Archived: The Old Forge

Updated 21 January 2016

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 1 and 2 December 2015 and was unannounced. This meant staff and the provider did not know we would be visiting. The inspection was carried out by one inspector.

We previously inspected the service on the 6 January 2014. At that time the service was meeting the regulations inspected.

Before the inspection the provider completed a Provider Information Return (PIR) The PIR is a form that the provider submits to the Commission which gives us key information about the service, what it does well and what improvements they plan to make. We reviewed the previous inspection reports of the home and other information we held about the home.

Some people who used the service were unable to communicate verbally with us. Therefore we used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

During the inspection we walked around the home to review the environment people lived in. We spoke with the registered manager, support lead and four support staff. We also spoke with one relative by telephone after the inspection and obtained written feedback from another relative. We looked at a number of records relating to individuals care and the running of the home. These included three care plans, medicine records for three people, staff duty rosters, shift planners, three staff recruitment files and three staff supervision records.

Updated 21 January 2016

The Old Forge is a care home which provides accommodation and personal care for up to four people with learning/physical disabilities. It is a converted bungalow in a village setting.

At the time of our inspection there were four people living in the home. There was a registered manager in post. 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.

The inspection took place on the 1 and 2 December 2015 and was carried out as part of our schedule of comprehensive inspections.

Staffing levels were not sufficient to meet people’s needs. As a result risks associated with eating and swallowing were not managed in line with professional guidance. Sufficient staff were not always provided to ensure people who required two staff for moving and handling could have their personal care needs met and access to activities were limited.

Risk assessments were in place, however some risk assessments lacked details on how specific risks were to be managed and risk assessments were not in place for all identified risks.

Systems were in place to manage infection control, however staff practice did not always promote safe working practices to prevent the risks of cross infection. The kitchen was under refurbishment and therefore out of use. As a result the laundry room and sink was being used on a temporary basis to wash dishes. There was no risk assessment in place to manage the risks of cross infection associated with this. Discussions had taken place regarding potential risks and staff were aware of what they needed to do to prevent cross infection.

Improvements were required to recruitment practices. We have made a recommendation to address this.

Food and fluid intake was monitored but accurate records were not maintained of the total amounts required and taken. We have made a recommendation to address this.

Mental capacity assessments took place and decisions on people’s care and treatment were made in line with legislation. Deprivation of liberty safeguards (DoLS) had been approved by the local authority. However the home failed to obtain copies of the approved applications and inform the Commission in a timely manner.

Staff were kind, caring and gentle in their approach. They offered people choices and engaged with them. However we saw limited use of aids, objects of reference and signing to communicate with people as was outlined on their communication diaries. We have made a recommendation to address this.

Relatives told us staff were kind, caring and gave an example where they felt staff had gone the extra mile.

Care plans were in place. They were not person centred and were not updated to reflect change in people’s needs. They showed no evidence of people’s involvement in them.

The range of activities on offer was limited and activities did not take place regularly. We have made a recommendation to improve access to more person centred activities for people.

Staff were suitably inducted, trained, supervised and appraised. They told us they worked well as a team and felt the home was well led and managed. They found the registered manager and support lead to be accessible and approachable. However we found the registered manager was responsible for managing two locations with not enough staff to enable them to do it effectively.

Medicines were safely managed. Systems were in place to audit the service but the audits failed to address the issues we found at this inspection.

We found 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.