Archived: Fernwood Court Care Home

Fernwood Court Care Home is a residential care home providing personal care for up to 56 people aged 65 and over. People are accommodated in a purpose-built building, over four floors. The service was providing personal care to 52 people, at the time of this inspection.

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

The management of people’s medicines was not always safe. Prescribed topical creams were not always administered as prescribed. The reasons for administering as required medications, and the outcomes of doing so, was not always fully recorded.

People’s care plans and risk assessments did not always provide enough detail to ensure people had choice in how their support was given, or to enable staff to keep people safe, for example when people were experiencing distressed behaviour.

There were not always enough staff on duty at night, to safely meet people’s needs. Staff were safely recruited and trained to meet people’s needs. Staff were trained in infection control, and infection control procedures were in place.

People were offered nutritional meals and were supported to eat where this was needed. The cook had information about people’s medical conditions, medication and personal preferences and used this information to ensure people received suitable foods.

Staff did not always promote people’s dignity. Staff promoted people’s independence and respected their privacy and confidentiality.

People, relatives, staff and health care professionals all had opportunities to give their views about the service, via a system of ongoing mini surveys. However, not all people had access to feedback about the surveys that had taken place.

Accessible information standards were not fully met, for people where English was not their first language.

The provider had a complaints policy and procedure in place. Complaints were effectively dealt with.

People participated in meaningful community outings and took part in a range of activities provided in the home.

People did not always have opportunities to discuss their end of life care. End of life care plans were not always in place. This meant people’s support may not reflect their preferences.

Quality assurance systems and processes were ineffective and did not consistently identify areas for improvement.

People were not always supported to have maximum choice and control of their lives. This meant staff may not be supporting people in the least restrictive way possible or in their best interests.

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 02 August 2017)

Why we inspected

This was a planned inspection based on the previous rating.

The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see all 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 Fernwood Court Care Home on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to safe care and treatment, person centred care, dignity and respect, staffing and good governance at this inspection.

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 continued to receive safe care. People told us they felt safe. Risks to people’s safety had been assessed and care and support was delivered in a way that kept people safe from harm. Sufficient numbers of staff were available to meet people’s needs. Staff had appropriate employment checks in place. People received their medicines as prescribed.

The care people received continued to be effective. Staff had the skills and knowledge to meet people’s needs. People were asked for their consent before care was provided. People are supported to have maximum choice and control of their life's and staff support them in the least restrictive way possible; the policies and systems in the service support this practice. People were able to choose what they would like to eat and drink and were happy with the choices provided. People had access to appropriate healthcare professionals when they required.

People continued to receive support that was kind and caring. People’s choices were respected and their dignity and privacy maintained. People were encouraged to be as independent as possible.

The service people received continued to be responsive to their needs. People were involved in the planning and review of their care needs. Staff were aware of people’s individual needs and supported them according to their preferences. People and their relatives were aware of how to raise issues or concerns and these were responded to.

The home continued to be well-run. People and staff were complimentary about the registered manager. The registered manager promoted an open culture within the home. Staff were aware of their roles and responsibilities. Systems were in place to assess and monitor the quality of service people received which included seeking feedback from people and their relatives about the quality of service provided.

Below is a summary of what we found. The summary is based on our observations during the inspection. There were 53 people living at the home on the day of the inspection. There were 27 people living in the mental health unit and 26 people living in the dementia unit. Due to the complex care needs of the people we were only able to speak with one person. We observed how most people were supported to help us understand their experiences of care. We spoke with four members of staff who supported people, the manager who was supporting the inspection process and five relatives. We looked at four people's care records.

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

Is the service safe?

We found that people were not being supported by staff in a safe manner. On arrival to the home we observed there were not enough staff to meet people's needs at breakfast time. We saw people being left for unacceptable periods of time with no staff to support them. We saw one member of staff trying to support people in the dining room and lounge area on their own. This meant that during breakfast times there was not enough staff to support people safely.

A person we spoke with said, "I do feel safe living here". A relative said, "I do feel staff support X safely". Another relative said, "There is not always enough staff, due to sickness".

