CQC report explained · a nursing home
What the CQC found at Lady Forester Community Nursing Home
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- People told inspectors they felt safe. Risks were assessed and reviewed, staffing levels were sufficient, equipment was checked, and medicines were securely managed with clear records.
- Effective?
- Good
- Staff had the training and skills needed to support people. People's health, nutrition, consent and capacity were considered, and staff worked with healthcare professionals.
- Caring?
- Good
- Inspectors found kind and respectful interactions. People were involved in decisions, their privacy was protected, and staff supported them to remain as independent as possible.
- Responsive?
- Good
- Care plans reflected people's needs, preferences and communication requirements. People could choose how they spent their time, keep in touch with relatives, join activities and receive personalised end of life care.
- Well-led?
- Good
- The home had a registered manager and an experienced management team. Audits, feedback and discussions with people were used to monitor quality and make improvements.
What inspectors found, November 2019
Rated Good; inspectors found safe, kind and personalised care, with improvements since the previous Requires Improvement rating.
Inspectors visited on 23 and 24 October 2019. The first day was unannounced and the second was announced. They spoke with people using the service, relatives and staff, observed care, and checked care, medicines, recruitment and management records.
All five areas were rated Good: Safe, Effective, Caring, Responsive and Well-led. Inspectors found enough skilled staff, safe medicines systems, good support with health and nutrition, and care that respected people's choices, dignity and independence.
The previous inspection, published in October 2018, had rated the service Requires Improvement and found three breaches of regulation. Inspectors found that the provider had made improvements and was no longer in breach.
Safe staffing and risk checks
Inspectors found enough skilled and experienced staff. Risks, equipment and emergency evacuation arrangements were assessed and monitored.
“There were sufficient numbers of skilled and experienced staff to meet people's needs.” from the report
Respectful care
People were treated with kindness, dignity and respect. Staff supported people to make choices and do as much as they could for themselves.
“There was a relaxed and happy atmosphere and staff interacted with people in a kind and respectful manner.” from the report
Personalised choices
People could choose when to get up, when to go to bed and how to spend their day. Their preferences and social histories were recorded in care plans.
“People were able to make choices about their day to day care.” from the report
Learning and improvement
Management systems had improved since the previous inspection. Audits and checks were being used to identify shortfalls and drive improvements.
“There were a number of audits and checks which were effective in identifying shortfalls and driving improvements.” from the report
Food and healthcare
People spoke positively about the food. Staff supported individual diets, monitored food and fluids where needed, and worked with health professionals.
“Everyone we spoke with was very complimentary about the meals provided.” from the report
Inspectors raised no specific concerns in this report.
- 01How will you keep my relative's care plan updated if their needs, preferences or signs of distress change?
- 02How do you check that staff continue to follow the Mental Capacity Act and make least restrictive best-interest decisions?
- 03How are call-bell response times monitored, and what happens if response times become slower?
- 04How will you record and respect my relative's wishes about end of life care, including religious preferences?
- 05How do your audits identify problems, and can you give an example of an improvement made recently?
This was a planned inspection of the care home and the personal care provided by the linked domiciliary care agency, covering all five key questions. This explanation was written from the published report of 16 November 2019 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, October 2018
Lady Forester Community Nursing Home was rated Requires Improvement; inspectors found safe and caring support but weaknesses in care planning, people's rights and management checks.
Inspectors made an unannounced, comprehensive visit over two days. They spoke with people, visitors, managers and staff. They observed care and reviewed six care plans, risk assessments, medicine guidance, quality checks, incident records and recruitment records.
The home was rated Good for Safe and Caring. Inspectors found that people were protected from abuse, medicines were generally given safely, staff were recruited safely, and people's privacy, independence and relationships were respected.
The home was rated Requires Improvement for Effective, Responsive and Well-led. Care plans were not always accurate or up to date. Mental Capacity Act assessments were missing, some risk calculations were wrong, and support for distress, end of life care, communication needs and personal identity was not always properly planned.
