since the inspection in January 2016 the manager and provider had worked with staff to change a negative culture to a more positive culture. The home had promoted staff from within to take on roles as team leaders to ensure that people were cared for well.

People who were able to, told us they felt well cared for, staff were kind and they were treated with dignity and respect. We saw staff had a good rapport with people and knew people well. There was laughter and fun. We heard staff communicating clearly and effectively.

The rating for key question, is the service caring, identified during the inspection of 25 January 2016 has changed as a result of this inspection. The rating for key question, is the service safe, remains unchanged. A comprehensive inspection will take place to inspect all five questions relating to this service. These questions ask if a service is safe, effective, caring, responsive and well led. At the next inspection we will also check to ensure improvements made for this inspection have been sustained.

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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

This inspection took place on 25 January 2016 and was unannounced. The home was formed of two houses, one provided care for people who did not have nursing needs (the residential home), the other provided accommodation for people with nursing needs (the nursing home). At the time of our inspection there were eight people living in the residential home and 32 people living in the nursing home. People in the residential home had a range of needs with some people being independent and others being at the end of their life. People in the nursing home had more significant needs relating to their health and mobility. Most people who lived in both houses were living with dementia.

We carried out a previous comprehensive inspection of this service on 7, 8 and 12 May 2015. The service was rated as inadequate overall. Breaches of legal requirements were found in relation to medicines management, people’s care needs not always being met, action not always being taken to respond to risks to people, people not always being spoken to in a respectful manner, issues relating to records, staff not being adequately supervised and ineffective quality assurance systems.

At this inspection, we found actions had been taken to respond to the previous concerns identified. However, we identified concerns relating to staff not always taking sufficient action to obtain prescribed medicines and not always identifying potential risks. We also identified a repeated concern relating to people not always being treated with dignity and respect. Further concerns related to medicated creams not always being recorded appropriately, the environment not being suitable for people living with dementia, people feeling there were not always sufficient staff to meet their needs and activities not always meeting people’s social needs.

Following our previous inspection in May 2015, the registered manager had taken a number of steps to improve the service being delivered at Forde Park Care but at the time of our inspection these steps had not been fully embedded. They had introduced new systems, organised training for staff and had sought advice from external healthcare professionals.

We found a lack of consistency in the care people were receiving. Forde Park Care had undergone a number of staff changes in the months prior to our inspection. A number of senior staff had left, sometimes without notice. This had caused disruptions and the registered manager was taking steps to recruit new staff to senior positions. Although steps were being taken, we found these disruptions in staff changes and numbers had affected the people living in Forde Park Care.

People generally told us they felt safe at Forde Park Care and felt well cared for. However, we identified some concerns in relation to the management of risk and medicines. Staff had not taken adequate steps to obtain medicines on one occasion.

A new electronic system had been introduced in order to reduce the risks of medicine errors and to regularly audit medicine stock. This new system was still in the process of being fully implemented at the time of our inspection. We found that because of the confusion caused by this new system, medicated creams were not being managed properly. As soon as we mentioned these issues to the registered manager, paper medicine administration record (MAR) charts were reintroduced for staff to record the application of creams.

Medicine audits had been completed and advice had been sought from external pharmacists in order to ensure staff were following best practice. We observed a medicine round and found this was completed correctly and stocks were correctly recorded.

Some people and some staff we spoke with felt there were not enough staff on duty. The registered manager was in the process of recruiting a number of new staff to the homes. Existing staff had been safely recruited and the registered manager had ensured staff had a disclosure and barring service check (police record check). Following people’s feedback around the lack of staff we have a made a recommendation for the provider to review their staffing levels and a recommendation for the provider to review how they met people’s social needs.

Although the registered manager was taking steps to improve on the environment of the homes, including renovating a number of the rooms, we found the environment was not suitable for people with dementia. The registered manager was aware of these issues and was taking steps to improve the environment for people.

During our inspection we observed some interactions between staff and people living in Forde Park Care which was not caring or respectful. Some people we spoke with commented negatively on the caring attitude of the staff. People made comments such as “It is not respectful” and “There’s always different girls and they don’t understand”.

Other people, however, made very positive comments about the caring attitude of the staff and said “I can’t speak wrong of them they are exceptionally kind” and “Everybody is very kind and caring”. We observed some caring interactions between staff and people and were given examples of the ways in which staff had prioritised people’s wellbeing.

People spoke highly of the food and told us they always had a choice. Where people had larger appetites, however, we found they were not offered further helpings of food. We found that people were assisted to sit down at the table in the residential home a long time before their meal was served. Once the meal was served, however, staff interacted with people and people talked and enjoyed their meal. Following the feedback from people and our observations of the lunchtime meal we have recommended the provider review mealtimes to ensure people are given enough food to satisfy their appetites in a social and enjoyable environment.

Staff had been trained in safeguarding people and whistleblowing, and knew how to identify signs of potential abuse. Staff felt confident that any concerns they brought to the registered manager’s attention would be dealt with appropriately.

Staff training was regularly updated and staff had access to further training opportunities and qualifications.

Staff had received training in, and understood the Mental Capacity Act 2005 and the presumption that people could make their own decisions about their care and treatment. We found that where Deprivation of Liberty Safeguards (DoLS) applications were required for people, these had not all been completed. The lack of these applications having been made had not had a detrimental effect on people living in Forde Park Care and they had not been unduly deprived of their liberty.

The nursing staff at the home had not always demonstrated good oversight of the people in their care. The registered manager had a range of quality monitoring systems in place which were used to continually review and improve the service. Their systems had picked up a number of the issues we had identified but not all of them.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

We found that records associated with pressure area care lacked detail and were not up to date or accurate. This means people could be at risk of inconsistent care.

On the day of the inspection we found staffing levels were sufficient to meet the needs of the people who lived at the home. Care workers had been trained to administer medication.

This was a planned inspection. We also followed up on minor concerns from our inspection on 8 January 2013. During our previous inspection we had concerns because people did not always have care provided in a respectful way and records were poorly maintained. On 8 and 10 July 2013 we found that the home had made improvements.

We spoke with nine people who lived at the home and two relatives of people who lived there. We also spoke with six care workers, two deputy managers, the manager, the cook and three visiting health professionals.

People told us that they were treated respectfully by care workers and that they were involved in discussions about their care. People were positive about the care delivered. One person said 'I'm very happy here, they look after me.'

People enjoyed a range of different activities including ball games, arts and crafts, walks, music therapy and gardening. One person said 'I enjoy looking after the pot plants and tomatoes.'

People's needs had been assessed and their care had been delivered in line with those assessments. Care plans, training records and audit systems had been updated.

We saw evidence that appropriate background checks had been completed on care workers at the home prior to employment.

During our inspection we found that people living at the home were not always treated with the respect they deserved and needed. People who were able to communicate with staff received a more respectful standard of care than more vulnerable, less communicative people.

Although people told us they were happy living at the home they told us they would like more activities to be provided. The provider was in the process of facilitating this.

People were involved in their care and where possible were able to make decisions about their daily lives. Where people did not have the capacity to make decisions, systems were in place to make decisions in the person's best interests.

People were pleased with the care they received and felt well cared for. People had access to a wide range of health care services. However, care records were poorly maintained and did not reflect the staff knowledge or care that was provided.

There were sufficient numbers of skilled and experienced staff on duty at the home.