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Archived: The Fearnes Good

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Reports


Inspection carried out on 14 & 19 November 2014

During an inspection to make sure that the improvements required had been made

We undertook an unannounced inspection to The Fearnes on 14 and 19 November 2014. The Fearnes is registered to provide accommodation and personal care for up to 40 older people, many of whom are living with dementia. At the time of the inspection there were 37 people living there.

At the last inspection in April 2014 the service was meeting the regulations inspected. There was a registered manager in place at the time of our inspection. 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 Socail Care Act 2008 and associated Regulations about how the service is run.

People were kept safe and free from harm and were treated with dignity and respect by a caring, professional team of staff. Staff demonstrated a good awareness of ensuring people were kept safe and were able to explain how they would report suspected abuse.

The registered manager was aware of their responsibilities in regard to the Deprivation of Liberty Safeguards (DoLS). These safeguards aim to protect people living in care homes and hospitals from being inappropriately deprived of their liberty. These safeguards can only be used when there is no other way of supporting a person safely. DoLS applications were correctly completed and submitted to the local authority.

People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. People’s needs were met in a timely manner with people not having to wait lengthy periods for call bells to be answered. The registered manager told us they were recruiting a further three staff. Staff told us once the three additional staff were employed they felt there were enough staff employed to run the home effectively. Suitable employment checks had been completed before staff commenced their employment.

Staff felt well supported by the management team and involved in the running of the home. They said they took an active part in the team meetings and felt comfortable to raise any ideas or concerns. There was a system in place to ensure staff received relevant training.

People were treated with respect and dignity by staff who demonstrated a caring, patient and friendly manner. People’s privacy was maintained, with staff providing discreet support and guidance. Staff knocked on people’s bedroom doors before entering bedrooms and explained clearly to people what they needed to do in a sensitive and considerate manner before supporting people with their care needs. Staff appeared to know the people who lived in the home well and spent time sitting and talking with them, ensuring they enjoyed their day.

People’s needs were assessed and care was planned and delivered to meet their needs. For example, records showed people who had been assessed as having a high risk of skin damage were referred to the local specialist healthcare professionals. Staff had followed the guidance given by the specialist to ensure people’s skin integrity was maintained. Staff were able to discuss individual people and demonstrated a good knowledge of their care needs. Staff told us what activities people enjoyed doing and how people were supported to take part in activities they preferred. People told us they enjoyed the trips out in the mini bus and helping to make cakes. We saw photographs on display of people enjoying outings such as trips to Christchurch Quay and The New Forest.

The provider had a complaints procedure and people knew how to complain if they needed to. People felt if they needed to complain they would be listened to and any complaint acted upon. The management team had acknowledged complaints, and investigated and notified all parties as to their outcome.

The provider completed a variety of weekly, monthly and annual audits to check the quality of their service, such as; infection control, dementia care and dining experiences. Where actions had been highlighted the provider had put systems in place to ensure good practice was communicated to staff. For example, the infection control audit highlighted good practice needed to be shared regarding handwashing, the provider then ensured this topic was a regular agenda item at the staff meetings.

The home expressed a warm and friendly culture with staff stating they felt they worked well as a team and supported each other. One person told us, “I’m very happy here, the staff are so friendly and always cheer me up”.

Inspection carried out on 14 November 2014

During Reference: R6 not found

Inspection carried out on 9 April 2014

During a routine inspection

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

• Is the service caring?

• Is the service responsive?

• Is the service safe?

• Is the service effective?

• Is the service well led?

This is a summary of what we found-

Is the service safe?

Care was planned to meet people’s needs. Where a need was identified a plan was in place to meet this need. For example, one person’s care record stated that they required the assistance to change position. This plan detailed the equipment required and the numbers of staff. However, the provider may find it useful to note that one person who required the use of a hoist to change position did not have a moving and handling plan. This person additionally had two hoist slings in use of differing sizes which staff confirmed were being used. We raised this with the manager at the time of inspection and the incorrect hoist sling was removed. We checked that a new moving and handling plan had been written at the end of this inspection. We spoke with four care staff who were aware of people’s needs and how these should be met.

CQC monitors the operation of the Deprivation of Liberty Safeguards which apply to care homes. No applications had been submitted, however the provider had a policy and relevant staff understood how an application should be made. The provider considered restrictions placed upon people living at the home. However, the restrictive care provided to one person had not been fully considered or documented. The manager told us that they would urgently review this person’s care.

Is the service responsive?

People accessed the services of healthcare professionals as required. One person told us, “I can see the doctor if I want to. I have seen the optician and chiropodist also.” A person’s relative said, “She can see the doctor if she needs to. The chiropodist comes and sees her feet.” We spoke with a visiting healthcare professional who told us that the home made appropriate referrals and that staff followed their advice regarding the care and treatment of people.

The provider had made arrangements to deal with emergencies. For example, we found that an evacuation bag was present in the home which contained items such as foil blankets and waterproof covers to use in the even the home needed to be evacuated. The home operated a managers on call system out of hours.

Is the service caring?

People were treated with consideration and respect and their privacy was maintained. We spoke with one person and the relatives of two people. One person told us, “The staff are very friendly.” One person’s relative said, “They are all very kind.” Another person’s relative commented, “They are very polite.” Staff communicated with people in a sensitive and considerate manner. For example, we saw a member of staff reassuring one person who was upset and crying. We observed another member of staff sat at a table supporting a person with their meal. The staff member waited until the person had finished what was in their mouth before offering more food. We saw that bedroom and bathroom doors were kept closed when people were being supported with personal care and staff knocked on doors before entering.

