Forster House

On this page

• 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

This is the first assessment for this service. Whilst staff and leaders understood their individual roles and responsibilities, the governance systems in place were not always effective in identifying health and safety concerns. We saw regular audits were in place. However, audits did not always identify where updates were required, for example, care plans did not have enough detail and were not updated regularly to reflect people’s needs.

This service scored 41 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People, relatives, and stakeholders provided a mixed response to experiences of the learning culture being embedded in the service provided. One relative told us, ‘The move into Forster Street so far has gone well, however, it is early day’s’.

Staff we spoke with told us how they were involved in learning lessons in the service. Staff told us, when an accident or incident happens, they all come together as a team and look at actions and planning to reduce the risk of re-occurrence in future. Staff we spoke with felt listened to and able to raise concerns. The management team told us how they review accident and incidents and look at themes and trends.

Processes in place showed accident and incidents were reviewed and analysed monthly. Review of team meetings showed learning from incidents was a regular agenda item. We saw evidence learning was shared with other stakeholders and there was a process to document actions

People we spoke with provided mixed views about staff and care being delivered. One person had recently moved into the service, their relative told us how ‘things had gone smoothly with the move’. However, not all people who recently moved into the home felt the care provided was consistent or safely managed.

The registered manager and clinical lead were involved in assessing and care of people. Where people were moving from another service, we found the provider had a system in place to safely gather essential information of people’s care needs. Staff we spoke with told us, when a person is assessed to move into the home, staff are involved and get chance to meet the person. Staff told us they are required to read and understand the assessment of care needs before providing care needs.

The provider had systems and processes to review the needs of people following a care package referral to ensure the service had the skills and capability to meet a service user’s care needs. This was carried out by the registered manager and clinical lead. Once this had been agreed as potentially a good match the registered manager or clinical lead visited the service user and completed a full assessment of needs. The process included visits to the home and a transition of care which included overnight stays. Where a person was transitioning out of the home a plan of sharing information was created in partnership with their social worker to ensure appropriate information was shared.

Relatives, stakeholders, and service users provided mixed experiences of how they were safeguarded at the service. Stakeholders said the service was not always able to meet the needs of service users and to keep them safe. For example, where a person needed support with behavioural distress, this was not seen to be managed correctly and caused physical impact to a person.

Staff were clear on safeguarding systems and processes to follow in the event of a safeguarding concern. They were aware of the types of abuse and who they would report to. The management team understood how to raise and investigate safeguarding concerns

We observed staff keeping people safe. Staff demonstrated awareness of potential risks to people and how to mitigate these to prevent harm. Staff treated people with respect and there was positive engagement between staff and service users.

Systems and processes to protect people from abuse and neglect were in place. Staff were aware and understood the safeguarding policy. Staff consistently reported incidents and accidents, which allowed a timely response to act on safeguarding concerns. People’s rights under the Mental Capacity Act 2005 were fully supported and understood by staff. Care plans had mental capacity assessments to evidence the capacity people had.

People felt they were involved in how risks were assessed and managed. However, feedback from stakeholders showed concerns on how risks were managed and monitored at the service.

The management team told us how they involved people, relatives and appropriate health professionals in identifying and assessing risks. The management team ensured additional training was available for staff, for example, epilepsy training. Staff told us they received regular training, and this included how to support people with complex needs. Staff told us they read care plan guidelines and were aware of the risks identified in the person’s care plan.

The lounge was on the second floor along with bedrooms. The kitchen was downstairs. Care plans and risk assessments did not demonstrate risks considered around the stairs. The fire assembly sign was in the back garden. However, the meeting point was out the front on the public path. This raised concern that confusion could be caused to staff, leading to staff and people being trapped in the back garden behind a padlocked metal gate.

Risks to people had not always been assessed in conjunction with them or clear plans developed, with accompanying guidance for staff, for managing these. This included the failure to consistently assess and manage risks associated with people’s specific health conditions, such as monitoring the potential risk of a person having diabetes. Some people's care plans lacked clear guidance for staff about their role in helping people to manage health conditions. For example, guidance about people’s diet management was limited and not person-centred. The management team told us they would review the person’s care plan and ensure the staff team understood how to manage people’s health risks. Risk assessments were not in place for the risks associated with people using the stairs.

