Fernbrook House

We found the following examples of good practice.

People and staff had regularly been tested for COVID-19 and where positive results had been returned the registered manager had acted quickly to support people and mitigate risks.

All staff had received training on infection prevention control and how to use PPE effectively.

The registered manager had followed government guidance on infection prevention control measures and had kept these up to date.

People were supported to have visitors safely and were visits were unable to go ahead alternative contact measures were in place.

Fernbrook House is a nursing home providing personal and nursing care to people aged 65 and over. The service can support up to 30 people and at the time of the inspection there were 24 people living there. The service is in a residential area and accommodates people in an adapted building across two floors.

People’s experience of using this service and what we found

People were being supported safely by staff who knew them well. However, written guidance to staff around the support people needed, in particular with their medicines was not always accurate or complete. This meant the provider had not ensured people would be protected from risk if they received care from staff who did not know them.

We raised concerns about medicine administration at our last inspection. The registered manager had acted promptly to address areas of risk. However, their improvement plans had not been sustained and quality checks had not picked up the concerns we found at this inspection.

After this inspection the immediate concerns we raised were resolved promptly so that any temporary staff would have the necessary information to support people safely. Further time was needed to ensure the provider used their systems effectively to pick up concerns and act on them.

At our last inspection we had raised concerns about infection control practices. The provider had addressed these issues and started a programme of refurbishment, which was ongoing. The provider and the whole staff team demonstrated a commitment to minimise the risks from COVID-19. There were measures in place to prevent infection and to support people to remain in touch with families and friends.

There was an established registered manager who knew people well and who managed the staff team effectively, for the benefit of the people they supported. Morale was good and there was a positive culture at the service.

There were enough staff to support people safely. Staff worked effectively to ensure people achieved good outcomes. We received positive feedback from relatives about the care people received and observed during our visit to the service that staff supported people with kindness.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 21 November 2019) and there were two breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

We issued a warning notice following our last inspection outlining our concerns around medicine. Sufficient improvement had been made at this inspection and we did not need to take action in relation to the notice. However, the provider’s improvement plans had not been implemented fully effectively and the provider was still in breach of one regulation around leadership.

Why we inspected

We undertook this targeted inspection to check whether the Warning Notice we previously served in relation to Regulation 12, (1)(2)(a)(b)(e)(g)(h) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. We also reviewed the actions taken in relation to the breaches found at the inspection of July 2019. The overall rating for the service has not changed following this targeted inspection and remains requires improvement.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Fernbrook House on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Fernbrook House is a nursing home providing personal and nursing care to 24 people aged 65 and over at the time of the inspection. The service can support up to 30 people. The nursing home is in a residential area and accommodates people in an adapted building across two floors.

People’s experience of using this service and what we found

People told us they felt safe at Fernbrook House. However, the environment was not always cleaned effectively to reduce the risk of infection and people’s medicines were not always managed safely. Cleaning products were not always securely stored to prevent possible injury to people and some environmental risks had not been addressed. Staff understood how to safeguard people from the risk of abuse and there were enough staff to meet people’s needs. Incidents were investigated, and actions taken to prevent any recurrence.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice but had not been followed. People's needs were assessed prior to them moving into the service to help ensure they were cared for effectively. Staff received training, support and supervision to enable them to carry out their roles. The service worked in partnership with other health and social care professionals and these relationships had supported people to have good outcomes.

People, their relatives and health professionals were extremely positive about the care provided at Fernbrook House and there was a positive culture within the service. Staff were kind and supported people with dignity and respect. Positive relationships had been formed between staff and people using the service. People were supported by staff who knew them well and supported them according to their needs and preferences. People were involved in how the service was run and encouraged to be as independent as possible. They had the choice to participate in activities which promoted a good quality of life. End of life planning required further development. We made a recommendation that the service consults a reputable source to further develop end of life planning.

People, relatives and staff were positive about the registered manager and how the service was managed. Auditing systems were ineffective and had failed to address key concerns identified at this inspection.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Good (published 9 May 2017).

Why we inspected

The inspection was prompted in part due to concerns received about poor care at the service. A decision was made for us to inspect and examine these concerns.

Enforcement

We identified two breaches in relation to medicines management, the storage of cleaning products, infection control and managerial oversight at this inspection. The provider took some action to mitigate the risks after the first day of inspection, however further improvement was still required.

Please see the action we have told the provider to take at the end of this report. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme and to check that improvements have been made. If we receive any concerning information we may inspect sooner.

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.

Since October 2016, Fernbrook House now has a new provider and at this inspection we found the new management team had made several improvements.

Staff delivered support effectively and care was provided in a way that promoted people’s independence and wellbeing, whilst people’s safety was ensured. Staff were recruited and employed upon completion of appropriate checks as part of a robust recruitment process. Sufficient numbers of staff enabled people’s individual needs to be met adequately. Trained staff dispensed medications and monitored people’s health satisfactorily.

