Fern Hill House Care Home

Fern Hill House Care Home is a residential care home providing accommodation, care and support for up to 24 people aged 65; some people using the service were living with dementia. Accommodation is provided over three floors. During our inspection the top floor was not in use. There were 17 people living in the home.

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

Since the last inspection, there had been improvements made but time was needed to embed new systems to ensure they were effective and could be sustained. The provider had addressed the serious concerns raised in the fire safety enforcement notice. However, additional work needed to be completed and signed off by the fire safety officer. Quality monitoring systems had improved with evidence shortfalls had been identified and acted on. However, further improvements were needed in areas such as developing action plans and ensuring care records, equipment servicing and medicines management audits were fully effective.

The management of risks to people's health, safety and wellbeing had improved. However, we found areas that could be improved further to ensure staff were provided with guidance about how to provide care in a safe way. Accident and incident management had improved, and lessons were learnt from any incidents. Staff had been provided with the provider’s mandatory safety training. Training and supervision sessions were used to ensure learning and improvements took place. The manager and staff were clear about when to report incidents and safeguarding concerns to other agencies. Relatives had no concerns about the safety of their family members. We observed good interactions between staff and people.

People's medicines were managed and stored safely, and records were clear. However, improvements were needed in relation to recording the application of creams, medicines for disposal and keeping records of medicines ordered. We were assured the provider was preventing visitors from catching and spreading infections and there had been no COVID-19 outbreaks in the home. The service was clean and odour free. During the inspection, the cleaning schedules were reviewed to ensure staff were following safe guidance.

Staff were recruited safely, and records showed there were consistent numbers of staff available to meet people’s needs. Relatives made positive comments about the care and support provided by staff particularly during the pandemic. New care planning records reflected people’s choices and considered people’s diverse needs. People looked settled and happy and we observed them being treated with care and respect. People's views and opinions were sought through day to day discussions and surveys; resident meetings were due to recommence. Relatives confirmed they had been kept up to date and involved in any changes and decisions.

The manager and provider understood their responsibility to be open and honest when something went wrong. Staff said the manager was approachable. The manager and staff worked in partnership with a range of professionals to ensure people received the care and support they needed. The manager was supported by the management team and had enrolled on training to support him with the role. Staff told us they were supported and enjoyed working at the service. Staff and relatives made positive comments about the manager’s contribution to improvement and ongoing communication.

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

Rating at last inspection and update

The last rating for this service was Inadequate (published 15 December 2020).

During this inspection, we noted improvements had been made but needed to be further embedded into daily practice. Therefore, we have identified continued breaches in relation to the management of risk and effective quality assurance systems. We have made a recommendation regarding safe management of medicines.

This service has been in Special Measures since 16 December 2020. During this inspection, the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This was a planned inspection based on the previous rating.

On 10 and 12 November 2020, we carried out an announced focused inspection of this service. Breaches of legal requirements were found with regards to good governance, fire safety, risk management, training and infection prevention control practices. We made recommendations in relation to safeguarding, lessons learned and involvement.

We also served a warning notice for non-compliance with Regulation 17 Good Governance and we made a referral to the fire service who visited and served a fire safety enforcement notice.

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

We undertook this focused inspection to check they had followed their action plan and whether the Warning Notice we previously served in relation to Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

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.

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 has changed from Inadequate to Requires Improvement. This is based on the findings at this inspection.

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

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

Follow up

We will continue to monitor information we receive about the service until we 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 and what we found

The service was not safe. We found significant concerns in relation to fire safety, resulting in us contacting the fire service. Risks to people’s health and well being had not been sufficiently managed and staff were not always trained in line with the provider's timeframes. People were being put at risk from the risk of transmission of Covid-19 and other infectious disease because of inadequate infection prevention, cleaning and control processes.

Some of the fire safety and infection control issues were addressed subsequent to the inspection.

Whilst accidents and incidents had been recorded, there was no evidence that these were reviewed by management so appropriate action was/could be taken in response to risk. We reviewed training records and found multiple occasions when staff were working together without having undertaken the provider's mandatory training.

The service was not well led. The provider failed in their responsibility to ensure people using the service were protected by robust fire safety procedures, placing people at risk for a significant period of time. There was a new manager in place who had submitted their application to register with us. The provider did not always promote a person-centred culture that achieved good outcomes for people. Audits were not sufficiently robust to identify the issues we found during the inspection.

