Fernhill

Fernhill is a residential care home providing personal care to 57 people at the time of the inspection. The service can support up to 58 people. The building was split into four smaller units giving it a much homelier feel. People could move around freely. There were café areas, a ‘post office’, hairdressers and many smaller areas for people to engage in activities and private conversations. The service had an accessible garden.

The service had gone through some major upgrading. Some work was not yet completed including the design of a new roof garden and updating in several areas. Though this work was not yet completed we found no concerns of issues that effected the running of the service and in keeping people safe.

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

People said about the staff; “I observe that the staff are very well trained here, they know what they are doing” and “Everyone gets on well here, staff and the residents are happy.” Staff interacted with people at their pace, were unrushed and lots of positive interaction between each other. Staff in all roles were empowered to sit and chat to people and developed relationships that helped people feel confident to speak up. Relatives told us the service was, “The staff are very good with mum, they never rush her they have time for her” and “The staff are there for mum when she needs them, she is never rushed”. People and their relatives were supported in a variety of ways to have a say in how the service was run. A relative said; “There are regular residents and relatives’ meetings here”.

The leadership of the home was commented on as being outstanding and everyone we spoke with said they would highly recommend the home. Staff commented that it was the best place they had worked and wanted their loved ones to move in. One staff said a new member of staff had told them; “What they had learnt at Fernhill is that from what they see and what we do with people they wouldn’t be scared to get dementia if they were somewhere like here.”

People received exceptional care and support from a staff team who valued and celebrated individuality and diversity. Care was provided in a highly respectful manner which put people at the heart of all that was provided. Visitors commented on the exceptional care and support they received, as well as their loved ones.

The management and staff were skilled at supporting people's relatives to understand the changes in their family member's behaviours, wishes and emotions. The company employed ‘Admiral Nurses.’ These are specialist dementia care nurses who gave expert practical, clinical and emotional support to people and their families facing the challenges of dementia.

There was an outstanding comprehensive programme of often unique and personalised activities arranged every day that was very much based on people's interests and preferences. There were also group activities. A staff member said; “We ask people if they could have one wish we could answer for you what would you like us to do.” They went onto say how many wishes they had made come true for people.

Staff worked exceptionally well together to involve people, and their family members in the planning and delivery of care. People and relatives told us the staff had found suitable activities to support individual preferences. This included gardening and growing fruit and vegetables, shared events with local schools and involvement with volunteers from the local community.

The service encouraged people to become more mobile to increase their independence. This had resulted in one person ‘Pimping up the Zimmer Frame.’ Which meant they personalised their own Walking frame to add colour/designs which had been proven that people would use this more as it was personalised.

The service had a café, post office and sweet shop. People could go to the café area at any time to enjoy a drink and snack as a change of scenery or with visiting family and friends. People could access the post office to send letters or cards and buy ‘old fashioned’ sweets from the sweet shop.

Staff were creative in how they engaged people and prevented people feeling isolated. People and their relatives were supported with end of life care in a sensitive and individual way.

People and their relatives experienced a positive and inclusive approach to care and encouraged to give their feedback to help improve the service. The staff worked with outside professionals and communities to improve people’s health and social wellbeing. The registered manager and staff team all had a very good understanding of their roles and were empowered to make suggestions to keep improving the care.

People were supported to access healthcare services, staff recognised changes in people's health, and sought professional advice appropriately.

People told us they felt safe and secure and well cared for. People were safe because the service had good systems for monitoring risk and staff had a good understanding of people’s needs and how to keep them safe. People and relatives told us there was enough staff on duty to meet their needs and they did not need to wait when they called for support. People were supported to take their medicines safely.

People told us the food was ‘Good’ and ‘Lovely’ and they had plenty of choice. People and relatives they told us they were involved in planning their care and assessing their needs. People and relatives told us they could choose the décor and personalise their rooms. 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.

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

Rating at last

The last rating for this service was Good (published 1 January 2017).

Why we inspected

This was a planned inspection based on the previous rating.

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.

Fernhill was a purpose-built residential home delivering nursing care and support to older people living with dementia. The home is registered to accommodate up to 58 people. At the time of our inspection there were 48 people living there. People were living across two floors. There were four house groups with up to 15 bedrooms with en-suite facilities in each. Each house had a communal living, dinning and kitchenette area. There was also a main kitchen, reception area, hair salon, sweet shop, cinema room, a sensory room and a café. These rooms were used by people and their families to meet and relax in. The manager’s office was situated in the middle of the home on the ground floor.

The service had a registered manager in place. 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.

People and relatives told us that the food was good. We reviewed the menu which showed that people were offered a variety of healthy meals. We saw that food was discussed and recorded on chef visit sheets. We found that some of these required updating.

People, relatives, a therapist and staff told us that the service was safe. Staff were able to tell us how they would report and recognise signs of abuse and had received training in safeguarding.

Care plans were in place which detailed the care and support people needed to remain safe whilst having control and making choices about their lives. Each person had care files which included guidelines to make sure staff supported people in a way they preferred. Risk assessments were completed, regularly reviewed and up to date.

Medicines were managed safely, securely stored, correctly recorded and only administered by on duty nurses that were trained and qualified to give medicines.

Staff had a good knowledge of people’s support needs and received regular local mandatory training as well as training specific to people’s changing needs. Staff told us they received regular supervisions which were carried out by the management team. We reviewed records which confirmed this.

Staff were aware of the Mental Capacity Act and training records showed that they had received training in this. Capacity assessments were mostly completed and best interest decisions recorded as and when appropriate.

People were supported to access healthcare appointments as and when required and staff followed professional’s advice when supporting people with ongoing care needs. Records we reviewed showed that people had recently seen the GP, mental health team and a chiropodist.

People, relatives and a therapist told us that staff were caring. We observed positive interactions between staff, managers and people. This showed us that people felt comfortable with the staff supporting them.

Staff treated people in a dignified manner. Staff had a good understanding of people’s likes, dislikes and interests. This meant that people were supported by staff who knew them well.

People had their care and support needs assessed before being admitted to the service and care packages reflected needs identified in these. We saw that these were regularly reviewed by the service with people, families and health professionals when available. There was an Admiral Nurse who supported the families at Fernhill and could be contacted by staff to assist in best practice when managing people’s individual needs and during pre-assessments.

Relatives and people were encouraged to feedback. We reviewed the relative’s satisfaction survey results for 2016 which contained mainly positive feedback. An action plan was in place and actions were completed. This demonstrated that the service was open to people’s comments and acted promptly when concerns were raised.

There was an active system in place for recording complaints which captured the detail and evidenced steps taken to address them. We saw that there were no outstanding complaints on file.

People and staff felt that the service was well led. The registered manager and clinical lead both encouraged an open working environment which we observed throughout our inspection.

The service understood its reporting responsibilities to CQC and other regulatory bodies they provided information in a timely way.

Quality monitoring audits were completed by the registered manager and clinical lead. The registered manager analysed the detail and identified trends, actions and learning which was then shared as appropriate. This showed that there were good monitoring systems in place to make sure safe quality care and support was provided to people at Fernhill.

Colten Care had a set of Aims and Values which put people in the centre of the care they received. These reflected delivering a professional service which was friendly, kind, individual, reassuring and honest. During our inspection we found that staff and management demonstrated these by using person centred approaches. These included acknowledging people and each other, promoting choice and independence whilst talking people through the support they were providing in an empowering way.