Archived: Ferndown Nursing Home

We found the following examples of good practice.

All people using the service had received their first Covid-19 vaccine and there had been no outbreaks of Covid-19.

The service had safe and effective measures in place to prevent visitors from spreading infection at the entrance and on entering the premises. Staff always answered the door and gave visitors a personal protective equipment (PPE) pack. There was signage at front entrance advising visitors on lateral flow testing and PPE. Visitors had temperatures taken and a track and trace form completed.

The service had alternative arrangements to visiting in person. Relatives could book video calls or call on the telephone at any time. The home also facilitated window visits for relatives.

Staff were aware of the two-metre social distancing requirement. The service had two metre floor markers to enable staff and people using services to achieve social distancing.

The service had measures in place to prevent people from spreading infection when admitting a person to the service from hospital or from the community. Procedures were in place to ensure people isolated for the required period. Clear procedures were in place to ensure staff isolated for the required period should they test positive for Covid-19.

The service had stocks of PPE to enable staff to care for people safely. Hand sanitiser was available throughout the premises. Staff had PPE donning/doffing and handwashing training updates monthly.

Staff and people using the service accessed regular testing. All staff had completed NHS training on testing at home. The service was taking part in the whole home testing programme, this meant staff were tested for Covid 19 each week and residents were tested every 28 days.

The services premises looked clean and hygienic. The layout and facilities had been changed to support IPC and good ventilation. There were socially distanced tables and chairs in communal rooms. The service had a courtyard garden, residents used this during the summer for socially distanced visits. The service had built a visiting pod with an external entrance to facilitate visits.

IPC audits were completed regularly and included extra measures the service had put in place due to Covid-19.

Ferndown Nursing Home 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.

Ferndown Nursing Home is registered to accommodate 29 older people. The home is split over two floors with the first floor having access via stairs or a lift. On the ground floor there is a large lounge and dining room. There is level access to the outside patio and courtyard areas. There were 21 people living at the home at the time of inspection.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Staff had received an induction and continual learning that enabled them to carry out their role effectively. Staff received regular supervision and felt supported, appreciated and confident in their work. People and their relatives had been involved in assessments of care needs and had their choices and wishes respected including access to healthcare when required. The service worked well with professionals such as doctors, nurses and social workers.

People were protected from avoidable harm as staff received training and understood how to recognise signs of abuse. Staff told us who they would report this both internally and externally. Staffing levels were sufficient to provide safe care and recruitment checks had ensured staff were suitable to work with vulnerable adults. When people were at risk staff had access to assessments and understood the actions needed to minimise avoidable harm. Medicines were administered and managed safely by trained and competent staff.

Staff were clear on their responsibilities with regards to infection prevention and control and this contributed to keeping people safe. Accident and incidents were recorded and analysed. Lessons learnt were shared with staff in handovers and during meetings.

People had their eating and drinking needs understood and were being met.

People told us they enjoyed the food and thought the variety, quality and standard was good.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People, their relatives and professionals described the staff as caring, kind and approachable. People had their dignity, privacy and independence respected.

People had their care needs met by staff who were knowledgeable about them. Their life histories were detailed and relatives had been consulted.

The home had an effective complaints process and people were aware of it and knew how to make a complaint. The home actively encouraged feedback from people, their relatives and professionals. A variety of activities were provided and the home were working on continual development of this.

People’s end of life wishes, needs and preferences were included in their care plans. Relatives and professionals had confidence in the service. The home had an open and positive culture that encouraged the involvement of everyone.

Leadership was visible within the home. Staff spoke positively about the management team and felt supported. There were effective quality assurance and auditing processes in place and they contributed to service improvements. Action plans were carried out and lessons learnt. The registered manager sought to work in partnership with other organisations to improve outcomes for people using the service. The service understood their legal responsibilities for reporting and sharing information with other services.

Further information is in the detailed findings below.

This unannounced inspection took place on 13 September 2016. It was carried out by one inspector.

Ferndown Nursing Home provides residential and nursing care for up to 29 older people. There were 25 people living in the home at the time of our visit.

There was a relaxed atmosphere within the home. People and staff told us it was well led. There were two registered managers who covered management of the service through a job share. 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. They were supported by a head of care who was a registered nurse and an assistant manager who had key responsibilities which included staff supervision and training. This meant there was a clear management structure and staff and people knew who to report to. Staff told us management were supportive and flexible. For example one member of staff told us that following changes in their personal life they were able to adjust their working hours to suit their new circumstances. One of the registered managers told us their philosophy is if staff are happy and feel valued that this influences the quality of care they provided.

There were enough staff to support people safely. One of the registered managers told us staffing levels were dependent on how many people were living in the home as well as the level of care and support they needed. We saw that staff were generally available at the assessed level. When staff were absent at short notice there was some use of agency. We saw the appropriate checks had been made to ensure agency staff were safe to work with vulnerable adults and that they had the right skills and experience.

There was an annual training plan which meant training was thought out and structured to ensure it was appropriate and staff knew in advance what training they were required to do. Staff told us about recent training which they had completed which enabled them to do their jobs more effectively. For example trained nurses had training in syringe drivers , a procedure for administering pain relief. Two care workers told us they had completed dementia awareness training which enabled them to consider how they communicated with people so that they had more understanding of the feelings people maybe experiencing.

