Fernways

Fernways is registered to provide personal care and support to people living in specialist ‘extra care’ housing in London Borough of Redbridge. Not everyone who lived in the housing received personal care from the service. CQC does not regulate premises used for extra care housing; this inspection looked at people’s personal care and support service. People using the service lived in their own flats within a gated community where there were 52 properties. The service was providing personal care to 17 people at the time of the inspection.

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

The provider had missed calls to people using the service, this related to staff absence and system failure. Medicines management required improvement; there were no protocols for medicines which were administered as and when required (often referred to as PRN medicines) and there were often gaps found in medicine administration records and no record of follow up with prescribing health professionals or GPs as to what to do if medicines were missed. Lessons were not always learned when things went wrong, incidents and accidents were not regularly discussed with staff.

Improvements were required in respect of governance systems at the service. We found a lack of systematic follow up or record of response to issues noted in staff communications. Similarly, records of communications with health professionals were not always recorded. There was no record of what occurred in staff handovers, and staff meetings did not contain rolling agenda items such as safeguarding or incidents and accidents.

We have made recommendation about recording people’s end of life wishes.

There were systems in place to safeguard people from abuse. Risks to people were assessed and monitored. Infection prevention measures were in place.

Staff were supported through induction, training and supervision. The service worked alongside other agencies to provide effective care. People were supported with their health needs. People’s needs were assessed so the service knew whether they could meet them or not. People were supported with their dietary needs. 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’s equality and needs were recorded so staff could support people in culturally sensitive way. The service had received compliments about the care they provided. People and relatives were supported to express their views on the service. People were supported respectfully and their independence promoted.

People received personalised care; their care needs were recorded in their care plans. People’s communication needs were met. People were supported with activities. The provider was responsive to complaints and concerns raised.

The provider had some quality assurance measures in place. While some aspects of their quality assurance systems did not work well, such as medicines audit follow up and incident and accident reporting, other aspects helped to improve the service, such as spot checks.

. People and relatives, we spoke with were generally positive about the service and staff working there. Staff knew their roles.

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

Rating at last inspection

The previous rating for this service was good (published 08 December 2017).

Why we inspected

The inspection was prompted in part due to concerns received about people’s care calls being missed. A decision was made for us to inspect and examine those risks.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement and recommendations

We have identified breaches in relation to safe care and treatment good governance at this inspection. We have also made a recommendation about recording people’s end of life wishes.

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 for 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.

We found the following examples of good practice.

There were safety measures in place for visitors to the housing complex. All people entering the service were required to provide evidence of a recent negative COVID-19 Lateral Flow Test (LFT) result. Where visitors had not completed tests before visiting, the service offered these. There was Personal Protective Equipment (PPE) available for visitors to wear, such as a face masks, to limit potential infection transmission. At the time of our inspection, visitors were not being permitted to the housing complex as there had been a recent COVID-19 outbreak.

Relatives of people using the service, and all those living at the complex, had been advised either by phone or email. Similarly, there was signs at the entrance informing people visiting had been restricted temporarily. People were supported to maintain contact with relatives if required, for example where relatives delivered food to people in the complex, this was taken by staff at reception and delivered to people in their flats. As people lived in their own flats they were free to come and go as they pleased. However, the provider supported those who had tested positive for COVID-19 by asking them to isolate where possible. Where this wasn’t possible, for example with people who had dementia and tended to wander, a zoned lounge had been clearly marked for their use and staff accordingly.

Although visiting had been restricted, professional visitors, like the community matron, and primary care givers, such domiciliary care services, were permitted access to provide health and personal care to people who required it.

Staff were tested regularly. Staff members took Polymerase Chain Reaction (PCR) tests weekly and LFT daily before attending shifts on site. Only staff providing negative test result were permitted to work.

The service had enough staff. Staff absences were covered by existing staff and or agency staff. Where agency staff were used, arrangements were in place to limit their employment at multiple services, and so by reducing the risk of transporting infections between them. We met with the nominated individual, the person responsible for the oversight of regulated activity at the service, and they were able to explain their contingency planning should shortfalls occur due to COVID-19 staff shortages.

Infection control policies, procedures and risk assessments were up to date. These supported staff to keep people safe. The provider kept up to date with government guidance with regard to COVID-19 to ensure they were following it correctly, cascading relevant information to staff.

All staff had been trained in infection control and the use of PPE, including agency staff. We saw staff using PPE correctly. Handwashing guidance and infection control signage was displayed in prominent places. The communal areas of the complex were kept clean at all times to maintain hygiene and help prevent the spread of infections.

At the last inspection on 25 November 2014 the service was rated ‘Good’. At this inspection we found the service remained ‘Good’.

The home had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the home. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the legal requirements in the Health and Social Care Act 2008 and the associated regulations on how the home is run.

People continued to receive safe care. Risks were identified and actions were taken to minimise these risks to support people as safely as possible. Systems were in place to ensure medicines were administered safely and when needed. There were enough staff on duty to support people.

People continued to be supported by experienced staff who received training and support to enable them to continue to provide an effective service. The staff team worked closely with other professionals to ensure that people remained as healthy as possible and received the healthcare they needed.

People continued to be supported by kind, caring staff who treated them with respect. Their privacy and dignity were maintained.

People continued to receive individualised care and support that was responsive to their needs. They were encouraged to make choices about their daily lives and to continue to do things they enjoyed.

Management systems ensured the service continued to be well led. People were involved in decisions about their care and about what happened in the service. They were able to provide feedback on the running of the service and this was acted on.

Further information is in the detailed findings below.

People told us that they were asked for their views on the service. One person told us "they do ask if the food is alright, that kind of thing." We found the service had various systems in place for monitoring the quality of care provided. The service had a complaints procedure in place and people told us they knew how to make a complaint. One person said "I would talk to the manager." We found that records were kept up to date and that they were stored securely.

Care workers were knowledgeable about the needs of people they supported and how to meet them. People told us that the care workers worked flexibly to meet their needs. One person said "I am a very satisfied customer. I hope I can stay here for the rest of my life." A professional spoken to said " the staff are brilliant, they listen to advice given and follow it. I have no complaints about Fernways, only praise."

People said that they felt safe with the care workers and that they would raise any concerns with the manager. People were supported by care workers who were competent to deliver their care.

The service had a quality assurance programme in place to regularly assess and monitor the quality of service that people receive.

We found that the records held on behalf of people did not include adequate information about the care and treatment provided to people. We had concerns about the accuracy of care plans and risk assessments for people who use the service.