Fernbank Lodge

Fernbank Lodge is a residential care home providing accommodation for persons who require nursing or personal care to up to 18 people. The service provides support to people with mental health needs and older people. At the time of our inspection there were 17 people using the service.

Fernbank Lodge is an adapted building over 2 floors with a stair lift, 2 lounges, a dining room, 2 conservatories, a rear garden and front seating area.

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

We found medicines systems and processes were generally robust, although we have made a recommendation about the management of some medicines.

We found that systems regarding staff training, scheduling, and support appeared good, although we have made a recommendation about the staff recruitment record keeping.

There were systems and training in place to keep people safe and reduce the risk of abuse. People living in the home and their relatives agreed Fernbank Lodge was a safe place to live.

Health and safety systems were in place to ensure the safety of the premises was maintained to keep people, visitors, and staff safe.

Infection prevention and control measures were in place to reduce the likelihood of infectious diseases being transmitted within the home. There was personal protective equipment available in various locations in the home for people to use. The provider was following current government guidance with regards to visitors coming to the home.

There was a culture from the provider and the registered manager to learn lessons when things went wrong. Events were reviewed and actions implemented to reduce the likelihood of a repeat incident, where possible.

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.

There was a positive and person-centred approach to the care and support in the service. People living in the home liked their staff and registered manager and any suggestions or concerns were responded to.

The registered manager was clear about her role and how to manage the service and the checks needed to keep quality of care to a good standard. The provider also demonstrated their checks on the service and registered manager, to help provide further oversight.

People living in the home, their relatives, and staff were all consulted regarding improvements to be made in the home and how to improve care.

The registered manager and staff worked well with others to ensure good health outcomes and safety of the people living in the home.

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

Rating at last inspection

The last rating for this service was good (published 30 November 2017). At our last inspection we made 1 recommendation for the provider to seek and implement best practice guidance in the documentation of quality audits. At this inspection we found the provider had acted on this recommendation and had a system to document and monitor quality audits.

Why we inspected

We received concerns in relation to risks to people from falls and staffing levels. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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 the service can respond to COVID-19 and other infection outbreaks effectively.

We found no evidence during this inspection people were at risk of harm from these concerns, as the provider had managed the concerns and put measures in place to ensure people were safe. Please see the safe and well-led sections of this full report.

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 remained good based on the findings of this inspection.

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

Recommendations

We have made 2 recommendations regarding staff records and medicines. These can be found in the safe key question.

Follow up

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

Fernbank Lodge is registered to accommodate up to 18 people with personal care needs. Accommodation is provided over two floors, with a stair lift providing access to the first floor. There are a range of communal rooms, comprising of two lounges, two conservatories and a dining room. There are small garden areas at the front and rear of the home, with seating for people to use during the summer months.

At the last inspection in October 2015 the service was rated Good. At this inspection we found the service remained good.

People who lived at the home told us they had agreed the level of support they required to help them achieve their goals. Staff were able to explain the support individuals required and the way in which they supported people who lived at the home.

Risk assessments were carried out to ensure risks were identified and minimised. Staff were knowledgeable of these and people who used the service told us they felt safe. Care plans detailed the actions required by staff to minimise identified risk.

People at Fernbank Lodge told us they were happy with the number of staff available to support them. We were told, “I only have to ring that bell and it’s like they can fly, they come to me that quick.” And, “There’s enough staff here and they’re well organised, that’s the key.”

Medicines were managed safely. Staff responsible for supporting people with their medicines had received training to ensure they had the competency and skills required.

Recruitment checks were carried out to ensure suitable people were employed to work at the service. People spoke highly of the staff employed to support them. They told us they had no concerns with the staffing at the home and they considered staff to be helpful and caring

We found people had access to healthcare professionals and their healthcare needs were met. People told us they were supported to access further healthcare advice if this was appropriate and they were happy with the care and support provided. One person who lived at the home told us, “This is a good home, with good care and good staff.”

People who lived at Fernbank Lodge told us they liked the meals provided at the home. We found people were provided with meals and drinks that met their individual preferences and needs. Comments we received included, “The food is second to none here.” And, “I’ve just had homemade salmon fishcakes because I wanted them. They were delicious.”

The registered manager and a quality auditor employed by the registered provider carried out checks to identify where improvements were required. Staff told us they were informed of the outcomes of these. The registered manager explained the checks were not always documented.

We have made a recommendation regarding quality assurance.

We found people who received support were empowered to raise their views on the service at Fernbank Lodge. Meetings and surveys took place to enable people to give feedback to the management team.

