Archived: Fernhill

Updated 24 April 2015

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 4, 5 and 6 November 2014 and was unannounced. The inspection team included two inspectors, and a specialist advisor who was a nurse with a background in nursing. Before the inspection, the provider completed a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We reviewed the information we held about the service, which included the provider information return and notifications.

During our inspection we spoke with a senior manager, the registered manager, head of care, seven care workers, three registered nurses, one domestic and two activity staff. The registered manager had been in post since April 2014 as the home manager and became the registered manager in July 2014. We spoke with four people who were using the service and four relatives.

We looked at the care records of eight people, four staff recruitment files, staff duty rosters, and 15 people’s medicine administration records. We also looked at other records relating to the management of the service. This included servicing certificates for the fire safety equipment and testing records for legionella. We undertook general observations in communal areas and during mealtimes. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

Following our visit we spoke with six health and social care professionals who provided us with information about how the service met people’s needs and their experience of working with the staff in the home.

Updated 24 April 2015

This inspection took place on 4, 5 and 6 November 2014 and was unannounced. Fernhill provides accommodation and nursing and personal care for up to 58 older people, specialising in care for people with dementia. There were 56 people living there when we visited. This provider is required to recruit a registered manager for this type of service. There was 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 and associated Regulations about how the service is run.

People were not safe living in the home because not all concerns about abusive practice had been reported to the local authority. The senior management team and the registered manager were not aware of the outcome of an internal investigation into these concerns.

There were not enough staff to meet people’s needs. The majority of staff told us more staff were needed to meet people’s needs. We observed that there were not enough staff to meet people’s needs.

People received their medicines when they required them and medicines were stored safely.

Recruitment checks had been completed before staff worked unsupervised at the home.

People, who did not have mental capacity to make specific decisions for themselves, had their legal rights protected. Best interest decisions involved people’s representatives and health care professionals in accordance with the principles of the Mental Capacity Act 2005. The home complied with the conditions of Deprivation of Liberty Safeguards (DoLS) where they had been authorised. These safeguards aim to protect people living in care homes and hospitals from being inappropriately deprived of their liberty.

The service was not always caring. We observed some staff interactions that were not respectful and two health care professionals told us that some staff were not always respectful towards people.

People’s representatives told us that staff were caring and contacted them if there were any concerns. People were supported by staff to meet their social and welfare needs. People were supported to take part in activities in the home, go out on trips and at times supported on a one to one basis with their social needs.

Staff were not always trained to meet people’s needs. The majority of staff had not received training to support people whose behaviour challenged. Staff had completed training in other areas to meet people’s needs and received support in meetings and in shift handovers.

The service was not well led. Audits of care provided did not always identify actions that were required to ensure people’s needs were responded to. There was however an improvement plan in place to improve how audits were carried out.

People gave us mixed feedback about the registered manager. Some staff told us they were “supportive” whilst other staff told us the registered manager was not approachable or fair.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 which corresponds to regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to safeguarding people, care and welfare of people who use services, supporting people to eat and drink; and not monitoring the quality of the service effectively. You can see what action we told the provider to take at the back of the full version of this report.