Staff understood their responsibilities and how to keep people safe. People’s rights were also protected because management and staff understood the legal framework of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

The manager and staff ensured access to healthcare services were readily available to people and worked with a range of health professionals, such as social workers, community mental health nurses and GPs to implement care and support plans.

Staff were respectful and compassionate towards people ensuring privacy and dignity was valued. People were supported in a person centred way by staff who understood their roles in relation to encouraging independence whilst mitigating potential risks. People were supported to identify their own interests and pursue them with the assistance of staff. Person centred social activities took place within the service.

Systems were in place to make sure that people’s views were gathered. These included regular meetings, direct interactions with people and questionnaires being distributed to people, relatives and healthcare professionals. The service was assisted to run effectively by the use of quality monitoring audits carried out by the manager and provider, which identified any improvements needed and actions were taken. A complaints procedure was in place and had been implemented appropriately by the management team.

We considered our inspection findings to answer five key questions; is the service safe, effective, caring, responsive and well-led? This is a summary of what we found;

Is the service safe?

When we arrived at the service a member of staff checked our identity and we were asked to sign in the visitor's book. This meant that the appropriate actions were taken to ensure that the people who used the service were protected from others who did not have the right to access their home.

Staff had received a range of training to ensure that they worked in ways that were safe. Training included fire safety, first aid, the safeguarding of vulnerable adults from abuse (SOVA) and the Mental Capacity Act (MCA) 2005. This assured people who used the service that staff had the knowledge to know how to care for them safely and protect them from harm.

During our inspection we assessed how the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS) were being implemented. Mental capacity assessments had been completed for people correctly to maintain the safety and rights of people who used the service.

People told us they were content living in the service and that they would speak with the staff if they had concerns.

We found that people lived in a safe environment which was kept maintained. We saw records which showed that the health and safety in the service was regularly checked. This included regular fire safety checks which meant that people were protected in the event of a fire.

When people needed to use equipment such as hoists, specialist beds and mattresses we found that these were kept clean and well maintained to ensure people's safety.

Is the service effective?

People told us that they were very happy with the service and that it met their needs. People made comments such as, "I am quite content here," and, "The staff are good." People who were unable to verbally express their views were relaxed, interacted well with staff and were being well supported. Feedback from relatives showed that they were happy with the care and support offered at Fernbrook House. One person told us, "It is always so warm and welcoming."

People's care was supported through assessments, care plans and risk assessments being in place. This ensured that staff understood people's needs and could care for them safely, effectively and consistently.

Staff who worked in the service were recruited safely and checked to ensure that they were suitable to work with vulnerable people. New staff undertook an induction programme so that they got to know about the service, expected levels of practice and the needs of the people living in Fernbrook House.

Is the service caring?

We saw and heard good interactions between the staff and people who used the service. Staff were respectful, caring, encouraging and supportive towards people.

We saw that feedback from relatives about the service included comments such as, 'The most important aspect is that the staff really care and take time to talk to residents on a one to one basis," and, "The staff are all very caring."

Is the service responsive?

We saw that staff consulted with people and offered them choices in their daily lives. People's choices were taken into account and listened to.

Staff were responsive to people's changing wishes and needs about where they went and what they did and supported them well.

People's care records showed that where concerns about their wellbeing had been identified the staff had taken appropriate action to ensure that people were provided with the support they needed. This included seeking support and guidance from other health care professionals.

Is the service well-led?

The service had a manager in post who was supported by the senior team of the organisation. The provider had systems in place such as quality surveys and audits to monitor and improve the service. This showed us that the service was being well led.

We saw that care and treatment for each person was planned and reviewed with their involvement where possible. People were given choices in their day to day lives.

Staff were trained and supported to care for people properly and to keep them safe. Risks to the health, welfare and safety of people using the service were identified and managed.

The service was clean and there were systems in place for minimising the risks of the spread of infection.

Medicines were stored, administered and disposed of safely and people's medicines were regularly reviewed to ensure that they were appropriate and effective.

The service was well managed and there were effective systems in place for monitoring and improving the quality and safety of the service, taking into account the views and suggestions of people living there.

People living in the service were mostly content. One person told us, 'I am quite happy here, the food is good, the staff are good and I can do as I wish.' One visiting relative said, 'The staff are always welcoming, I feel like part of the furniture."

We found that the service needed to take action in some areas to improve the quality of care and service provided to people. People needed to have more opportunities for stimulation and activity. Care and staff practices needed to be better monitored to ensure people's health and welfare.

People praised the staff at the service and we found that staff had been trained to a satisfactory level. Staff did not however receive regular formal supervision or support to assist them in their ongoing development and maintaining standards.

The issues that we identified showed us that the overall quality monitoring of the service needed to be improved.