• Care Home
  • Care home

Archived: Fernleigh House

Overall: Inadequate read more about inspection ratings

Albaston, Gunnislake, Cornwall, PL18 9AJ (01822) 832926

Provided and run by:
Angel Care Agency Ltd

Important: The provider of this service changed. See old profile

All Inspections

6 August 2018

During a routine inspection

The inspection took place on 6, 7 and 13 August and was unannounced.

Following the last inspection, the Commission considered its enforcement policy, and took enforcement action, which was to impose a condition on the provider's registration. This meant on a monthly basis, the provider was requested to submit a report detailing action they had taken to improve medicines management, the assessment and management of people’s health and safety needs, infection control, the cleanliness and maintenance of the environment, governance systems, their recruitment process and ensuring staff employed were suitable for the work and to ensure staff received the training and supervision necessary to meet people’s needs. We also met with the provider.

The Commission had been receiving and reviewing the provider's monthly returns, which had demonstrated ongoing improvement at the service. The findings of this inspection found the information which had been provided had not always been fully accurate and did not always reflect the current regulatory position within the service.

Fernleigh House accommodates up to 11 people in one adapted building. It is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. At the time of the inspection 9 people were living at the service.

Fernleigh House also provides a domiciliary service from the same location, providing personal care to people living in their own homes in the community. Not everyone using the domiciliary service received regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided. At the time of the inspection 15 people were receiving personal care from the service.

There was no registered manager employed to run the service. 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 provider told us they were in the process of recruiting a new manager. A staff member, who described themselves as the deputy manager had taken on some managerial responsibilities but had also been providing care to people using the domiciliary service due to lack of staffing. This had reduced the number of hours they had been available to provide management support to the service.

People were not safe living at the service. People were supported by staff who had not all been recruited safely; for example some staff did not have appropriate references in place or had not provided information about their previous job roles. Staff had received safeguarding training but when staff had raised allegations of abuse, the provider had not ensured people were protected until a proper investigation had been completed. Staff did not always have up to date information to keep people safe. Risks that might affect people, relating to their needs or to the environment, had not all been assessed, recorded or updated effectively.

People’s health needs were not always monitored properly and staff did not always have the skills or knowledge to support people safely with their health care needs. Staff had not received training related to people’s individual needs, such as diabetes or skin care. People were not always supported in line with the principles of the Mental Capacity Act 2005.

People were not supported by sufficient numbers of staff to ensure their safety. Due to staff shortages, staff were working long hours to cover shifts and staff who had not been trained to provide care, were being used to support people’s care needs.

Medicines were not always managed safely. During the week of the inspection, there was not always a staff member trained to administer medicines, working in the home. People told us their medicines were often late and when people had run out of medicines, these had not been re ordered.

People’s preferences had not always been sought or recorded. People were not enabled to fulfil any aspirations they had. They had not been consulted about what food they would like to eat, how they liked to spend their time, or how they wanted to be cared for at the end of their life. People’s records did not always reflect their current needs. Staff knew how to communicate with each person but this information had not been recorded to ensure consistency between staff.

People’s confidential information was not always protected and people were not always treated with dignity and respect. The home had not been maintained or upgraded in a way that met people’s needs. People’s needs had not always been considered in relation to the design of the environment. People using the domiciliary service told us staff were kind.

The provider had not taken sufficient action to ensure the service improved. People’s views about the service had not been sought and information provided by other organisations relating to gaps in the quality of the service had not been acted upon.

The provider had not monitored the service effectively to identify areas for improvement. Where changes had been made, they had not checked to ensure staff had implemented these. The monitoring they had completed had not identified all the concerns identified during the inspection. Where work had been delegated to members of staff they had not ensured staff had the skills and knowledge to complete the work and had not checked it had been done to the correct standard.

People using the domiciliary service told us staff were caring and did not miss visits.

During the second day of the inspection, the local authority reviewed the needs of the people living in the home and decided they would no longer commission with the service. By the final day of the inspection, everyone living in the residential home had been found alternative accommodation by the local authority.

Following the inspection, the provider decided to apply to cancel their registration of the care home and the domiciliary care agency. This is being processed. No one is now receiving a service from this provider at this location.

We found breaches of regulation. You can see what action we told the provider to take at the back of the full version of the report.

5 December 2017

During a routine inspection

This unannounced comprehensive inspection took place on 4 and 8 December 2017. The previous inspection took place on 14 October 2016 when we rated the service as ‘requires improvement’.

Fernleigh House is a care home and is registered to provide accommodation for up to 11 older people who require personal care. People in care homes receive accommodation and personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Ten people were living at the service when we inspected.

