Forest Care

Forest Care is a home care service. At the time of the inspection the service was supporting 22 younger and older people with their personal care. People’s care was a mixture of privately and local authority funded. Some people lived in their own homes. Other people lived in care homes and purchased additional care from the provider privately. The provider also cared for people who received live in care services.

People's experience of using this service:

The provider had a sustained record of excellence in providing care that was tailored to people’s individual needs, impacting people’s lives in an immensely positive way.

This was reflected in positive outcomes in relation to meeting people’s communication needs, involving people in the design and development of their care, supporting people to remain independent in their own homes, helping people build and maintain social links to avoid risk of isolation and promoting trusting and cherished relationships with staff.

Staff were responsive and perceptive to people’s needs in relation to their health and wellbeing. They understood people’s preferences, motivations and were able to tailor their communication to maximise people’s opportunity to be in control of their care.

The provider was flexible to changes in people’s needs and the registered manager had a strong conviction to ‘pull out all the stops’ to ensure people’s continuity of care.

The provider had a compassionate and empathic approach to providing end of life care, that was characterised by working in partnership with people and other stakeholders to meet people’s changing needs.

People received safe care in relation to risks associated with their health, medical conditions and environment. There were systems in place to protect people from the risk of abuse and harm.

Staff received training, support and guidance in their role to help ensure they were working effectively in line with best practice.

The registered manager had a sound overview of the service and had effective systems to monitor safety and quality.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection:

The rating at the last inspection (11 November 2016) was outstanding.

Why we inspected:

This was a planned, comprehensive inspection of the service.

Forest Care is a domiciliary care agency providing personal care to people living in their own home. At the time of the inspection 25 people received support with their personal care. Staff carry out daily and weekly visits to people depending on their needs, and provide 24 live in care to people with more complex care needs when required. Most people fund their own care, although the agency also provides services to people funded by the Local Authority and Continuing Health Care when requested. The service also provides domestic support and acts as a recruitment agency for the rest of the provider’s care and nursing homes. However, we did not inspect these elements of the service, as they are not regulated activities and are not required to be registered with The Care Quality Commission (CQC).

The service had a registered manager in place. 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.

The registered manager provided outstanding leadership and was committed, innovative, knowledgeable and organised. They provided clear and confident guidance and demonstrated strong values in all aspects of their role. Staff consistently told us they felt extremely well supported and valued and they were very happy at work. The culture at the service was open, transparent and welcoming. The registered manager made time for staff who received awards and letters of recognition to say thank you.

People consistently told us knew who the registered manager and deputy manager were. They, in turn, knew people very well. They covered shifts and visited people at home to check they were happy and find out if they wanted any changes to their care. They were flexible in their approach to delivering people’s care packages, and adapted the rotas to meet people’s preferences and needs if required.

Forest Care had excellent links with the local community. This was promoted by the registered manager who, along with staff, represented the agency at community events and forums, raising money for local charities and raising awareness of equality, and conditions such as dementia and diabetes.

Effective quality assurance systems were in place to assess and monitor the quality of care and drive improvements. People told us they completed questionnaires and were often contacted by telephone to check they remained satisfied with the service they received. Their views were listened to and acted upon.

Regular audits were carried out by the registered manager and quality manager to ensure the service met people’s expectations, and the standards required under the Health and Social Care Act 2008. Any shortfalls were acted upon and communicated to staff.

The registered manager understood their responsibility to submit notifications of events to the commission as required by law. People’s care records and other records relating to the management of the service were well maintained, up to date and securely stored.

Staff interacted very positively with people and spoke about them with affection. They were extremely committed to the people they supported and were very caring, compassionate and kind. A health professional told us one person, who wanted to stay at home when they were nearing the end of their life, was able to do so because of the commitment and compassionate care they received from the staff at Forest Care.

People told us that staff really respected their privacy and dignity and treated their homes with the utmost respect. Staff promoted people’s independence and encouraged them to do things for themselves, such as getting dressed, where possible and safe to do so. Staff understood their responsibilities in relation to confidentiality and ensured they followed this in their day to day communication.

Staff had excellent knowledge of what was important to people, their life histories and interests and had time to sit and talk with them. People and their relatives consistently told us how they valued their relationships with staff who always made time for them and went the extra mile to ensure they were happy and safe. Staff were very aware of people who were at risk of isolation and made extra visits in their own time to ensure they felt important and valued, such as on Christmas day.

People and relatives had been fully involved in completing initial care assessments and care plans which were detailed and gave guidance to staff in how to provide care in a way that put the person at the centre of their care. Staff found ways to support people to maintain relationships with family and friends which included supporting people to attend family events planned for outside of their regular visit times.

People knew how to make a complaint. They told us they would contact the office and speak with the registered manager or deputy manager who they had all met. The information about complaints was in their file at home and this had been explained to them. We consistently heard that people had no complaints about Forest Care. Where concerns had been raised in the past, these had been dealt with to the satisfaction of people.

People felt safe, had trust in the staff who visited them and knew who to contact if they were worried about their safety. Staff were able to recognise different forms of abuse, understood the provider’s safeguarding and whistle blowing procedures and knew who to contact if they had any concerns.

Clear measures and guide lines were in place for staff to follow to minimise risks. Detailed risk assessments were completed for each person which identified any specific concerns and covered different scenarios according to people’s health and mood. Environmental risk assessments were carried out at each person’s home when they started to receive their care which identified any safety risks to both the person and staff. Staff had been given guidance and understood how to keep themselves safe when working alone in the community.

Incidents and accidents were recorded and investigated appropriately and any learning shared with staff and across the company. Staff knew what their responsibilities were if they encountered an incident or accident in a person’s home. They had received first aid training and spoke confidently about what they would do.

The provider followed robust recruitment practices to ensure that only people suitable to work in social care were employed. These included criminal records checks, previous employment references and photographic evidence of their identity.

There were sufficient staff who were deployed effectively to meet people’s needs. People consistently told us staff always arrived on time and stayed for their allotted time, often longer, and care was provided in line with their wishes and preferences. Staff told us they had “Ample time” to complete their visits and did not feel rushed.

Staff had a good knowledge of people’s medicines and how these should be administered, or how much prompting people required if they were able to take their medicines by themselves. Where staff were required to support with this aspect of people’s care they understood their responsibilities with recording medicines.

People consistently told us staff were well trained, competent and confident. Staff received regular training including specialist learning to support them to meet people’s specific needs, such as dementia or Parkinson’s disease. Staff also received supervision and observed practice to check they continued to meet the required standard. Staff received an annual appraisal which provided them formal opportunities to discuss their performance and personal development.

Some people were supported to manage their health and make healthcare appointments by their family. Where this wasn’t possible, staff encouraged people to seek specialist treatment and advice, for example, from their GP, if they complained of feeling unwell. Staff supported with this when necessary. Each person had a communication book and details of any health concerns were recorded by staff. Concerns were passed back to the registered manager and followed up to ensure people received the support they needed.

Staff understood the principles of the Mental Capacity Act 2005. They sought consent from people before providing any care or support and understood to report any concerns about people’s changing capacity to the registered manager.

People were encouraged and prompted by staff to eat healthily and have plenty of drinks. Staff prepared food for people during their visits if this was required, which included home cooked food such as casseroles and apple pie. Staff were aware of any special dietary requirements and assisted people to eat if they were unable to do so themselves.

This was the first inspection of the service since they registered with the commission.