We have made a recommendation about engaging with people, staff and relatives.

Relatives spoken with felt their family members were safe from abuse. Records showed appropriate safeguarding referrals and notifications had been submitted to the relevant bodies. However, safeguarding training had not been completed by all staff, despite this being seen as a mandatory course by the provider.

We have made a recommendation about safeguarding training.

There was no evidence of lessons learned following accidents and incidents. However, the nominated individual took some action during our inspection to address this.

We have made a recommendation about lessons learned.

The service had robust recruitment systems and processes in place. Medicines were managed safely. Equipment within the service, such as hoists had been serviced regularly. The service engaged with external professionals such as GP’s and district nurses.

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 10 September 2018).

Why we inspected

This inspection was prompted in part due to concerns we received in relation to infection control, medicines, care practices and management of the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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 coronavirus and other infection outbreaks effectively.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to inadequate. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. 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.

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service.

We have identified breaches in relation to risk assessment, infection control, fire safety and good governance.

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

Full information about CQC’s regulatory response to the more serious concerns found during inspections 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.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Fern Hill House Care Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Fern Hill House Care Home provides accommodation and care and support for up to 24 people, some of who were living with dementia or mental ill health. There were 17 people accommodated in the home at the time of the inspection.

Fern Hill House Care Home is located on a main road close to the town centre facilities of Bacup. It is an older style property with facilities on three floors, which could be accessed by steep staircases or a number of chair lifts and a passenger lift. There was a small car parking area with a gated seating and smoking area to the front of the house.

The service was managed by a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

At the last inspection carried out on 13 and 14 February 2018, the service was rated as ‘Requires Improvement’. We found three breaches of the regulations in respect of medicines management, risk management and care planning. This was the third occasion the provider had failed to meet the regulations as they were also rated as requires improvement in January 2016 and March 2017. Therefore, following the inspection of 13 and 14 February 2018, we imposed conditions on the provider’s registration that required them to send us a monthly improvement plan to show what they would do and by when to improve the service.

Following the last inspection of 13 and 14 February 2018, regular meetings had been held with the registered persons, CQC, the local authority safeguarding team and the commissioners of services. The clinical commissioning group medicines optimisation team, infection control team and local commissioners of services had worked with the provider and the management team and staff to support them with improvements. The provider had voluntarily suspended admissions to the home and an agreement was made to allow a restricted number of admissions to the home until the commissioners were satisfied that significant improvements had been made. An action plan was available to support further improvements and was regularly updated by the provider and shared with local commissioners and CQC.

At this inspection, we found the rating had improved to ‘Good’.

The management of people's medicines had improved and they were managed in a safe manner. People had their medicines when they needed them. Staff administering medicines had received training and supervision to do this safely.

Records relating to people's care and support had improved. The information in people's care plans was sufficiently detailed to ensure they were at the centre of their care. We discussed how the information could be improved. People's care and support was kept under review and, where possible, people were involved in decisions about their care. Risks to people's health and safety had been identified, assessed and managed safely. Relevant health and social care professionals provided advice and support when people's needs changed.

Improvements had been made to ensure the home was a clean, safe and comfortable place for people to live in. However, there had been slow progress with further improvements to people’s bedrooms. Following the inspection, the registered manager sent us a detailed improvement plan with clear timescales. Appropriate aids and adaptations had been provided to help maintain people's safety, independence and comfort.

The management team and staff had worked hard to introduce much needed changes and improvements; they were aware further improvements were needed and there was a plan in place to support this. People and staff were happy with the improvements that had been made and considered the service was managed well. Communication had improved and people felt they had been involved in decisions and consulted about any changes.

People were happy with the personal care and support they received and made positive comments about the staff. They told us they felt safe and happy in the home and staff were caring. People were comfortable in the company of staff and it was clear they had developed positive trusting relationships with them. Staff understood how to protect people from abuse.

People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Staff respected people's diversity and promoted people's right to be free from discrimination.

People had access to a range of appropriate activities both inside the house and in the local community. People's nutritional needs were monitored and reviewed and appropriate professional advice was sought when needed. People were given a choice of meals and staff knew their likes and dislikes.

