Forster House

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

People were fully assessed prior to moving into the home. People’s likes, dislikes, wishes and preferences were all taken into consideration through effective care planning guidelines. We observed staff working well together and all staff and management had consistent values and approaches to providing care to people. Consent to provide care was in place. However, DoLS applications were not always completed in a timely manner. This meant people were at risk of living in the home with restrictions applied that were not legally authorised.

This service scored 54 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The registered manager told us how they assessed people’s needs. The registered manager’s approach was to involve all staff in the service with assessing people’s needs and their suitability for the home. This approach meant we saw in-depth pre assessments, which allowed all staff to learn about the person and their needs prior to the person moving in. Staff told us they felt included by this process.

We reviewed an assessment and this covered people’s care needs, likes and dislikes and any associated risks. We saw evidence of mental capacity assessments. This included a best interest decision and included all appropriate stakeholders involved in the person’s care. Once an agreement was found we saw how the assessments completed formed a person-centred care plan. Furthermore, we saw the assessment process included visits to the home to assess suitability of the building style, and whether the person felt comfortable within the home’s setting.

We saw people were comfortable with the care they were receiving. People had a good relationship with staff and responded well to them. A relative we spoke with told us it was very early days, as the person had only lived at the home for a couple of weeks. However, so far, the needs of the person were felt to have been met according to the relatives’ observations and experience.

We reviewed daily notes which were recorded on an electronic care planning system. Staff always had a mobile device on them whilst providing care to people. This meant up-to-date notes were completed and the person receiving care sat with the staff member as their notes were completed. Staff told us they felt confident in using the electronic system. Some records we reviewed required further development in the content of detail recorded, for example, evidencing how a person was involved in the process of selecting and preparing their lunch or meal choices and preparation.

We saw an electronic care planning recording system in place. This recorded the care a person received and provided staff with constant access to the person’s care plan and risk assessments. Whilst reviewing records, we found the electronic system difficult to look back on charts completed for people, such as the recording of fluids and bowel monitoring records. This did not provide assurance around the monitoring of people’s health needs. The system did not provide an alert system when a person had not had enough fluids for the day as per guidelines found in their care plan. Training was provided to staff in recording information and use of the electronic care planning system. We saw staff had the opportunity to feedback how the system worked and what needed to be improved. Paper records were in place for medicines administration during this site visit.

We observed people were happy with the care they received during this site visit. People communicated positively to the inspector and to the staff. One relative told us the staff team seemed nice and caring.

The management told us how they involved all staff and senior management when completing assessments for people. We found gaps in the training records provided and the registered manager told us that whilst training was completed, the records had not been updated. The registered manager told us they were looking for and identifying training and development for staff which included training around supporting with behavioural needs. The registered manager also told us they were sourcing additional training for staff prior to a person moving in.

Stakeholders told us there was a process in place to ensure people were kept safe when they were moved in from different services. Stakeholders told us how referrals were sent by the local authority and the provider responded in a timely way. The response considered the suitability of the referral and whether the service could meet the care needs of the person.

We saw a process was in place to ensure people were safely moved in and out of the home. The registered manager looked at the suitability of the person and where there were any clinical health needs. These were assessed by the provider’s qualified clinical lead. Once an agreed care package was completed, a full transition care plan was put in place which had outcomes and stages for the person to safely move into the home.

People we spoke with told us they were happy with food and meal choices provided. A person had a plan to ensure a low-fat diet. However, we saw this was not being followed. For example, we saw one person was provided lunch which was high in fat content and this was against the care plan guidance. We saw a person was assessed as requiring a health check by a diabetic nurse, however, this had not been completed and no evidence was found where the provider had planned and booked an appointment. We raised this to the provider and social worker during the assessment and were told they were awaiting the person to be fully registered at the local GP surgery.

Staff told us they received training on nutrition and how health options are to be offered to people. The management team were aware of people having diet plans in place. However, we shared a concern on how this was monitored to ensure people were having healthy meals matching their diet care plan. The registered manager told us they were looking to work with staff and provide further guidelines on how people with diet plans should receive their support.

People who move into the service were provided a local authority assessment and care plan. The provider also completed their own pre assessment of people’s needs. The provider also developed care plans and risk assessments following this. During the assessment visit and following our feedback, the registered manager and the service user put in place a meal planner for the week. This broke down meal options and guided staff on healthy food options to offer people.

The person who we spoke with during our visit had not long moved into the service. They had outcomes in place following their move which had been created alongside all stakeholders involved in the person’s care.

Staff were aware of the outcomes for people and understood how these outcomes would improve their lives. For example, staff were supporting a person to explore and investigate interests in the local community. The registered manager told us they promoted outcomes for people and understood the importance of having outcomes for people to work towards.

The provider had a process in place to gather information and look at the outcomes people wished to work towards. This process involved the local authority who first sent a referral and their care plan. This care plan had the person’s needs, assessments and agreed outcomes they wished to achieve. This was also covered in the pre assessment completed by the provider at the time of assessing a person. Initial outcomes were transferred into people’s care plans. We saw evidence where a review took place on a person’s care plan to ensure outcomes were amended and new ones created when outcomes were achieved. Outcomes in place were positive and promoted personal achievements for people to work towards. Outcomes also encouraged skill building and independence. For example, encouraging people to be more involved in daily tasks they completed, such as cooking and cleaning.

People and relatives were involved in consent to care. We saw where people lacked capacity to consent to their care then a lasting power of attorney was in place.

Staff were aware of people’s mental capacity and how to raise concerns if they felt a person’s capacity may be declining or in need of reassessing. The registered manager told us the process to assess people’s mental capacity and how to apply for deprivation of liberty safeguards (DoLS) authorisations.

Local authority assessments we saw included mental capacity assessments which provided an outcome to all stakeholders involved in the person’s care as to whether the person had mental capacity or not. We saw one person who had been living at the home for 2 weeks required a DoLS. However, we did not see evidence this was requested by the provider. The registered manager told us they were waiting for the original DoLS to come from a previous care provider. During our site visit the provider had put through a request for a DoLS assessment.