Ferncross Residential Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Medicines had improved and were being managed more safely. However, the management of prescribed creams did not follow best practice and the provider took immediate action to improve their safe storage. Medicines audits were in place however, they now appeared to be overcomplicated. Improvements had been made to the processes to manage risks and people were supported by staff who knew the help people needed to promote their safety. However, we found some elements of risk management had not been recognised. A new accident and incident recording system was in place and these events are now being regularly recorded. However, the oversight of all incidents was not being consistently recorded, audited or analysed. Improvements had been made to the environment since the last inspection and the service is no longer in breach of regulation. An ongoing plan is in place for repair, refurbishment and fire safety of the premises. Regular safety checks are now in place. We found some specific equipment in use had no systems in place for regular checks. New processes had been implemented to ensure staff were recruited safely and the service is no longer in breach of regulation. However, checking systems that had been put in place had not been consistently completed and no audits checks on the files were completed. Enough suitably qualified, competent, skilled and experienced staff were not always deployed effectively we found a breach of the legal regulation 18. Staffing levels seemed at times to be insufficient. We saw a range of different staff behaviours, skills and knowledge demonstrated especially when supporting people with dementia. Staff had received a variety of training which was predominantly completed online. Systems were in place to protect people from abuse and harm. People were supported to have choice and control and where relevant they and their relatives were involved in planning their care. People lived in a clean environment.

This service scored 53 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had worked with the local authority quality team since the last inspection, and this had resulted in several changes that had improved the safety and care for people. We saw family’s and relevant other were kept informed of incidents in the home. A relative said, “They ring me straight away if anything happens.”

Staff told us they would be confident that any concerns raised to management would not be overlooked or ignored. The provider agreed the new system used for recording accidents and incidents was not detailed enough nor was it being regularly overseen or analysed.

A new accident and incident recording system was in place and events were now being regularly recorded. However, these records were not consistently being reviewed by the provider. Action had been taken in response to incidents, for example: additional checks, changes to the environment and appropriate referrals to other agencies. However, there was little evidence of debriefs following incidents or accidents meaning opportunities to learn and prevent re-occurrence may have been missed. From those records it is clear some notifiable incidents to us have not been made.

People’s needs were assessed before admission to the home to ensure their needs could be met adequately. One person recently admitted to the home told us, “I do like it here.”

Care was planned and organised with people and their relatives, in ways which ensured continuity. The provider told us a pre-admission assessment was completed to ensure people could settle into the home safely, and relatives were involved as much as possible during the transition period. Staff told us information in care records had improved about people’s needs and staff knew people’s preferences and routines.

The local authority quality team and commissioners of the service had been supporting the provider to improve since the last inspection. The quality team told us although the initial progress was slow improvements had been made resulting in safer and better care.

The provider shared information about the safety and quality of the service is shared with partners and stakeholders monthly. Pre-admission assessments were carried out to ensure the service could meet people’s needs. Whenever possible, health professionals and those important to the person were included, this helped ensure all information was gained about the person and care was planned to meet their needs and wishes.

Relatives we spoke with felt their relatives were safe. One person said, “If I had to go into a care home, I would go there.” They were also very positive about the friendliness and kindness of staff.

Staff had received training in safeguarding and understood the signs that could mean a person was at risk of harm and/or abuse. Staff told us they would report concerns to the provider, and they were confident any concerns would be actioned. One staff member told us if they saw any issues, “I wouldn’t think twice I would definitely report it.”

We observed staff delivering care and interacting with people. Most of the observations showed people were appropriately supported and seemed comfortable in the company of staff. However, some staff practice indicated concerns with their skills and experience when interacting with people living with dementia, which posed a risk of people's needs being neglected or sometimes restrictive practice. The provider understood the Deprivation of Liberty Safeguards (DoLS), and followed this when it was in the best interest of the person.

Incidents of safeguarding had been identified and shared with the local authority. However, not all the incidents and allegations had been notified, as legally required, to us. Consents generally had been obtained and DoLS were in place and up to date. Mental capacity assessments and best interest decisions had been made for people in relation to; living in the home; support with medicines; locked doors; sensors and door alarms.