The service occupied an old Victorian building with narrow corridors, steep stairs and uneven floors in places. The home had a capacity for 5 people and was occupied by 1 person at the time of this assessment. The bedrooms were spacious, painted white and visibly clean. Bedrooms were upstairs and downstairs. The communal kitchen was downstairs with a dining room. The lounge was on the second floor. However, the registered manager told us there was flexibility and the lounge could be moved downstairs to meet the needs of any future service users if they were to move in. We observed the toilet to be visibly clean but observed some toilet seats were loose and could be a risk. The garden was clear. However, we saw there were uneven pathways that had potential to cause a risk to people with mobility needs.

There were weekly, monthly and quarterly audits in place, they included health and safety, infection control and care plan reviews. The provider had recently received an infection control audit from the local authority’s quality team which had actions for the provider to improve in the home. We saw evidence the provider had acted on the findings. For example, paper towel dispensers were fitted above each handwashing facility in the home. We also saw evidence where actions were in progress, for example, the flooring was awaiting to be changed to wipeable laminate. The registered manager told us they were welcoming to external agencies completing reviews around infection control as this prevented potential harm to people. This was important due to the complex needs of people the home provided care to.

Relatives told us they saw the same consistent staff team and rotas we saw confirmed this. Due to the person recently moving in, people and relatives were not able to provide much feedback, however, they did feel the staff were suitable and friendly.

Staff felt the provider employed enough staff to deliver a reliable service. Staff we spoke with told us they always received appropriate training relevant to their role and found the training helpful. Staff also told us team meeting were used to go through certain subjects allowing them to ask questions and discuss to ensure understanding. The management team had in place staff monitoring which included regular supervisions and an active training matrix.

During our site visit we observed the service currently had in place one to one support. This was due to only 1 person living in the home. However, according to the care plan, they needed two staff members for certain activities. The registered manager told us they would be available to assist, and their office was not far from the home’s location.

New staff went through an induction which included training and opportunities to shadow experienced staff to help them learn about the role and expectations. Records we reviewed showed staff received regular supervisions and yearly appraisals. The provider followed robust recruitment procedures to ensure staff were suitable to support people. The provider had a process when matching the needs and personalities of people living in the home when considering potential new staff. People living in the home were involved in recruitment. They would actively be asked by the registered manager if they would like to be supported by the new staff member and feedback would be gained.

Staff told us they received training in infection prevention control. They also said they had access to plentiful supplies of the right personal protective equipment (PPE). The provider and staff were aware of current relevant national guidance. One staff member told us, “We always have enough PPE, never run out’. Staff described how they follow guidance to dispose of used PPE.

The home was visibly clean and tidy. We saw staff completed daily cleaning and recorded this to evidence cleaning had taken place. We saw cleaning products were stored safely and there was enough stock. Signage to direct staff was around the home, for example, how to clean your hands following guidelines to prevent the risk of infection.

The service used effective infection, prevention, and control measures to keep people safe. Staff had access to policies and procedures to ensure they kept up to date with any changes in guidance. Infection prevention was included in staff inductions and refresher training was provided periodically to ensure staff remained updated with current guidance and practices. Spot checks were in place to ensure staff adherence to guidance.

One person and their relatives told us they were happy with the support they received to take their medicines safely.

The staff we spoke with told us they received training to support people to take their medicines safely. One staff member said they completed on-line training, after which they were observed by the management team in administering medicines to ensure competency. The management team told us they ensured all staff received medicines training at induction as well as refresher training regularly.

People were supported to receive their medicines safely. The provider had policies and procedures for safely managing medicines. We reviewed records and saw evidence staff kept accurate records of when medicine had been administered. People’s care plans contained up to date information. Medicines audits were completed weekly and monthly and were completed by the registered manager or senior management team. Medicine audits were comprehensive and reviewed all administration documents, including guidelines such as ‘as required’ (PRN) medicine, medication administration records (MAR) and care plan guidelines. The senior management team completed spot checks on staff to check medicine competency.