We carried out a review of the data available to us about Forge House on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Forge House, you can give feedback on this service.
Forge House provides accommodation and personal care for up to six people aged between 18 and 65 years, who have a learning disability and autism. Forge House Care Ltd is a care organisation based in Chatham. At the time of our inspection, six people were using the service.
The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.
The Secretary of State has asked the Care Quality Commission (CQC) to conduct a thematic review and to make recommendations about the use of restrictive interventions in settings that provide care for people with or who might have mental health problems, learning disabilities and/or autism. Thematic reviews look in-depth at specific issues concerning quality of care across the health and social care sectors. They expand our understanding of both good and poor practice and of the potential drivers of improvement.
As part of thematic review, we carried out a survey with the manager at Forge House and the behaviour support therapist at this inspection. The service had a registered manager who was also the registered provider and a manager for Forge House. The registered manager was not available for most part of this inspection. The thematic review considered whether the service used any restrictive intervention practices (restraint, seclusion and segregation) when supporting people.
The service used positive behaviour support principles to support people in the least restrictive way. No restrictive intervention practices were used.
People’s experience of using this service and what we found
Effective governance systems to monitor performance had not been fully embedded into the service. Provider audit systems had not been effective in identifying the areas we found at this inspection and the manager at Forge House did not carry out any audits to check the quality and safety of the service. Records were not always up to date. We have made a recommendation about this.
The registered manager and staff had not spoken with people and their relatives about end of life plans. We found no end of life care plans in place. This is an area for improvement.
The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.
The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.
People were safe at Forge House. Staff knew what their responsibilities were in relation to keeping people safe from the risk of abuse. The provider followed safe recruitment practices.
Medicines practice was safe. Medicines records were accurately signed with no gaps in recording. Staff had detailed knowledge of the system in place. The environment was well maintained, and infection control procedures were adhered to.
People were consulted on key issues that may affect them. People’s rights, their dignity and privacy were respected.
People received the support they needed to stay healthy and to access healthcare services. Each person had care plan, which set out how their care and support needs should be met by staff. These were reviewed regularly.
Staff supported people to maintain a balanced diet and monitor their nutritional health.
Staff received regular training and were provided with appropriate support and supervision as is necessary to enable them to carry out their duties.
People knew how to complain and that any concerns would be listened and responded to by the provider. Relatives said they felt able to express concerns and were confident of these being addressed.
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.
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 (Report published on 21 March 2017).
Why we inspected:
This was a planned inspection based on the previous rating.
We have found evidence that the provider needs to make improvements. The provider acted to mitigate some areas of concerns found during the inspection and we will check if this has been effective when we next inspect. Please see the Well led sections of this full report.
Follow up:
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
Forge House is a privately owned care home. The service provides personal care, accommodation and support for up to six adults. People had a variety of complex needs including mental and physical health needs and behaviours that may challenge. There were six people living at the service at the time of the inspection.
At the last Care Quality Commission (CQC) inspection on 17 February 2015, the service was rated Good in all domains and overall.
At this inspection we found the service remained Good.
Due to people’s varied needs, some of the people living in the service had a limited ability to verbally communicate with us or engage directly in the inspection process. People demonstrated that they were happy in their home by showing warmth to the deputy manager and staff who were supporting them. Staff were attentive and interacted with people that used the service in a warm and friendly manner. Staff were available throughout the day, and responded quickly to people’s requests for help.
The provider was also the registered manager of 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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the service is run.
People continued to be safe at Forge House. People were protected against the risk of abuse. We observed that people felt safe in the home. Staff recognised the signs of abuse or neglect and what to look out for. Staff knew how to protect people from the risk of abuse or harm. They followed appropriate guidance to minimise identified risks to people's health, safety and welfare. Medicines were managed safely and people received them as prescribed.
There were enough staff to keep people safe. The provider had appropriate arrangements in place to check the suitability and fitness of new staff. Staff were trained to meet people’s needs and were supported through regular supervision and an annual appraisal so they were supported to carry out their roles.
Each person had an up to date, personalised support plan, which set out how their care and support needs should be met by staff. These were reviewed regularly. Staff received regular support to help them to meet people's needs effectively.
