Fernleigh Care Home

Fernleigh Care Home is a residential care home providing accommodation and personal care to 24 people aged 65 and over at the time of the inspection. The service can support up to 27 people accommodated over three floors.

We found the following examples of good practice.

The service supported people to receive visits in a variety of ways. These included visits within the service, via virtual means and within a visiting pod. Visitors were screened for symptoms of COVID-19 and evidenced a negative Lateral Flow Device (LFD) test prior to the prior to the visit taking place, they were also provided with Personal Protective Equipment (PPE).

Essential caregivers were supported to provide continuity of care to people. Their support was valued by the staff team.

Fernleigh Care Home is a residential care home providing accommodation and personal care to 26 people aged 65 and over at the time of the inspection. The service can support up to 27 people accommodated over three floors.

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

Medicines were not always safely managed. As a result, people were at increased risk of receiving medicines not in line with the prescriber’s instructions.

Risk was not always safely managed. As a result, people who had been identified as being at risk of malnutrition were at increased risk of developing health issues related to malnutrition.

The provider had quality control systems in place, however these were not always effective enough to ensure the quality and safety of the service was maintained.

The provider did not always learn lessons when things went wrong. Audits did not always identify issues and effective actions plans were not always developed or did not always result in improvements being made.

People were supported by staff who had been recruited safely, who were caring, respectful and knew people well. Staff demonstrated a good understanding of safeguarding, including the signs of abuse, and were able to describe how to report concerns.

There were enough skilled and experienced staff to meet people’s needs. Staff were adequately trained and had regular competency checks.

Effective infection prevention and control (IPC) policies and procedures were in place and the service was following best practice and Government guidance in relation to the management of COVID-19 and other infections.

People and their relatives were involved in developing and reviewing their care plans and risk assessments. People’s relatives and staff felt they were able to contribute to the development of the service.

People’s relatives and staff felt supported by the management team and provided positive feedback about the quality of communication throughout the COVID-19 pandemic.

Accidents and incidents were documented and reported on appropriately and lessons were identified and learnt from to reduce the risk of re-occurrence.

People were supported to have maximum 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 practice.

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 22 January 2019).

Why we inspected

The inspection was prompted in part by notification of a specific incident, following which a person using the service died. This incident is subject to a criminal investigation. As a result, this inspection did not examine the circumstances of the incident.

The information CQC received about the incident indicated concerns about the management of falls and the environment. This inspection examined those risks.

We also received concerns in relation to medicines, infection prevention and control, staffing levels, record keeping and the management of the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

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.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the safe 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 Fernleigh Care Home on our website at www.cqc.org.uk.

Enforcement

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to medicines and governance 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

There was a registered manager. 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 felt safe living at the service. Staff knew how to recognise abuse and how to report it. Risks were assessed so that staff knew what action to take to keep people safe. They did this while also promoting people’s independence and autonomy.

There were sufficient numbers of staff, with the required knowledge, skills and experience to support people with their needs. Recruitment processes were safe and this meant that so far as possible only people of suitable character and experience were employed.

Medicines were managed in a safe way Staff had received training about this and knew the level of support people required with their medicine.

Staff were knowledgeable about the needs of the people they supported. People were supported to make choices around their care and daily lives. Staff had attended training to ensure they were able to provide care based on current practice when assisting people.

Staff always gained consent before supporting people. There were policies and procedures in place in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards and staff followed these.

People were supported to eat and drink enough and had a balanced diet. Staff understood and met people’s nutritional needs. They supported people in a sensitive way. People had access to the healthcare professionals they required.

The adaptation and decoration of the premises was designed to meet the needs of people who used the service and to support people living with dementia.

People were treated with kindness and compassion by the staff. Staff knew people well and knew the best way to communicate and offer reassurance when this was required. People’s social needs as well as their physical and emotional needs were incorporated into the plan of care and used to promote and maintain people’s abilities and independence.

People and their relatives were involved in making decisions and planning their care, and their views were listened to and acted upon. Staff treated people with dignity and respect. People knew how to raise concerns and had confidence that they would be listened to and action would be taken. Feedback provided was used to make improvements to the service.

People were complimentary about the registered manager and staff. It was clear that relationships between people and staff were positive and people had confidence in the service. Many of the staff had worked at the service for many years and this provided continuity for people who used the service. Staff were motivated and the culture was person centred and family orientated. There were effective quality monitoring systems. A variety of audits were carried out and this meant that any shortfalls were quickly identified and used to drive improvements.

