Fernleaf Residential Home

Fernleaf Residential Home is a residential care home providing accommodation for persons who require nursing or personal care to up to 21 people. The service provides support to people living with dementia. At the time of our inspection 17 people were living at the home. The home is split over two main floors with communal areas on the ground floor and an outdoor communal space. At the time of the inspection, the location did not care or support for anyone with a learning disability or an autistic person.

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

Risks were not consistently managed. Medicines and infection risks were not always managed safely.

Internal quality assurance processes were not always effective in monitoring the service which meant improvements were not always made.

People who used the service were protected from the risk of abuse, harm and neglect by suitably trained staff who knew them well. Concerns were reported and acted upon. People we spoke with told us they felt safe.

There were enough competent staff on shift to ensure people were safe and received good quality care. Staff were recruited safely; however, recruitment files needed some improvement to ensure that all steps taken were fully documented prior to a person starting at the service.

Staff were supported with an induction and rolling training programme to ensure they were skilled within their roles. Induction documentation could be improved to show all information and support provided to a new starter and training was required on supporting autistic people and people with a learning disability.

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 the service was well-led and they received person-centred care. Relatives we spoke with supported this and told us management were open and approachable. Management and staff were clear about their roles, responsibilities and continuously looked for ways to develop and improve the service and the level of care provided.

Staff, people, and their relatives and visitors were encouraged to share their views. The registered manager understood their responsibility to be open and honest with people and had acted when things went wrong. The provider worked in partnership with others.

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 CQC inspection leading to a rating for this service was good (published 22 May 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We undertook a focused inspection to review the key questions of safe and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

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

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

The provider took actions during and after the inspection visit to mitigate some of the identified risks.

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

Enforcement

We have identified breaches in relation to medicines and quality monitoring at this inspection. 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 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

The registered manager had taken an innovative approach to infection control and cleanliness, for example they had sourced a door handle that automatically sanitised hands when used.

There were very organised systems in place to ensure staff were meeting COVID-19 testing and vaccination requirements.

The service supported people to maintain relationships with families and friends, either by visiting within the home or via video calls.

The registered manager had produced their own monthly COVID-19 audit to assure themselves that staff continued to meet current guidelines around PPE, handwashing and infection control procedures.

We found the following examples of good practice.

•The manager had implemented a robust system for all visitors which included a temperature check, hand sanitising and the requirement to wear a face mask upon entering the home. Detailed information was displayed around the home to remind people how to wash their hands effectively.

•Staff were provided with the appropriate personal protective equipment [PPE]. Staff were knowledgeable on when to change PPE and had received enhanced training from healthcare professionals.

•The manager had registered for 'whole home testing' for staff and residents. The manager had a system in place to identify all who had been tested.

•Thorough risk assessments were carried out to assess the impact of COVID-19 on people and staff. Actions were taken to mitigate risks to people when needed.

•The provider was very supportive of the manager and the well-being of the staff team.

•Strict cleaning schedules were in place and appropriate decontamination processes were also in place. This included regular deep cleans of all bedrooms, communal areas and touch points such as light switches and hand rails.

•The provider undertook contingency planning in case there were further outbreaks of COVID-19.

•The manager had an admission process in place which minimised the risk of potential transmission of infection to people living at the home. For example, all people were isolated for two weeks following admission to the home or when discharged from hospital.

•The service had supported people to keep in contact with loved ones including video calls.

•The service had implemented safe visiting for people who were receiving end of life care this included the supply of PPE for visitors and the use of a separate entrance.

Fernleaf residential accommodates 21 people in one adapted building. At the time of our inspection there were 18 people living at the home.

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. In this report when we speak about both the company and the registered manager we refer to them as being, ‘the registered persons’.

At the last inspection on the service was rated, ‘Good’.

At the present inspection the service remained, ‘Good’. Arrangements were in place to carry out regular quality checks and had ensured that there was enough staff on duty. In addition, people told us that they received person-centred care.

