CQC report explained · a nursing home
What the CQC found at Forest Hill
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Requires improvement
- People were not always protected from abuse or avoidable harm. Staffing was sometimes insufficient, cleanliness was poor in places and medicines were not always given at the prescribed time.
- Effective?
- Good
- People's needs were assessed and they were supported with healthcare, food and drink. However, staff did not always have enough time to read current care plans or receive regular supervision.
- Caring?
- Requires improvement
- Staff were caring and respected people's privacy and dignity. However, people were not always involved in care reviews or given information in ways they could understand.
- Responsive?
- Requires improvement
- Care plans were not consistently personalised, reviewed or up to date. People were not always supported with meaningful activities, accessible information or effective responses to complaints.
- Well-led?
- Requires improvement
- Quality checks and management oversight did not identify or resolve important problems consistently. Staff and relatives also gave mixed feedback about communication and whether concerns were acted on.
What inspectors found, May 2022
Rated Requires Improvement; inspectors found risks around safeguarding, staffing, cleanliness, medicines and care planning.
The inspection took place without notice on 17 and 21 February 2022. Inspectors spoke with people, relatives and staff, observed care, and checked care records, medicines, training and quality checks.
They found some good care. Staff knew people's health needs, supported access to healthcare and provided a varied diet. Staff were generally kind and respected privacy and dignity.
However, people were not always protected from avoidable harm. Staffing was sometimes too low, areas were unclean or poorly maintained, medicines were not always given at the prescribed time, and care records were not consistently up to date. The overall rating was Requires Improvement. The ratings for Safe, Caring, Responsive and Well-led were Requires Improvement, while Effective was Good.
Kind and respectful staff
Staff were generally caring and treated people with dignity. Inspectors saw staff offering care warmly and respecting privacy.
“Throughout our inspection, we saw staff took time to spend with people when they were able.” from the report
Healthcare support
People were supported to see healthcare professionals when needed, and records confirmed this.
“People were supported by staff to access healthcare services when required.” from the report
Food and drink
People had a varied menu, with support and special diets provided where needed.
“People were supported and encouraged to have a varied diet that gave them enough to eat and drink.” from the report
Safeguarding failures
seriousThe provider did not always act promptly after safeguarding concerns. Investigations found failures to prevent avoidable harm and reduce the risk of repeat incidents.
“Recent local authority safeguarding investigations identified a number of occasions where the provider had failed to keep people safe from avoidable harm” from the report
Not enough staff
seriousStaffing levels did not always meet people's needs safely. Inspectors found 10 days with fewer staff than the provider had assessed as necessary on one unit.
“There were times when there was not enough staff to meet people's needs safely.” from the report
Poor cleanliness and maintenance
seriousSome areas, equipment and pressure cushions were dirty or damaged. The report also found too few domestic staff to keep the building clean.
“Areas of the service were not clean or maintained well.” from the report
Medicines not always on time
needs fixingInspectors were not assured that prescribed medicines were always given at the right time. A lunchtime medicines round was still continuing late in the afternoon.
“We were not assured people received their prescribed medicines at the right times.” from the report
Care plans and communication
needs fixingPeople were not always involved in care reviews, and records did not consistently reflect their wishes, preferences or current risks. Accessible communication was not provided consistently.
“Information in people's care plans was not consistently kept up to date.” from the report
Weak management checks
seriousThe provider's audits did not reliably identify or fix problems with safety, cleanliness, staffing or person-centred care.
“There was a lack of robust oversight of the quality of care.” from the report
- 01What action has been taken to prevent safeguarding incidents and reduce the risk of repeat harm?
- 02How do you now calculate staffing levels, including support for people needing one-to-one observation or emotional support?
- 03What checks are made to ensure bedrooms, equipment, pressure cushions and shared areas are clean and well maintained?
- 04How do you ensure medicines are given at the prescribed time, especially when staffing is short?
- 05How are people who have difficulty communicating involved in care reviews and supported to make complaints?
This inspection covered all five CQC key questions and included infection prevention, COVID-19 vaccination requirements, care observations, records, medicines, staffing and quality systems. This explanation was written from the published report of 12 May 2022 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, November 2017
Forest Hill was rated Outstanding overall, with especially strong caring and personalised support, and Good ratings for safety, effectiveness and leadership.
Inspectors visited on 15 and 17 August 2017. The first visit was unannounced. They spoke with people, relatives, staff and managers, observed care, and checked care records, medicines, staff files and quality checks.
People told inspectors they felt safe and very well cared for. Staff understood people's individual needs, risks and preferences. There were enough staff, medicines were managed safely, and people were supported to access healthcare, food and activities.
The caring and responsive parts of the service were rated Outstanding. Inspectors saw kind, respectful care and creative support that helped people stay independent, follow their interests and remain connected with their community. Safe, effective and well-led were rated Good, meaning the home met a high standard in these areas but was not judged exceptional overall.
Kind and dignified care
Staff treated people with warmth, patience and respect. Inspectors saw staff protect privacy and help people feel valued.
“Staff always treated people with dignity and respected their right to privacy.” from the report
Personalised activities
Activities reflected people's life histories, interests and wishes. People were supported to continue hobbies, attend events, care for pets and stay involved in their community.
“Staff looked for creative ways to support people's lifestyle choices and maintain interests which were important to them.” from the report
Open leadership
Staff, people and relatives could raise concerns or suggest improvements. Quality checks were used to identify issues and make changes.
“There was an open and inclusive culture within the service, and staff had clear guidance on the standards of care expected of them.” from the report
Support at the end of life
People and relatives were involved in decisions about future care where appropriate. Staff received additional training and considered people's cultural and religious needs.
“People had advance care plans in place which included, where appropriate, clear records of their wishes about resuscitation.” from the report
Inspectors raised no specific concerns in this report.
- 01How would you use my relative's life history, preferences and communication needs to plan their care and activities?
- 02How do you review staffing levels when people's care needs change?
- 03What activities and community links would be available for my relative's particular interests, faith or culture?
- 04How would you involve my relative and our family in decisions about care towards the end of life?
- 05How can we raise a concern or complaint, and how would you keep us informed about the response?
This was an inspection of all five key questions, using conversations, observations and checks of care, medicines, staff and quality records. This explanation was written from the published report of 22 November 2017 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Forest Hill
3 rated inspections over 7 years: the service has slipped, from Good to Requires improvement.
- May 2022Requires improvementcurrent ratingdown from OutstandingSafe: Requires improvementEffective: GoodCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- November 2017Outstandingup from GoodSafe: GoodEffective: GoodCaring: OutstandingResponsive: OutstandingWell-led: Good
- June 2015GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- January 2014
Report published without a new overall rating.
- November 2012
Report published without a new overall rating.
- February 2011
Registered with the Care Quality Commission on 15 February 2011.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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