Archived: The Ferns Residential Home

The Ferns is a residential care home providing support with personal care needs for older people. The service can accommodate up to 36 people. At the time of the inspection there were 36 people living there. Accommodation was provided in one adapted two storey building. There were two communal lounges and one large dining room.

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

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. People had not had Deprivation of Liberty Safeguards applications made which put them at risk.

Staff did not receive adequate support in the form of regular supervision and appraisal.

There were systems to monitor safety and the quality of the service people received. However, these were insufficient to monitor changes in people’s mental capacity and whether a Deprivation of Liberty Safeguard was required.

Staff had received regular training, although their understanding of the principles of mental capacity were insufficient to meet peoples needs.

We received mixed feedback from people and staff regarding whether they felt included within the service. Some people and staff told us they felt confident to express their views and raise concerns, others told us they did not feel comfortable to speak out.

Health and safety risk assessments were in place to ensure people's safety and environmental hazards were monitored and regularly reviewed.

Infection prevention control measures were robust. Visitors were checked before being permitted into the service and the provider had regular clean schedules in place. There were processes in place to protect people from the risk of the spread of infection and measures were in place to mitigate the risks associated with COVID-19.

Staff received safeguarding training, they told us how they protect people against abuse and how they would report any concerns.

The provider worked in partnership with other health and social care professionals to achieve good outcomes for people.

Medicines were stored and administered in a safe way. Quality audits were in place to ensure medicines were safely managed.

Staff were recruited safely, the registered manager ensured that all relevant staffing checks were conducted prior to employment.

Relatives told us people were safe living at the home and with the staff who supported them.

Health and safety checks were regularly carried out and contingency plans were in place to keep people safe.

Relatives felt involved in the service, they told us the registered manager was approachable and they had confidence in their abilities.

The mealtime experience was a sociable event. The food smelt and looked appetising. People told us how much they enjoyed their meals.

The home was decorated to a high standard, people’s photographs were placed in communal places and each person’s room was personalised to their own preferences.

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 11 December 2019).

Why we inspected

We received concerns in relation to the way the home was managed, communication and restrictions being placed on people. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. We inspected and found there was a concern with the absence of Mental Capacity assessments. A decision was made for us to inspect and examine those risks. We widened the scope of the inspection to include the key question of effective.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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 COVID-19 and other infection outbreaks effectively. This included checking the provider was meeting COVID-19 vaccination requirements.

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 effective 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.

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

Enforcement and Recommendations

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. We will continue to monitor the service and will take further action if needed.

We have identified a breach in relation to consent 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.

The Ferns Residential Home is a residential service providing support with personal care needs for older people. The service can accommodate up to 36 people although at the time of the inspection there were 34 people living there. Accommodation is provided in one adapted two storey building.

Peoples experience of using the service:

People using the service and their relatives were very positive about the service and the care provided. A relative told us, " It gives me tremendous peace of mind knowing my (relative) is here." A person using the service told us, "Staff are amazing, they are always cheerful and full of smiles."

People were cared for by staff in a way that kept them safe and protected them from avoidable harm. Enough staff were available to respond to people’s needs in a timely manner. People received their medicines when they needed them, and systems were in place to ensure that medicines were stored and administered safely and that adequate supplies were available. Accidents and Incidents were investigated, and measures were taken to prevent re-occurrences. The premises were clean, and staff knew and followed infection control principles.

The service was effective. Peoples needs were assessed and planned and delivered in accordance with legislation and best practise. Staff were well trained and knowledgeable about the needs of the people they supported. Balanced and nutritious meals were served, and people were complimentary about the quality of the food. People were supported to have choice and control over their lives and staff supported them in the least restrictive way. People were supported to have 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 practise.

People were cared for by staff who were kind and caring, The atmosphere in the home was friendly and relaxed. We observed staff interacting with people as equals. People were involved in making decisions about there care and were supported to maintain their independence.

There were systems to ensure care was responsive. People received care in accordance with their needs and preferences. People were supported to maintain contact with their friends and families. There were opportunities for social stimulation. People felt their concerns and complaints would be listened to and responded to. People had plans relating to end of life care decisions where required.

People gave us positive feedback about the quality of care they received. The feedback on the leadership of the service and the registered manager from people and staff was positive.There were effective governance systems in place to monitor the quality of service and the health, safety of welfare of people.

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 May 2017)

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

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

The Ferns Residential Home is registered to accommodate up to 36 older people who need help with personal care. On the day of our inspection 33 people were living at the home.

The home has a registered manager in post who is also one of the providers. They were present for our inspection. 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.

At the last inspection in March 2015, the service was rated Good. At this inspection we found the service remained Good.

People continued to be safe because they were supported by staff who understood how to identify and report potential harm and abuse. Staff were aware of any risks to people and what they needed to do to help reduce those risks, such as helping people to move safely around the home.

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

People continued to be supported by staff who had the skills to meet their needs. Staff had received training relevant to their roles and were supported in their roles by the manager and their colleagues. Checks had been completed on new staff to make sure they were suitable to work at the home.

People continued to receive food they enjoyed and were supported to eat and drink enough to keep them healthy. When they needed it, people continued to be supported to access other healthcare professionals to make sure their health needs were met. People's medicines were managed and stored in a safe way, and they had their medicines when they needed them.

People said staff treated them with kindness and compassion and they felt involved in their own care. Staff respected people’s dignity and privacy and supported them to keep their independence.

People continued to receive care that was personal to them because staff knew what their individual preferences and needs were. People told us they received their care when they needed it and were not kept waiting by staff.

