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Inspection carried out on 25 October 2017

During a routine inspection

The inspection visit took place on 25 October 2017 and was unannounced.

Fernbank Lodge is registered to accommodate up to 18 people with personal care needs. Accommodation is provided over two floors, with a stair lift providing access to the first floor. There are a range of communal rooms, comprising of two lounges, two conservatories and a dining room. There are small garden areas at the front and rear of the home, with seating for people to use during the summer months.

At the last inspection in October 2015 the service was rated Good. At this inspection we found the service remained good.

People who lived at the home told us they had agreed the level of support they required to help them achieve their goals. Staff were able to explain the support individuals required and the way in which they supported people who lived at the home.

Risk assessments were carried out to ensure risks were identified and minimised. Staff were knowledgeable of these and people who used the service told us they felt safe. Care plans detailed the actions required by staff to minimise identified risk.

People at Fernbank Lodge told us they were happy with the number of staff available to support them. We were told, “I only have to ring that bell and it’s like they can fly, they come to me that quick.” And, “There’s enough staff here and they’re well organised, that’s the key.”

Medicines were managed safely. Staff responsible for supporting people with their medicines had received training to ensure they had the competency and skills required.

Recruitment checks were carried out to ensure suitable people were employed to work at the service. People spoke highly of the staff employed to support them. They told us they had no concerns with the staffing at the home and they considered staff to be helpful and caring

We found people had access to healthcare professionals and their healthcare needs were met. People told us they were supported to access further healthcare advice if this was appropriate and they were happy with the care and support provided. One person who lived at the home told us, “This is a good home, with good care and good staff.”

People who lived at Fernbank Lodge told us they liked the meals provided at the home. We found people were provided with meals and drinks that met their individual preferences and needs. Comments we received included, “The food is second to none here.” And, “I’ve just had homemade salmon fishcakes because I wanted them. They were delicious.”

The registered manager and a quality auditor employed by the registered provider carried out checks to identify where improvements were required. Staff told us they were informed of the outcomes of these. The registered manager explained the checks were not always documented.

We have made a recommendation regarding quality assurance.

We found people who received support were empowered to raise their views on the service at Fernbank Lodge. Meetings and surveys took place to enable people to give feedback to the management team.

There was a complaints procedure which was known to people who used the service. People told us they had no complaints, but they were confident the registered manager would respond to any complaints made. People told us they liked the registered manager. One person commented, “Registered manager is like a daughter to me.”

People who lived at Fernbank Lodge told us they enjoyed the activities provision at the home. We were told, “We do exercises in chairs, now that’s a good shout.” And, “I go to the things I like to go to.”

The registered manager demonstrated their understanding of the Mental Capacity Act 2005. Staff were able to give examples of how they supported people to make decisions. We found where people’s rights were restricted, this was done lawfully.

Staff told us they were proud to work at Fernbank Lodge and they enjoyed supporting people to live happy lives. Staff received appropriate training and develop

Inspection carried out on 5 & 12 October 2015

During a routine inspection

This inspection was carried out on the 5 and 12 October 2015 and the first day was unannounced.

We last inspected Fernbank Lodge in June 2014 and identified no breaches in the regulations we looked at.

Fernbank Lodge is registered to accommodate up to 18 people with personal care needs. At the time of the inspection there were 18 people who lived at the home.

Accommodation is provided over two floors, with a stair lift providing access to the first floor. There is a range of communal rooms, comprising of two lounges, two conservatories and a dining room. There are small garden areas at the front and rear of the home, with seating for people to use during the summer months.

The home has a manager who is registered with the Care Quality Commission. 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.

There were systems in place to ensure people who used the service were protected from the risk of harm and abuse. The staff we spoke with were knowledgeable of the action to take if they had concerns in this area.

Staff were knowledgeable of peoples’ assessed needs and delivered care in accordance with these.

There were arrangements in place to ensure people received their medicines safely.

Processes were in place to ensure people’s freedom was not inappropriately restricted and staff were knowledgeable of these.

During the inspection we saw independence was promoted wherever possible. We saw people were supported to mobilise and engage in an organised activity with patience and understanding.

People were referred to other health professionals for further advice and support when appropriate.

People told us they liked the food provided at Fernbank House and we saw people were supported to eat and drink adequately to meet their needs and preferences.

There were sufficient staff to meet people’s needs. We saw appropriate recruitment checks were carried out to ensure suitable people were employed to work at the home. Staff received regular supervision to ensure training needs were identified and received appropriate training to enable them to meet peoples’ needs.