There was a complaints procedure which was known to people who used the service. People told us they had no complaints, but they were confident the registered manager would respond to any complaints made. People told us they liked the registered manager. One person commented, “Registered manager is like a daughter to me.”

People who lived at Fernbank Lodge told us they enjoyed the activities provision at the home. We were told, “We do exercises in chairs, now that’s a good shout.” And, “I go to the things I like to go to.”

The registered manager demonstrated their understanding of the Mental Capacity Act 2005. Staff were able to give examples of how they supported people to make decisions. We found where people’s rights were restricted, this was done lawfully.

Staff told us they were proud to work at Fernbank Lodge and they enjoyed supporting people to live happy lives. Staff received appropriate training and development opportunities to enable them to maintain their skills and knowledge. Staff told us they found the registered manager and registered provider to be approachable and praised the way they were supported.

This helped to answer our five questions: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found.

Is the service safe?

From our observations we saw that people were relaxed and comfortable living at the home. There was a good rapport with the staff team that was appreciated by the people living there. People were treated with respect and dignity and their rights were being respected.

The home had information and procedures in relation to the Mental Health Act and Deprivation of Liberty Safeguards. Staff had being trained to understand when an application should be made and how to submit one. This meant that people would be safeguarded as required.

The service was safe, clean and hygienic. Equipment was well maintained and serviced regularly therefore not putting people at unnecessary risk.

Medication practices were robust. Only staff that had received appropriate medication training had responsibility of the administration of medication. A routine annual medication audit was in place, undertaken by an external administrator. This helped to ensure that medication practices remained safe, by ensuring that any shortfall was identified and addressed.

It the service effective?

There was an advocacy service available if people needed it. This meant that people living at the home or their relatives could access additional support.

From our observations and through speaking with staff it was clear that there was a good understanding of each person's assessed needs and that personal preferences were accommodated. Specialist dietary, mobility and social care needs had been identified in care plans as required.

People's mobility and other needs had been taken into account in relation to the adaptation of the building, meaning that people were able to move round freely and safely.

People told us that their visitors, including family and friends could visit at a time of their choice and that they could see these people in private.

Is the service caring?

We saw that people were supported by kind and attentive staff. Care workers showed patience, humour and gave encouragement when supporting people. One person said, 'They (the staff) are all very good and kind, I like it here'

People's preferences, interests and diverse needs had been recorded and care and support had been provided in accordance with people's preferences. This helped to ensure that people were provided with an individualised service that met their specific requirements.

People living at the home, their relatives and friends and the staff team, had been provided with an annual satisfaction questionnaire. We viewed the outcome of the most recent questionnaires. Outcomes were positive. We were told that any suggestion for improvement would be considered and actioned if at all possible. This showed that people were listened to and that their views and opinions were valued.

We also saw the minutes of staff meetings, resident meetings, night staff meetings kitchen staff meetings and management meetings. These were detailed and covered a range of issues that were important to the people concerned. These different forums gave people opportunity to have their say and influence change.

Is the service responsive?

People told us that they liked the staff that supported them, that their needs, wants and wishes were being met by the staff team and that they enjoyed living at the home. One person told us, 'It is very good here, we are all well looked after'.

The home had received no formal complaints for some considerable period of time. However people knew how to make a complaint if they were unhappy. Nobody we spoke expressed any complaints or concerns only complements. There was an 'open door' policy making easier for people to say what they wanted at a time of their choice. This meant that any niggle or concern could be dealt with immediately.

Is the service well-led?

The registered manager was experienced and worked closely with the staff team on a daily basis. This helped to ensure standards were maintained and that any shortfall could be quickly addressed.

The service had quality assurance systems in place. Records seen by us showed that any identified shortfalls were addressed promptly. As a result the quality of the service was continually improving.

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

People told us that they were happy with the levels of care and support provided by staff at the home. One person told us, 'Living here is like having a big cuddle as I feel safe and at home'.

We saw staff were related to people positively and were supportive and knowledgeable about people who lived at the home. The family member of a person living at the home told us, 'I visit my Nan every week. All the staff are really nice and we know Nan is in good hands. We have no worries and trust them'

People told us that they felt safe living at Fernbank Lodge and that staff were supportive of their safety.

We saw that there had been further improvements in care and support planning with the introduction of a computerised system.

We saw that the home had been completely refurbished since the new owners took over in February 2012. The home had been redecorated, carpets and flooring replaced and additional bathing and toilet facilities created.