Ferguson Lodge

Updated 14 December 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

This inspection was undertaken by 5 inspectors, an operations manager and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Ferguson Lodge is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Ferguson Lodge is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed the information we held about the service, including the statutory notifications we had received from the provider. Statutory notifications are reports about changes, events or incidents the provider is legally obliged to send to us. We contacted the local authority commissioning and safeguarding teams, the local NHS infection prevention and control [IPC] team, fire service, Integrated Care Board and Healthwatch to request feedback. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England.

We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with 9 people who used the service and 5 relatives about their experience of the care provided. We spoke with 18 members of staff including the registered manager, deputy manager, duty manager, administrator, senior and care staff. In addition, we received feedback from one healthcare professional.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us. We reviewed a range of records, this included care and medicine records for 27 people. We looked at the recruitment records for 3 staff and a variety of records relating to the management of the service, including policies and procedures. Following the inspection site visits we requested additional information by email and continued to seek clarification from the provider to validate the evidence we found.

Updated 14 December 2023

About the service

Ferguson Lodge is a care home providing accommodation and personal care for up to 46 people. The service provides support to people with a dementia related condition, physical disability, sensory impairment or older person in 1 adapted building. At the time of our inspection there were 39 people using the service.

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

A system to ensure regulatory requirements were met was not in place. We identified widespread shortfalls across the service including the assessment of risk, management of medicines, duty of candour, safeguarding, need for consent, staffing and governance.

A duty of candour policy statement was in place. However, this did not assure us the provider understood their responsibilities in relation to this regulation. Documentation to show how staff had worked in an open and transparent way and to evidence what actions had been taken in response to notifiable safety incidents were not in place.

Systems were in place to recruit staff safely. However, there were inconsistencies in the recruitment records viewed. We have made a recommendation about this. A range of risk assessments were in place. However, all the risks people were exposed to had not been fully assessed. Risk assessments to ensure the safety of the environment and equipment were not always in place. For example, a legionella risk assessment had not been completed in line with requirements. Medicines were not always managed safely.

Appropriate action had not always been taken to safeguard people from the risk of abuse and some incidents had not been reported to the local authority in line with their reporting thresholds. There were not enough staff to meet people’s needs. We observed periods where people had to wait for staff support due to them being busy doing other tasks. One person told us they regularly had to wait for support due to staff being very busy. Staff displayed kind and caring attitudes towards people during their interactions and people spoke positively about staff.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. For example, staff had not always assessed people’s ability to consent to their care and treatment.

The provider had not ensured the 'Statement of Purpose' for the location had been notified to CQC and effective communication systems were not fully in place to share information between staff. We have made a recommendation about this.

There were gaps in the training delivered to staff which had been deemed mandatory by the provider. In addition, not all staff had completed training in relation to supporting people who have a learning disability or autism which is a legal requirement.

People’s nutrition and hydration needs were met. However, the meal time experience was not always person-centred for some people. We have made a recommendation about this. Systems were in place to work with health care professionals to ensure the physical health needs of people were met.

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

Rating at the last inspection

The last rating for this service was good (published 5 October 2018).

Why we inspected

The inspection was prompted in part by notification of an incident following which a person using the service sustained a serious injury. This incident is subject to further investigation by CQC as to whether any regulatory action should be taken. As a result, this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about the management of risk of accidents and incidents and the safety of equipment. This inspection examined those risks.

After our inspection visits we received further information informing us a second person using the service had sustained serious injuries. This incident is also subject to further investigation by CQC as to whether any regulatory action should be taken. Therefore, the inspection did not examine the circumstances of this incident either. However, a decision was taken for us to complete further inspection visits to check the safety of the service and equipment used.

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 COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well led 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 Ferguson Lodge on our website at www.cqc.org.uk.

Enforcement and recommendations

We have identified breaches in relation to the statement of purpose, need for consent, safe care and treatment, safeguarding, good governance, staffing and duty of candour at this inspection. We have also made recommendations in relation to recruitment and person-centred care during meal times.

Please see the action we have told the provider to take at the end of this report.

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 continue to monitor information we receive about the service, which will help inform when we next inspect.