Fernhill House

Fernhill House is a care home with nursing providing accommodation for persons who require nursing or personal care and treatment of disease, disorder or injury. Fernhill House accommodates up to 66 people in one purpose-built facility, with many different areas for people to spend time together or more privately as they choose. Care and support is provided to people with dementia, nursing needs, and personal care needs. There were 63 people living at the home at the time of our inspection.

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

On the first day of the inspection we noticed that not all topical creams were stored securely. There were no risk assessments for paraffin based topical creams. Some topical creams had no prescription labels or open date.

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. The provider was not always working in accordance with The Mental Capacity Act 2005 and there was no evidence of the provider following best interest decision processes where medicines were administered covertly.

Some care plans and risk assessments were overdue on the first day of the inspection. A visit by the local authority prior to our inspection had resulted in a suggestion to improve wound care plans, however, limited evidence of improvement was available during our inspection.

Governance and quality assurance at the service were not always effective. The provider's systems and processes such as regular audits of the service had failed to identify issues found during this inspection.

People were safeguarded from the risk of harm or abuse. Staff were recruited safely. People were supported by a sufficient number of staff. When people required additional support from external services, they were promptly referred by staff who were skilled in recognising when people's needs change.

People, their relatives and staff spoke highly of the management team. They felt the service had an open culture, where the registered manager was available to support them and encouraged feedback, both positive and negative.

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 3 October 2018).

Why we inspected

We received concerns in relation to the management of medicines, management of falls and an alleged delay in seeking emergency medical care. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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 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.

Enforcement and Recommendations

We have identified breaches in relation to need for consent, management of medicines and good governance at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

There was a registered manager in post. 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.

This is the provider's first inspection since they registered the service with the CQC.

Overall, people received their medicines safely and as prescribed. However, the provider needed to ensure safe medicines management was consistently followed by all staff to mitigate risks to people’s safety and welfare.

People were supported to stay as safe as possible by staff who understood what actions to take to reduce risks to their well-being. This included reducing risks to people’s physical health and mental well-being. People, their relatives and staff were confident if they had any concerns for people’s safety the management team would put plans in place to help them. There was enough staff to meet people’s care needs.

People benefited from living in a home where there were systems in place to reduce the risk of infections and staff knew what action to take to care for people if they experienced any infections. Checks on the environment were undertaken and systems for identifying if there was any learning after safety incidents were in place.

Staff considered people’s care needs and involved people who knew them well before people came to live at the home, so they could be sure they could meet people’s needs. Staff had received the training they required so people would be supported by staff with the skills needed to provide care and support.

People were supported to choose what they wanted to eat and to obtain care from health and social care professionals so they would remain well. 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.

People had developed caring relationships with the staff who provided support and showed us they liked the staff who cared for them. Staff communicated with people in the ways they preferred and encouraged them to make their own day to day decisions about their care. People received care from staff who acted to promote their dignity and independence.

People’s care had been planned by taking their individual wishes, histories and needs into account. People’s care plans incorporated advice provided by other health and social care professionals, so they would receive the care they needed in the ways they preferred. Systems were in place to respond to any concerns or complaints and to incorporate any learning into care subsequently provided.

The registered manager and provider checked people received the care they wanted, so they would be assured people enjoyed a good quality of life and risks to their safety were reduced. The registered manager listened to the views of people, their relatives and staff when developing people’s care and the home further. The management and staff team planned further work and their ambition was to be outstanding so people would benefit from living at a home where staff continued to develop their caring skills and experience.

Further information is in the detailed findings below.