The Ferns Care Home

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.

The Ferns Care Home is a purpose-built residential care home providing accommodation and personal care to up to 48 people. The service provides support to younger adults, those with a physical disability and people over the age of 65, including those living with dementia. At the time of our inspection there were 41 people using the service.

Care is provided over two floors each with private rooms and a series of communal facilities. The upper floor is used to accommodate people who have been discharged from hospital and are awaiting support to return home or move to alternative accommodation.

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

People were not always kept safe. Appropriate systems to manage and control infections at the home were not followed. Improvements had been made to supporting people with their medicines and records showed people received these in line with guidance. Staffing was an ongoing issue for the provider, although appropriate recruitment processes were followed, and people felt staff tried hard to support them. People felt safe living at the home and risks related to care and the environment were monitored and reviewed.

People’s care plans were detailed and reviewed on a regular basis. Staff told us they received regular training and updates and were supported in their practice through supervision. Meals and dietary support sometimes lacked choice and staff did not always have time to actively encourage people at mealtimes.

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. Practice around the Mental Capacity Acting and ensuring appropriate consent had been obtained had improved.

Management of the service remained of variable quality. The service was without a permanent manager. Audits and checks were not always robustly completed or followed up. People’s views on the service had been sought and acted upon.

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 9 March 2022). The provider remains rated as requires improvement. This is the second inspection where the provider had been rated as requires improvement.

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 that whilst the provider had improved in some areas they remained in breach of regulations.

Previous recommendations

At our last inspection we recommended the provider improve supervision and support to staff. At this inspection we found the provider had acted upon this recommendation.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 7 February 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 medicines management, ensuring appropriate consent was sought and implement oversight and quality monitoring of the service.

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, effective 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. This is based on the findings at this inspection.

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 The Ferns Care Home on our website at www.cqc.org.uk.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to infection control and oversight and management of the service at this inspection.

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.

The Ferns Care Home is a care home for up to 48 people. The service provides care and accommodation for older people, people living with dementia and those with mental health needs. At the time of the inspection there were 40 people using the service.

The service is a purpose-built home with individual rooms and a range of communal facilities. There are two floors, each with their own shared spaces such as lounges and dining rooms. At the time of the inspection the upper floor was being used as a ‘step-down’ facility, allowing people to be discharged from hospital whilst care packages and additional support were organised.

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

People were not always supported to receive their medicines appropriately and safely. We found some medicines had not been given and records were not always well completed. Cleanliness at the home needed to be improved and some additional elements related to the management of COVID-19 were not well managed. By the second day of the inspection action had been taken to address these issues. Risks, both in relation to care and the environment were monitored. Staff recruitment was undertaken appropriately. People and staff felt there were enough staff to support the current numbers living at the home, although there was a high reliance on agency staff due to recruitment pressures.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not always support this practice. Records did not always evidence how staff followed the principles of the Mental Capacity Act. People's needs had been assessed prior to them coming to live at the home. People were supported to access appropriate food and fluids and meals were described as being good. The premises were in need of some updating and redecoration. Staff had received a range of training and development but had not always received regular supervision to support and monitor their practice. We have made a recommendation about this.

People told us they were happy with the care they received, and that staff were kind and helpful. People’s day to day choices were considered when providing care and their views were considered. Staff had a good understanding of people as individuals and people were treated with dignity and respect.

Care plans were in place, but the quality of the information varied. Reviews of care varied in their quality. People told us activities were available but felt additional activity time would be welcomed. Visiting was supported during the pandemic, in line with government guidance. People’s preferences and choices were considered. The home had a range of processes to support people communicating. End of life care was considered as part of the care planning process.

There were a range of audits and checks in place, although the issues identified at the inspection had not been identified by these processes. A registered manager who no longer worked at the home was registered for the service. We raised this with the provider. Staff felt the service lacked strong leadership and direction. Some attempts had been made to involve people and staff in decisions about the running of the home. The home worked in co-operation with a range of other agencies.

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

Rating at last inspection

This service was registered with us on 18/5/2020 and this is the first inspection under the current provider.

Why we inspected

We initially inspected this service because the home was dealing with a COVID-19 outbreak and we wanted to assess the service in terms of infection control, prevention and management. 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. This included checking the provider was meeting COVID-19 vaccination requirements.

During the inspection we found a number of concerns outside of this initial focus and opened up the inspection to a full inspection of the service, covering all five domains.

We have found evidence that the provider needs to make improvements. Please see the caring, 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.

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.