During our evening visit other service users were seen to intervene for people who needed assistance to mobilise or attempted to stand up. There were no call bells available in the communal areas should people need to call for assistance as staff were not always present.

The provider agreed the new system used for recording accidents and incidents was not detailed enough nor was it being regularly overseen by them. Staff told us they felt adequately trained to meet the needs of people in the home. However, our observations indicated some staff would benefit from a better understanding of current guidance in relation to supporting people living with dementia.

We looked at falls records which demonstrated most falls in the home were unwitnessed, this potentially suggested insufficient staffing especially in the evenings and we observed this during our evening visit. The provider and registered manager did not analyse falls trends for themes to consider how to minimise them. We observed people being offered support however, this was not always in line with best practice guidance. We observed people being offered support however, this was not always in line with best practice guidance. Where people had fluctuating abilities and needed reassurance and support some staff did not seem to recognise this or always respond appropriately.

There was some evidence of the provider checking accidents and incidents however, this was not being consistently recorded, audited or analysed. The records were much improved since the last inspection especially where actions had been taken such as referrals to community nurses, falls team and implementation of sensors mats where required. There were also much improved and more detailed care records including risk assessments implemented. However, we found some elements of risk management had not been recognised for example for self-administering of insulin, skin integrity and for anticoagulation therapy. The provider acted immediately to rectify the records. Staff had been trained to use equipment to support people to safety in the event of an emergency. The provider had ensured Personal Emergency Evacuation Plans (PEEPs) had been completed to show staff how to safely support people in the event of a fire or the need for a building evacuation.

One of the lounges had new furniture and flooring and had been decorated since our last visit. A relative told us, “The home always looks nice when I visit.” Another told us the dining room seems to have improved, but they need more comfortable seating for visitors.” A designated cleaner had recently been employed.

Regular safety checks are now being completed by the provider. However, there are still ongoing action plans and recommendations for fire safety in the home. The provider told us there was an ongoing plan in place for repair and refurbishment in the home. Staff had received fire evacuation training. This ensured staff knew what to do in the event of an emergency to lessen the risks and keep people safe.

On our first visit to the home, we had a walk around we observed most bedroom doors to be propped open with wedges rendering fire doors ineffective in the event of a fire. The provider took immediate action and removed the door wedges. During the evening visit we made we saw not all people had their own equipment available to support their independence and mobility. We observed an incident when a person tried to stand using a folding table, the inspector had to intervene to prevent injury because no staff were present, and no call bell was available for people to request assistance. During the same evening, fire doors were seen propped open with wedges on the ground floor bedrooms.

After the last inspection, improvements had been made to the safety and décor of the home and a regular maintenance person had been employed. The provider had introduced new practices to ensure regular maintenance and safety issues were identified and acted on. There were still some actions to complete for full compliance with fire safety advice. The provider had ensured Personal Emergency Evacuation Plans (PEEPs) had been completed to show staff how to safely support people in the event of a fire or the need for a building evacuation. The management team used a variety of methods to assess, monitor and improve the quality of the service provided. However, we found that these were not always completed effectively as we found some equipment in use had no systems in place for regular checks such as air flow mattress & bedrails.

The deployment of staff left people in the communal areas at times without supervision and/or having their needs met in a timely way. During our evening visit one person told us after making a request of staff, “You have to get used to waiting here.” Staff did not appear to recognise there were times of the day where people may have an increase in their needs especially those with dementia. There were several falls and injuries recorded that were more often unwitnessed than witnessed. Staffing levels in the evening meant at times there was only one staff member available to all people as the other 2 staff were required to support 2 people with moving and handling.

The provider did not assess people’s dependency needs on a regular basis and staffing during the day relied on management being available should people require extra support. The provider had recently appointed ancillary assistants who supported the staff team in the evening between 6pm and 9pm however, these could not provide direct care and required the supervision of a senior member of staff. Staff we spoke with told us they felt there were enough staff to meet people’s needs and because of the ancillary staff and designated cleaner they now had more time to spend talking with people. Staff told us they completed a variety of training but it was predominately all on line.

