Archived: Ferringham House Limited Residential Care Home

Ferringham House Limited Residential Care Home is registered to provide accommodation and care for up to 14 older people with a range of health needs. At the time of our inspection, eight people were accommodated at the home, some of whom were living with dementia. Ferringham House Limited Residential Care Home is situated in a residential estate on the edge of Ferring village. All rooms are used as single occupancy and all have en-suite facilities. There is an open-plan sitting/dining room and people have access to gardens at the home.

There was a registered manager in post who registered in February 2017. They had been working as manager at the home since October 2016. 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 registered manager was on annual leave at the time of our inspection. We were joined by the provider for both days.

We found a significant lack of risk assessments in place and when information was provided it did not detail the exact support each person needed. Some risks had not been identified in the recent review of care plans. This included a lack of detailed guidance surrounding skin integrity, diabetes and mental health issues. Guidance was limited when advising staff how to support peoples specific needs. The lack of assessment and guidance available to staff meant risks were not managed safely putting people at risk of unsafe care and treatment.

Medicines were not managed safely. We found numerous concerns regarding how the home administered, stored and recorded medicines which were prescribed to people. This included gaps and errors in Medication Administration Records (MARs). One person did not receive their medicines for nearly two days. There was a lack of information in place to guide staff of what to do when people missed their medicines which meant the person was at risk from harm. The inspectors shared the incident of missed medicines with the local authority safeguarding team for their review.

During our inspection, a district nurse shared their concerns about one person's care and the potential delay in receiving the correct medical attention. They gave us permission to use their professional view in this inspection report.

Supervisions and training were provided to the staff team. The recently registered manager had commenced a supervision programme with the staff team. However, there were inconsistencies regarding the competencies of some staff in their knowledge and abilities to carry out their role and responsibilities safely and effectively. This included a lack of knowledge about managing medicines safely and risks associated with supporting people.

Care was not personalised. Care plans failed to offer the level of guidance required for staff to meet people’s physical and emotional needs. Information was limited regarding people’s preferences, likes and dislikes. Care plans were very similar to each other within the detail written about how people wished to be supported by staff. People living at the home had limited access to activities and other daily stimulation as their individual choices had not always been considered. There was very little detail available within each care plan about how people wanted to spend their day. This meant staff members supporting people may not of had information about people to enable them to be supported in a person-centred way.

Confidential sensitive information relating to people including their care plans and MARs were kept unlocked throughout our inspection. This meant private and personal information relating to individual people and their care was at risk of not remaining confidential.

We observed staff involving people in day to day decisions about the care they received. However, there were no records to suggest people had been involved with their own care. This meant people may not have had care delivered the way they preferred. We observed one occasion where a person's dignity was not respected.

Audits to monitor the quality of the health and safety of care provided were not accessible to the provider or inspectors at the time of our inspection. Audits received since the inspection had failed to highlight the potential risks to people within how medicines were managed. They had also failed to effectively assess gaps within care plans, risk assessments and the activities provided to people. Therefore, there was a failure to assess and monitor and to improve the quality and safety of the services provided to people.

There was a lack of governance and accountability in reviewing and checking the care being provided to people. This included decisions regarding which care staff were leading the shift in the registered manager's absence. There was a lack of knowledge from the provider about seeking guidance from health and social care professionals in accordance with safeguarding adults procedures and regulations. This meant the correct action to protect and support people was not always taken in a timely manner. The provider was advised to contact the local safeguarding team regarding one incident for their review.

Since 2014, Ferringham House has failed to deliver high quality consistent care and support to people. The provider had been unable to sustain improvements to the quality of care provided to people.

Records relating to health appointments people had attended were inconsistent and required improvement. Information was not always shared with staff regarding specific health conditions.

Staff gained consent from people prior to supporting a person and staff had some understanding of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards.

People had developed positive relationships with the staff supporting them and mostly enjoyed living at the home. The food cooked for people looked appetising. People spoke positively about their mealtime experience. No complaints had been received at the time of our inspection. Mostly, the home operated safe recruitment processes. Bedrooms were personalised with people's own belongings. The home smelt fresh and clean throughout our inspection.

Full information about CQC’s regulatory response to these concerns will be added to reports after any representations and appeals have been concluded.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve.

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made. Services placed in special measures will be inspected again within six months. The service will be kept under review and, if needed, could be escalated to urgent enforcement action.

Ferringham House Limited Residential Care Home is registered to provide accommodation and care for up to 14 people with a range of health needs. At the time of our inspection, nine people were living at the home. Ferringham House Limited Residential Care Home is situated in a residential estate on the edge of Ferring village. All rooms are currently used as single occupancy and all have en-suite facilities. There is a large, open-plan sitting/dining room and people have access to gardens at the home.