We found that the home had a system in place in relation to the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). This is legislation that makes provision relating to people who lack capacity, and how decisions should be made in their best interests. We found that where people lacked capacity the appropriate assessments were taking place as part of determining people's capacity to make decisions. The manager had a good understanding of the MCA and DoLS and confirmed that there was someone living in the home who had an application approved through the local authority under the DoLS legislation. The staff we spoke with were aware of the DoLS application and the reason for it being in place. The staff we spoke with told us they had received training in the MCA and DoLS and they were able to explain it to us. Records we saw confirmed the training had taken place.

Is the service effective?

We found that the people's care records we looked at all had the appropriate documentation. Assessments and care and or support plans were in place. These records ensured that people's needs were being identified and met as they wanted. Where health professionals were needed to meet people's needs we saw that this was in place. For example, the records in place for someone who needed their meals supplemented showed that a Speech and Language Therapist had been involved. This meant people were able to receive the support they needed.

We found that the service had a system in place to ensure the appropriate staffing levels were in place to meet people's needs. However the system in place was not effective in ensuring the appropriate staffing levels were in place where people needed support from more than one member of staff. On the day of the inspection our observation was that there was not always enough staff working during meal times to ensure people could be supported safely on the dementia unit. We observed during the inspection that people with complex support needs and were at risk of falling were being left for long periods of time on their own in the lounge area. This was due to a lack of available staff during meal times. This meant that there was not always enough staff to meet people's needs.

Is the service caring?

We found that staff were caring. One person we spoke with said, "The staff are very nice". One relative said, "I am very happy with the home. The staff are absolutely wonderful". The staff we spoke with all understood people's needs and knew how to meet them. Where people had specific needs, staff knew this, even where staff were just covering due to staff sickness. This meant that the service was caring in meeting people's needs.

Is the service responsive?

We found since our previous inspection action had been taken to improve areas of concern. For example, staff were now all having an appraisal once per year as part of ensuring they had the right skills and knowledge to support people appropriately.

People living on the mental health unit were now able to get a drink and a snack at night time, where they were unable to at the last inspection. This meant that the service was able to respond appropriately where concerns were identified.

Is the service well-led?

The service was led by a registered manager, who was supported by their line manager. We met both of them who were present at the time of our inspection and assisted us with any information we needed.

We found that the service had the appropriate systems in place to monitor quality. Staff we spoke with told us the manager was regularly on the units as part of checking on how care and support was being delivered.

People we spoke with were happy with the care they received. One person said: "I like it here. The staff are a good bunch". Relatives we spoke with were pleased with the care provided.

The home was taking people's preferences into account. Some people that could not make decisions had not had their capacity assessed to ensure that decisions were taken in their best interest.

We saw that care for people in the dementia care units had improved. People were well supported and were having their health and personal care needs met. Some practices within the mental health units were not making sure that people's individual needs were fully met.

Staffing levels had improved since our last inspection. However the provider should note that the experience of staff and the lay out of the home should to be taken in account when determining the number of staff needed to provide people with the care they need.

People were supported by staff that were trained and supervised. An appraisal system that assessed staff's performance and identified training and development needs was not yet in place.

The home had systems for checking the quality of care people received. People's views were sought and acted upon.

The registered managers named in this report were not managing this service at the time of the inspection. Their name appears as they were registered at the time.

People we spoke with said they were happy with the care they received. Some people could not tell us about the care they received and we observed that people looked presentable and appropriately dressed and groomed.

People's privacy was promoted and the staff spoke with them in a respectful way. People were not always consulted about their care and their choices and wishes were not always acted upon.

People's needs were assessed and plans of care were developed. However, these did not always contain the information for care staff to be sure they were providing people with care that met their needs.

Training for some care staff was not up to date and they did not receive the support and supervision to provide people with appropriate care.

The home had systems in place to review and monitor the service. Where shortfalls were identified there was not always evidence to show these had been acted upon. People's views about care were sought through surveys and relative's meetings.

A complaints procedure was available for people to raise concerns and complaints about their care. There had not been any formal complaints in the last 12 months