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Fernlea Requires improvement

Reports


Inspection carried out on 27 January 2020

During a routine inspection

About the service

Fernlea is a residential and nursing care home providing accommodation, nursing and personal care to 48 people aged 65 and over at the time of the inspection. The service can support up to 52 people. Fernlea accommodates people in one purpose-built building over two floors.

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

Concerns were raised over nursing practice during the inspection. The provider had not always ensured that nurses caring for people with wounds had the competence, skills and experience to do so safely. The registered manager did not always have a full overview of actions the nurses were taking.

We identified concerns with the administration and management of medicines. People did not always receive their medicines as prescribed.

Risk assessments and care plans were not always fully accurate. Actions stated as required in care plans were not always followed. This put people at risk of unsafe care.

People were well supported to maintain a balanced and nutritious diet. People were very complimentary about the food at the home. Staff received training and supervision, and told us they felt supported in their role.

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.

Feedback from people and their visitors was very positive around the quality of care delivery at the home. People felt they were treated with dignity and respect and had their independence promoted.

There was a very well-resourced and varied programme of both individual and group activities provided for people. People were well supported to maintain relationships and avoid isolation.

There has been a lack of oversight of the operations of the service and this has led to the concerns identified in this inspection. Statutory notifications were not sent to CQC as required. The management team were very responsive to concerns raised during the inspection.

We made one recommendation to ensure people's consent forms were signed by appropriate people.

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 good (published 5 June 2019).

Why we inspected

We received concerns in relation to the management of people’s pressure care. As a result, we undertook a focused inspection to review the key questions of effective and well-led only. However, during the initial, focused inspection we found concerns in relation to record keeping and clinical and managerial oversight. This led us to return to the home and conduct a full, comprehensive inspection of the service.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

Enforcement

We have identified breaches in relation to people’s safety regarding accurate care records, nursing and medicines competencies and clinical and managerial oversight of the service.

Please see the action we have told the provider to take at the end of this report.

Since the last inspection we recognised that the provider had failed to notify us of certain events. This was a potential breach of regulation. Full information about CQC’s regulatory response to this is added to reports after any representations and appeals have been concluded.

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.

Inspection carried out on 13 May 2019

During a routine inspection

About the service:

Fernlea is a care home that was providing personal care and accommodation to 45 adults. The service can support up to 52 people, some who may require nursing care and/or living with dementia, physical or mental health needs.

People’s experience of using this service:

People and their relatives told us they received safe care and treatment. They spoke positively about the care and support provided. People were safeguarded from abuse and avoidable harm by well trained staff who cared about people’s wellbeing. The registered manager had robust safeguarding reporting procedures and staff had appropriately reported concerns to the local authority.

People’s care needs were assessed and planned for and there were enough staff to meet people’s needs and give people the time and reassurances they needed. We asked the registered manager to review care records for respite care as they were brief.

People received their medicines safely. Medicines administration and storage practices were robust and regular internal and external medicines audits had been carried out to monitor the practices in the home.

Staff showed a good understanding of their roles and responsibilities for keeping people safe from harm. Individual risks to people and environmental risks had been assessed and monitored. However, the registered manager needed to have oversight on records of accidents and incidents to assure themselves that staff had taken the correct action to support people after an incident. People were not adequately observed for injuries that may appear after a fall and the provider did not show how they had learned from incidents, events or near misses in the home.

We made a recommendation about the management of accident and incidents and reporting procedures.

The registered manager and the provider had maintained the premises to a high standard and any faults were timely rectified. The home was clean and hygienic and regular infection control audits had been carried out.

Staff supported people to have maximum choice and control of their lives and supported people in the least restrictive way possible; the policies and systems in the service supported this. We observed the seeking of consent from people before moving them or providing them with support. Consent records had been kept and people’s mental capacity assessed. Some authorisations for restrictions on people’s liberties had been considered or applied for where required. However, we asked the registered manager to review and consider whether other people in the home required applications for authorisation, due to their vulnerability and some restrictions in place for their safety. The registered manager took action after our inspection.

Staff had received a range of training and support to enable them to carry out their roles safely. We discussed the need to ensure that all staff including bank staff renewed their training when it was due.

People received support to maintain good nutrition and hydration and their healthcare needs were understood and met. Staff offered people a pleasant dining experience with adequate choice and alternatives for those requiring special or modified diets. People’s views about meals were mixed. However, we saw the registered manager took these views into consideration and made necessary changes for each individual wherever possible.

There was a strong emphasis on supporting people with their end of life preferences. There was a dedicated staff team to support people in this area and all other staff were provided with training in end of life care.

People and family members knew how to make a complaint and they were confident about complaining should they need to. They were confident that their complaint would be listened to and acted upon quickly. Previous complaints had been dealt with appropriately.

The provider continued to review the governance systems that we found at the last inspection to monitor and improve the care delive

Inspection carried out on 28 September 2016

During a routine inspection

This was an unannounced inspection that took place on 28 September 2016. This was the first inspection since the service was registered in October 2014. There were 46 people using the service at the time of the inspection.

Fernlea is a purpose built two storey detached home situated in the residential area of Hazel Grove Village, close to public transport and local facilities. The home is set in well-maintained gardens with adequate parking and clearly defined parking areas for disabled visitors. Fernlea is registered to provide accommodation for up to 50 adults who require nursing or personal care.

The home had a manager registered with the Care Quality Commission (CQC) who was present on the day of the 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.

We found that suitable arrangements were in place to help safeguard people from abuse. Staff knew what to do if an allegation of abuse was made to them or if they suspected that abuse had occurred. Staff were able to demonstrate their understanding of the whistle blowing procedures (the reporting of unsafe and/or poor practice).

We found people were cared for by sufficient numbers of suitably skilled and experienced staff who were safely recruited. Staff received the essential training and support necessary to enable them to do their job effectively and care for people safely.

We saw people looked well cared for and there was enough equipment available to ensure people’s safety, comfort and independence were protected. People’s care records contained enough information to guide staff on the care and support required. The records showed that risks to people’s health and well-being had been identified and plans were in place to help reduce or eliminate the risk. We saw that people were involved and consulted about the development of their care plans.

People told us they received the care they needed when they needed it. They told us they considered staff were kind, had a caring attitude and felt they had the right skills and knowledge to care for them safely and properly. We saw that staff treated people with dignity, respect and patience.

Procedures were in place to prevent and control the spread of infection and risk assessments were in place for the safety of the premises. All areas of the home were secure, clean, well maintained and accessible for people with limited mobility; making it a safe environment for people to live and work in.

We saw that appropriate environmental risk assessments had been completed in order to promote the safety of people who used the service, members of staff and visitors. Systems were in place for carrying out regular health and safety checks and equipment was serviced and maintained regularly. Procedures were in place to deal with any emergency that could affect the provision of care, such as a failure of the electricity and water supply.

The medication system was safe and we saw how the staff worked in cooperation with other healthcare professionals to ensure that people received appropriate care and treatment.

Staff were also able to demonstrate their understanding of the principles of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS); these provide legal safeguards for people who may be unable to make their own decisions.

People were provided with a choice of suitable and nutritious food and drink to ensure their health care needs were met. We saw that food stocks were good and people were able to choose what they wanted for their meals.

To help ensure that people received safe and effective care, systems were in place to monitor the quality of the service provided. Regular checks were undertaken on all