The Care Quality Commission
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  • Care home

Archived: Ferns Nursing Home Limited

Overall: Inadequate read more about inspection ratings

40-42 Part Street, Southport, Merseyside, PR8 1HY (01704) 501401

Provided and run by:
Ferns Nursing Home Limited

All Inspections

25 February 2016

During a routine inspection

An unannounced focused inspection took place on 25 February 2016 to follow up on concerns from the previous inspection on 8 July 2015 which were related to people not having enough to drink, placing them at risk of dehydration. We found the rating was not displayed for members of the public to see and this was brought to the attention of the provider. Due to the level of concerns on the first day of our inspection we then proceeded with a full comprehensive inspection on 26 February 2016 and a follow up visit on 2 March 2016.

At the previous inspection there were breaches of Regulation 14 Hydration and 15 Premises and equipment identified and the service was rated as requires improvement. We found on inspection the service remained in breach of these regulations in addition to further breaches of regulation.

The service had also been previously rated Inadequate for two breaches of Regulation 12 Safe Care and Treatment and also Regulation 17 Governance in December 2014.

The service was a 33 bedded nursing care home. One of the stipulations of their registration was that they were required to have a Registered Manager to lead the service. The manager was in the process of registering at the time of our inspection to become the 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.’

Due to the level of concerns and the immediate breaches of Regulation 14 and 15 found on the first day of our inspection, we undertook a full comprehensive inspection.

We found the service was not keeping people safe from harm or abuse. One resident who was unable to communicate their needs requiring 24 hour nursing care was observed to have marks/bruises to their arms which had not been documented or investigated and there was no body map to illustrate where and when the mark/bruise was first seen. We were shown photographs taken by a family member of marks/bruises which had appeared since October 2015. We also found evidence the relative had made several complaints but the service failed to send a safeguarding to the Local Authority and failed to investigate all the complaints with an outcome.

There were not enough staff to meet the needs of the residents. We observed people who required assistance to eat and drink were not having adequate amounts of food and fluids. This was observed from the fluid balance charts and also by our observations of individual residents. For example, one resident's plate of food was cold as there were not enough staff to provide them with the support they needed to eat. We also observed one resident's water jug and beaker in their bedroom was dry to touch.

We were concerned the service did not have empathetic or skilled qualified staff to care for people with complex health needs such as dementia. One qualified nurse was observed to have retrospectively completed care records. Another nurse spoke disrespectfully about one resident and were not knowledgeable in the care of people with dementia despite there being a high number of residents suffering with dementia. We found the service did not offer staff dementia training. The manager was not skilled in implementing effective systems according to risks. We were also concerned that the manager was being restricted in their role by the owners who specified how many staff could be deployed despite them not being aware of all the complexities of the needs of the residents.

The residents care records were incomplete with risk assessments missing and also no Mental Capacity Assessments/Deprivation of Liberty Authorisations in place for people who were lacking in mental capacity. We questioned the practices of administering medication to people who lack mental capacity in the absence of a Best Interests Process being followed. One resident who lacked mental capacity was being administered medication by the nurse placing the medication on the person's tongue whilst the person opened their mouth to drink their thickened fluids. We discussed this with the nurse who had not considered their practice may be classed as covert administration of medication.

The Fire Service had inspected the premises a few weeks prior our inspection and rated the service as inadequate with an action plan to mitigate risks.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.

Following the second day of our inspection we asked the service for an urgent action plan given the seriousness of the concerns we found. We followed this up on the third day of our inspection and found sufficient improvements had not been made. On 3 March 2016, the provider informed us of their decision to close the home voluntarily and cancel their registration. We worked closely with other stakeholders and all people who used the service were moved to other care homes within 7 days of the provider informing us of their intention. The registration of the provider is in the process of being cancelled.

8 July 2015

During a routine inspection

We carried out this unannounced inspection of Ferns Nursing Home on 7 July 2015. The home provides accommodation and nursing care for up to 33 adults. Accommodation is provided over three floors and the home is accessible to people who are physically disabled. Access to upper floors is via a staircase or passenger lift. The service is situated close to the centre of Southport, Merseyside.

