Ferendune Court

Ferendune Court is a residential care home registered to provide care and accommodation for up to 48 people. Thirty-two people were living at the service at the time of the inspection.

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

There were systems in place to ensure people safely received their medicines. However further improvement was needed due to recording errors and while audits had been completed, they did not always demonstrate action was taken where shortfalls had been identified.

We received mixed views from the staff team about working at the service. Some told us they were

supported and received training, whilst others said there were not enough staff which impacted the quality of care provided.

People experienced person centred care from staff who were compassionate and knew people's needs. Staff treated people with kindness, dignity and respect.

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.

People were protected by the provider's recruitment procedures. The provider made appropriate preemployment checks to ensure that only suitable staff were employed. Staff understood their responsibilities in terms of safeguarding and knew how to report concerns if they suspected abuse.

Care plans detailed people's support needs and how care workers should support people to meet those needs. Information varied, with some records being very informative whilst others were written more broadly and lacked details on people's individual preferences.

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.

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 requires improvement (published 18 July 2019). There was a breach in relation to person-centred care. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found some improvements had been made and the provider was no longer in breach of Regulation 9 HSCA RA Regulations 2014 (Person centred care). However, the provider was now found to be in breach of Regulation 17 HSCA RA Regulations 2014 (Good Governance).

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 23 and 29 May 2019. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve person-centred care.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions, Safe, Responsive and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service remains requires improvement. This is based on the findings 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.

We have found evidence that the provider needs to make improvements. Please see the Well-Led section of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Ferendune Court on our website at www.cqc.org.uk.

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.

People’s experience of using this service:

People told us they felt safe living at Ferendune Court. However, they told us that staff were not always effectively deployed and available at all times to meet people's needs.

There were group activities for people to join in, however, people told us little was offered to those who chose or needed to remain in their rooms.

Systems were in place for the recording of incidents and accidents. They were monitored and analysed over time to look for any emerging trends and themes.

People were kept safe from abuse. Staff understood their responsibilities and knew how to report any concerns. People's risks associated with their care were managed to help ensure people's safety and freedom were supported and maintained.

People were cared for in a clean and hygienic environment. Staff were aware of processes to reduce the risk of cross infection. Appropriate arrangements were in place in relation to the management and administration of medicines.

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.

People told us that staff were well trained and kind and caring. We observed positive interactions between people and staff. People's privacy and dignity were promoted and staff were aware of the importance of supporting people to sustain their independence.

There was a complaints policy in place and any concerns that had been raised were investigated and responded to by management. The service regularly sought the views of people and relatives to identify improvements.

There was no registered manager at the time of the inspection. The provider had put measures in place to support the day to day management of the home. The management team were open and transparent, and keen to improve the service. There were quality assurance systems but these were not always effective as we identified shortfalls which had not been discovered through the provider’s own processes.

During our inspection we identified one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Rating at last inspection: Good (Published 21 July 2017)

Why we inspected: This was a scheduled full comprehensive inspection carried out in line with our inspection methodology which is based on the last inspection rating.

Follow up: We have asked the provider to send us an action plan detailing how they will make

improvements to the service.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

We had found two breaches of the regulations at our previous inspection in September 2016. At this inspection we looked to see what measures had been taken to ensure the quality of the service, and to see if these measures had been effective and improvements had been achieved. The provider told us that all the actions required to meet the regulations had been completed by the end of November 2016 as scheduled in the actions plans. During our inspection on 27 June 2017 we found that all of the recommended actions had been completed.

Ferendune Court is registered to provide accommodation for up to 48 older people who require nursing and personal care. The home is situated in Faringdon, Oxfordshire. At the time of our inspection there were 46 people living at Ferendune Court.

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 2008 and associated Regulations about how the service is run.

People told us they felt safe and staff were aware of their responsibility to keep people safe. Risks to people's safety were appropriately assessed and managed. The service promoted positive risk taking resulting in people gaining a huge confidence boost.

Staff displayed a thorough knowledge of how to identify any safeguarding concerns and knew the process of reporting such concerns. Medicines were administered, recorded and stored in line with current guidelines.

Staff had been recruited safely to ensure they were suitable to work with vulnerable people. There were sufficient numbers of suitable staff to keep people safe.

The registered manager was knowledgeable about The Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. The Metal Capacity Act Code of Practice was followed when people were not able to make important decisions themselves. The registered manager and staff understood their responsibility to ensure people's rights were protected.

Records showed that staff received the training they needed to keep people safe. The manager had taken action to ensure that training was kept up-to-date and future training was planned.

Staff told us they felt supported by the management and received supervision and appraisals, which helped to identify their training and development needs.

People had regular access to healthcare professionals. A wide choice of food and drinks was available to people and suited their nutritional needs. People’s individual preferences regarding food were always taken into account.

People had positive relationships with staff and were treated in a caring and respectful manner. Staff delivered their support in a calm, relaxed and considerate manner. People and their relatives were actively encouraged to participate in the planning of people’s care. Staff were empathic when dealing with people's privacy and dignity.

