Fern House

Fern House is a purpose-built complex which consists of a residential care home providing accommodation and personal care for up to 30 older people and 49 extra care housing apartments where some people are provided with personal care from staff onsite. At the time of our inspection there were 19 people living in the care home and 26 people living in the extra care housing apartments who were receiving personal care.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

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

Improvements had been made since the last inspection. Medicines management had improved, although systems needed to be embedded and developed further. We have made a recommendation about guidance for staff and records relating to topical and when required medicines.

The management of risks to people had improved although accident and incident monitoring required further development. Effective systems were in place to manage any allegations of abuse and to ensure these were reported to the appropriate authorities. Lessons were learned when things went wrong and information shared with staff.

There were enough staff to meet people’s needs. Recruitment processes ensured staff were suitable to work in the care service. People lived in a clean and pleasant environment. Robust infection control procedures were in place which helped keep people and staff safe during the COVID-19 pandemic.

People, relatives and staff spoke positively about the service. Comments included; “I would recommend this home without hesitation. It’s safe care and [family member’s] very happy there. We're completely satisfied with everything” and “I would recommend this home as you get well looked after, fed well and my room is bright and airy. There is a big family atmosphere and I feel at home here.”

Leadership and management had improved. A new manager was being recruited and the director of operations was currently running the service alongside the deputy manager. People, relatives and staff spoke positively about the management team and the improvements made in the last six months. New governance systems had been implemented which included more robust provider oversight and monitoring. The provider had an ongoing action plan and was committed to ensuring improvements made were sustained and developed further.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was inadequate (published 24 February 2021). At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since 24 February 2021. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We carried out an announced inspection of this service on 15 and 29 January 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, safeguarding and good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

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.

Fern House is a purpose-built complex which consists of a residential care home providing accommodation and personal care for up to 30 older people and 49 extra care housing apartments where some people are provided with personal care from staff onsite. At the time of our inspection there were 25 people living in the care home and 35 people living in the extra care housing apartments who were receiving personal care.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

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

People were not safe. Systems for recording and monitoring accidents and incidents were unsafe as they did not accurately reflect what was happening in the service. Safeguarding procedures were not followed consistently. Risks to people were not assessed and managed. Medicines were not managed safely. Lessons were not learned when things went wrong.

There was no system for calculating safe staffing levels and there were not always sufficient staff to keep people safe. We have made a recommendation about reviewing staffing levels.

There were continued breaches at this inspection with similarities to the issues found at the last inspection in relation to medicines, risk management and governance. There was a lack of consistent and effective leadership and an ineffective governance structure which meant the service was not appropriately monitored at manager or provider level. Effective systems were not in place to address shortfalls identified at the inspection and drive improvement.

Staff were recruited safely. People lived in a clean and pleasant environment. Robust infection control procedures were in place which helped keep people and staff safe during the COVID-19 pandemic.

People who used the service and relatives provided consistent positive feedback about their experience. The provider was responsive to the inspection findings and shared plans to improve their systems and processes.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection (and update)

The last rating for this service was requires improvement (published 15 January 2020) and there were two breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection not enough improvement had been made and the provider was still in breach of regulations.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 30 October and 26 November 2019. Two breaches of legal requirements were found. We served a Warning Notice in relation to Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and a requirement for Regulation 12. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and governance.

We undertook this focused inspection to check they had followed their action plan and met the Warning Notice and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to inadequate. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Fern House on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so

We have identified breaches in relation to safe care and treatment, safeguarding and governance at this inspection. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

We have identified a breach in relation to failure to notify CQC about significant events at this inspection and are reviewing our regulatory response outside of the inspection process.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Fern House consists of a residential care home which provides personal care for up to 30 people and an independent extra care housing scheme, where people own or rent their own flats and have the option of using the onsite personal care and support service.

At the time of the service there were 28 people living in the residential care home and 14 people receiving personal care who lived in the independent extra care housing scheme.

Not everyone who lived in the building received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

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

People said they felt safe and secure using the service. However, medicines were not consistently managed in a safe and proper manner. Systems to assess and monitor risk needed improvement as some key risk assessment documents were absent or not up-to-date. Overall, there were enough staff deployed to ensure people received prompt care and support and staff were recruited safely.

People said they received effective care that met their individual needs. People were supported by staff with the right skills, experience and training. Staff felt well supported by the management team. People had access to a good range of food and drink. There were good links with healthcare services.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. We made a recommendation relating to how capacity assessments and best interest decisions were documented.