There was no registered manager in post. The last registered manager had de-registered with the Commission in March 2015. Since that time, a number of managers had been in post and subsequently left before they could register with the Commission. The current manager was in the process of registering with the Commission, but, at the time of our inspection, a registered manager had not been in post for a period exceeding 400 days. The provider was in breach of their registration conditions as a result. 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 last inspection took place on 10 December 2015. As a result of this inspection, we issued two Warning Notices in February 2016. We asked the provider to take action to address areas of concern relating to safe care and treatment and good governance. The provider was required to take appropriate action to meet the Warning Notice in relation to safe care and treatment by 4 March 2016 and in relation to good governance by 1 April 2016. In addition, we found the provider in breach of a regulation relating to staffing and asked them to submit an action plan on how they would address this breach. An action plan was submitted by the provider which identified the steps that would be taken. At this inspection, we found that the provider and manager had taken appropriate action to meet the Warning Notices and were now meeting the required standards. However, we identified that further time and action was necessary to ensure the improvements continued and were embedded consistently into staff practice.

Generally, risks to people were managed to protect them from harm. However, risk assessments for two people had not identified or assessed all areas of potential risks to keep them safe. The manager was reviewing people’s risk assessments and was in the process of updating these, as well as the care plans. Medicines were managed safely overall and staff had completed the necessary training; their competency to administer medicines had been checked. The manager had implemented a new system to ensure that new staff were recruited safely and all necessary checks had been made with regard to their suitability to work in care. There were sufficient numbers of staff on duty. People felt safe living at the home. One member of staff did not understand their responsibilities in relation to safeguarding and not all staff had completed training in safeguarding adults at risk.

Since the new manager came into post, a supervision planner and schedule had been introduced to record staff had supervision meetings at least four times a year. Staff had access to e-learning and had completed training in a number of areas, although not all staff training was up to date. Staff meetings had taken place in 2016 and staff spoke positively about the changes which the new manager had implemented. Capacity assessments had been completed for people in line with the requirements of the Mental Capacity Act 2005. No-one living at the home was subject to Deprivation of Liberty Safeguards and people were free to come and go. People were supported to have sufficient to eat and drink. Comments on the standard of the catering were variable, but people had a choice from options on the menu. People’s risk of malnourishment was assessed and actions taken if people lost or increased weight over time. People were supported to maintain good health and had access to a range of healthcare professionals and services.

People were looked after by kind and caring staff, who knew them well. People were supported to express their views and to be involved in planning their care. They were treated with dignity and respect.

The manager was in the process of reorganising the information contained in people’s care plans and this was work in progress. Some care plans were not up to date and not all staff had read the care plans. A range of activities was on offer to people throughout the day and in line with their preferences and choices. An outing into the community had taken place recently with a visit to Shoreham Airport and people had enjoyed a BBQ to celebrate the Queen’s Birthday. People and their relatives knew how to make a complaint although no formal complaints had been recorded in the last year. The complaints policy needed updating to provide information about when complaints would be acknowledged, investigated and completed.

Significant improvements had been implemented by the manager since our last inspection and a range of audit systems was in place. However, these were not always sufficient to measure, monitor and drive improvement for all aspects of the service. The Commission needs to be confident that the improvements made to date will be sustained over time. There was a lack of audits in relation to care plans, risk assessments and staff training. People, their relatives and staff were asked for their views about the home and generally these were positive. Staff spoke positively about the manager and of the improvements she had implemented since coming into post.

At the last comprehensive inspection, this provider was placed into special measures by CQC. This inspection found that there was enough improvement to take the provider out of special measures.

Our inspection was undertaken by an inspector. We considered our inspection findings to answer questions we always ask: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with three people using the service, one relative, two staff supporting them and from looking at care records and other records relating to the management of the service.

If you want to see the evidence supporting our summary, please read the full report.

Is the service safe?

There was a system in place to show what had been learned from accidents and incidents. Risk assessments in people's care records were updated following significant events and they were reviewed monthly.

Medicines were kept in a locked cupboard or trolley and the keys were kept safe by staff trained to administer medicines. Appropriate arrangements were in place for the safe ordering, storing, administering and disposing of medicines.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. We were told that no applications have needed to be submitted and that, should people's needs change and they require nursing care or a higher level of support, then they would need to be moved to another home that was equipped to deliver this.

Is the service effective?

People told us that they were happy with the care that had been delivered and their needs had been met. One person thought that it was good living at the home and told us that they enjoyed the company. Care plans were reviewed every month and updated to ensure that people's most up-to-date needs were being planned for.

Is the service caring?

People were supported by kind and caring staff. People told us that they enjoyed chatting with staff. A staff member told us, "I like it here, home from home. We work as a team and well together".

