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We are carrying out checks at Ferns Nursing Home using our new way of inspecting services. We will publish a report when our check is complete.

Reports


Inspection carried out on 28 & 29 April 2015

During a routine inspection

This inspection was unannounced and took place on 28 and 29 April 2015.

Ferns Nursing Home is registered to provide nursing care and accommodation to up to 39 people. The home specialises in the care of older people.

There is 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.

People described the registered manager as open and approachable. People felt able to raise concerns with them and were confident any complaints or concerns would be responded to. There were regular meetings for people who lived at the home to enable them to keep up to date with changes and share their views.

There was a staffing structure which provided clear lines of accountability and responsibility. In addition to the registered manager there was a deputy and a team of registered nurses and senior carers. This ensured people always had access to experienced senior staff.

People told us they felt safe at the home and with the staff who supported them. People said staff were kind and sensitive when assisting them. One person said “I rely on the staff for everything. They are always kind and I always feel very safe with them.”

There was sufficient staff to meet people’s needs in a relaxed and unhurried manner. People received care promptly if they requested assistance. The registered manager kept staffing levels under review and made changes to ensure people’s needs were met.

People’s clinical needs were monitored and met by a team of registered nurses. Registered nurses had opportunities to undertake training which kept their skills and knowledge up to date. One person said “You can always talk with the nurse if you’re feeling a bit ropey. They’re very helpful.” In addition to healthcare support from registered nurses people were referred to other professionals according to their individual needs.

All staff had access to on-going training to make sure they had up to date knowledge to enable them to safely and effectively support people. People had confidence in the staff who worked at the home.

People had their nutritional needs assessed and food was provided in accordance with people’s needs and preferences. Without exception people were very complimentary about the food served. Comments included; “Food is very good,” “Food couldn’t be better and there’s always a choice” and “All meals are excellent. Always plenty to eat.”

People said they were supported by kind and caring staff. Comments included; “Staff are kind and gentle when they help” and “Staff are always polite and cheerful.”

People received care that was responsive to their needs and personalised to their wishes and preferences. People told us they were able to make choices about all aspects of their daily lives. The staff responded to changes in people’s needs and care plans were up dated to make sure they reflected people’s current needs and preferences.

People were able to take part in a range of group and one to one activities according to their interests. One person told us “One of the good things about here is there’s always something to occupy you.”

Inspection carried out on 21, 28 August 2014

During a routine inspection

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led? Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at. If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

Some people were at risk of unsafe care and treatment. People were not supported to move safely. A compliance action has been set for this and the provider must tell us how they plan to improve.

People who used the service were not always protected from the risk of abuse. The provider had not responded to an allegation of abuse and had failed to report this, and other incidents of concerns to the appropriate authorities. A compliance action has been set for this and the provider must tell us how they plan to improve.

Some people's care records and daily care charts were inaccurate or incomplete. For example, there was information in people’s records about creams they required to protect their skin. The forms used did not contain enough information about where and when creams were applied. A compliance action has been set for this and the provider must tell us how they plan to improve.

Recruitment processes used to select and employ workers at the home were inconsistent. Appropriate checks were not always carried out on new staff before they started work. This meant that the home was not following safe procedures to ensure that staff were suitable to work with vulnerable adults. A compliance action has been set for this and the provider must tell us how they plan to improve.

There were not enough qualified, skilled and experienced staff to meet people’s needs. People, and their relatives had expressed concerns about staffing in the home. Staffing arrangements did not ensure continuity of care for people who used the service. A compliance action has been set for this and the provider must tell us how they plan to improve.

Staff received inconsistent support and training and some staff did not receive appropriate professional development. Staff had not received regular and consistent supervision and appraisals were overdue. This meant that people who used the service were cared for by staff who were not fully supported to deliver care and treatment safely and to an appropriate standard. A compliance action has been set for this and the provider must tell us how they plan to improve.

Is the service caring?

During our inspection, we observed that people were treated with dignity, consideration and respect. However, some people who used the service expressed concern about night staff who worked in the home. For example, one person told us that night staff were less tolerant than day staff and some night staff did not speak with people at all. Another person told us that a member of night staff had been abrupt with them for using their call bell and had caused another resident to cry.

Is the service responsive?

The provider did not always respond appropriately or promptly to complaints. While one complaint had been addressed and responded to, others had not been fully addressed. For example, one complaint was not investigated promptly. Concerns raised by people and relatives in 2013 were similar, and in some cases the same, as in 2014, with insufficient actions or change. This meant that people's concerns were not always effectively or fully addressed. A compliance action has been set for this and the provider must tell us how they plan to improve.

