We conducted an inspection of Forrester Court on 12 and 15 December 2016. The first day of the inspection was unannounced. We told the provider we would be returning for the second day. At the last inspection on 10, 11 and 12 July 2014, we asked the provider to take action to make improvements in relation to delivering person centred care and this action has been completed.
Forrester Court provides care and support for up to 113 people who require nursing and personal care. There were 102 people using the service when we visited. There are three floors within the building and each floor consists of two units. Three of the home’s units are for people who have nursing needs, two of the units are for people with residential care needs, some of whom have early onset dementia and the remaining unit is home to those with palliative care needs.
There was no registered manager at the service. 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. The registered manager had left two weeks prior to our inspection and had been replaced by another manager within the organisation. This manager had started working at the service on the first day of our inspection.
There were not enough staff scheduled to work on the first day of our inspection and prior to this. We reported this to the manager who scheduled extra staff to work the next day and assured us they would maintain this level of staffing.
People were supported to maintain a balanced, nutritious diet. People at risk of malnutrition had appropriate assessments conducted and were referred to the community dietitian as appropriate. Advice was implemented by care staff and the kitchen staff who were also aware of people’s dietary needs. People were supported effectively with their other healthcare needs and were supported to access a range of healthcare professionals. However, care plans were not always updated to reflect people’s current needs in respect of their dietary needs.
People using the service and their relatives were involved in decisions about their care and how their needs were met.
The organisation had good systems in place to monitor the quality of the service. Feedback was obtained from people through monthly residents and relatives meetings as well as annual questionnaires and we saw feedback was actioned as appropriate. There was evidence of auditing in many areas of care but these did not identify the issues identified in relation to care plans and understaffing.
There were good systems in place for the safe management and administration of medicines. Staff had completed medicines administration training within the last year and were clear about their responsibilities.
Staff demonstrated a good knowledge of their responsibilities under the Mental Capacity Act 2005. Mental capacity assessments were completed as needed and we saw these in people’s care files. Where staff felt it was in a person’s best interests to deprive them of their liberty, applications were sent to the local authority for Deprivation of Liberty Safeguards authorisations to ensure this was lawful.
Staff demonstrated an understanding of people’s life histories and current circumstances and supported people to meet their individual needs in a caring way.
Recruitment procedures ensured that only staff who were suitable, worked within the service. There was an induction programme for new staff, which prepared them for their role. Staff were provided with appropriate training to help them carry out their duties and received regular supervision.
People who used the service gave us good feedback about the care workers. Staff respected people’s privacy and dignity and people’s cultural and religious needs were met.
People using the service felt able to speak with the management team and provide feedback on the service. They knew how to make complaints and there was a complaints policy and procedure in place. Care staff gave excellent feedback about the deputy manager and the rest of the management team.
People were encouraged to participate in activities they enjoyed and people’s participation in activities was monitored. People’s feedback was obtained to determine whether they found activities or events enjoyable or useful and these were used to further develop the activities programme on offer. The activities programme covered five days a week and included a mixture of one to one sessions and group activities. At the time of our inspection the service was running a specific Christmas activities timetable which included Christmas carol singing, a visit to see some of London’s Christmas lights and church visits.
We found two breaches of regulation in relation to staffing and good governance. You can see what action we told the provider to take at the back of the full version of the report.