Fernside Hall Care Home

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 inadequate. At this assessment the rating has changed to good. This meant people were safe and protected from avoidable harm.

This service scored 72 (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.

At our last assessment we found events within the service were not reflected on or findings used to drive improvement within the service. These issues had since been addressed, and systems put in place to make sure accidents and incidents were reviewed to understand what had gone wrong and what could be put in place to reduce the risk of re-occurrence. This learning was shared with staff through meetings and handovers. Additionally, the provider had introduced an initiative where incidents were shared and discussed with staff across all of their services in order to promote learning. Where incidents had meant people’s safety was compromised, these were reported appropriately. Audits of incidents and safety events were in place to look for any themes and trends which could be addressed to promote safety.

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.

Assessments known as ‘Living Well’ assessments were completed, where appropriate, by social workers and shared with the registered or deputy manager who then met with the person and completed their own assessment of their needs to make sure they could be met safely at the service. The registered manager made sure that any equipment identified as needed during this assessment was in place before the person moved into the service. Where needed, people were supported to staff to attend hospital visits to ensure their safety.

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.

At our last assessment we found that not all aspects of people’s safety were managed well and staff lacked understanding in this area. Since then, a number of actions had been put in place to address these issues. Staff had received additional training, including spending 2 weeks in another of the provider’s services to revisit their induction training. Staff’s understanding of this learning had been followed up in supervisions. Staff demonstrated a good understanding of maintaining people’s safety and we observed staff supporting people to move around the service as they wished without any restriction. When a person had responded to a survey saying they didn’t know if they felt safe, a meeting was arranged with them to address this. The registered manager had a good understanding of safeguarding and worked well with the local authority. Safeguarding information with internal and external contact details was available to staff throughout the service.

All the people we spoke with felt they or their relative were safe. One person said, “It’s definitely safe, they are very sensible about it.”

The Mental Capacity Act 2005 (MCA) outlines how decisions should be made for individuals lacking capacity. MCA principles were consistently followed with capacity assessments completed, and correct procedures followed in relation to making best interest decisions where people lacked capacity to make informed decisions about their care. Systems were in place to make sure where people lacked capacity, the principles of the MCA were followed. Capacity assessments were completed as needed and, where people lacked capacity, best interest assessments were completed appropriately.

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.

Issues identified at our last assessment had been addressed in relation to safety assessments and lack of guidance for staff to enable them to support people safely and consistently. Overall risk assessments of people’s health and safety were completed and where risks were identified, individual risk assessments were developed. Risk assessments included good information for staff to follow about how to provide care and support safely and were reviewed monthly to make sure the information was still relevant and up to date.

Although risk assessments often lacked evidence of the involvement of the person concerned, one person’s relative told us how they had been involved in discussions about managing their family member’s risks. Staff told us they read risk assessments and were informed of any new information relating to risks to people during handover.

The provider did not always detect and control potential risks in the care environment in a timely way.

At our last assessment we found multiple issues that could affect people’s safety in the environment. The provider had developed an action plan to address this, and action had been taken as needed. A programme of maintenance was in place for areas in need of improvement, however more robust checks were needed to identify issues in need of immediate attention. For example, on the second day of our assessment we saw part of the ceiling in the attic had fallen down. This had happened since our first visit when we had also checked the attic space. Whilst the problem with the ceiling was known and had been reported, the management team could not tell us what was being done about this. Some more minor issues were quickly addressed, such as a call bell not working in a ground floor toilet, a call bell not in place in an ensuite bathroom and some fire doors to bedrooms not closing. However, there was a lack of reassurance daily checks would be implemented to quickly identify and address these issues in future.

A recent fire safety inspection had not identified any serious issues and Personal Emergency Evacuation Plans (PEEPS) were in place for each person with an easily accessible associated list. However, when there was an unplanned fire alarm during our visit, some staff did not follow the correct procedure and walk to the assembly point until prompted by the inspector.

Some dementia friendly features were in place, including a fidget board and improved signage. Equipment to support people’s safety was in place and maintained well.

People were happy with the environment. A relative told us, "My [relative] has the best room in the home!" They said a carpet had been fitted at their request and the room had been personalised with their own belongings and furniture.

The provider ensured there were enough qualified, skilled staff. They received support, supervision and training. The staff worked well together and provided safe care that met the peoples' individual needs.

At our last inspection we found the provider had failed to make sure systems for staff recruitment were safe. This had been addressed and systems and processes around recruitment were now safe. Staff followed a comprehensive induction and training programme. Records showed staff were up to date with training and those who sought to develop in their role were given training and support to enable this. Staff told us morale in the team had very much improved, they felt they worked together well as a team and felt well supported by the registered manager and wider management team. One said, “I feel like I can go to them with any problem. I talk to them every day”.

People were complimentary about the staff team. One person said, “They are good, they are very nice” and a relative told us, "I know them by name as I am here a lot. It is nice and pleasant, and they are all really lovely staff".

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.

At our last inspection we identified concerns in relation to how infectious conditions were managed. This had been addressed. The registered manager had worked closely with the local authority infection control team who were complimentary of the work staff had done in relation to preventing the spread of infection within the service. A member of staff had a lead role in infection prevention and control and had attended training with the local authority. They worked with domestic staff to ensure good standards of cleanliness in the service. Personal protective equipment was in place and used appropriately.

People thought the service was clean. One said, “Yes, it’s clean, they come around and clean up” and another told us, “I think they overdo it, they are obsessed with cleanliness!”.

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.

Since our last inspection there had been significant improvements in management of medicines. Medicines were stored safely and securely with temperature monitoring in place for all storage areas. Controlled drugs were stored securely and records were completed accurately.

Staff completed paper Medication Administration Records (MARs) appropriately, providing assurance that service users received their medicines as prescribed. Documentation was in place to record any missed doses, however for some people, medicines administration was recorded as ‘sleeping’ on multiple occasions, with no evidence of escalation to the GP.

Written protocols were available for medicines administered on a ‘when required’ (PRN) basis. These protocols clearly outlined how to meet people’s needs. Medicines care plans were detailed, person-centred, and provided sufficient information to support staff in managing physical health conditions such as diabetes. However, some had not been updated to reflect recent changes to medicines.

For people who required their medicines to be administered covertly (where medicines can be hidden in food or drink) staff demonstrated good knowledge of individual requirements.

Staff clearly documented the application of medicated patches, ensuring they rotated application sites in line with manufacturer’s guidance. Body maps were used to support and document the application of creams and risk assessments were in place for flammable emollients.

The recording of the administration for time specific medicines and bowel monitoring was completed regularly. However, the thickener recording sheet lacked clarity regarding the number of scoops added to each individual drink. As a result, it was not possible to confirm whether fluids had been thickened to the correct consistency prior to each administration.

Training and competency assessments for all staff involved in medicines administration was up to date.

Staff discussed learning from medicines-related incidents during monthly meetings and shared this learning with all staff to promote safe practice and continuous improvement.

Audits were completed on a monthly basis. These audits identified areas for improvement, and staff appropriately escalated concerns to ensure timely action was taken.