Is the service well-led?

There were systems in place to check the quality of the service. The views of people and their representatives were sought and relatives told us that if they had any concerns, they would approach staff. However, the home did not have suitable processes to identify, monitor, assess and manage risks to the health, safety and welfare of people who use the service and others. A compliance action has been set for this and the provider must tell us how they plan to improve.

The Care Quality Commission (CQC) requires providers to notify us of some incidents and events that occur in the home. Both during and following our inspection, we learned of several incidents that had not been reported to the CQC. The provider’s failure to report incidents meant we had not been able to check they had taken appropriate action and did not promote a multi-agency response to concerns.

Inspection carried out on 23 October 2013

During a routine inspection

The service was meeting the needs of older people, most of whom needed nursing care due to long term physical conditions. The home had an open, friendly and lively atmosphere. We observed frequent, respectful interaction between people and staff and people speaking to each other in a friendly manner.

One person we spoke with told us ‘You get everything you need here, the staff are all very helpful and you can do things in your own time’.

One person told us they were very happy living in the home and that the staff 'they always tell you what's going on'. Another person told us that the staff always asked 'would you like to?' and respected their choices.

We saw that staff used signals and gestures for people unable to respond verbally and this appeared to reflect their knowledge of people and their relationships with them. We found a system of individual care planning in place which was regularly reviewed for each person.

The service worked well with other agencies to meet care standards. We found evidence that staff were trained to understand their role in safe use of medicines. We spoke with six staff members who expressed a highly positive commitment towards the people who used the service and to the home.

We observed an open culture of feedback from relatives and encouraged suggestions from staff about improvements. There were systems to identify and manage risks relating to the service and for monitoring and checking quality and safety in the home.

Inspection carried out on 24 July 2012

During a routine inspection

We spoke with seven people who lived in the home. They told us that staff provided the care and support they needed. Everyone spoke very highly of the home. People said staff were very patient and kind and they listened to them. One person said “they don’t tell you what to do, the staff, they always ask you”.

We spoke with three relatives who were visiting people who lived in the home. They had been involved in choosing this home for their relative. One told us “we couldn’t have found a better nursing home. We looked at a few different ones. I’ve no doubt that we picked the best place for mum”.

Regular activities and events were arranged, as were occasional trips out of the home. The weekly activity programme was given to each person so they could choose what they wanted to take part in. Activities included flexercise (a chair based gentle exercise programme), quizzes, sing along, cinema club, card games, craft sessions and garden activities.

People who lived in the home told us they felt very well cared for and that staff were available when they needed them. People said staff helped them to do the things they needed help with. Comments from people included “the staff understand what help I need. I’m very happy here”, “I’ve no complaints. I’m very happy here” and “I’m so happy here. All the staff are very kind”. People told us staff arranged for them to see their GP or other health care staff if they needed to.

People told us they liked the food served in the home. Meals were discussed regularly and were always on the agenda for residents’ meetings. Some people chose to eat in their own rooms; others ate in the main dining area. One relative said “I come in every day and have a nice meal with my husband. The food is very nice here. It’s really nice to come in and spend time with him”.

People we spoke with said they thought the home was a safe place for them to live. One person said “it is a safe place for me. I have never had any complaints since moving here”. One person told us they chose to move to this home because they did not feel safe in their own home after they had a fall. They told us “I couldn’t go home so I moved here. I do feel very safe here”.

Visitors we spoke with said the home was a safe place for their relatives. One told us “I have never had any worries about safety. They always make sure mum is safe. The manager runs a very tight ship here and they wouldn’t let anything go”.

People who lived in the home spoke very highly of the staff team. Many people told us that staff “went out of their way” to ensure they were well cared for. They said staff were available when they needed them and they understood the care and support they needed. One person said “all the staff are lovely and have been very kind”.

Visitors we spoke with said there were enough staff to meet people’s needs. There were always a variety of staff working, including qualified nurses. One relative said “the staffing levels seem pretty consistent. They are a lovely group of staff”.

People who lived in the home and their visitors told us they were asked to give their views on the home and that they were listened to. They told us about the resident’s meetings and the relatives’ meetings. They said they felt able to raise any issues with any of the staff.

One relative told us “I visit every day. I’ve no complaints whatsoever. There are meetings but you can talk to the staff when you are here. You don’t have to wait for the meetings. They are always interested in what you have to say”.

Reports under our old system of regulation (including those from before CQC was created)