Care Outlook (Forest Hill) was rated Requires Improvement overall following a focused inspection in December 2022, with four regulatory breaches identified covering staffing, safe care and treatment, consent, and good governance. Persistent failures in electronic call monitoring, inconsistent care planning, unsafe medicines management, and absent mental capacity assessments posed ongoing risks to the 270 people receiving personal care.
Concerns (9)
criticalMissed or late visits: “Analysis of the ECM data showed persistent issues with lateness, unlogged visits, short visits, carers being logged in two locations at one time.”
critical
Medication management
: “Care plans contained conflicting information about the level of support people required to take their medicines.”
criticalConsent / capacity: “The provider had not conducted mental capacity assessments or followed a best interest process for these people in line with the MCA.”
criticalGovernance: “The provider did not have effective systems in place to monitor the safety and quality of the service as they had not identified the issues we found.”
criticalStaffing levels: “The provider had failed to ensure that sufficient numbers of suitably qualified, skilled and experienced persons were deployed.”
moderateCare planning: “Care plans contained conflicting information about people's risks and how these should be managed.”
moderateStaff training: “Not all staff had completed training to give them the necessary skills and knowledge to support people with a learning disability and autistic people.”
moderateRecord keeping: “We were not assured that all documents we reviewed were an accurate representation of what was in place as most documents had been edited before sending.”
minorPerson-centred care: “Care plans did not always contain sufficient detail about people's individual food and drink preferences.”
Strengths
· Staff had a good understanding of safeguarding procedures and knew how to escalate concerns
· The provider followed safer recruitment processes including DBS checks and employment history verification
· Staff followed safe hygiene practices and had plentiful PPE supply; COVID-19 mask wearing was maintained
· People were supported to access healthcare professionals including GPs, district nurses, opticians and chiropodists
· Staff received regular supervisions and ongoing training to develop their skills and knowledge
Quality-Statement breakdown (16)
safe: Staffing and recruitmentRequires improvement
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Using medicines safelyRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongGood
effective: Ensuring consent to care and treatment in line with law and guidanceRequires improvement
effective: Supporting people to eat and drink enough to maintain a balanced dietRequires improvement
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawRequires improvement
effective: Staff support: induction, training, skills and experienceRequires improvement
effective: Staff working with other agencies; Supporting people to live healthier livesGood
well-led: Managers and staff being clear about their roles; Continuous learning and improving careRequires improvement
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringGood
well-led: Engaging and involving people using the service, the public and staffRequires improvement
well-led: How the provider understands and acts on the duty of candourGood