Is the service well led?

The provider undertook a variety of audits to check the quality of their service. For example, we looked at audit reports relating to infection prevention and control, dining experience and privacy and dignity. We found that actions had been taken as a result of this monitoring. For example, and infection control audit had identified the need to have equipment to clean up spillages. We saw that the home had these available. We spoke with the chef who told us that they used the feedback of people and staff to influence the menu. They told us they also looked at the amount of food waste to assist them in their assessment of what to put on the menu.

People felt able to make suggestions and complaints about their care. We spoke with one person and the relatives of two people. One person told us, “I can make complaints and they listen. I complained that they never tell me when my visitors are coming. The manager has apologised.” A person’s relative said, “I would feel able to complain. They listen.” We saw that the complaints process was displayed in the reception area of the home. We found that the home recorded and responded to complaints and shared compliments about the service. The manager told us that a relatives and residents meeting had been arranged for the weekend following the inspection.

In this report the registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a registered manager on our register at the time. A manager was in place at the time of this inspection who told us they were in the process of applying to become the registered manager.

Is the service effective?

Peoples’ needs were assessed and care was planned and delivered to meet their needs. We spoke with one person and the relatives of two other people. One person told us, “The carers are brilliant” A person’s relative said, “They look after her well.” Another person’s relative commented, “They are very good to her and very helpful.” This relative also remarked, “They work as a team, they all muck in.”

Inspection carried out on 16 October 2013

During a routine inspection

Due to people’s physical and mental frailty we were only able to speak with one person who lived at The Fearnes about their experiences of living at the home. We therefore used a number of different methods to help us understand people’s experiences of living in the home.

We spoke with three visiting relatives, one visiting GP, a visiting social care professional and four care staff to obtain their views about the home.

We observed where appropriate the care and support people received. We looked at relevant documents and records. We also observed the day-to-day activities and working practices in the home.

We saw that people received the support they required in accordance with their agreed plans of care and staff knew about people’s specific needs.

The provider had arrangements in place that ensured people were protected from the risks of inadequate nutrition and hydration.

The merger of two residential units in the home had resulted in a crowded and noisy communal lounge used by people in the reconfigured unit.

There were systems in place that ensured equipment available and used to promote people’s independence and comfort was effective and safe to use.

There provider had arrangements in place that ensured there were enough staff on duty at all times with the skills and experience to meet people’s needs and the quality of the service provided was monitored and improved where necessary.

People were not always protected against the risk of unsafe or inappropriate care because their records were not always accurate and completed.

Inspection carried out on 15 January 2013

During a routine inspection

In this report the name of a registered manager appears (Alan Wyeth) who was not in post and not managing the regulatory activities at this location at the time of our inspection. Their name appears because they were still a registered manager on our register at the time.

At the time of our inspection visit there were 25 people accommodated at the home.

We spoke with three people in order to obtain their views about the service they received.

We were unable to speak with most people who lived at the home because of their physical and mental frailty. We therefore also gathered evidence of people’s experiences by looking at relevant records and observing what was going on. We also talked with the relative of one person.

We looked at documents that showed individuals’ or their representatives consented to the care and treatment the service provided to people.

We saw that people who worked at the home supported and helped people appropriately and promoted their dignity and independence.

There were arrangements in place that ensured the home was clean and people were protected from the risk of infection.

We saw that staff received training and management support that enabled them to carry out their roles.

The provider had systems in place that ensured the quality of the service was monitored, procedures were followed properly and identified where improvements could be made.

Inspection carried out on 10 May 2011

During a routine inspection

At the time of our compliance review, due to the absence of the registered manager, The Fearnes was being was being managed by its deputy manger. People told us that that she was doing a “good job”.

We were only able to get comprehensive views and opinions of two people accommodated at The Fearnes, because many of the people living there had enduring mental health problems such as dementia and were unable to express their opinions about the outcome groups we were looking at and assessing. Consequently many of the experiences of people living in the home that we refer to in our report were based on our observations of the support that we saw staff providing for individuals. They were also based on the views about the service that we were able to obtain from some relatives and care professionals who regularly visited The Fearnes.

People living at the Fearnes told us that it was a nice place to live because “you can relax and be yourself” and “there aren’t many rules”. They told us that they received the help and care they required and that their accommodation was clean and comfortable. They said that there were organised activities that they could take part in and that the food was “very good” and “lovely”.

We saw staff explaining to and showing people how they could do things and watching them to make sure that they did not injure themselves. We saw them helping and supporting individuals’ in a number of different situations. These included, using hoists to transfer people from wheelchairs, helping people to eat at meal-times, supporting them to take medicines that they required and enabling them to participate in social activities. In all these situations we saw that staff were polite, sensitive, and when supporting people doing it in ways that promoted and respected their choices and promoted their dignity, privacy and independence.

Visiting relatives said that the staff “were charming” and provided good care and “could not do enough” for their relatives living at The Fearnes. They told us that they were involved in and consulted about decisions about the care and treatment their relatives received. They told us that if they raised any concerns that they were resolved very quickly.

Healthcare professionals who regularly visited The Fearnes told us that the staff working in the home were “very good at communicating” with them as well as following instructions or guidance they gave about any treatment that their patients needed.

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