Staff told us they experienced supervision as a positive experience and explained they were observed in practice as part of the process of supervision. One member of staff told us it was helpful as they had received feedback about not always using protective equipment. They found the feedback was instrumental in ensuring they improved their practice.

People told us that staff were considerate and friendly. We saw positive interactions between staff and people which demonstrated that people had got to know staff well and were relaxed in their company . Staff talked about people warmly and unanimously reported loving their jobs and enjoying the relationships they had built up with people. Three staff talked about the home being like family.

People were protected from the risk of harm and abuse. Staff were able to describe to us how they would recognise abuse and what actions they would take. We saw that when there had been an incident affecting a person staff had reported it appropriately and it was referred to the local authority safeguarding team. The provider had taken all necessary actions to ensure people were kept safe.

People told us they enjoyed the food and that they were provided with choices of what they would like to eat and where they would like to eat it. People were appropriately assessed to identify if they had any specific dietary requirements. Where necessary people had been referred to the Speech and Language Team (SALT). We saw that recommendations from SALT had been incorporated into people’s care plans and staff understood how to support people safely. People’s diet was monitored and checked by staff to ensure they had enough to eat and drink.

People had personalised care plans that reflected their individual likes, dislikes and preferred routines. People were involved in a detailed holistic pre assessment of their needs. This ensured that the home was the right place for them to move to and that staff had the right skills to meet their needs.

Medicines were managed safely. Medicine Administration Records (MAR) were signed to indicate that people’s prescribed medicine had been given. Medicines were stored securely and at the correct temperatures. Registered nurses administered medicines for people who were receiving nursing care. Care workers administered medicines to people who were provided with residential care. They had received appropriate training and had been assessed to ensure they were competent. There were regular checks of medicines and MAR to ensure that any errors were identified promptly.

Staff had an understanding of the Mental Capacity Act 2005 (2005) and how it applied to their work. Appropriate mental capacity assessments had been carried out. Where some people were unable to consent to being in a care home appropriate applications for a Deprivation of Liberty Safeguard (DoLs) had been made. Staff were able to explain to us how they provided people with choices and how they encouraged people to make their own decisions.

People had opportunity to engage in social activities. There were designated activity staff who organised afternoon activities which included quizzes, entertainment and crafts. There were also trips out. People who stayed in their rooms were checked regularly by staff to ensure they did not become isolated and to check if they needed anything.

Below is a summary of what we found. The summary describes what people using the service, and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

Staff records demonstrated that the staff employed to work at the home were suitable and had the skills and experience needed to support the people living at the home.

Staff training records showed that staff had been trained in safeguarding vulnerable adults. Staff we spoke with where able to tell us about the different types of abuse and were aware that they should report any concerns to an appropriate person.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have been needed to be submitted, policies and procedures were in place. The provider may like to note that following changes to Deprivation of Liberty Safeguards following the Supreme Court recent ruling the home may need to review people's needs to assess if DoLS applications were now required.

Is the service effective?

During our visit we observed that staff provided support and engaged with people positively. People appeared relaxed and comfortable in the presence of staff. Speaking with staff it was evident that they understood individuals' care and support needs. We saw that care plans were based on people's assessed needs and that risk assessments had been completed and were regularly reviewed.

Is the service caring?

People told us that they were happy with the care they received and felt their needs had been met. We saw staff treated people in a sensitive, respectful and professional manner. People's privacy and dignity was respected. In people's care plans we saw that there was information about what they needed help with and how staff should support them. A relative told us that 'The staff are great' and their relative 'was well looked after.'

Is the service responsive?

People's needs were assessed before they moved into the home. Care plans covered all aspects of people's care needs and were reviewed on a monthly basis. The staff told us that during the handover, all the individuals were discussed which ensured that staff were updated about the support people received.

Is the service well-led?

We saw that people, their relatives and visiting professionals had been asked for their feedback on the home. We found that the home responded to the feedback and action plans were put in place; however the registered manager was unable to confirm they had been completed. Staff told us they felt supported and would raise any concerns with the registered manager.

People's needs were assessed and care was planned and delivered to meet people's needs. A visiting family member told us, "They told us about everything we could expect before my husband came here, and the care has been exactly as they told me."

We saw that staffing levels were consistent with the staff rota. The staff we spoke to were knowledgeable about people's needs and how these should be met. We saw that medicines were stored securely and given at the correct time. The home had a new head of care who told us that the home is in the process of implementing new medication management procedures. We saw that the home had procedures in place for the management and disposal of controlled drugs.

We found that the home has had a new wing added to the building. The new wing was not open at the time of our inspection. However, the manager said the home intends to offer residential care services in the new wing.

People's needs were assessed and care was planned and delivered to meet people's needs. One person told us, 'The staff help us with anything we need, like helping us get dressed.' There were sufficient numbers of staff who were knowledgeable about people's needs and how these should be met.

Medicines were stored securely and given at the correct time. One person told us, 'They give us our pills, always at the same time.' However, we found that the reason's for not administering medicines were not clearly identified. Controlled Drugs were entered into the Controlled Drugs register.