Ferguson Lodge

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.

Ferguson Lodge is a residential care home providing personal care for 46 people some of whom may be living with a dementia. At the time of the inspection 43 people were living at the home.

At our last inspection we rated the service Good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection is written in a shorter format because our overall rating of the service has not changed since the last inspection.

At this inspection we found the service remained Good.

Why the service is rated Good.

The staff team treated people, and their relatives, with kindness, compassion and respect. Relationships were warm, friendly and caring. There was lots of laughter and smiles and everyone was relaxed in each other’s company. Staff were observant and responded to people’s needs in a timely and respectful manner.

People and their relatives had been involved in writing care plans and one page profiles so staff got to know the person and some of their history. This was useful in developing relationships and planning activities that were meaningful for people.

The provider had effective systems to ensure people were safe. Any identified risks had been assessed and minimised to keep people safe.

Safe, values based recruitment processes were used and there were enough staff to meet people’s needs.

There was a focus on good nutrition and hydration. All meals were freshly prepared using only fresh ingredients. This had a positive impact on people’s health and well-being.

People remained registered with their family doctor if they chose to and were supported with access to other healthcare professionals if needed, including dentists, podiatry, district nurses and specialist consultants.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Staff understood safeguarding procedures and any concerns in relation to harm, accidents and incidents were logged and investigated. Lessons learnt were a key element to analysing any incidents or concerns which were used to develop the quality of the service.

Staff managed medicines safely and audits were used to ensure safe systems of ordering, storing, administering, recording and returning medicines were used.

The provider ensured there were enough, trained and well supported staff to meet people’s needs in a safe way.

An electronic system was used to make sure staff training was up to date. Staff attended training relevant to people’s needs including nutrition, dementia care and care of the dying person. In addition, staff attended moving and handling training, first aid, safeguarding and mental capacity training.

The premises were safe and dementia friendly. Appropriate checks of fixtures, fittings and equipment were completed. Thought and consideration had been given to the environment to support people to identify specific rooms whilst also maintaining a homely and welcoming atmosphere.

Everyone we spoke with said the service was well run and there were no areas that needed to improve. There were no complaints and any minor concerns were responded to immediately and shared with staff, where appropriate, so lessons could be learnt.

Systems were in place to monitor the quality of the service provided and action plans were used to drive improvements.

The registered manager was focused on innovation and sustainability using technology to good effect to ensure effective and efficient systems were in place.

A sister service known as ‘Home Care Services – Care Hub’ was available for people living in the local community. People who received respite care at Ferguson Lodge and some relatives of people living at Ferguson Lodge also used the service if they needed some support with meals or maintenance. This meant there was support available by a trusted organisation known to people. This service does not provide personal care and therefore is not registered or regulated by the Commission.

Further information is in the detailed findings below.

During the inspection five key questions were answered; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people who used the service, their relatives and the staff told us.

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

Is the service safe?

Some people told us that they felt safe. Safeguarding procedures were robust and staff understood how to safeguard the people they supported. One person told us, 'I feel very safe here. There is no cruelty here. We have regular meetings and I would speak to staff straightaway.' Another person told us, 'I got information about the service before I came here. They are marvellous and I do feel safe here.'

We spoke with staff about Deprivation of Liberty Safeguards (DoLS). The deputy manager told us that there had been no applications and showed us the policy and procedures they followed. They told us that staff had received relevant training and had access to the policy and procedures.

We saw that the service was safe, clean and hygienic. The home had an effective infection control system. Equipment was well maintained and serviced regularly, so preventing any unnecessary risks. All the staff told us how they worked to prevent infection and told us how they would manage an outbreak at the home so that the risk of infection spreading could be reduced.

Is the service effective?

One relative told us, 'My relative has improved so much since she came here. She had been in hospital previously. We can see a positive change and the staff are so good.'

People explained how their care and welfare needs were met. All people told us that they had support with health appointments and felt that the service was flexible. One person told us, 'It is lovely here. There is something new to do each day; there is always a choice of food and things to do.'

Is the service caring?

We saw that staff communicated well with people and were able to explain things in a way that could be easily understood. We saw that they did not rush people in the home and we saw that the interactions were caring. All the relatives we spoke with said they felt the care was very good. One relative told us, 'The staff are so on the ball. They really are good.'

We saw that people were treated with respect and dignity by the staff. We saw that people were given choice in their care and all the relatives we spoke to told us they were very happy with the care. All the people we spoke with also told us that they were happy with the care and support they received.

Is the service responsive?

All the people told us that they were very happy with the service. One told us, 'If you feel ill at any time, even during the night, you can ring the buzzer and the staff will come. They come straightaway.' A relative told us, 'They let us know everything that is going on with my relative's care. The district nurse visits regularly too. I feel my relative's care is very good.'

We saw that staff responded to people's requests for help in a timely way.

Some of the people we spoke with told us they were involved in decisions about their care. They told us that the staff were flexible and responded to their requests at times they had asked, for instance in their rooms when they had pressed the buzzer for assistance or personal care tasks.

We saw that there was a complaints policy at the home. People told us they found the registered manager very approachable and would not hesitate to raise any issues or complain.

People's care needs had been reviewed at least every six months. We saw that when people's requirements had changed the provider had responded and reviewed their care needs so that they could meet their changed support requirements.

People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

Is the service well-led?

We spoke with the registered manager and deputy manager. They showed us that there was an effective system to regularly assess the quality of service that people received. We found that the views and opinions of people using the service and their carers, family and relatives were also regularly recorded. The manager showed us that activities had been arranged in response to the views and opinions they had received.

We saw the home had systems in place to make sure that managers and staff learnt from any accidents, complaints, whistleblowing or investigations. This reduces the risks to people and helped the service to continually improved.

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

During this inspection we found that improvements had been made to protect people against the risks associated with the management of medicines, and the action plan had addressed the concerns we had previously identified.

During this inspection we checked people were getting the medicines that they needed by looking at their medication records and the storage of medicines. We did not speak to people who used the service on this visit.

We found people were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

People we spoke with told us they were involved in making decisions about how their care was provided. "The staff are very good, they'll do anything that you ask of them. They respect my wishes and are very polite." We saw there were processes in place to involve people who used the service, and their relatives in decisions made about people's care.

We reviewed four care records and saw that people's preferences and care needs had been well documented. We spoke with three members of staff. Staff were knowledgeable about the people's care needs and what they should do to support them.

There were enough qualified, skilled and experienced staff to meet people's needs. We found there was an effective system in place to monitor and assess the quality of the service provided.

We found the quality of records had improved since our last visit. Records were clear and easy to follow. However people were not protected against the risks associated with medicines because there were not adequate checks in place to ensure that medicines were safely administered.

People told us that they enjoyed the range of activities which were available within the home. One person said, 'They have a lot of activities on, today was good, they put the old songs on and we had a sing along.'

Some of the people who lived at the home had complex needs which meant they were not able to tell us their experiences. We used a number of different methods to help us understand their experiences, which included speaking to relatives, health professionals and observation. During our visit we saw that staff treated people with respect and courtesy.