The Ferns Care Home

Updated 22 July 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 Act.

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

The inspection was carried out by an inspector and a specialist advisor.

Service and service type

The Ferns is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

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 information we had received about the service. We sought feedback from the local authority and professionals who work with the service. 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 of this information to plan our inspection.

During the inspection

We spoke with 6 people, 1 relative and 8 staff, including the registered manager, regional manager, care and domestic staff. We spoke with 1 visiting healthcare professional. We contacted 4 external professionals via email and a further 5 relatives via telephone.

We observed interactions between staff and people. We reviewed a range of records. This included 7 people's care records and medicines records. We reviewed a variety of records relating to the management of the service, including policies and procedures, training records and meeting minutes.

Updated 22 July 2023

About the service

The Ferns Care Home is registered to provide accommodation and personal care to a maximum of 47 older people, including people who live with dementia. At the time of the inspection there were 27 people living at the home.

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

Lessons had not always been learned from previous safeguarding incidents. Delays in reporting safeguarding concerns had put people at higher risk.

The registered manager and regional manager had made some positive changes to the service, but there was still work to do. Auditing and governance systems had not always identified core areas for improvement. The auditing of incidents was basic and not always effective in identifying trends. We have made a recommendation about this.

Staff reacted to individual incidents and concerns, but there was a lack of meaningful oversight and reflective practice. The registered manager understood the principles of the duty of candour. At times they had not shared information fully and in a timely way with relevant external agencies.

The registered manager and regional manager were responsive to feedback during and after the inspection, and demonstrated some immediate improvements.

Care planning was person-centred initially but reviews were not always meaningful. The provider had plans in place to improve records.

The provider had significantly improved the approach to infection prevention and control, completing refurbishment work and reviewing practices. There were sufficient staff to keep people safe, and a reduction in the use of agency staff. People felt safe and relatives provided positive feedback.

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

Medicines administration was mostly safe. Staff were trained, supervised and had their competence regularly assessed. Records were clear and stock checks and audits ensured the risks of errors were reduced. De-escalation strategies for people who were prescribed medicines ‘when required’ needed improvement. We have made a recommendation about this.

Staff demonstrated a good understanding of people who used the service and a desire for them to receive good quality care.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 22 November 2022).

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 18 October 2022. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve. We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the key questions safe and well-led which contain those requirements.

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 remains requires improvement based on the findings of this inspection. This service has been rated requires improvement for the last three consecutive rating inspections.

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

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this report. You can see what action we have asked the provider to take at the end of this full report.

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.

Enforcement and Recommendations

We have made recommendations the provider reviews de-escalation strategies linked to medicines use, safeguarding auditing, lessons learnt and oversight of care documentation.

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.