Archived: The Old Forge

The Old Forge is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The care service has not been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. The values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen. We found that people were not able to be included in their local community due to its geographical location and the lack of transport and staffing. At the time of our inspection, two people were living in the service.

The service did not have a registered manager in place. The previous manager deregistered with the Care Quality Commission (CQC) in January 2018. 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.

People’s relatives spoke positively about the care being provided within the service. We observed staff who cared for people in a respectful and kind way. We saw positive relationships had been formed between staff and the people they cared for.

The provider had failed to monitor the quality of the management in the home and this had resulted in a lack of progress concerning the expected improvements from our previous inspection in February 2017. There were still not enough staff available to meet people’s needs and to keep them safe. Activities were not regularly available outside of the home. This prevented people from accessing their local community and placed them at risk of social isolation.

We identified breaches to Regulation 12 of the Health and Social Care Act 2008. This was because personal emergency evacuation plans did not accurately reflect people’s needs and did not give clear and consistent guidance to staff on how to evacuate the service safely. Furthermore, the fire emergency plan was not up to date. Risks related to the care being provided and the environment had not always been mitigated. When risks were identified, appropriate action was not always taken to minimise the risk.

In addition, there were gaps and inaccurate records alongside a lack of managerial oversight. This placed people at risk of receiving inappropriate or unsafe care. Insufficient staff members meant people did not always receive the care they required at the time they needed it. Staff were not always trained in the areas needed to carry out their role.

People did not always receive food that was safe for them to eat. Professional advice was not always followed.

Medicines were administered appropriately, and records reflected this. Staff understood how to protect people from the risk of infection. Recruitment records contained the relevant checks and staff had received training in how to protect people from the risk of abuse. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems at the service supported this practice. We have made a recommendation to ensure staff were trained in Mental Capacity Act and were following the best interest process. We found this was not always happening.

There was a lack of care reviews taking place with people and their representatives. Although we found some good practice in relation to how people were assisted to communicate, we also found guidelines were not being followed. We have made a recommendation about the Accessible Information standard.

We found this was not a well-managed service. There was a lack of management presence, with no clear reason given. The service manager was managing two services, but appeared to spend little time at The Old Forge. The senior staff were clearly struggling to manage the service, and management support had been slow to respond. A lack of management oversight meant the service had not operated to an acceptable level. Where areas of the service had been identified as requiring improvement these had not been acted upon in a timely way.

We found senior staff were not aware of the requirements related to the Duty of Candour. We have made a recommendation about this.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

The service had transferred to a new provider and their registration with the Care Quality Commission was completed in October 2016. The home 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.

Most aspects of the service were safe, however we had concerns about the level of staffing. There were times when there were not enough staff to meet people’s needs. We have made a recommendation about staffing levels. The administration, recording and storage of medicine was safe. The registered manager took appropriate steps to ensure suitable people were employed to support people using the service.

The service was effective; this was demonstrated through the support staff received to carry out their roles effectively. The Mental Capacity Act 2005 (MCA) had been considered in relation to people’s care and where appropriate applications for the Deprivation of Liberty Safeguards had been submitted to the local authority. People’s health needs were met through contact with external professionals, and people’s dietary needs were met.

The service was caring. Comments included praise for the staff regarding their competence and their caring attitudes. People were treated in a respectful way and records related to people were considerate. People appeared well cared for and their need were being met.

The service was mostly responsive. We had concerns sometimes there were not enough staff to support people to participate in activities outside of the home and the people who remained at home were not given enough stimulation. We have made a recommendation about activities. Care plans outlined people’s needs and changes to people’s care needs were documented. Systems were in place to manage complaints.

The service was well led. There was a registered manager in place. Staff and relatives spoke positively about them and felt supported by them. Audits were in place to identify areas of required improvement and to drive forward those improvements. Feedback we received about the service was positive. There were plans in place to introduce feedback from relatives and staff. There was a contingency plan in place to ensure continuity of service in the event of unexpected disruption.