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Inspection carried out on 11 February 2019

During a routine inspection

About the service:

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 b

Inspection carried out on 4 January 2018

During a routine inspection

This inspection took place on 4 January 2018 and was unannounced. When we last inspected Fernbank in October 2015 we rated it as good, with requires improvement in safe. This was because we had issued a requirement in relation to ensuring recruitment was robust and checks were completed before new staff began working.

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 proc

Inspection carried out on 17 and 21 October 2015

During a routine inspection

This inspection was unannounced and took place on 17 and 21 October 2015. Fernbank House is registered to provide care and support for up to 11 people. They do not provide nursing care. At the time of this inspection there were ten people living at the service.

A registered manager was in post who is also part of the partnership who runs the 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 2014 and associated Regulations about how the service is run.

The Care Quality Commission (CQC) is required to monitor the operation of the Mental Capacity Act (2005) (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are put in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves or others. At the time of the inspection, one application had been approved and others had been made to the local authority in relation to people who lived at the service. The registered manager told us these were waiting to be approved.

Recruitment processes were not as robust as they should have been. Not all checks were in place to ensure new staff were suitable to work with vulnerable people. This did not fully protect people from the risk of unsuitable people being employed.

People’s medicines were being well managed, although written guidance was not available to tell staff when they should consider an as needed medicine (PRN) for people who lacked capacity.

There were not enough slings for each person who needed to use the hoist to have their own, which was a risk of cross infection. Following feedback the registered provider purchased additional slings to ensure there were sufficient.

When people were being transferred in wheelchairs around the home, foot plates were not used. This was a risk to people as they may catch their feet on the carpet which could cause injury.

There was sufficient staff with the right skills and knowledge to meet people’s needs. Staff received training in all aspects of health and safety as well as understanding the needs of older people and dementia. Staff had support and supervision to help them understand their role and do their job effectively.

People said they felt safe and well cared for. Staff knew people’s needs and preferences. One person said ‘‘Staff are all lovely, they really look after us, they know us all and we know them.’’

Staff knew how to protect people from potential risk of harm and who they should report any concerns to. They also understood how to ensure people’s human rights were being considered and how to work in a way which respected people’s diversity.

Care and support was being well planned and any risks were identified and actions put in place to minimise these. People had access to their plans as they were kept in their room. Daily records showed people’s personal, health and emotional needs were monitored. People confirmed they were able to see their GP when needed and relatives confirmed they were kept informed of any change in the needs of their relative.

The provider ensured the home was safe and that audits were used to review the quality of care and support being provided. This took into consideration the views of people using the service and the staff working there.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

Inspection carried out on 28 February 2014

During a routine inspection

At the time of this inspection, there were ten people living at Fernbank House. We were able to speak with six people about their experience of being cared for at the home. We also spoke with three care staff and the registered manager/owner. We spent time observing how care and support was being delivered and checked how medication was being administered and recorded.

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.

Inspection carried out on 29 June 2012

During a routine inspection

We carried out this unannounced inspection on 29 June 2012 as part of our planned inspection programme.

We spent time at the home talking with five people who lived there as well as two members of staff and registered provider. At the time of this inspection there were ten people living at the home with two care staff per shift, plus the manager and a cleaner.

We observed how care and support was delivered during different times of the day. Some people that live at this service have dementia and therefore not everyone was able to tell us about their experiences. To help us understand the experiences of people we used our SOFI (Short Observational Framework for Inspection) We spent time in communal areas to help give us an insight into how people spent their time, the type of support they received and whether they have positive experiences. Some people using the service were able to tell us their views.

We looked at some of the key records kept by the home. These included care plans, risk assessments, staff training records and surveys completed by people living at the home. This helped us to better understand how well the home was run.

People we spoke with who were able to share their experiences of living at the service were very positive. Comments included ��my daughters chose this home for me because it was small and friendly. You get to know the staff really well and I have been very happy here.�� ��Staff are very kind and helpful, the food is excellent and I find they always knock on my door before coming in, little things like that.��

We looked at how well care and support was planned and reviewed. The plans contained good basic information about what personal, health and emotional care needs people had and how staff should meet these needs. Risk assessments were in place to show how the home identify manage and minimised any risks for people. Plans also included details about people�s social history and their likes and dislikes. Plans are located within each person�s own room.

We observed staff providing care and support in a kind and sensitive manner and we were told by staff that they felt well trained and supported to do their job.

People�s views were taken into consideration when reviewing the quality of care and support.

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