People were supported to eat and drink enough to meet their needs. They also received the support they needed to stay healthy and to access healthcare services.
Staff encouraged people to actively participate in activities, pursue their interests and to maintain relationships with people that mattered to them.
The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The provider and staff understood their responsibilities under the Mental Capacity Act 2005.
Staff were caring and treated people with dignity and respect and ensured people's privacy was maintained, particularly when being supported with their personal care needs. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice.
The deputy manager was in day to day control of the service. They ensured the complaints procedure was made available in an accessible format if people wished to make a complaint. Regular checks and reviews of the service continued to be made to ensure people experienced good quality safe care and support.
There were systems in place to review accidents and incidents and make any relevant improvements as a result.
The deputy manager provided good leadership. They checked staff were focussed on people experiencing good quality care and support. People and staff were encouraged to provide feedback about how the service could be improved. This was used to make changes and improvements that people wanted.
Further information is in the detailed findings below.
We carried out this inspection on the 17 February 2015 and it was unannounced.
Forge House is a privately owned care home. The service provided personal care, accommodation and support for up to six adults. People had a variety of complex needs including mental and physical health needs and behaviours that may challenge.
Due to people’s varied needs, some of the people living in the service had a limited ability to verbally communicate with us or engage directly in the inspection process. People demonstrated that they were happy in their home by showing warmth to the deputy manager and staff who were supporting them. Staff were attentive and interacted with people that used the service in a warm and friendly manner. Staff were available throughout the day, and responded quickly to people’s requests for help.
The service had a registered manager, who was also the nominated individual for the company. 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.
CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The registered manager and staff showed that they understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS).
Staff had been trained in how to protect people from abuse, and discussions with them confirmed that they knew the action to take in the event of any suspicion of abuse. Staff understood the whistle blowing policy and how to use it. They were confident they could raise any concerns with the registered manager or outside agencies if this was needed.
Where people lacked the mental capacity to make decisions the home was guided by the principles of the Mental Capacity Act (MCA) 2005 to ensure any decisions were made in the person’s best interests. Staff were trained in the Mental Capacity Act 2005 (MCA) and showed they understood and promoted people’s rights through asking for people’s consent before they carried out care tasks.
Staff were knowledgeable about the needs and requirements of people using the service. Staff involved people in planning their own care in formats that they were able to understand, for example pictorial formats. Staff supported them in making arrangements to meet their health needs.
Medicines were managed, stored, disposed of and administered safely. People received their medicines when they needed them and as prescribed.
People were provided with food and fluids that met their needs and preferences. Menus offered variety and choice.
There were risk assessments in place for the environment, and for each individual person who received care. Assessments identified people’s specific needs, and showed how risks could be minimised. People were involved in making decisions about their care and treatment.
There were systems in place to review accidents and incidents and make any relevant improvements as a result.
The registered manager investigated and responded to people’s complaints and people said they felt able to raise any concerns with staff.
Staff respected people and we saw several instances of a kindly touch or a joke and conversation as drinks or the lunch was served and at other times during the day.
People were given individual support to take part in their preferred hobbies and interests.
Staff were recruited using procedures designed to protect people from the employment of unsuitable staff.
Staff were trained to meet people’s needs and were supported through regular supervision and an annual appraisal so they were supported to carry out their roles.
There were systems in place to obtain people’s views about the quality of the service and the care they received. People were listened to and their views were taken into account in the way the service was run.
We had limited conversations with people who used the service as not everyone was able to tell us about their experiences. It was noted that people interacted well with staff they were familiar with, and observations showed that people appeared happy and contented.
The staff supporting the people that used the service knew what support they needed and we saw that the support being given to people matched what their care plan said they needed.
Medications were handled appropriately and people that used the service had their medicines given to them in a safe way.
We found that there was a robust recruitment process in place that helped to make sure that only people who were deemed as suitable were employed to care for people that used the service.
We saw that there were monitoring processes in place that ensured that people were protected against the risks of inappropriate or unsafe care and treatment as the service regularly assessed and monitored the quality of the service provided.
The staff supporting the people that used the service knew what support they needed and we saw that the support being given to people matched what their care plan said they needed.