Forest Court Care Home

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• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We assessed 2 Quality Statements in the Key Question of Safe. Staff were aware people who lived with dementia could not always recognise risks or understand the steps they needed to take to keep themselves safe. Staff used the relationships they had built up with people, as well as their knowledge of people’s needs and abilities, to support them to remain safe. Staff had access to information and guidance which supported them to help keep people safe. Relevant risk assessment and associated care plans were completed and reviewed to ensure the actions adopted, to reduce and mitigate risks to people, remained appropriate, effective and the least restrictive option. When assessing risks and planning people’s care, staff worked closely with people’s relatives. This meant people’s relatives had opportunities to speak on behalf of their relative and contribute to the discussions and decisions made about how to keep their relative safe. The provider had recently made further adaptions to the environment to support people’s safety when they moved around the building independently. There were processes in place to manage people’s medicines safely; to ensure people took their medicines as prescribed and to ensure the medicines prescribed remained effective.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safeguarding during this assessment. The score for this quality statement is based on the previous rating for Safe.

People’s relatives told us staff took action to keep their relative safe. A relative said, “I feel [Name] is safe, the staff are caring, and they keep an eye on [Name]. They help [Name] to manage things and stop [Name] if they think [Name] is doing something that will put [Name] in danger. This place is as near to excellent as you can find” and another relative said, “We feel the home are keeping [Name] safe, very much so, we visit frequently, inside the home, it is obvious the residents are well cared for. I don't feel there is any compromise on [Name] safety." One relative told us they were concerned about the number of falls there relative was having but confirmed they were able to speak with the staff or managers about any concerns they did have. Some, relatives were aware staff referred to risk assessments and care plans to support them in the management of people’s risks. A relative said “Staff refer to risk assessments and care plans.” Another relative, when talking about how staff kept their relative safe said, “They [staff] did a risk assessment on [Name] when [Name] moved in and there is a care plan in place, yes, because they [staff] refer to it.” Relatives confirmed communication between them, the care staff and the managers, about any changes to their relative’s care, was good.

Staff understood that people who lived with dementia had difficulty in recognising risk and knowing how to keep themselves safe. Staff knew where to find information about people’s risks and the guidance they needed to keep people safe. A member of staff said, “We are given information on admission, plus it’s in the care plan and risk assessment, in handover (daily staff meeting) and on the digital devices which has made access to the records easier.” Staff were aware of those who were at higher risk; from falls, seizures, choking or altercations with others. Staff told us senior staff made them aware of new emerging risks. A member of staff told us they had learnt in the staff handover meeting, that one person’s risk of falls had increased because they were not using their walking aid correctly. Staff told us they received training to help them support people to remain safe. Although not all staff we spoke with could remember receiving training on managing choking; they were able to describe the action they needed to take whilst they waited for the nurse on duty to attend. The registered manager told us she would review staffs’ knowledge on this and provide refresher training if needed. Staff in various roles, with differing levels of responsibility, were clear about the actions they needed to take in response to an accident or incident. Staff told us they worked collectively to manage and mitigate risks to people. As a team they understood people’s safety was everyone’s responsibility and they confirmed communication across the staff group, about risks and people’s safety, was good.

We observed staff helping people to remain safe by reminding people to use their walking frame when mobilising, by providing people at risk of choking with adapted meals plus supervision at mealtimes and by defusing conflict between those who lived with dementia. We observed kitchen and care staff working together when meals were served to ensure the right meal was served to the right person. We observed the new measures the provider had put into place, and how these were effective in reducing risks to people who moved around the environment independently.

Risk assessments and care plans provided staff with guidance on how to manage and mitigate risks to people. The new environmental safety measures the provider had put into place needed to be added to some people’s risk assessments however, this was not detracting from the practical improvement this had made to people’s safety. People’s risk assessments and care plans were reviewed regularly, including after an accident or incident, to ensure the adopted actions were still effective in mitigating the risk or if they needed to change. There were processes in place to audit and analyse accidents and incidents to help identify potential patterns and trends so learning could be taken from these. During the inspection additional information was added to the staffs’ handover form making it clear who was prescribed a blood thinner (anti-coagulant). This would help agency staff, who may not be so familiar with people’s medicines and associated risks, identify those people who may be at risk of internal bleeding.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe and effective staffing during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

People’s relatives told us staff supported their relative to take their medicines safely and the GP reviewed their relative’s medicines to ensure they remained appropriate and effective. A relative confirmed that following their relative’s admission to Forest Court Care Home, the GP had reviewed their relative’s medicines, made some changes and since then their relative had been less agitated and more relaxed. Another relative told us they were made aware of any changes to their relative’s medicines. They said, “Staff talk in a gentle voice, and they are patient.” This related to the times their relative refused their medicines. They said, "[Name] has lots of medication, [Name] is allergic to certain tablets, and they [the staff] know this. They have never made a mistake with [Name] medications. They [the staff] are serious about it." We observed how staff ensured people took their prescribed medicine to help maintain their health without causing them distress. Staff remained with people and adopted a patient and unrushed way of administering their medicines. We observed staff sometimes returning to further support people when they had initially declined their medicines. We observed staff making sure people who required pain relief or medicine to help with distress, received these in a timely way.

Staff who administered medicines were knowledgeable about the medicines they administered and knew how to manage them safely. This included, for example, the correct rotation on a person’s body when removing and reapplying pain relief patches and the correct storage of unopened and opened insulin. Care staff were aware of the risks associated with prescribed thickening agents (products used to thicken drinks) and they ensured the safety measures in place were followed. Staff knew what had to be in place before people’s medicines could be administered covertly (hidden in food or drink) so people were protected against any form of abuse and illegal restrictive control.

There were systems and processes in place to support the safe management of people’s medicines. This included ensuring medicines were ordered in a timely way, checked on arrival and stored appropriately. Medicines not administered, were safely returned to the pharmacy for disposal. Medicine administration records and other associated records were correctly maintained. There were planned reviews of people’s medicines by the GP, including reviews if people’s medicines were not benefiting them. Medicines were only administered by staff who had completed the necessary training and whose competency in this task was regularly checked. There were processes in place for monitoring medicine administration practices and the completion of all relevant records, to support the early identification of medicine related omissions and to reduce the risk of other medicine related errors. Information was in place to provide staff with guidance in the use of medicines prescribed to be administered ‘when required’ and covert (hidden in food or drink) administration of medicines. People who received their medicines covertly, had records in place which demonstrated an assessment of their mental capacity (in relation to their medicines) had been completed and best interest decisions about their medicines had been made, on their behalf, by appropriate persons.