Archived: Ferndene Care Home

At the time of our inspection 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 service had previously been rated as ‘requires improvement’ in 2015 and 2017. At this inspection the service was rated as ‘requires improvement’. This was the third consecutive time the service was rated as ‘requires improvement’. The service had made some improvements but had not fully addressed the issues raised at previous inspections. At this inspection we found breaches of regulation 18 and regulation 17. There was insufficient numbers of suitably skilled staff. Due to the failure of the provider to address issues previously identified at inspection there was a breach of regulation 17.

The provider had ensured that there was usually a sufficient number of staff on duty however some staff did not have the experience required to carry out their duties. People told us that they received person-centred care. Sufficient background checks had been completed before new staff had been appointed according to the provider’s policy. A system was in place to carry out suitable quality checks and appropriate checks had been regularly carried out, however action plans were not always in place to address issues identified.

There were systems, processes and practices to safeguard people from situations in which they may experience abuse including financial mistreatment. Most risks to people’s safety had been assessed, monitored and managed so they were supported to stay safe while their freedom was respected. The environment was clean. Staff did not adhere to arrangements to prevent and control infections.

Guidance was in place to ensure people received their medicines when required. Processes were in place to manage medicines. Where people required their medicines via a specialist method to administer food arrangements had not been in place to ensure the method of administration did not affect the efficacy of the medicine. We have made a recommendation about the management of some medicines.

Where people were unable to make decisions, arrangements were in place to ensure decisions were made in people's best interests. Best interests decisions were specific to the decisions which were needed to be made.

Care was not always delivered in line with current best practice guidance. There were ongoing issues with regard to staff not consistently treating people with dignity and respect. Arrangements were in place to ensure staff received training to provide care appropriately and effectively. People were helped to eat and drink enough to maintain a balanced diet. People had access to healthcare services so that they received on-going healthcare support.

People were supported to have choice and control of their lives. Staff supported them in the least restrictive ways possible. The policies and systems in the service supported this practice.

People were usually treated with kindness and compassion and they were given emotional support when needed. They had also been supported to express their views and be involved in making decisions about their care as far as possible. People had access to lay advocates if necessary. Confidential information was kept private.

Information was provided to people in an accessible manner. People had been supported to access a range of activities. People were supported to access local community facilities. The registered manager recognised the importance of promoting equality and diversity. People’s concerns and complaints were listened and responded to improve the quality of care. Arrangements were in place to support people at the end of their life.

The registered manager encouraged a positive culture in the home. Staff had been helped to understand their responsibilities to develop good team work and to speak out if they had any concerns. People, their relatives and members of staff had been consulted about making improvements in the service. There were arrangements for working in partnership with other agencies to support the development of joined-up care.

Further information is in the detailed findings below.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for (location's name) on our website at www.cqc.org.uk. We carried out an unannounced focussed inspection of this service on 25 September 2017.

At our previous inspection on 19 July 2017 we found that the provider did not have effective and safe systems in place for the management and administration of medicines. After the inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches. We undertook a focussed inspection on 25 September 2017 to check that they had followed their plan and to confirm that they now met legal requirements. At our inspection on 25 September 2017 we found the provider had made the necessary improvements.

Ferndene Care Home provides care for older people who have mental and physical health needs. It provides accommodation for up to 48 people who require personal and nursing care. Care is provided on two floors which are divided into two units. At the time of our inspection there were 44 people living in the home permanently and one person on a short term basis.

At the time of our inspection 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.

We found the issues raised at our previous inspection had been addressed. Where people received their medicines without their knowledge (covertly) arrangements were in place to ensure this was in their best interests and managed safely.

The provider had complied with their medicines policy. Staff ensured they had assurance that people had taken their medicines before signing the medicine administration records (MARs). The provider had systems in place to ensure that people received their medicines as prescribed. Where risks had been identified risk assessments and plans of care to meet the risks had been completed.

Arrangements were in place to ensure people received their ‘as required’ medicines (PRN) appropriately. Medicine records were completed fully.

However we also found some minor additional issues in relation to medicines management. Medicines were not consistently managed safely. The provider had started to carry out medicine audits on a regular basis however medicine audits did not identify some of the issues we found at this inspection.

The application of topical creams had not been recorded consistently. Fridge temperatures were regularly recorded as not within an acceptable range to ensure medicines were effective which meant medicines were not stored consistently at a recommended temperature.

There was not 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. There was a manager in post who was applying to become registered as the manager?

On the day of our inspection staff interacted well with people. People and their relatives told us that they felt safe and well cared for. Staff knew how to keep people safe. The provider had systems and processes in place to keep people safe.

Medicines were not consistently administered and managed safely.

We saw that staff obtained people’s consent before providing care to them. Where people could not consent, staff worked in ways that protected their rights.

We found that people’s health care needs were assessed and care planned and delivered to meet those needs. People had access to healthcare professionals such as the district nurse and GP and also specialist professionals. People had their nutritional needs assessed and were supported with their meals to keep them healthy. People had access to drinks and snacks during the day and had choices at mealtimes. Where people had special dietary requirements we saw that these were provided for.

There was not sufficient staff consistently available to meet people’s needs. However at the time of inspection the provider was using agency staff to maintain staffing levels. Staff responded in a timely and appropriate manner to people. Staff were kind and sensitive to people when they were providing support. People were treated with respect.

Staff were provided with training on a variety of subjects to ensure that they had the skills to meet people’s needs. The provider had a training plan in place. A plan was in place to provide staff with supervision. People were encouraged to enjoy a range of social activities. They were supported to maintain relationships that were important to them.

Staff felt able to raise concerns and issues with management. Relatives were aware of the process for raising concerns and were confident that they would be listened to. Regular audits were carried out and action plans put in place to address any issues which were identified. The process had failed to identify some of the issues we found at inspection. Accidents and incidents were recorded and investigated. The provider had not consistently informed us of notifications. Notifications are events which have happened in the service that the provider is required to tell us about.

Due to people's complex needs some were unable to share their views in a meaningful way. However, we spoke with the manager, deputy manager, five members of staff, three people who used the service, one relative and one visiting health care professional and looked at records. Two of the people who used the service told us, 'It could not be better, there is something going on all day and it is the next best thing to being at home.' We spoke with a visitor who told us, 'The staff are very caring and they treat my relative respectfully and with dignity.' A visiting health care professional told us, 'The residents are always busy which gives a good impression when you visit.'

We saw food was prepared using fresh ingredients, it was well presented and people were offered a variety of choices.

We found that Ferndene Care Home met the needs of the people who live there. The gardens were accessible, well maintained and contained three patio areas for people and their families to use.

The provider had systems in place to monitor and assess the quality of the service.

We undertook our visit early in the morning and spent time in a communal area in part of the home. We observed how staff interacted with people living in the home. We found that night staff provided safe care and that they enabled people to make choices about how they wanted to spend their time, even where their understanding and communication was limited.

We spoke to one person who used the service, eleven staff members and the registered manager and looked at records. These included care records and information about how the service operated.

We saw that people had information to tell them about what the home provided when they moved in, that they could express themselves in the way they wished and were encouraged to be as independent as possible.

When we asked one person if they liked living at the home they told us, 'I wouldn't want to go anywhere else. It's my own home and I love my room.'

The person also told us how they enjoyed the social activities staff at the home had organised. We saw there was a range of activities and events that people took part in.

We found that the manager and staff had the right skills and experience for the job and that people and staff felt confident taking any suggestions or concerns to the manager.