The Fernes

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question good. At this assessment the rating has remained good. This meant people were safe and protected from avoidable harm.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

Incidents and accidents were reported, investigated and analysed for any themes in order to prevent recurrence. Staff told us they were encouraged to report concerns. One staff member said, “We are definitely encouraged to report things. [Management team] tell us it’s an open and safe environment to do so.”

Lessons learned were shared with staff through daily stand-up meetings, monthly staff meetings and electronic messaging. Staff told us learning was shared and they were informed about updates to care plans, including for example, changes to equipment being used to move people safely.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

Records showed the service was supported by a range of health care professionals. There were links with local services, such as the local GP practice who carried out weekly reviews, or more often if needed. This meant people’s ongoing health was monitored and their medicines were regularly reviewed. One health professional told us, “Staff can also call us or email for advice if needed. Generally, the staff are very good at getting in touch.”

People and their relatives told us they had good access to GP’s and other health professionals, and care plans included relevant assessments and clinical guidance.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

Staff had received safeguarding training and understood their responsibilities to protect people from harm and abuse. They knew how to recognise, report and escalate concerns. One staff member said, “Safeguarding is to put something in place to protect a vulnerable person.”

Records showed safeguarding concerns were referred appropriately to external agencies and statutory notifications were submitted to the Care Quality Commission when required.

People and their relatives told us they felt safe. One person said, “I had several falls when I first came to live here. Staff came as soon as I shouted out and helped me, and this made me feel safe living here quickly. The falls are much better now as staff remind me to use my walker or to call them if I feel dizzy and I want to get up." Another person’s relative described the service as “absolutely safe.”

Systems were in place to monitor safeguarding concerns, identify themes and trends, and take proactive action where required. This helped ensure people were protected from abuse, discrimination, avoidable harm, and neglect.

People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. In care homes, this can be done through a procedure called the Deprivation of Liberty Safeguards (DoLS), which is part of the Mental Capacity Act 2005 (MCA). We checked whether the service was working within the principles of the MCA and how they managed DoLS within the service. We found that DoLS applications were submitted to the local authority in line with legal requirements. The registered manager kept track of applications and authorisations, and at the time of the inspection, none of the authorisations were subject to any conditions.

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

People were assessed for risks such as choking, skin damage and falls. When risks were identified, care plans provided guidance for staff. For example, choking care plans included guidance such as what position the person should be sat in, what type of cutlery to use, and any textured dietary requirements. Care plans for people at risk of skin damage included details of pressure relieving equipment and how often people should be supported to change position. Air mattresses we looked at were set correctly, and position change records showed people were supported in line with care plan guidance.

All staff we spoke with were aware of risks to people’s safety. They knew how to reduce the risk of harm and understood the importance of this. For example, staff were able to describe how to manage people’s risk of choking, and steps to take to reduce the risks.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

Regular safety checks were carried out across the service. This included gas, electrical and fire safety checks, and checks on equipment, such as hoists and lifts. Personal evacuation plans reflected people’s support needs in the event of needing to evacuate the building in an emergency. The service was well maintained, and there was a responsive system to address any issues as they arose.

There was a well-maintained secure garden area for people to use, and we were told this was used regularly in the warmer weather, including for events.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

The provider used a dependency tool to calculate staffing levels, the and the staff rota reflected the dependency tool. The provider used a ‘whole home’ approach, which meant that all staff played a part in ensuring people’s needs were met. Some people’s relatives told us they felt more staff would be useful, for example at mealtimes and at weekends. However, people told us that overall, they felt there were enough staff on duty to meet their needs. People told us and we observed that call bells were answered quickly.

Robust recruitment processes were in place to help ensure staff were suitable for their roles, including completion of appropriate pre-employment checks such as Disclosure and Barring Service (DBS) checks.

Staff received a comprehensive induction and regular supervision to support them in their roles. Managers told us they routinely discussed performance and personal development with staff.

Training compliance was high across the service. Staff completed mandatory and role-specific training relevant to the needs of people they supported, including dementia, choking management, manual handling, and tissue viability. This helped ensure staff had the knowledge and competence to deliver safe and effective care and respond appropriately to people's assessed needs.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

People raised no concerns about the cleanliness. Many spoke highly of the housekeeping staff. One person said, “We cannot speak highly enough about how immaculately clean the home is. I like my room clean and my laundry perfect. The staff keep everything just as I like it.”

The provider had effective systems in place to prevent and control the risk of infection. The environment was clean, well maintained and free from unpleasant odours. Appropriate personal protective equipment (PPE) was readily available, and cleaning schedules were up to date and consistently completed.

Staff had received infection prevention and control training and demonstrated an understanding of their responsibilities. Relatives and healthcare professionals told us the environment was clean and said they had no concerns about infection risks.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened.

Staff who administered medicines had completed training and had their competencies assessed. Medicines were stored safely; medicines rooms were temperature controlled and records of temperature checks showed rooms and medicine fridges were maintained at safe temperatures. Records showed people had their medicines administered on time as prescribed.

Protocols were in place for when people needed additional medicines on an as required (PRN) basis. The provider had good links with the local pharmacy. Records showed people’s medicines were regularly reviewed. People told us they were happy with how their medicines were managed. One person said, “If I have a headache or any kind of pain, staff will get me some pain killers.”

Some people were self-administering their medicines. The processes in place for monitoring this had not always been followed. We fed this back to the management team, and it was addressed immediately.