Inspectors found three breaches of regulations. These concerned person-centred care, required notifications and good governance. The overall rating fell from Good at the previous inspection to Requires Improvement.
Protection from abuse
Staff knew how to recognise possible abuse and how to report concerns. The home acted on safeguarding concerns appropriately.
“People were protected from the risks of harm or abuse as the staff team knew how to recognise the signs and how to report concerns.” from the report
Kind and respectful care
People said staff were caring and respectful. Staff protected privacy and encouraged people to remain as independent as possible.
“People were supported to maintain relationships with those that mattered to them.” from the report
Medicines and health support
Staff were trained and assessed as competent to give medicines. People were referred promptly to other healthcare professionals when needed.
“People received their medicines, as prescribed, with the assistance of staff who were competent to safely support them.” from the report
Food and drink
People had choices and received support with meals at a suitable pace. Specific diets and individual preferences were catered for.
“People received support with their diet and nutrition to promote well-being.” from the report
Open management approach
People and staff found the management team approachable. Staff felt able to raise concerns and suggestions.
“People and staff members told us that they found the registered manager to be open and approachable.” from the report
Care plans were incomplete
seriousCare and support plans did not consistently describe current needs, preferences, repositioning support or end of life wishes. Staff said they often relied on verbal information instead.
“People did not have up to date care and support plans that reflected their needs and preferences.” from the report
Mental Capacity Act practice
needs fixingThe home could not show formal, decision-specific capacity assessments for people who may lack capacity. This meant people's rights could not be assured.
“We could not be assured that decisions made on behalf of those living at Lady Forester Community Nursing Home were in accordance with best practice outlined by the MCA.” from the report
Distress was not always supported
needs fixingOne person remained upset for a prolonged period while staff passed by without trying to understand the cause or provide reassurance.
“Staff members did not respond to this person in a timely manner and did not seek to understand the cause of their distress or reassure the person.” from the report
Management checks missed problems
seriousQuality checks failed to identify errors in risk assessments, missing care plan information, medicine recording gaps and failures to apply the Accessible Information Standard.
“The management team and provider did not have effective quality checks in place to identify and drive improvements in the service they provided.” from the report
Staff time was sometimes limited
minorPeople and staff gave mixed views about staffing. Inspectors saw staff busy in the morning, with little time for meaningful conversation.
“People's experience of positive staff interaction differed throughout the day and was inconsistent.” from the report
Activities were uneven
minorThere was little to occupy people during part of one morning. One person living with dementia was left with limited explanation or support during an activity.
“However, we saw one person who was living with dementia had been moved to this table with little explanation of what was happening.” from the report
- 01How have you made sure every person's care plan reflects their current needs, wishes and end of life choices?
- 02How do you complete and record decision-specific Mental Capacity Act assessments and best-interest decisions?
- 03How do staff find out how to support someone who is distressed, anxious or at risk of loneliness?
- 04What checks now make sure risk assessments, medicine records and care plans are accurate and complete?
- 05What activities and communication support are available for people living with dementia, sight loss or hearing loss when the activities coordinator is not working?
This was an unannounced comprehensive inspection covering all five key questions, with ratings compared with the previous inspection in October 2015. This explanation was written from the published report of 25 October 2018 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 Lady Forester Community Nursing Home
3 rated inspections over 4 years: the service has held its Good rating throughout.
- November 2019Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
Read what inspectors found at Lady Forester Community Nursing Home →
- October 2018Requires improvementdown from GoodSafe: GoodEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
Read what inspectors found at Lady Forester Community Nursing Home →
- December 2015GoodSafe: GoodEffective: GoodCaring: GoodResponsive: Requires improvementWell-led: Good
- July 2014
Report published without a new overall rating.
- November 2013
Report published without a new overall rating.
- December 2012
Report published without a new overall rating.
- November 2011
Report published without a new overall rating.
- April 2011
Registered with the Care Quality Commission on 18 April 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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