Ferncross Residential Home

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture. The provider for this location is also the registered manager. Daily they were leading and managing the service and had since the last inspection following which they had introduced new processes and was driving improvements. Improvements had been made across the safety of the service. However, the processes for assessing risk, safety monitoring and service improvement were not always consistent and/or effective and we found a breach of regulation relating to good governance. We were not assured that the governance systems used were effective in identifying how the service could improve. At our last inspection we recommended the provider/registered manager acquainted themselves with legislative requirements as they related to health and social care. At this inspection we noted there were still some gaps in their knowledge of the requirements. Following accidents and incidents in the home the processes in place did not allow for identifying lessons to be learned and then shared with staff on a regular basis. Staff morale at the service was good. Staff spoke about the provider positively and felt they were treated fairly and had the freedom to speak up.

This service scored 57 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Some staff did not always show they understood the specific needs of people with dementia, and we observed at times this impacted on demonstrating they were promoting dignity, equality and human rights. Staff spoke very positively about the care people received. One staff member told us, “I love working with the elderly, spending time listening to their stories. It’s not just a job.” Another staff member explained how they promoted peoples’ rights, they told us, “I always make sure I ask them what they prefer, whatever it is, I ask them out of respect. I ensure their dignity by giving them privacy when they need it, but I also promote their independence by encouraging them to do things they can do for themselves.”

The home is registered with a specialism service user band of dementia. However, there were several areas for meeting the requirements of the service user band that were not in place. For example, the physical environment did not use dementia design principles, and we did not see there was a clear dementia care model used.

The provider recognised that further training and development of staff was needed in specific areas such as dementia care, mental capacity act and first aid and was investigating more appropriate training. Staff told us their training was predominately all completed by doing online courses and 2 of the staff we spoke with said they would prefer more face-to-face training. The provider demonstrated there were still some gaps in their knowledge of the requirements of the regulations. One staff member said, I feel 100% supported by the managers.” The management team maintained a high level of visibility within the home and were available to support the staff team should it be required.

The provider had been working closely with the local authority quality improvement team and had taken advice from an independent consultant to drive improvements around the safety and quality of the service. Staff spoke positively about the support they received from management.

Staff told us the management team were regularly in the home providing support and were confident they would listen to any concerns they raised. A staff member explained they were able to speak with the provider should they have any concerns. A staff member said of the provider “Never puts us under any stress, communications are good and always listens.”

Information on how to report concerns was displayed in the home. Meetings between the management team and staff had been held but these were not consistently recorded. The home is small and regular conversations were ongoing between people. Staff were given opportunities to discuss performance via a supervision and appraisal processes. People and or /relatives were asked to provide feedback on the service via a questionnaire.

Staff told us they felt they were treated fairly and were happier since extra staff had been employed. A staff member said, “Staffing is good organised well and the bosses are in all day.” Staff told us they were valued by the provider they worked together as a team and enjoyed working at the service. One staff member told us, “We get praised on the group chat.”

Policies and procedures were in place to support staff to carry out their roles to the best of their ability. The provider had tailored working arrangements to enhance staff wellbeing. Staff told us the rota planning included them and we were told by one staff member their working pattern accommodated their childcare commitments.

The registered manager was supported by a manager and an assistant manager, who were regularly present in the home. It was not clear how tasks were delegated in relation to the day to day running of the home and the oversight of the quality of the service. The registered manager had taken responsibility for driving improvement within the home, working with the local authority quality improvement team and other healthcare partners. They had introduced new systems for the governance, management and accountability. However, these had not picked up the issues identified during this assessment. Staff told us that more improvements were needed to the systems used and the provider acknowledged this.

Medication audits in place were overcomplicated and repetitive. Some were incomplete, they had become ineffective. Oversight and monitoring of risks and incidents was also inconsistent. There was no clear process in place to analyse themes and trends in relation to incidents and accidents. This meant some opportunities to learn from audits had been missed. Lack of effective oversight had led to gaps and inaccuracies in care records. For example, we found food and fluid intake was not always recorded accurately. There was also a lack of specific care plans for diabetes, anticoagulation therapy and some individually prescribed equipment. Where there had been legal requirements for the provider to notify us of deaths and other notifiable incidents to us these had not always been done.

People were supported by staff and management team to access other organisations for support with their health, care and social activities.

The local authority quality team and health and social care professionals involved in the quality improvement process who had been supporting the provider and service were positive about the improvements made so far since our last visit.

The service worked in partnership with various organisations including social workers, GP’s and advocates to provide continuity of care. The provider had engaged with a variety of organisations and their representatives working together to ensure that continuous improvements to the service were being made.

There was ongoing commitment by the provider and engagement with the local authority commissioner’s quality improvement process. The provider identified some training gaps especially for face to face and external training for specific topic areas such as dementia. Some staff commented on the lack of face-to-face training available and the provider accepted there was a need to invest in their own learning too.

There was a lack of records relating to lessons being learned, audits did not always identify issues we found during the assessment. Feedback surveys had not always been analysed and we were not able to see how the service used the information. Learning and innovation had been applied during the period since our last visit however, there were still areas that require further improvement to ensure the delivery of a good, safe and quality service. The observations we made showed that not all staff were familiar with the national best practice and guidance in respect of dementia care.