Care plans were person-centred and ensured the care and support suited people’s needs and expectations. People’s own preferences were reflected in the support they received.

The management appreciated and acted on people's and relatives’ opinions on the service, including complaints. Such information was used to implement changes and enhance the functioning of the service. People and staff had confidence in the manager as their leader and were complimentary about the positive culture within the service. There were systems and processes in place to help monitor the quality of the care people received.

Ferendune Court is registered to provide accommodation for up to 48 older people who require nursing and personal care. The home is situated in Faringdon, Oxfordshire. At the time of our inspection there were 41 people living at Ferendune Court.

The service had 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 2008 and associated Regulations about how the service is run.

People, their relatives and staff raised concerns about staffing levels. We saw people did not always receive support on time and had to wait for staff to be available to provide support.

Staff supervision was not consistent and one- to-one meetings were not carried out regularly. We have made a recommendation about staff supervision.

A quality assurance system was in place but it was not always effective as it had failed to highlight the issues identified at our inspection.

Records kept by the service were not always available, accurate or complete.

Staff and resident meetings were held regularly, however, some staff members told us they had ceased attending the meetings as they had not felt listened to and empowered to contribute to the meetings.

People were supported by staff who knew how to keep them safe. When people had risks to their health and safety identified, staff knew how to support them appropriately. Risk assessments were in place for staff to follow.

There was a robust recruitment procedure in place to ensure prospective staff members had the skills, qualifications and background needed to support people.

Medicines were managed safely. The provider had arrangements in place for proper and safe management of medicines.

The registered manager was knowledgeable about The Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. The Metal Capacity Act Code of Practice was followed when people were not able to make important decisions themselves. The registered manager and staff understood their responsibility to ensure people's rights were protected.

People received the support they required to meet their nutritional needs. Staff showed an excellent knowledge of the specialist diets people required and gave appropriate support to people who needed assistance with meals. Staff made referrals to and sought support from a range of health care professionals in a timely way.

Staff were kind and caring. They treated people with respect, maintained and promoted people’s dignity.

Staff had built positive and strong relationships with people and their relatives, earning their trust. Staff were aware of people's communication needs and we observed staff engaging people in conversations. A varied activities programme was available that was tailored to people's interests and hobbies.

People and their relatives told us they were comfortable raising complaints. We saw a system was in place which showed that when people complained, they were listened to.

We found two breaches of regulations 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have advised the provider to take at the end of this report.

We conducted this inspection because we identified concerns around people's care and welfare and nutritional needs in January 2014. We found that while the provider had taken appropriate action with regards to people's nutritional needs, there was still need for improvement to meet expected practices regarding people's care needs and records.

Below is a summary of what we found. The summary describes what people using the service, their relatives 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 effective?

The service was not always effective because people's needs were not always being met. Care workers did not always follow people's care plans, which put people at risk of inappropriate care or treatment.

People's care plans did not always contain current guidance for care workers to meet people's needs. This meant that people could be at risk of inappropriate care or treatment as an accurate record of their care needs had not been maintained.

People were protected from the risks associated with malnutrition, falls and moving and handling. Care workers demonstrated a good knowledge of people's care needs.

Is the service caring?

The service was caring. We found that people benefitted from kind and caring care workers. We conducted short observational framework for inspection (SOFI) observations throughout our visit. We observed that people were treated with respect.

People spoke positively about the home and the support they received from care workers. People told us and we observed, they had choice around food and drink which they enjoyed.

The inspection was carried out during a time of impending change to the service. The nursing service will cease and residential care only will be provided later this year. It appears that this has caused anxiety for both residents and visitors. One visitor we spoke with told us 'I am very worried about the future'.

We observed staff treating people with dignity and respect. Staff called people by their preferred name and always knocked before entering a person's room. We found that there were some shortfalls in the recording of the assessing and planning of care. We found that there were some inconsistencies between assessments and guidance for staff and have required that improvements are made.

People were not always supported to be able to eat and drink sufficient amounts to meet their needs. Staff did not always have the time needed to ensure that people received the correct support and interaction. We have required that improvements are made.

We found that the provider had policies in place relating to the obtaining, storing, administering and disposal of medicines. Staff had received training before undertaking responsibility for administering medication.

Appropriate recruitment checks were carried out and recorded. New members of staff completed an induction and attended core skills training. Staff we spoke with told us they received training to support them to carry out their role correctly.

The provider had systems in place to monitor and evaluate the quality of services provided.

We observed staff treating people with dignity and respect. Staff would always knock before entering a person's room and there was a system in place to alert staff and visitors when individuals were receiving personal care.

Staff told us that they followed care plans which they felt contained adequate information.

The provider and staff were aware of their responsibilities regarding protecting people from abuse and the people we spoke with said that they felt happy and safe. Staff felt supported and the provider had processes in place to ensure that people were assisted and cared for by trained and experienced staff.

The provider had effective systems in place for monitoring the quality of service provision . People using the service had recently been asked for their feedback. People knew how to make a complaint and we saw that complaints that had been made were recorded and dealt with in a timely manner.