Forest Manor Care Home

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’s aims and outcomes were not always supported by staff and risk assessments did not always fully reflect people’s needs. People were not consistently supported with their needs such as nutritional requirements in a timely or person-centred way. We saw evidence that care plans contained guidance for staff in supporting people to have healthier lifestyles and transition to other services such as hospital admissions to ensure they were done safely.

This service scored 46 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People told us they were included in their care planning and reviews. People said that staff sat with them and discussed their care. Relatives supported this feedback. One relative said, “The [registered] manager always phones me before any changes are made.”

Staff told us that they were able to provide feedback and input into care planning and reviews. Staff said they had time to review people’s care plans and identify any changing needs. One staff member said, “We do get plenty of time to review care plans, we also discuss changes at hand over and team meetings, so everyone has consistent and up to date information.”

Although care plans, we reviewed were person-centred and communicated people’s aims and choices, at times risk assessments did not fully reflect people’s needs. For example, we observed a person with a low bed that was unable to be raised. The registered manager stated this was to prevent a falls risk. However, the care plan did not reflect this and there was no falls risk identified. This placed people at risk of not having their needs identified and inappropriate equipment being used to support them.

People were not able to answer questions about whether they were receiving evidence-based care and treatment. However, from observations we saw people did not always receive care in line with best practice guidance. For example, where people required support with eating at mealtimes, this was not done in a person-centred way. People were not always offered choices and staff did not sit with people for the duration of the meal. Staff moved between people assisting multiple people to eat their meals which meant that due to the length of time taken people’s food was often cold and they were not offered another meal.

The registered manager acknowledged the concerns we observed during the meal service and took steps to ensure this was rectified.

The registered manager told us it was a requirement for staff to record all fluid and nutritional intake for people living at the home. We reviewed the notes made by staff from the lunchtime meal we observed. We found fluid and nutritional records did not match what people had been given to eat or the amount they had consumed. This placed people at risk of harm from having inaccurate information recorded in their care notes and meant people were put at greater risk of weight loss or dehydration.

People were not able to answer questions about how staff and teams worked together. However, we observed staff working well with each other and contacting external health professionals. We were therefore assured that people had a positive experience.

The registered manager told us how people were encouraged to spend time at the home prior to deciding on whether to live at home. Staff told us they had supported people and their relatives to look around the home and spend time with other people to ensure the service met their needs.

A professional visiting the service told us that the registered manager and staff were responsive to people’s needs and followed their recommendations consistently.

We saw evidence of the registered manager evaluating people’s readmission to the home following hospital admissions to ensure this was undertaken safely and effectively. Care plans contained referrals and communication to other medical professionals involved in people’s care allowing a joined-up approach to ensure people received their care effectively.

People told us they were supported to access other healthcare professionals as needed such as GPs and dentists.

Staff were knowledgeable about people’s needs and conditions and provided appropriate support. For example, there were meal and food choices available to match people’s needs. The chef said, “We work hard to offer as much choice as possible to people on limited or restricted diets. Having something like diabetes shouldn’t stop you from enjoying food.”

Care plans we reviewed contained guidance and information on people’s scheduled appointments such as annual dental and optician appointments. The home had a close link with the local GP practice and staff were able to contact them directly for any immediate concerns. Care plans also contained guidance for staff on how to promote healthy choices for people whilst respecting their right to choose.

People and their relatives told us they did not always receive positive outcomes. People described a lack of person-centred care. One person said, “I know staff are busy, but I don’t get a shower as often as I would like.” Another person commented, “I’m bored here, feel like I’m wasting away.”

Staff we spoke with told us they were passionate about providing positive outcomes to people but at times felt unable to achieve this as they were reactive to situations. For example, one staff member said, “It can be hard, when someone has high level needs, we have to respond quickly and this can take up a lot of time and it’s unplanned, we just have to respond.”

While care plans detailed people’s aims, there was no evidence that outcomes were recorded, reviewed or monitored within care plans. This meant that the registered manager did not have oversight of people’s care or outcomes. For example, one care plan stated a person wanted to remain as independent as possible whilst showering. This aim was reviewed and carried forward monthly, but the care plan did not detail whether this had been achieved or what steps staff had taken to support the person with their desired outcome.

People received a mixed experience when consenting to care and treatment. While people told us they were included and consented to their care plan and reviews, our observations saw staff making decisions for people regarding choices such as meal and drink options.

The registered manager was knowledgeable about the mental capacity act, however staff we observed did not support people appropriately to make best interest decisions where they lacked capacity. For example, at mealtimes we observed everyone being served orange squash without being offered the choice of any other beverage. People were asked which meal choice they wanted but were not supported with visual supports to help them make decisions as per best practice guidance for people living with dementia or diminished capacity.

Care plans contained mental capacity assessments and where appropriate were supported with best interest decisions that guided staff on how to support the person in their preferred way when people lacked capacity. However, the management team did not have oversight of the quality of care provided and failed to undertake competency checks with staff therefore the management team had not identified the concerns we saw through our observations.