We observed staff numbers at times to be insufficient to meet people's needs. We saw 2 people required 2 staff to safely manage their moving and handling needs. Where this is required when 3 staff are available to meet everyone’s needs it could lead to some people having to wait for a staff member to be available. During our evening visit the 3 staff on duty did not appear to have a good oversight of people in the communal lounges. We observed where there were 8 people in one lounge and there were periods of several minutes when no staff came in. One person who was showing signs of distress was responded to by other residents who tried to reassure them and encourage them to remain seated. There was no call bell for them to call for assistance. This was repeated in the smaller lounge where someone was trying to stand up when no staff were present other residents had to encourage them to sit back down. We observed there was a broad range of different staff behaviour, skills and knowledge demonstrated. Some staff seemed to lack an understanding of people with dementia and how to support them in a dignified and respectful manner. We also observed some staff providing support in a pleasant and patient manner. Where people clearly had fluctuating abilities this was not always recognised by staff and compensated for in their level of support to them. During our observations an inspector had to intervene and alert staff to people’s needs.

Enough suitably qualified, competent, skilled and experienced staff were not always deployed. A dependency scoring tool is used to determine the ideal number of staff required but was not regularly completed. The current staff training is predominately completed by elearning modules. We noted from the staff training matrix that some staff were not yet working towards or had completed the nationally recognised care certificate. Training records and induction checklists had not been consistently completed. The training matrix for elearning showed only 54% of staff had completed the practical training aspect of moving and handling, only 45% of staff had completed training on the mental capacity act and only 36% had done training on equality and diversity. The provider confirmed training dates had been booked for face to face training in first aid and following our findings face to face training on dementia care had been sought. The home is registered with a service user band of dementia however, there was no evidence of any specialist dementia training being completed by staff. Safer recruitment practises had been implemented to ensure staff being employed were of suitable character and fit for the role. We checked the files of 6 staff who had been employed since the last inspection and found the recruitment processes used had improved. However, we found some minor concerns, and these were immediately addressed by the provider. A checklist / index had been introduced for all the recruitment files however, these had not been consistently completed and no audits check on the files had been done. These findings have been addressed in the key question of well-led.

No one raised concerns around the home’s cleanliness and hygiene. Relatives were happy with the quality of cleanliness in the home. Several people complimented it. One relative stated there were no bad odours when they looked round the home.

Staff had received Infection Prevention and Control (IPC). Staff told us that the recent employment of a designated cleaner had been positive for them as it now allowed them to spend more social time with people.

Personal Protective Equipment (PPE) and hand sanitiser was readily available and was seen to be used effectively.

The home was clean and regular checks of the cleanliness and infection prevention were being completed. A regular cleaner had been recently appointed.

Medicines management was noted to be much improved and safer from the last inspection. However, the management of topical medicines needed improving. People had their medication administered safely, and in line with their needs and preferences. People received medicines safely from staff who were trained to administer medicines.

Staff confirmed they received training in medication administration and their competence was assessed regularly. Staff could tell us what action they would take if people refused their medication and the signs they would look for if someone needed as and when required (PRN) medication for pain. Systems in place for managing topical medicines safely needed improving and the provider took immediate action to address this. The audits being done by the staff and management were repetitive and often not completed in full and had become ineffective.

On the first day multiple prescribed topical creams were found in people’s bedrooms and a communal bathroom and on request were moved to safe storage. Safer management and storage were implemented by the provider during our visits. Guidance & risk assessment were not in place for people on anticoagulation therapy and some handwritten instructions for use copied from the prescription for topical medicines were not always double signed in line with safe practice guidance. The provider and medicines champion for the home addressed this. Controlled drugs and eye drops were stored and administered following best practice. Controlled drugs are drugs which are dangerous or otherwise harmful and have the potential for abuse or misuse. We observed staff administering medicines. Medicines audits, though in place, were overcomplicated and incomplete. We have addressed this further under the key question of well-led.