Archived: Fernbank House

Fernbank House is a small residential care home that was providing personal and nursing care to ten people at the time of this inspection. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

People’s experience of using this service:

People enjoyed living at Fernbank House, they felt safe and well cared for. One person said “Its home from home here. I really love it.”

Care and support was well planned and promoted people’s independence, choice and diversity. This was because prior to a new person being admitted, the registered manager or senior member of staff completed a pre- admission assessment.

Staff understood what was important for each person and how best to deliver safe and effective care. Staff had good training to ensure their competencies and help them understand the needs of people who were fail, elderly and living with dementia. Staff felt they were well supported to do their job.

Detailed risk assessments were in place to support people to take positive risks and remain safe.

Staff understood how to safeguard people from abuse. Recruitment processes had improved since the last inspection to ensure only staff who were suitable to work with vulnerable people were employed.

People were supported to maintain good health through ensuring regular check-ups and good liaison between the community nurse team and GP’s. People had access to podiatry, opticians and other allied health professionals as needed.

People enjoyed a good variety and choice of meals. Drinks and snacks were offered throughout the day. People were complimentary about the meals available. One person said “The food is five stars, you really couldn’t ask for better. If you don’t like what’s on offer you can ask for something else.”

Staffing levels were sufficient to meet people’s needs and staff had the right skills and support to deliver high quality care and support. Since the last inspection, night staffing had increased to two waking night care workers.

There was effective leadership. The registered manager was also the registered provider. They spent several days per week at the service, but had delegated the day to day running of the service to a home manager. They worked together to ensure everyone understood their role and responsibilities.

Medicines were being safely managed. People confirmed they had their medicines on time and were asked about whether they needed any additional pain relief.

The staff said there was good team working. The staff team were stable and they did not have to rely on agency staff to fill gaps or sickness in the rotas.

People’s views were sought and actions taken to improve where possible, such as changes to menu choices. The ethos and values of the service were embedded into everyday practice. People were treated with kindness and respect. Their privacy and dignity was upheld and their diverse needs were fully considered.

Good governance ensured records and the environment were well maintained. There was learning from any accident and incidents, although the service would benefit from completing monthly audits on these. We have made a recommendation in respect of this.

Improvements had been made to ensure environmental and fire safety checks were being completed and recorded regularly. Recruitment processes had improved so that new staff were only employed once checks and references had been received.

We have made one recommendation in respect of how accident and incidents are reviewed.

The service met the characteristics for a rating of "good" in all the key questions we inspected. Therefore, our overall rating for the service after this inspection was "good". More information is in the full report.

Rating at last inspection: REQUIRES IMPROVEMENT (January 2018)

Why we inspected: This was a planned inspection based on the previous rating.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

Fernbank is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. It is registered to provide care and support without nursing for up to 11 older people. Accommodation is provided over three floors with a stair lift access to those bedrooms on the first and second floor. At the time of this inspection there were 10 people living at Fernbank.

The service is required to have a registered manager. The provider is the registered manager of this service. 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 this inspection we found recruitment practices had not improved. Recruitment files did not demonstrate that full checks had been completed on new staff to ensure they were suitable to work with vulnerable people. We also found that risks in relation to fire had not been fully assessed and reviewed. People did not have their own personal emergency evacuation plan (PEEPS). The fire risk assessment for the service had not been reviewed for several years and some of the weekly and monthly checks of fire safety lighting and equipment had not always been documented. We therefore made a referral to the Devon and Somerset fire and rescue service to provide input to the service. We were informed the trainee manager had recently taken over some aspects of auditing and this included fire safety checks. They had started a new audit and the previous two weeks prior to the inspection taking place; there had been the correct fire safety checks. They also said they were going to be completing PEEPS. Since the inspection the provider has assured us all matters identified have been addressed.

We found for one newer person to the service, the service had failed to complete any risk assessments in relation to keeping them safe and well. The person had been admitted due to falls, but this had not been risk assessed. The staff were knowledgeable about the persons need and risks associated with them, but the lack of documentation placed them at potential risk.

There were some systems and audits in place to review the quality of care provided, but these had failed to pick up on the issues we have identified in this inspection report. Some checks were being completed but not documented. For example checking hot water for risk of scalds.

People’s rights were protected because the service understood and applied the Mental Capacity Act 2005. They assessed people’s capacity to make decisions. Where people lacked capacity, Applications to Deprivation of Liberty Safeguarding teams had been made.

Care and support was well planned in conjunction with the individual and their family. People said they received kind, compassionate and timely care and support. Staff understood people’s needs, wishes and preferred routines. This helped them to deliver care which was personalised.

Staff understood how to keep people protected and who to report any concerns to. Medicines were being safely managed for people.

Staff were able to deliver effective care and support because they had the right training, support and skills to meet people’s needs. There were sufficient staff available each shift to ensure needs were met in a timely way.

The home was clean, homely and infection control processes ensured people were kept well.

People had a good variety and choice of meals to ensure their health and well-being was maintained. People’s healthcare needs were closely monitored and where needed the service worked in partnership with other healthcare professionals to achieve and maintain good health outcomes for people.

People said they enjoyed living at Fernbank. Comments included “I’m very happy here” and “Everybody’s really kind – no exceptions. I am in good hands.”

We found three breaches of Regulations in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The action we have asked the provider to take can be found at the back of this report.

People we spoke with were overall very happy with the care and support they received. One person told us ''This is a really lovely home, I was so pleased when they said they could take me. I am very well looked after.'' Another person said ''It's the best around here, Sue and the staff really care, it's like one big happy family.'' We also spoke with one relative and heard from another via our website where they had provided positive feedback stating their relative ''was exceptionally well cared for'' and described the service as ''excellent.'' We heard from visiting health care professionals, how the staff referred people in a timely fashion about any health care needs and how staff were keen to learn new skills and information to help them understand the needs of people they cared for.

We found care was being well planned and staff understood the needs and wishes of people they cared for. Medications were well managed and accurate records were maintained of all medications given.

There were sufficient staff per shift to meet the needs of people. Most staff had worked at the home for a good length of time and knew the people they cared for well. Staff kept their training and skills updated to ensure they were competent and trained to provide the right care and support to people.

We found records were accurately maintained, kept secure, but could be accessed when needed.