People were cared for by kind and compassionate staff who treated people well. People’s independence and autonomy was promoted by the service. People were listened to and their views were valued and used to improve the service.

People said they received high quality care and support. Care plans required reviewing to ensure they were accessible and contained up-to-date information on people’s needs. Complaints were logged, investigated and lessons learnt to drive continuous improvement of the service.

People and staff said the service was well led and that management were effective. Systems to assess, monitor and improve the service were not sufficiently robust as some of the deficiencies we identified for example around care planning and medicines management should have been prevented from occurring. People’s feedback was sought and used to make improvements to the service.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update.

The last rating for this service requires improvement (published 30 October 2018). The service remains rated requires improvement

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection not enough improvement had been made and the provider was still in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

We have found evidence that the provider needs to make improvements. Please see the ‘Is the service safe?’, ‘Is the service responsive?’ and ‘Is the service well led?’ sections of the full report.

You can see what action we have asked the provider to take at the end of this full report.

The provider acted positively on the concerns we raised on day one of the site visit and had made a number of improvements by day two.

Enforcement

We have identified breaches in relation to safe care and treatment (medicines management) and good governance (risk management and audit processes) at this inspection.

We issued a warning notice to both the provider and registered manager for the breach of regulation 17 (good governance) requesting compliance with the regulation by 7 February 2020. We issued a requirement action in relation to the breach of regulation 12 (safe care and treatment).

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The residential unit at Fern House 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.

The self-contained apartments at Fern House provide care [and support] to people living in specialist 'extra care' housing. Extra care housing is purpose-built or adapted single household accommodation in a shared site or building. The accommodation is rented, and is the occupant’s own home. People's care and housing are provided under separate contractual agreements. CQC does not regulate premises used for extra care housing; this inspection looked at people's personal care and support service.

There was no registered manager in post at the time of inspection. However, the recently appointed manager was in the process of registering with the Commission [CQC]. 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.

This inspection took place on 31 August and 12 September 2018 and was unannounced. This was the first inspection of the service since it registered with the Commission [CQC] in July 2017.

Policies and procedures ensured people were protected from the risk of abuse and avoidable harm. Staff told us they had received safeguarding training, and they were confident they knew how to recognise and report potential abuse.

Risks associated with personal care were well managed on the extra care housing scheme. However, on the residential unit risk assessments did not always provide staff with accurate and up to date information.

The service was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS) and acting within the legal framework of the Mental Capacity Act 2005 (MCA). This helped to make sure people’s rights were protected.

Systems were in place to ensure people received their prescribed medicines safely. However, staff did not always follow correct procedures when administering medicines therefore we could not be certain they were being given/applied as prescribed.

There were enough staff available to meet people’s needs but staff were not always deployed effectively. In addition, safe staff recruitment and selection procedures were not always followed

Staff received appropriate training and told us the training provided was informative and relevant to their role. Staff were supported by the management team and received formal supervision where they could discuss their ongoing personal development needs.

Infection control policies and procedures were in place. However, staff on the residential unit did not always follow the correct procedures when managing clinical waste.

We saw arrangements were in place that made sure people's health needs were met. For example, people had access to the full range of NHS services. This included GPs, hospital consultants, community health nurses, opticians, chiropodists and dentists.

The care plans and supporting records and reports identified specific risks to people health and general well-being, such as falls, mobility, nutrition and skin integrity but on the residential unit they did not always provide accurate and up to date information.

Relatives told us they were made welcome and encouraged to visit the home as often as they wished. They said the service was good at keeping them informed and involving them in decisions about their relative’s care.

Private accommodation and communal areas on the residential unit were well maintained and provided people with a pleasant, comfortable and safe environment.

People told us they enjoyed the food and there was a good choice at every mealtime. However, we found the food and fluids charts in place for some people on the residential unit were not always being completed correctly by staff.

There was a complaints policy available which detailed the arrangements for raising complaints, responding to complaints and the expected timescales within which a response would be received.

Systems were in place to assess and monitor the quality of care provided to people and to drive improvements. Audit results were analysed for themes and trends and there was evidence that learning from incidents took place and appropriate changes were made to procedures or work practices if required. However, they were no always sufficiently robust and had not identified some shortfalls in the service highlighted in the body of the report.

We identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.