We carried out this inspection to follow up on requirements set at the last inspection. At the last inspection on 17 and 18 December, we asked the provider to take action to make improvements to: the arrangements to protect people from abuse, staffing levels, how staff were supported in their role, care planning, the handling of complaints and how they checked on the quality of the service. The provider sent us an action plan following the inspection outlining what action they were going to take to make the required improvements. We found improvements had been made in all of the areas. Some of the improvements were still embedding but overall the service was safer, more effective and more responsive than we had found at our last inspection. The provider had introduced new ways of checking on the quality of the service and was listening to people’s views about the service and acting on them.

A new manager had been appointed to the home since our last inspection in December 2014. The new manager had submitted an application for registration as the 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.

New procedures for preventing abuse and for responding to allegations of abuse were in place. Staff we spoke with were confident about recognising and reporting suspected abuse and the manager was aware of their responsibilities to report abuse to relevant agencies.

Staff worked well with health and social care professionals to make sure people received the care and support they needed. Staff referred to outside professionals for advice and support as required.

People told us they enjoyed the meals and food provided. They told us the quality and quantity of food was good. People were provided with drinks on a regular basis during the course of our visit. However, we found that accurate records were not being maintained to record when people who required assistance with their drinks and fluids had been supported to have them. The provider was therefore not able to demonstrate that people had been supported to have an adequate amount of fluids. You can see what action we told the provider to take at the end of this report.

New care plans had been written for each of the people who lived at the home. These contained sufficiently detailed information about most aspects of people’s needs.

We looked at how medication was managed. Medication was in good supply and was stored safely and securely. Our findings indicated that people had been administered their medicines as prescribed.

The management team had knowledge of the Mental Capacity Act 2005 and their roles and responsibilities linked to this. However, care staff had not been provided with this training. Reference to people’s mental capacity had been documented in their care plan but there was little detail to this. We have made a recommendation regarding this.

During the course of our visit we saw that staff were caring towards people and treated people with warmth and respect. People who lived at the home gave us positive feedback about the staff team. However, some people told us staff did not always support them well with some aspects of their personal care. We have made a recommendation regarding this.

The staffing levels had been increased since our last inspection and we found that the levels were being maintained consistently. People who lived at the home, staff relatives told us they had seen improvements staffing. However, we did receive feedback that staff still rushed people sometimes and did not always give them the time they needed particularly with their continence needs.

Staff were only employed to work at the home when the provider had obtained satisfactory pre-employment checks. Staff told us they felt appropriately trained to carry out their roles and responsibilities. Staff supervision and team meetings had been taking place on a more regular basis since our last inspection.

The home was accessible and aids and adaptations were in place to meet people’s mobility needs, to ensure people were supported safely and to promote their independence.

Most areas of the home were appropriately maintained. However, we did note some areas for improvement and refurbishment. A program of refurbishment was underway with new carpets being fitted in some areas of the home on the day of the inspection. At our last inspection we found there was limited communal space for people to use. Since then another room has been opened up as additional communal space for people to use for sitting or for dining.

During the course of this inspection we found that not all areas of the home were appropriately clean and staff were not following the required practices for infection control. You can see what action we told the provider to take at the end of the report.

The provider had introduced new systems to check on the quality of the service and listen to the views of people who lived at the home and ensure these were acted on.

17 and 18 December 2014

During a routine inspection

Ferns Nursing Home Limited is a care home that provides accommodation and nursing care and treatment for up to 33 adults who have nursing care needs. Accommodation is provided over three floors and the home is accessible to people who are physically disabled. Access to upper floors is via a staircase or passenger lift. The service is situated close to the centre of Southport, Merseyside.

During the inspection we met most of the people who lived at the home and we spoke with six people individually. We also spoke with a number of visiting relatives, three members of the care staff team, the cook, the deputy manager and the registered manager. We also spoke with the home owners.

We found that people living at the home were not protected from potential abuse because the provider did not have effective systems in place for responding to allegations of abuse. A procedure was in place for responding to allegations of abuse. However, this had not been reviewed for a number of years and included incorrect information about where to refer concerns to. Care staff told us they were confident about recognising and reporting suspected abuse and during discussions with the registered manager they told us they were aware of their responsibilities to report abuse to relevant agencies. However, during the course of our inspection we saw and heard of two different pieces of information which were safeguarding concerns. We found that these had been raised by care staff but no action had been taken by the registered manager in response.