Is the service responsive?

People told us that they would talk to the registered manager if they had any concerns. There were systems in place to record or log complaints and to show whether these had been handled and addressed appropriately.

Is the service well led?

The registered manager had a quality assurance system in place. Records showed that people, their relatives and staff were asked for their views about the service. There was an effective complaints monitoring system in place. Audits were in place to ensure that care plans were reviewed and risk assessments regularly updated to inform people's care plans.

Our inspection team comprised an inspector and a pharmacist inspector. We considered our inspection findings to answer questions we always ask: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People were treated with respect and dignity by the staff. One person told us that they were, 'satisfied with everything' and that the 'staff don't intrude unnecessarily'.

Whilst accidents were recorded in an accident book, there was no system in place to show what had been learned from accidents and incidents. Risk assessments in people's care records were not always updated following significant events, such as falls. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

The service was safe, clean and hygienic. Staff were knowledgeable about their responsibilities to deliver people's personal care needs appropriately and the need to use personal protective equipment. The provider informed us that the majority of staff have a National Vocational Qualification - Level 2 (NVQ2) which includes training on infection control.

Medicines were kept in a locked cupboard or trolley, but the keys were not kept in a safe way and presented a potential risk of misappropriation. Appropriate arrangements were not in place in relation to obtaining medicine. We saw that there was not always a sufficient supply of medicines in stock for people and that this had resulted in two people's medicines being 'out of stock'. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. We were told that no applications have needed to be submitted and that, should people's needs change and require nursing care or a higher level of support, then they would need to be moved to another home that was equipped to deliver this.

Is the service effective?

People told us that they were happy with the care that had been delivered and their needs had been met. It was clear from our observations and from speaking with staff, that they had a good understanding of the people's care and support needs and that they knew them well. However, some staff members had left recently and new staff were in the process of getting to know people. People's health and care needs were assessed with them, but there was no evidence in their care plans to show that this was the case. Care plans were not routinely reviewed or updated which meant that people's most up to date needs were not necessarily being met. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

Is the service caring?

People were supported by kind and caring staff. We saw that they were treated with respect and dignity and that staff were warm and friendly. The care staff we spoke with all enjoyed working with people. One said, 'I like it because it's small [the home], the residents are very friendly and I'm very chatty. I'm enjoying myself'. One relative told us that the staff were, 'all excellent' and that they had emailed the owner to compliment them on the staff following 'unrest recently'. A person who used the service told us that they were, 'Very, very happy' and that the home was 'gorgeous' and had a 'family feeling', although they also added, 'until a few months ago, when staff started leaving and the atmosphere dropped'.

Is the service responsive?

At a previous inspection, people had told us there were no planned activities for them and that they had discussed this with the manager. They had also raised this at one of their residents' meetings. As a result, we saw that there was now a programme of organised activities available to people on a daily basis. One person told us that they enjoyed the pampering session when they could have their fingernails manicured and polished.

People told us that they know how to make a complaint if they were unhappy. However, the provider did not have systems in place to record or log complaints to show whether people's complaints had been handled and addressed appropriately.

Is the service well-led?

The staff we spoke with were clear about their roles and responsibilities, but not all staff had a job description or contract nor were they aware of their terms and conditions of their employment. This had been raised with management at a team meeting.

The service did not have a quality assurance system, so there were no records to show that identified shortfalls had been addressed promptly. As a result, there was no monitoring or systems in place to improve the quality of the service. Three relatives we spoke with told us that their views had never been sought about the quality of the service. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

We spoke with two members of staff who told us they all enjoyed their work. They told us that they worked well as a team. During our observation we saw that staff interacted well with people when they were supporting them. We saw that staff were knowledgeable about people's needs and preferences. We found staff were respectful and maintained people's dignity, privacy and independence.

We were shown examples of person centred care records which were organised into separate sections. This provided clarity for staff. There was information on each which had been used to inform staff of individual wishes and preferences in relation to how their care was provided and how they like to spend their time.

We spoke with four people who use the service and had the following responses: "we are very lucky here, it is like being at home, the carers are lovely and you can't fault them, they make the home." Another person said "I am very happy here and I go and come as I like, I have my own car and I drive out and come back whenever I like, I have been here for three years and I am satisfied with the service; everything is going very well.'

People told us they were treated with respect and were involved in discussions about their care. All the people we spoke to were full of praise for the care staff we observed that staff were polite to people using services and sought their permission for us to view their rooms or speak with them.

People told us that they chose to do knitting, exercise, bingo or other activities and we witnessed a bingo session. People were given choices in the meals they had and felt that the food was excellent.

We noted that people's rooms had adjoined adapted toileting and bathing facilities. They had their personal belongings and had decorated the rooms to their taste.