Fernleigh House is also registered to provide a personal care service (known as domiciliary care) to people living in their own homes in the community. Twenty eight people living in the Gunnislake area and surrounding villages received care in their homes at the time of this inspection.

Fernleigh House care home had 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. At the time of this inspection the registered manager for the care home also had responsibility for the domiciliary care service, but was not registered to manage the service. An application to register as manager of the service was about to be submitted.

Following our previous inspection on 4 October 2016 we rated the service as ‘requires improvement’. We found breaches of Regulation 12: Safe care and treatment and Regulation 15: Premises and equipment. These related to poor management of medicines, and lack of repairs and maintenance of the home. At this inspection we found concerns relating to the cleanliness and infection control procedures in the care home. We found improvements had been made to the decoration and maintenance of the home, although further action needs to be taken to improve access around the home and to improve people’s comfort and safety. We also found the management of medicines continued to be unsafe.

During this inspection we found another three (making five in total) breaches in regulations. People who used the service, relatives, staff and health and social care professionals praised the registered manager and the staff for the care people received. However, we found the registered manager had placed an emphasis on ensuring people’s care needs were met while many management tasks had been missed or not carried out effectively. Staffing levels were insufficient to meet people’s needs safely at night, in the care home and the registered manager and deputy manager worked long hours covering vacant shifts by providing hands-on care both in the care home and in the domiciliary service . Procedures had not been carried out to ensure people were safe and protected from harm or abuse. The registered manager told us, “I pride myself on providing good care. However, I know the paperwork probably suffers.”

During the inspection we asked the registered manager to provide us with a range of evidence relating to the management of the service. These included records of the provider’s quality monitoring and improvement process, and evidence of recruitment, staff training and supervision. A number of records were not available at the time of the inspection. After the inspection the provider sent us copies of their most recent visit to the home on 13 September 2017. Their report showed they had identified a number of issues we had found during our inspection. However, they had failed to ensure actions were carried out to address the issues they had found. After the inspection the provider told us they were taking urgent actions to address the issues we found. One month after the inspection we received evidence of some staff recruitment documents.

The service was not safe. There were insufficient staff employed in the care home to meet people’s needs safely. At night there was only one member of staff on duty. Some people living in the home needed two staff to assist them to move safely. The registered manager was regularly contacted by night staff to visit the home during the night to provide assistance. They also provided hands-on care during the day and at night when other staff in the care home were unable to cover vacant shifts. We also found there were insufficient staff employed in the domiciliary care service to provide cover when staff were absent, although these shifts were often covered by the deputy manager or registered manager. The weekend following our inspection the registered manager and deputy manager were planning to provide visits to people who received a domiciliary care service. Their planned visits were from early morning until late at night on Saturday and Sunday to cover staff absences. After the inspection we spoke with the provider. They took prompt action to increase the staffing levels by employing a second member of staff at night in the care home. They also told us they were in the process of recruiting more staff to work in the domiciliary care service.

People’s medicines were not always stored, administered or recorded safely. We were unable to see evidence that staff responsible for administering medicines had received suitable training or that their competence to administer medicines had been assessed. The medicines policy was not specific to Fernleigh House and staff had not read or followed the policy. Procedures for administering medicines were not followed consistently. There were unexplained gaps in the administration records and these had not been identified or investigated. Safe recordings procedures had not always been followed. Some medicines were not stored securely.

People living in the care home, and people who received a domiciliary care service were not fully protected from the risk of abuse because some staff had not received training on safeguarding adults. Poor record keeping meant we were unable to see evidence that people were protected by safe recruitment procedures. One month after the inspection we received some evidence of checks and references taken up after new staff had begun working in the service. This showed the provider and registered manager had failed to ensure new staff were entirely suitable for the post before they began working in the service.

Risks to people’s health and safety were not always assessed, recorded or reviewed regularly. Care plans had not always been updated to reflect changes in risks. Staff did not have sufficient information on risks such as pressure sores or dehydration. Monitoring tools had been put in place but these were incomplete and these showed checks had not been carried out to make sure that staff had followed the instructions in the care plans and risk assessments and provided safe.

People living in the care home were not fully protected from risks associated with infection. The laundry was very small, cramped and untidy and used to store items such as mops that may present a risk of cross infection. Cleaning routines were not clearly identified or recorded.

People’s needs were not always fully assessed and reviewed regularly to ensure they received effective care. A care plan file was in place for each person. The files were large and contained two different styles of care plans. We found it was not easy to find current information in the files because of the amount of information retained. Some forms were not dated. There was conflicting information in some files where changes in people’s needs had not always been updated after reviews were carried out.

