Forest Manor Care Home

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

There had not been significant improvements since our last assessment and people still did not receive person-centred care consistently in line with their wishes. Where people told us they had concerns that they had raised with staff we could find no evidence of these concerns being acted upon or documented. People and relatives told us they had concerns about the environment of the home including accessibility of the building that prevented responsive and safe care. We took enforcement action against the provider and told them to make improvements.

This service scored 36 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People did not receive person-centred care. As demonstrated in this report, through the assessment and review of CCTV we saw people routinely being woken at times that were not reflected in their care plans. In addition, people were not offered choice in meals or clothing and they were not supported with repositioning in line with their care plan. We observed people being supported to shave and have haircuts by staff members within the communal dining room while other people were eating. We were not assured that all people had consented to this as we saw one person pushing the staff member away repeatedly but the staff member continued despite this.

We raised our concerns with the provider and registered manager who immediately developed an action plan to improve people’s experience and the monitoring of the service.

While improvements were seen in relation to the availability of toiletries in people’s room, there was no evidence people were supported with their personal care or using these items. For example, we checked a bedroom following a person receiving personal care with the deputy manager. There was no indication the sink had been used or any of the toiletry items had been used such as a toothbrush and soap. The deputy manager immediately spoke with staff who had supported the person that morning.

People confirmed there was a weekly GP walk round. However, concerns were fed back from the local authority about health concerns not always being referred to the GP or 111 in a timely manner. This means that those without capacity were at risk of not having their care needs met.

Some staff told us they had concerns about people not receiving medical treatment or support after falls. We attempted to review these concerns however some recording relating to falls had not been completed. We discussed this with the management team and saw no evidence that anyone had come to serious harm and the management team took immediate action to upskill staff.

The local authority and integrated care board raised concerns about care provision and continuity offered to people living at the home. They confirmed that were supporting the service to assess people’s suitability especially within the mental health unit.

People were not supported in line with their care plan. We saw multiple instances of people living with dementia being inappropriately supported in the mental health extension of the home and this environment did not meet their assessed needs.

Feedback about people’s experience remained the same since our last assessment. People and their relatives said they were supported with information in an accessible way that met their communication needs. People told us they had been included in their care plan but did not have access to the record itself.

The feedback and issues were raised on this assessment as at our last assessment. Staff were knowledgeable about accessible information and could describe methods to support people with receiving information in a way they could understand. However, through observation on the day we did not see staff using these techniques. For example, staff did not use pictures or items to help people understand and make decisions, for example, at mealtimes.

Care plans contained detailed information on how people wished to be supported and what format was most appropriate for their needs. We saw that methods such as easy read or large print documents were available. However quality monitoring processes had not identified the issues seen on assessment which had resulted in people not always having access to the information relevant to them.

Everyone we spoke with told us they knew how to raise a concern or give feedback if they needed to and everyone said they were confident the registered manager would respond. However, some relatives raised concerns about loved ones, some of whom were living with dementia, being cared for in the mental health unit and some residents having access to the whole home. They told us they had raised this with the registered manager and were awaiting a response with proposed actions.

We received mixed feedback from staff. Some staff told us there were regular meetings but some staff were not aware or had not attended these meetings.

The provider held immediate meetings with people, relatives and staff to address and update people about the concerns found on this assessment with the support of the local authority.

People were not supported to have equity and access in the home. The premises and equipment were not accessible to people. For example, multiple people raised concerns about not having access to areas of the home despite having capacity and mobility to move freely in the home. One person said, “Prisons don’t have this many locked doors, this is supposed to be my home.”

The provider acted on feedback and immediately took steps to reduce the number of codes need to move around the building.

Partners shared similar concerns expressed by people regarding access of the building and concerns with people being supported to seek additional medical help or guidance.

Some care plans contained clear details of people’s needs, wishes, abilities, including potential barriers people might experience and how staff could support them to overcome these barriers to ensure equity in access. However, the culture and performance of staff within the home did not support these practices.

People and relatives shared their experiences of equity and outcomes and multiple people told us they did not want or request to live at the home and acknowledged this was not a fault of the home but were disappointed with the lack of support they received from staff to act on these concerns. One person said, “I have told them [staff] and I want to leave, I want to arrange my own care and should be allowed to but no-one will help me.”

We fed back people’s concerns to the registered manager who advised they would speak to the local authority to attempt to find a resolution.

Despite the concerns raised by people and some members of staff acknowledging they were aware of people’s concerns this was not documented anywhere meaning the management team had not been made aware of people’s ongoing concerns.

People told us they had been supported to develop a care plan for their future care and where appropriate had been supported to put DNACPR and ReSPECT forms in place. These documents help staff and other professionals follow people’s wishes in times of emergency.

Staff we spoke with were knowledgeable about the type of care and support people required as they reached the end of life. However, based on the repeated concerns detailed in this report we were not confident people would receive this level of care in line with their wishes.

The provider acknowledged that quality monitoring and auditing systems had not effectively or responsively identified the failings seen on assessment. The provider took immediate action and steps to address the immediate risks we raised and sought third party professional support to ensure the home was supported to improve and ensure people received safe and responsive care in the future.