People told us they were happy and did not have any complaints. They knew how to raise their concerns and compliments and were confident they would be listened to.

A safe and robust recruitment procedure was followed to ensure new staff were suitable to care for vulnerable people. Arrangements were in place to make sure staff were trained and competent. People considered there were enough suitably skilled staff to support them when they needed any help. Staffing levels were monitored to ensure sufficient staff were available.

Effective quality assurance and auditing processes helped the provider and the registered manager to identify and respond to matters needing attention. There were systems to obtain the views of people, their visitors and staff. People felt their views and choices were listened to.

Fern Hill House Care Home provides accommodation and care and support for up to 24 people, some of who were living with dementia or mental ill health. There were 14 people accommodated in the home at the time of the inspection.

Fern Hill House Care Home is located on a main road close to the town centre facilities of Bacup. It is an older style property with facilities on three floors, which could be accessed by steep staircases or a number of chair lifts and a passenger lift. There was a small car parking area with a gated seating and smoking area to the front of the house.

Fern Hill House Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

At the time of our inspection the registered manager had not been managing the service since January 2018. A new manager had been recruited and was due to start working at the service from 26 February 2018. 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 the interim period the service was being managed by an area manager and a deputy manager.

At the last inspection on 7 and 10 March 2017 our findings demonstrated there were four breaches of the regulations in respect of risk management, care planning, maintaining the environment and a continued breach relating to quality assurance systems. Following the last inspection we met with the provider and asked them to complete an action plan to show what they would do to improve the service to at least good and to identify the date when this would be achieved.

Following the last inspection regular meetings had been held with the registered persons, CQC, the local authority safeguarding team and the commissioners of services. The clinical commissioning group medicines optimisation team, infection control team and local commissioners of services had worked with the provider, the previous and current management team and staff to support them with improvements. Following recent concerns the provider had voluntarily suspended admissions to the home until they, the commissioners and CQC were satisfied that significant improvements had been made. Following the inspection the providers met with the commissioners and an agreement was made to allow a restricted number of admissions to the home; we were told this would be kept under review. An action plan was available to support further improvements; this was regularly updated by the provider and shared with local commissioners and CQC.

During this inspection we found improvements had been made to address the shortfalls in the environment and quality assurance and auditing systems. However, our findings demonstrated a breach of regulation relating to medicines management and continued breaches of regulation in relation to risk management and care planning. The home was rated as requires improvement in January 2016 and March 2017. This is therefore the third occasion the provider has failed to meet the regulations.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

There had been a lack of consistent management and a lack of effective communication which had slowed progress to make improvements. The current management team had been in post for a short time and it was clear that they and the staff had worked hard as a team to introduce changes and make improvements. People, their visitors and staff were happy with the improvements that had been made and considered the management of the service had improved recently.

Staff administering medicines had been trained and supervised to do this safely. The internal audits had noted shortfalls in the way people’s medicines were managed. We found appropriate action had been taken in response to the audit findings. However, we found people’s medicines were still not being managed safely and further improvements were needed.

We found there had been an improvement in the records relating to people’s care and support and people’s preferences and routines were recorded. We found the new care plan format and associated risk assessments had been introduced, although we found the care plans did not always provide staff with clear guidance and direction on how best to support people when their needs changed.

There were areas of the home that still needed attention although we noted improvements to the environment had been made; there was a plan in place to support this and ongoing improvements. The home was clean and bright and appropriate aids and adaptations had been provided to help maintain people’s safety, independence and comfort. People told us they were happy with the improvements to the home.

Quality assurance and auditing processes had been improved to help the provider and the management team to effectively identify and respond to matters needing attention. Records showed that shortfalls had been recognised and had been followed up. The systems to obtain the views of people, their visitors and staff had also been improved.

A safe and robust recruitment procedure was followed to ensure new staff were suitable to care for vulnerable people. Arrangements were in place to make sure staff were trained and competent. People considered there were enough staff to support them when they needed any help. Staffing levels had been improved and were monitored to ensure sufficient staff were available.

People told us they enjoyed the meals and their dietary preferences were met. We observed meal times were a relaxed experience.

People told us they felt safe in the home and they were very happy with the service they received. People appeared comfortable in the company of staff. Safeguarding adults' procedures were in place and staff understood how to protect people from abuse. Communication between staff and visiting professionals had improved.

