Forest Manor Care Home

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• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

The governance and oversight of the quality monitoring within the home was not undertaken safely or effectively. Audits and management checks had failed to identify and mitigate risks that were identified on the assessment. Where other professionals had raised concerns there was no evidence of the provider taking action in timely manner. Staff said the registered manager was open and approachable and they were confident to raise their concerns, however staff felt they were not included in the development of the culture or direction of the home.

This service scored 39 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff told us the direction and culture of the home was not discussed with them. One person said, “The provider is now working in mental health, but this hasn’t been explained to us. I don’t know how this impacts me or my role.”

The registered manager and compliance manager acknowledged that staff had not been included in expansion plans for the business currently as they wanted to wait until firm decisions had been made. However, they acknowledged that could be disconcerting for staff and advised they would hold a meeting to address this issue immediately.

Some of the clinical staff raised concerns that the management team did not have a clinical background and at times they lacked support. However, staff said the management team were proactive in sourcing and contacting professionals in the community who could support them as needed.

The provider had appropriate management cover and provided support to staff out of hours by an on-call system. However, management cover had failed to identify or report the concerns found on inspection. Where concerns had been raised to senior managers there was no evidence of actions taken. For example, the maintenance log showed concerns had been raised to management but there was no follow up action recorded.

We received mixed feedback from staff, while staff told us that they felt confident to approach management some staff said they had not received a response to their concerns. One staff member said, “If we raise concerns about people’s health that’s actioned straightaway but not if we raise concerns about the environment or direction of the business, we don’t get a response, that concerns me.”

We spoke with the registered manager and the compliance manager about the feedback from staff and they advised they would arrange a meeting with the staff team to identify any concerns and offer a safe space for staff to have individual meetings if they preferred. We saw incident and accidents had been reported and followed up where appropriate included lessons learned that were shared with staff and the provider.

Staff told us there were no concerns regarding workforce equality, diversity and inclusion, they said they were treated equally, and the culture of the home was improving. Staff told us management supported reasonable adjustments where possible to accommodate areas like appointments and childcare.

The registered manager described how they fostered an open culture through an open-door policy and open communication but acknowledged this needed to include future business plans being communicated to people and staff effectively and provided assurances this would be actioned immediately.

Staff we spoke with confirmed they had not received a competency check for areas such as manual handling or administration of medicines. One staff member said, “I don’t think I have ever had a check like that before.” While another staff member said, “We used to have competency checks all the time, but it hasn’t happened for a long time.”

Quality monitoring processes were not comprehensive and were not completed consistently. Audits such as competency checks had not been undertaken and the provider and management team did not have oversight on the quality of care people were receiving. Where audits such as domestic checks and daily walk rounds had been completed these had not identified the issues found on inspection meaning people were consistently exposed to risk of harm and poor-quality personalised care.

People were unable to comment as to how the service worked in partnership with others or within the community. However, from issues identified on inspection we were not assured that people were kept safe following the recommendations from partners and other professionals.

The registered manager acknowledged that they had been made aware of concerns from other professionals such as the local authority but due to a period of outbreak and issues obtaining contractors the improvements had been delayed. The registered manager acknowledged that the action plan should have been updated and shared with people, staff and partners to inform them of the situation.

Professionals who had visited the service and undertook audits had repeatedly raised concerns about infection prevention control (IPC) within the home. They told us that despite receiving feedback from the provider and giving them recommendations and time to implement changes issues consistently remained with the standard of cleanliness and safety within the home.

The registered manager had completed an action plan in relation to issues raised by external partners and professionals, however despite actions being stated as complete we saw that issues remained and the date within the action plan had not been altered to reflect this. Internal IPC audits were being completed within the home but did not monitor the issues raised from external professional audits or fully identify the issues we found on assessment.

The registered manager and compliance manager acknowledged the concerns and failings found on the assessment and were open and transparent with their response and desire to improve the service. The management team acted on feedback we provided from the onsite assessment immediately and we saw evidence that these concerns had been communicated to staff with an appropriate action plan to support development, changes and improvement.

The provider had failed to implement learning and improvement in a timely manner. Despite concerns being raised about IPC and quality of care by other professionals over a period of time the registered manager had not implemented appropriate quality monitoring systems to evaluate the service being delivered. This meant people had been placed at risk of avoidable harm and people had experienced care that was not person-centred.