People lived in a home where they felt confident to express themselves and felt comfortable to speak with staff and managers about concerns and issues that affected them. The provider encouraged people and their relatives to give their opinions of the home through surveys and feedback forms.

The registered manager had developed an established and strong staff team. The registered manager and staff had created an environment that was welcoming and friendly and the home’s positive values and culture were seen during our inspection. Staff were clear on their roles and spoke about the people they supported with respect.

We saw that systems were in place to monitor and check the quality of care and to make sure the environment was safe. The provider continued to involve people in the running of the home by providing opportunities for them to make suggestions for improvements. People felt their views were respected.

Below is a summary of what we found. The summary describes what people using the service, and the staff told us, what we observed and the records we looked at.

Is the service safe?

People were treated with respect and dignity by the staff. Care plans identified people's needs and were reviewed regularly. Staff demonstrated a good understanding of people's needs. People were given choices and supported to make decisions themselves. Generic risk assessments were in place for things such as medication and trips and falls. Individual risk assessments were in place for moving and handling. Control measures were identified. This meant that people's needs were met and people were kept safe. People we spoke with told us they felt safe at the home.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. Documented procedures were in place for The Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. Relevant staff had been trained to understand when an application should be made and how to submit one. This meant that systems were in place to safeguard people as required.

People were not always protected against the risks associated with medicines. This was because stock of medicines were not always recorded and some liquids and powders had not been identified with an opened date. This meant staff could not be sure when the medicine would need to be disposed. There was not always enough information available for staff for medicine that was offered on an occasional basis. Only staff that had been trained administered medication. One person we spoke with said, 'The staff are spot on with my medicine.'

People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. People received care and support from staff who had the skills, experience and knowledge to meet their needs. People we spoke with told us they felt safe at the home. One person said, 'The staff know what they are doing.' Another person said, 'I have no complaints, you can't fault them.'

Systems were in place to make sure that managers and staff learned from events such as accidents and incidents, complaints and concerns. People had access to a copy of the complaints procedure. Staff confirmed they would support people to make complaints. This reduced the risks to people and helped the service to continually improve.

Is the service effective?

People experienced care and support that met their needs. People were supported to participate in activities. One person told us they preferred their own company but enjoyed the quiz the home had on Saturday afternoon. Another person told us they went out a lot with friends. People told us they were involved in changes to their care. One person said, 'They always contact my relative if there are any concerns.' Another person said, 'I heard on the grapevine they look after you here. I haven't regretted it all.' This meant that people were involved in decisions about their care.

People who were able to could move around the home and gardens freely and safely. Regular audits and checks took place. Issues identified were acted on. This meant the service had effective systems in place to identify improvements and continually meet people's needs.

Is the service caring?

People were supported by kind and attentive staff. We saw that support workers showed patience and gave encouragement when supporting people. We saw people responded positively to staff. One person said, 'Yes, staff are very caring, the manager told me to not try and pick things up if I drop them.' People were very positive about the staff and the care they received.

People's preferences, likes, dislikes and diverse needs had been recorded and care and support had been provided in accordance with people's wishes. People were involved in their day to day care and were supported to maintain relationships that were important to them. People's diversity and individuality were promoted and respected.

Is the service responsive?

We saw staff that responded quickly to meet people's needs and ensured people's safety and dignity was maintained. For example, staff responded quickly to call bells. One person said, 'I have used the call bell, they were here like a shot.' We saw that people were supported to express their views and that these were acted on. People had the opportunity to engage in activities both within the home and in the local community.

People we spoke with were aware of how to make a complaint. People told us they had no reason to complain. The home had not received any complaints since the last inspection.

Is the service well-led?

The registered manager, who is also the joint owner, was hands on. They told us they were currently in the process of recruiting a new member of staff but told us they wanted the right person. Staff told us the registered manager was approachable. People told us that if they had any issues they would speak to the registered manager and were confident they would be listened to. The service worked well with other agencies and services to make sure people received their care in a joined up way. Staff felt supported in their roles and felt their views were listened to. Staff we spoke with told us they were happy working at the home.

The service had a quality assurance system. A number of audits were undertaken monthly and annually. Action was taken as a result of audit findings. This meant the quality of the service was continually improving.

We saw that the manager had effective staff recruitment and selection systems. Records sampled demonstrated there was a clear process that ensured appropriate checks were carried out before staff began work. These checks helped the service to make sure that job applicants were suitable to work with vulnerable people.

We looked at the recruitment records for staff who had recently started to work at the home. We saw records included a Disclosure Barring Service, (DBS) check, proof of identity, full employment history, training, qualifications and health status. Staff told us the recruitment process was thorough. The details in interview records showed checks were made to ensure the information they provided on their employment application form was correct.

Care workers reported they received a good induction and had worked alongside more experienced staff until they were confident and competent to care for people on their own. Staff records we looked at reflected this. Records showed that care workers attended a range of mandatory and specific training to give them the skills and knowledge they needed to carry out their roles. They told us the training they received was good quality and they felt well supported. One care worker told us, " I absolutely love it here."

We saw information in staff records that confirmed they had attended training specific to their role. We saw a range of training booked for staff so they could keep up-to-date with current practice.

When the service had to employ agency staff recently we saw this had been given a lot of planning and attention. The management devised a thorough induction programme. This was so that any agency staff engaged to work in the home were fully aware of all necessary policies and procedures. These included moving people safely, fire, accidents, and the management of falls. We saw this information recorded on in specific training records kept by management.