We viewed the care plans for three people who lived at the home. Two of these provided sufficiently clear guidance on how to meet the person’s needs. However, one of the care plans we viewed contained only basic information about the person’s needs and some of this was inaccurate.

Staff worked well with health and social care professionals to make sure people received the care and support they needed. Staff referred to outside professionals promptly for advice and support.

Medication was in good supply and was stored safely and securely. We checked a sample of medication in stock against medication administration records. Our findings indicated that people had been administered their medicines as prescribed.

The manager had knowledge of the Mental Capacity Act 2005 and their roles and responsibilities linked to this. They were able to tell us how they would ensure a decision was made in a person’s best interests if it was deemed that the person did not have the mental capacity to make a specific decision. At the time of our inspection the manager advised us that there was nobody living at the home who lacked the mental capacity to make decisions required of them.

During the course of our visit we saw that staff were caring towards people and treated people with warmth and respect. People who lived at the home gave us positive feedback about the staff team in general. However, they told us that not all members of the staff team had a caring attitude towards them.

There were not always sufficient numbers of staff on duty to meet people’s needs. This was reported to us by people who lived at the home, relatives and members of the staff team. Staff rotas confirmed that staffing numbers were not always maintained at an appropriate level and at those deemed to be required by the provider.

Staff were only employed to work at the home when the provider had obtained satisfactory pre-employment checks.

Staff had been provided with the training they needed to carry out their roles and responsibilities. However, we found staff were not being provided with regular supervision or appraisal and team meetings were not taking place on a regular basis.

The premises were safe and well maintained and procedures were in place to protect people from hazards and to respond to emergencies. The home was clean and people were protected from the risk of cross infection because staff had been trained appropriately and followed good practice guidelines for the control of infection. The home was accessible and aids and adaptations were in place in to meet people’s needs and promote their independence.

We found that the communal space was limited to one main lounge and one small quiet lounge. Together these contained enough seating for up to 15 people. There was no dining room and people therefore ate their meals in the main lounge or in their bedroom. We saw that during lunch time and when there were visitors to the home, the main lounge became cramped.

There was a registered manager at the service 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 Social Care Act 2008 and associated Regulations about how the service is run.

The provider did not have effective systems in place to regularly check on the quality of the service. The views of people who lived at the home and their relatives were sought through surveys but we found that people’s feedback had not been acted upon.

14 November 2013

During a routine inspection

During our visit we spoke with two people using the service and asked them to tell us how they felt they were being cared for. Some of their comments included; 'Yes, it's very nice' and 'It's all OK, I like it here and am glad I came'. We also spoke to two relatives who told us they had no concerns as they felt their relative was well looked after.

People were provided with a choice of suitable and nutritious food and hydration to ensure their nutritional needs were met. We asked one person using the service if they liked the food and if they were given enough to eat. They told us; 'The food is lovely and plenty of it'.

We saw that people's care records contained enough information to show how they were to be supported and cared for. They also showed that people gave consent to their care and treatment if they were able to. Systems were in place to protect people who were not able to make decisions about their own care and support.

An inspection of the care records showed that people had access to other health care services. Staff worked closely with other agencies so that people's social, emotional and physical needs were effectively met. We were also made aware of the systems that were in place to make sure that information was passed on when a person's care was transferred to another service.

Arrangements were in place to ensure that people using the service were cared for by staff that were properly trained, supported and supervised.

5 September 2012

During a routine inspection

During our inspection of the home we spoke with five people who shared with us their views and experiences of living at the home. People told us they were pleased with the care they received. They said they enjoyed the activities and the choices available to them in respect of how they wished to spend their day. We observed good communication and understanding between the staff and people who were receiving care and support from them.

The people we met with appeared relaxed, comfortable and at ease with with the staff. People said there was a good team of staff in place though on occasions staff were very busy and the home would benefit from more staff on duty. Staff said with a recent drop in staffing levels they did not have as much now to assist people as they would like. A recent monitoring visit took place by the local authority's contracts team. The contracts team had also raised some concerns around the staffing levels at the home following feedback from staff they spoke with.

Staff interviewed were knowledgeable regarding the needs of the people they cared for and they informed us about people's individual routines, wishes and how they respected these. Staff told us they provided care for a number of people with high dependency needs and we saw records which showed us the level of care and support people received. We also observed people receiving the care they needed.

People told us they were able to express their views and the staff listened to them.