Archived: Fernside Hall Care Home

Our last inspection of Fernside Hall took place on 9 November 2015 and found breaches of regulations in regard to reporting of notifiable incidents, care records, reporting, analysis and actions following accidents and incidents, dignity and respect, audit and governance, recruitment, induction and training. We told the provider they needed to take action and we received an action plan. At this inspection we found improvements had been made with regard to these areas although the service needed to maintain and continue these improvements over a sustained period of time.

The manager of Fernside Hall at the time of the previous inspection had left the service. The manager at the time of our visit had been in employment at the service for approximately six months and had applied for registration with the Care Quality Commission. 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 told us they felt safe at the service and no-one we spoke with had concerns. Staff we spoke with understood how to keep people safe and what to do in an emergency situation. The service had safeguarding procedures and individual risk assessments were in place to keep people safe.

People we spoke with told us they liked living at Fernside Hall and were happy with the service. They told us staff were kind and caring and treated them with respect and good humour. A relative we spoke with confirmed this. We observed some compassionate and caring exchanges between staff and people living at the service and staff we spoke with knew people well.

We saw consent was requested wherever possible and people's individual preferences were taken into account.

Medicines were administered and generally managed safely although the service was in the process of altering the storage of medicines to ensure these were stored at the correct temperature.

Accidents and incidents were generally well recorded and appropriate procedures followed although the manager recognised this had not happened with one identified recent incident.

Staff were safely recruited to ensure they were of suitable character to work with vulnerable people. Staff received a range of training which was generally up to date and had opportunity to attend other service specific courses and professional development training. The manager was recommencing a programme of staff supervision and appraisals and was aware this was an area for improvement.

Overall, there were sufficient numbers of staff deployed although the service needed to review the numbers of staff deployed at peak times to ensure levels consistently allowed for safe care and support.

Care records were person centred and newer care records contained good, detailed information. Work was in progress to ensure all care records were of a good standard.

A range of activities was on offer, according to people's preferences and choices. People were consulted about what activities were of interest to them and the home employed an activities co-ordinator.

The home was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS) and acting within the legal framework of the Mental Capacity Act (MCA).

A range of audits and checks were undertaken by the service to monitor, identify issues and take action to resolve them. The service received regular visits from the provider to provide support and guidance.

People who used the service, relatives, staff and healthcare professionals praised the new manager and said they generally found them approachable and could see improvements had taken place.

We saw evidence people’s views were sought to making positive changes in the service.

A complaints policy was in place although the service had not received any recent formal complaints.

Fernside Hall is registered to provide residential care for up to 24 older people and there is a passenger lift available. The accommodation is arranged over three floors. There are two lounges and a dining room on the ground floor and a kitchen/sitting area on the first floor. There are 20 single bedrooms, 18 of which have en-suite toilet facilities and two double bedrooms with en-suite facilities. At the time of our inspection there were 19 people using the service.

Our last inspection of Fernside Hall took place on 19 February 2015 and found breaches of regulations in regard to staffing numbers and inadequate maintenance of the home. We also recommended that the provider ensure they have systems in place to ensure they have oversight of the management of the service.

The previous registered manager of Fernside Hall deregistered with the Commission in September 2015. The manager at the time of our visit had been in employment at the service for approximately five months. They told us they would be applying for registration with the Care Quality Commission. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider. Since the inspection the manager has left the service.

People who lived at the home told us they felt safe and staff had a good understanding of their responsibilities in keeping people safe. However, the service did not monitor accidents and incidents well which meant that they were not doing everything possible to mitigate risks to people who lived at the home.

Staffing was adequate but better deployment of care staff was needed to make sure staff were always available to people.

Procedures for recruitment of new staff were not always followed to make sure staff were safe to work with vulnerable people.

Staff felt that the training they had received was good but not all staff had received the induction and training they needed to support them in their roles.

People told us, and we saw, that the food provided at the home was of a good standard. However staff had failed to make sure that all of the people who lived at the home received the nutrition and hydration they needed to maintain their health.

Staff demonstrated a caring attitude but we found that people's dignity was not always respected.

Care plans did not demonstrate a person centred approach to care and were not up to date. This had been recognised and new care plans were in the process of being developed.

People told us they enjoyed the activities at the home although the working hours of the activities coordinator restricted the opportunity for planned activity.

There was a new manager at the home and staff told us they had confidence that they would they would make improvements to the service. There was a lack of regular quality auditing by senior management.

Systems were not in place to protect money being held at the home on behalf of the people who lived there.

Systems for auditing the quality and safety of care were not adequate.

You can see what action we told the provider to take at the back of the full version of the report.

When we inspected this service in June 2013 we found that improvements were needed in assessing and managing people's care and welfare, managing medicines, staffing and identifying, assessing and managing risks to the health, safety and welfare of people who used the service.

The provider told us that they had made improvements in all of these areas. We made this visit to see if the provider had achieved and maintained compliance.

We saw some improvements in all of the areas we looked at but identified the need for further action to be taken to achieve full compliance in assessing and managing people's care and welfare and identifying, assessing and managing risks to the health, safety and welfare of people who used the service.

People who used the service were complimentary of the care and support they received and we observed staff to be kind and considerate in their approach.

People told us that staff were kind and helpful but said that they very busy and this meant that sometimes they had to wait longer than they would like for assistance and that staff did not have much time to spend with them.

One person said "I have nothing to do" another said "I am not stimulated or engaged" and a relative asked us "Are they supposed to have something to do?"

Another visitor said that they considered their relative received good care.

We observed that there were long periods of time when staff were not available to people in the communal areas.

We found that care plans had not been put in place to meet with people's current and changing needs and that improvements were needed to ensure medicines were managed safely in the home.

We observed that staff treated people with care and kindness.

Two people we spoke with said that the staff were very good and helped them when they needed it.