Fernhill House

Updated 16 January 2024

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

This inspection was carried out by 2 inspectors and 1 Expert by Experience who spoke with people’s relatives remotely. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Fernhill House is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Fernhill House is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service.

During the inspection

We spoke with 3 people using the service and contacted 7 relatives of people to gain their view of the service. We spoke with 7 staff members, including the registered manager, the nursing unit manager and the dementia unit manager.

We reviewed a range of records. These included care records for 5 people and multiple medication records. We looked at 3 staff files in relation to recruitment. A variety of records relating to the management of the service, including quality assurance audits, incidents/accidents, and surveys, were reviewed.

Updated 16 January 2024

About the service

Fernhill House is a care home with nursing providing accommodation for persons who require nursing or personal care and treatment of disease, disorder or injury. Fernhill House accommodates up to 66 people in one purpose-built facility, with many different areas for people to spend time together or more privately as they choose. Care and support is provided to people with dementia, nursing needs, and personal care needs. There were 63 people living at the home at the time of our inspection.

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

On the first day of the inspection we noticed that not all topical creams were stored securely. There were no risk assessments for paraffin based topical creams. Some topical creams had no prescription labels or open date.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. The provider was not always working in accordance with The Mental Capacity Act 2005 and there was no evidence of the provider following best interest decision processes where medicines were administered covertly.

Some care plans and risk assessments were overdue on the first day of the inspection. A visit by the local authority prior to our inspection had resulted in a suggestion to improve wound care plans, however, limited evidence of improvement was available during our inspection.

Governance and quality assurance at the service were not always effective. The provider's systems and processes such as regular audits of the service had failed to identify issues found during this inspection.

People were safeguarded from the risk of harm or abuse. Staff were recruited safely. People were supported by a sufficient number of staff. When people required additional support from external services, they were promptly referred by staff who were skilled in recognising when people's needs change.

People, their relatives and staff spoke highly of the management team. They felt the service had an open culture, where the registered manager was available to support them and encouraged feedback, both positive and negative.

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 3 October 2018).

Why we inspected

We received concerns in relation to the management of medicines, management of falls and an alleged delay in seeking emergency medical care. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to requires improvement based on the findings of this inspection. We have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement and Recommendations

We have identified breaches in relation to need for consent, management of medicines and good governance at this inspection. Please see the action we have told the provider to take at the end of this report.

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 continue to monitor information we receive about the service, which will help inform when we next inspect.