There was a complaints policy in place, which was understood by staff and was available on the notice board within the home. An external consultant and the registered manager monitored the quality of service by carrying out checks on the environment, medicines and records. People were encouraged to give feedback to staff, which was acted upon.

The registered manager had not always notified the Care Quality Commission of incidents that occurred at the home. This has been reflected within the rating ‘Is the service well led.’

Inspection carried out on 24 June 2014

During a routine inspection

During our inspection we looked at how well people were cared for, cleanliness and infection control within the home, the safe management of medicines, the quality monitoring systems in place and how complaints were managed. The summery is based on our observations during the inspection. We spoke with four people living at the home, two members of the care staff team, the housekeeper and the registered manager. We also spent a period of time observing over the lunchtime period.

This helped to answer our five questions: 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.

Is the service safe?

From our observations we saw that people were relaxed and comfortable living at the home. There was a good rapport with the staff team that was appreciated by the people living there. People were treated with respect and dignity and their rights were being respected.

The home had information and procedures in relation to the Mental Health Act and Deprivation of Liberty Safeguards. Staff had being trained to understand when an application should be made and how to submit one. This meant that people would be safeguarded as required.

The service was safe, clean and hygienic. Equipment was well maintained and serviced regularly therefore not putting people at unnecessary risk.

Medication practices were robust. Only staff that had received appropriate medication training had responsibility of the administration of medication. A routine annual medication audit was in place, undertaken by an external administrator. This helped to ensure that medication practices remained safe, by ensuring that any shortfall was identified and addressed.

It the service effective?

There was an advocacy service available if people needed it. This meant that people living at the home or their relatives could access additional support.

From our observations and through speaking with staff it was clear that there was a good understanding of each person�s assessed needs and that personal preferences were accommodated. Specialist dietary, mobility and social care needs had been identified in care plans as required.

People�s mobility and other needs had been taken into account in relation to the adaptation of the building, meaning that people were able to move round freely and safely.

People told us that their visitors, including family and friends could visit at a time of their choice and that they could see these people in private.

Is the service caring?

We saw that people were supported by kind and attentive staff. Care workers showed patience, humour and gave encouragement when supporting people. One person said, �They (the staff) are all very good and kind, I like it here�

People�s preferences, interests and diverse needs had been recorded and care and support had been provided in accordance with people�s preferences. This helped to ensure that people were provided with an individualised service that met their specific requirements.

People living at the home, their relatives and friends and the staff team, had been provided with an annual satisfaction questionnaire. We viewed the outcome of the most recent questionnaires. Outcomes were positive. We were told that any suggestion for improvement would be considered and actioned if at all possible. This showed that people were listened to and that their views and opinions were valued.

We also saw the minutes of staff meetings, resident meetings, night staff meetings kitchen staff meetings and management meetings. These were detailed and covered a range of issues that were important to the people concerned. These different forums gave people opportunity to have their say and influence change.

Is the service responsive?

People told us that they liked the staff that supported them, that their needs, wants and wishes were being met by the staff team and that they enjoyed living at the home. One person told us, �It is very good here, we are all well looked after�.

The home had received no formal complaints for some considerable period of time. However people knew how to make a complaint if they were unhappy. Nobody we spoke expressed any complaints or concerns only complements. There was an �open door� policy making easier for people to say what they wanted at a time of their choice. This meant that any niggle or concern could be dealt with immediately.

Is the service well-led?

The registered manager was experienced and worked closely with the staff team on a daily basis. This helped to ensure standards were maintained and that any shortfall could be quickly addressed.

The service had quality assurance systems in place. Records seen by us showed that any identified shortfalls were addressed promptly. As a result the quality of the service was continually improving.

Staff told us that they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and quality assurance processes in place. This helped to ensure that people received a good quality service at all times.

Inspection carried out on 1 August 2013

During a routine inspection

We visited Fernbank Lodge as part of our planned schedule of inspections. We looked at outcomes 2, 4, 10, 12 and 16. All outcomes were judged compliant.

People told us that they were happy with the levels of care and support provided by staff at the home. One person told us, �Living here is like having a big cuddle as I feel safe and at home�.

We saw staff were related to people positively and were supportive and knowledgeable about people who lived at the home. The family member of a person living at the home told us, �I visit my Nan every week. All the staff are really nice and we know Nan is in good hands. We have no worries and trust them�

People told us that they felt safe living at Fernbank Lodge and that staff were supportive of their safety.

We saw that there had been further improvements in care and support planning with the introduction of a computerised system.

We saw that the home had been completely refurbished since the new owners took over in February 2012. The home had been redecorated, carpets and flooring replaced and additional bathing and toilet facilities created.