Appropriate Deprivation of Liberty Safeguard (DoLS) applications had been made to the local authority and people's mental capacity to make their own decisions had been assessed and recorded in line the requirements of the Mental Capacity Act 2005. People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible.

We found people’s access to appropriate and meaningful activities had improved and people were able to engage in varied and enjoyable activities both inside and outside the home. An activity person had been recruited. People were supported to maintain relationships with friends and family and supported to develop new friendships. There were no restrictions placed on visiting times for friends and relatives.

People told us they were happy and did not have any complaints. They knew how to raise their concerns and complaints and were confident they would be listened to. Appropriate action had been taken to respond to people’s concerns.

Fern Hill House Care Home changed its name from Burwood Care Home in June 2016 and amended their registration to accommodate younger people and people with mental ill health.

Fern Hill House Care Home provides accommodation and care and support for up to 24 people, some of who were living with dementia or mental ill health. There were 22 people accommodated in the home at the time of the inspection.

Fern Hill House Care Home is located on a main road close to the town centre facilities of Bacup. It is an older style property with facilities on three floors, which could be accessed by steep staircases or a number of chair lifts and a passenger lift. There was a small car parking area with a gated seating area to the front of the house. A dining room and two lounges were available on the ground floor with quiet seating areas around the home. Bathroom, shower rooms and toilet facilities were available. One bedroom had ensuite bathroom facilities and others were located near to toilet facilities or were provided with commodes.

The service was managed by a 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.

At our last inspection on 20 and 24 January 2016 we found the service was not meeting all the standards assessed. We found shortfalls in the management of medicines, infection control processes, recruitment practices and a lack of effective quality assurance and auditing systems. Following the inspection we contacted the local authority infection control lead who visited the home and provided support and advice to help them improve cleanliness and infection control.

We also recommended the improvement plan dates were followed to make sure people lived in a comfortable and suitable environment and that the provider should consider the relevant guidance and principles associated with the implementation and use of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.

Following the inspection of 20 and 24 January 2016 we asked the provider to take action to make improvements and to send us an action plan. In addition following our inspection a number of safeguarding concerns had been raised about the care and support people were receiving and about the environment. The local authority safeguarding team, medicines management team, infection control lead nurse, fire safety officer and local commissioners had visited the home and worked with management and staff to support them to make improvements.

During this inspection, we found some improvements had been made to the management of medicines, infection control processes and recruitment practices. Limited progress had been made in providing effective quality monitoring systems and in meeting the recommendations. Our findings demonstrated there were four breaches of the regulations in respect of risk management, care planning, maintaining the environment and quality assurance systems. You can see what action we told the provider to take at the back of the full version of the report. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

We also made recommendations about ensuring people were able to participate in decisions relating to their care and ensuring assessments and decisions relating to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards were recorded.

People told us they felt safe and staff were kind and caring. Safeguarding adults’ procedures were in place and staff understood how to safeguard people from abuse.

Some improvements had been made to ensure people's medicines were managed safely. Safe recruitment processes had been followed and records showed there were sufficient numbers of staff available who were provided with training, professional development and supervision.

Care plans and risk assessments had been completed to help ensure people received appropriate care. However, whilst care plans and risk assessments had been updated, some information was brief and lacked detail. We found people were not routinely involved in the care planning process and there was limited evidence to indicate people’s mental capacity to make their own decisions had been assessed and recorded.

Accidents and incidents were not routinely checked or investigated to make sure that staff responses were effective, to identify any trends and to see if any changes could be made to help minimise the risk of the same occurrence in the future.

People told us they enjoyed the meals and they were offered a choice at mealtimes.

People told us they were happy with the facilities available in the home. We found the cleanliness of the home had improved. Whilst some improvements had been undertaken there were areas of the home that remained in need of maintenance.

People were encouraged to remain as independent as possible and were supported to participate in daily activities. People’s rights to privacy and dignity were recognised and upheld by the staff.

People had access to a complaints procedure and were confident their complaints and concerns would be responded to.

In view of the number of shortfalls found during the inspection it was clear the current quality assurance and auditing processes were not effective in identifying shortfalls. However, new systems were being introduced to help the provider and the registered manager to effectively identify and respond to matters needing attention. Feedback was sought from people, their relatives and staff on a regular basis.