The service provides accommodation and personal care for up to 27 older people living with dementia and similar health conditions. At the time of our inspection there were 25 people using the service.

The service had a registered manager. 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 felt safe living at Fernleigh Care Home. They felt safe because they trusted staff’s ability to care for them. Staff knew their responsibility to keep people safe from harm and abuse. They followed the provider’s guidelines to support people and to report any concerns they had about people’s safety and wellbeing.

The provider had good practice guidance for staff to follow in the safe handling and reporting of medication.

Staff had the relevant skills they required to meet people’s needs. The provider completed relevant checks which ensured that staff had the right skills, experience and were safe to support people. Staff were provided with adequate training that they required to carry out their role effectively. The managers ensured that there was enough staff on duty to meet people’s needs.

People were supported in accordance with the Mental Capacity Act (MCA) 2005. Staff sought their consent to their care and treatment.

At the time of our inspection, the provider was in the process of refurbishing the home to give people access to an environment that met their needs and promoted their independence.

People were supported with their nutritional and health needs. They had access to a variety of healthy meals that they told us they enjoyed. They also had prompt access to healthcare services when they needed them.

Staff were kind and compassionate to people. They were knowledgeable about the needs of the people they supported and treated them with dignity and respect. They provided the support that people needed to be involved in decisions about their care.

People’s care plans did not always reflect the support that they received. The registered manager and deputy manager told us that they would address this. At the time of our inspection we found this to have minimal impact on the care people received as they were supported by staff who were knowledgeable about their needs and met them.

The provider listened to feedback from people using the service and their relatives. People told us that staff acted promptly on their feedback.

The provider had effective procedures for monitoring and assessing the service in a way that promoted continuous improvement. People and their relatives were satisfied with the service they received. Staff felt supported to contribute to the development of the service. They felt supported in their role which enabled them to deliver a good standard of care to people.

For two people who had recently moved into the service, an Initial assessment had been completed and this had been appropriately signed and dated. From the initial assessment, care plans had been devised and these had been reviewed to ensure that they remained up to date and relevant to each person's needs.

Food and fluid charts, completed for people who had been assessed as at risk of malnutrition and dehydration, were up to date and demonstrated the support given, to ensure that they received the nourishment they needed.

We checked the environment and it was obvious that work had got underway to improve the facilities within the service.

During our visit we were able to speak with three people who use the service and two relatives. This enabled us to gather their thoughts of the care and support being provided. People told us that they were very happy with the service received at Fernleigh. One person told us: 'They've been very good to me.' A relative explained: 'We can't fault it, they [care workers] treat him gently and respectfully and everything that needs to be done is done.'

We were also able to speak with one visitor and five members of the staff team. This enabled us to gain their views of the overall service provided. One relative explained: 'They [the staff] look after her really well, and they are always really nice.' A member of staff told us: 'I love working here, it is so interesting and there's always someone to help you if you need it.'

We looked at some care plans and found that although most contained the actions the care workers needed to take to meet the person's individual needs, some didn't fully reflect the person's current behaviours and how care workers should address these.

Records checked did not always reflect the care carried out by the staff or show that action with regard to a person's health care, had been taken in a timely manner.

During our visit we noted that some areas of the service were in need of improvement and refurbishment to ensure that it was suitable for the people using it.

We were told that the staff were kind and caring and we observed them carrying out their duties in a relaxed and patient manner, interacting well with people throughout our visit.

Everyone spoken with explained that they were happy with the care and support they were currently receiving and they told us that the staff were kind and helpful. One person told us, 'The staff are very good, always there if you need them, always willing to help.'

We were told that the staff were supportive and we observed them carrying out their duties in a kind and patient manner. During lunch time, staff were seen assisting people in a dignified manner and at a pace that suited them.

Everyone spoken with told us that they were happy living at Fernleigh and that they felt safe there. One person told us, 'the staff understand me, I rang the bell and they came quickly.' A relative spoken with explained, 'The overwhelming thing for us, is knowing that she is safe.'

At the time of our visit we noticed a strong odour in the main entrance. This was discussed with the manager and deputy manager and we were informed that this was being dealt with. New flooring had been placed in the main corridor and plans were in place to replace the carpet on the stairs.

Staff working at Fernleigh told us how much they enjoyed working for the service. One staff member explained, 'It's a really nice place to work, the manager is wonderful and the deputy is a breath of fresh air.'