There were systems, processes and practices to safeguard people from situations in which they may experience abuse including financial mistreatment. Risks to people’s safety had been assessed, monitored and managed so they were supported to stay safe while their freedom was respected. Medicines were managed safely. Background checks had been completed before new staff had been appointed.

Furthermore, there were arrangements to prevent and control infection and lessons had been learned when things had gone wrong.

Staff had been supported to deliver care in line with current best practice guidance. People were helped to eat and drink enough to maintain a balanced diet. In addition, suitable steps had been taken to ensure that people received coordinated and person-centred care when they used or moved between different services. People had access to healthcare services so that they received on-going healthcare support.

People were supported to have maximum choice and control of their lives. Staff supported them in the least restrictive ways possible. The policies and systems in the service supported this practice.

People were treated with kindness, respect and compassion and they were given emotional support when needed. They had also been supported to express their views and be actively involved in making decisions about their care as far as possible. People had access to lay advocates if necessary. In addition, confidential information was kept private.

Information was provided to people in an accessible manner. In addition, people had been supported to pursue their hobbies and interests. The registered manager recognised the importance of promoting equality and diversity. People’s concerns and complaints were listened and responded to in order to improve the quality of care. Arrangements had been made to support people at the end of their life.

There was a registered manager who promoted a positive culture in the service that was focused upon achieving good outcomes for people. They had also taken steps to enable the service to meet regulatory requirements. Staff had been helped to understand their responsibilities to develop good team work and to speak out if they had any concerns. People, their relatives and members of staff had been consulted about making improvements in the service. The provider had put in place arrangements that were designed to enable the service to learn, innovate and ensure its sustainability. There were arrangements for working in partnership with other agencies to support the development of joined-up care.

Further information is in the detailed findings below.

On the day of our inspection there was a registered manager in place. 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 risk to people’s safety was reduced because staff had attended safeguarding adults training, could identify the different types of abuse, and knew the procedure for reporting concerns. Accidents and incidents were investigated and used to reduce the risk to people’s safety. Regular assessments of the risks to people’s safety, the environment in which they lived and the equipment used to support them were carried out. People had personal emergency evacuation plans (PEEPs) in place.

People were supported by an appropriate number of staff. Appropriate checks of staff suitability to work at the service had been conducted prior to them commencing their role. People were supported by staff who understood the risks associated with medicines. People’s medicines were stored safely; however the temperature of the room in which they were stored did on occasions exceed recommended limits.

People were supported by staff who completed an induction prior to commencing their role and had the skills and training needed to support them effectively. Although there were a small number of areas where some staff required refresher training.

The registered manager ensured they had recorded how the principles of the Mental Capacity Act (2005) had been applied when decisions had been made for people. The appropriate processes had been followed when applications for Deprivation of Liberty Safeguards had been made.

People spoke highly of the food and were supported to follow a healthy and balanced diet. People’s day to day health needs were met by staff and external professionals. Referrals to relevant health services were made where needed.

Staff supported people in a kind and caring way. Staff understood people’s needs and listened to and acted upon their views. Staff responded quickly to people who had become distressed and communicated well with people living with dementia.

People told us they were provided with the information they needed that enabled them to contribute to decisions about their care. People were provided with information about how they could access independent advocates. People’s friends and relatives were able to visit whenever they wanted to.

People were involved with planning the care they wanted to receive from staff. People’s care records were written in a person centred way and staff knew people’s likes and dislikes and what interested them. People were encouraged to do the things that were important to them and they were supported to follow their hobbies and interests. People were provided with the information they needed if they wished to make a complaint.

The registered manager led the service well, understood their responsibilities and were well liked and respected by people, staff and relatives. People and staff felt the service was well managed. Staff understood what was expected of them and processes were in place to delegate further roles of responsibility to staff.

People were encouraged to provide feedback and this information was used to improve the service. There were a number of quality assurance processes in place that regularly assessed the quality and effectiveness of the support provided.