We were unable to satisfy ourselves that staff working in the care home, and staff working in the domiciliary care service had received adequate training to meet people’s needs. The registered manager showed us some training records but these were incomplete. They assured us they would send us evidence of all training completed by staff after the inspection but this was not received. Staff told us training was provided on-line and staff were expected to complete this in their own time. Some staff told us they did not have access to a computer in their own home, and some said pressures on their home life meant they were unable to complete training in their own time. Some staff said the on-line training did not suit their learning needs. One member of staff employed in the last year told us they had received no induction training apart from two days working alongside experienced members of staff. Other staff, however, told us they had received a good level of training.

Staff told us they were well supported by the registered manager and deputy manager. However, some individual supervision sessions may have been missed in the last year. The registered manager had drawn up a plan of future supervision dates. Staff meetings were held and staff told us they felt able to speak out and raise any concerns or issues.

At the last inspection in 2016 we found the service was working within the principles of the Mental Capacity Act 2005. At this inspection we saw that most people’s capacity to make important decisions had been assessed, and staff understood how to support people to make important decisions about their lives. However, some records did not fully explain how decisions made in people’s best interests had been reached.

The registered manager and staff worked closely with local health and social care professionals to ensure people’s needs were met effectively. A doctor told us the staff always contacted them promptly when necessary and said, “In particular [registered manager] stands out as exceptional in this regard, often committing well over and above her regular duties.” A community health professional praised the registered manager for their commitment and determinat

14 October 2016

During a routine inspection

This unannounced comprehensive inspection took place on 14 October 2016. This was the first inspection of the service since it was re-registered by new providers. The last inspection under the previous provider, found the service to be meeting the regulations.

Fernleigh house is a care home which offers care and support for up to 11 predominantly older people. At the time of the inspection there were nine people living at the service. Some of these people were living with dementia. A domiciliary care service is also run from Fernleigh House that supported 35 people in their own homes. The service is comprised of a detatched house over two floors with a stair lift to aid access to the upper floor.

The service had 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.

We looked at how medicines were managed and administered. We found it was not always possible to establish if people had received their medicines as prescribed. There were gaps in the medicine administration records. Medicines that required stricter controls were not managed and recorded in line with legislative guidance. Regular medicines audits were not being carried out.

Staff were very concerned they had not been paid their wages correctly for the past few months. At this inspection some staff told us they had not been paid any wages for the previous months work, 10 days after pay day. Staff were anxious and had tried to contact the provider with no success. The deputy manager who had responsibility for managing the domiciliary care agency had recently left the service. Five other care staff had also recently resigned due to not being paid correctly for the past six months.

People’s bedrooms were comfortable and personalised to reflect people’s individual tastes. However, the communal areas and main corridors of the service were in need of refurbishment. The furniture in the dining room was shabby and there were no curtains on the curtain pole. The wall lights did not have bulbs and so were not operational.

People were treated with kindness, compassion and respect. Staff were caring and patient. The service had identified the minimum numbers of staff required to meet people’s needs and these were being met in both services and despite five staff leaving, remaining staff were working extra shifts to cover the rota. People's needs were being met.

Staff were supported by a system of induction training and some supervision. Staff knew how to recognise and report the signs of abuse. Staff received training relevant for their role and there were opportunities for on-going training and support and development. However, more specialised training specific to the needs of people using the service, such as dementia care, was not being provided.

Staff meetings were held. These allowed staff to air any concerns or suggestions they had regarding the running of the service and helped effective communication between the management and the staff team. Staff felt well supported by the registered manager.

Residents meetings were held to seek the views and experiences of people living at the service. People’s views were listened to and action taken to address any issues raised. People who received a service in their own homes were regularly visited by the registered manager to seek their views of the service provided.

Meals were appetising and people were offered a choice in line with their dietary requirements and preferences. Some meals were delivered to people in their own homes from Fernleigh House. The cook took time to talk with people living at the service and out in the community, to help ensure the food was to their liking.

Care plans were well organised and contained accurate and up to date information. Care planning was reviewed regularly and people’s changing needs recorded. People, and where appropriate relatives, were included in their own care plan reviews. The copy of the care plan and assessments kept at Fernleigh House for people who received care and support in their own homes, did not contain all the information held at the person’s home. This meant it was not easy for staff at Fernleigh House to find the current care needs for a person in the community if there was a query. People told us they had not had any visits missed and that most of the time the carers arrived on time and spent the agreed time with them.

Activities at Fernleigh House were provided on a one to one basis by care staff when time allowed. The service had a regular scrabble club once a week, and some people were encouraged to access the local community.

Following this inspection the provider and the registered manager sent us details of action they were taking to address the concerns identified. We will check on the actions taken at our next inspection of the service.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014. You can see the action we have told the provider to take at the end of the full version of this report.