Ferndale Nursing Home

We found the following examples of good practice.

Staff followed the provider’s infection prevention and control (IPC) processes and policy to support new admissions to the service. The provider had conducted training in both IPC and Personal Protective Equipment (PPE) for all staff. All staff were observed to be wearing PPE correctly.

The provider gave information to people about the COVID-19 virus, social distancing and other infection control procedures.

Visitors could visit people face to face using a dedicated entrance to an area of the home. There were several spaces set up outdoors for safe visits to take place following national guidelines. The service had also introduced a new process that enabled people’s allocated visitors to meet in their room only.

Ferndale Nursing Home is situated in Crawley, West Sussex. It is a residential ‘care home’ for up to 28 older people, a majority of whom are living with dementia. Some people also required support with their nursing needs. At the time of the inspection there were 28 people living in the home.

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

Not all risks were well-managed. There was a lack of consideration and processes to ensure that people who required texture modified food or fluids were supported appropriately. We recommended that the registered manager sought advice and guidance from a reputable source.

People told us they felt safe and there was enough staff to meet their needs. People felt reassured and well-cared for by a small, consistent staff team. Risks in relation to people’s hydration, nutrition and falls were well-managed and people had received safe care. Staff knew the signs and symptoms that could indicate people were at risk of abuse. Medicines were managed safely, and people had received their medicines when they needed them. Infection prevention was maintained, and people were protected from the spread of infection.

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. People told us they had confidence in the abilities of staff. There was a coordinated approach to people’s healthcare and the registered manager and staff worked with people’s GP to ensure people received appropriate care to maintain their health or if they were unwell. People told us they were happy living at the home and that staff met their needs.

People received care from a small, dedicated team who demonstrated kind and compassionate care. Staff told us they cared about people and this was observed in practice as staff worked hard to ensure that people were treated in a respectful, considerate and affectionate way. A member of staff told us, “We are very proud of what we do, and what we do, we do with love.” A relative told us their loved one had become more settled and reassured since living at the home, they told us, “I like it here, they’re so considerate and affectionate. My relative seems much happier since they’ve been here.” People were treated as individuals and staff respected their right to be treated with privacy and dignity.

People were central to the care delivered. Staff worked hard to ensure that people’s needs, and their care were prioritised. Staff were responsive to people’s needs and had accessed best practice guidance and used their knowledge and skills to ensure people who were living with dementia were supported appropriately. People told us there was enough to occupy their time and they enjoyed the stimulation and activities. Staff interacted with people and ensured that they were not socially isolated. People were able to plan for care at the end of their lives to ensure they were provided with care that met their needs and preferences.

The home was managed well. The provider’s aims of ensuring that people’s well-being and comfort was of prime importance was demonstrated by the provider and staff. People, relatives and staff were complimentary about the leadership and management of the home and told us that if they raised concerns or issues these were listened to and acted upon. There was good oversight of people’s care from the provider and the committed staff team who worked together to ensure people’s comfort was maintained.

Rating at last inspection

The last rating for this home was Good. (Published 24 August 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow-up

We will continue to monitor information we receive about this home until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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

The home’s provider was also the registered manager. 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.

At the last inspection on 20 August 2016, the home was rated as Requires Improvement overall. This was because we found some areas of practice that needed to improve. There were not clear guidelines for staff in administering PRN (as required) medicines and decisions made in people’s best interest had not been recorded in line with the legislation. At this inspection we found that improvements had been made and the provider had addressed these concerns.

People and their relatives were positive about care at the home and told us that they felt safe. Risks were assessed and managed effectively and staff understood how to keep people safe. People received their medicines safely and were supported to access the health care services they needed. There were enough staff on duty and people told us that their call bells were always answered promptly. Recruitment processes were robust and staff received the training and support they needed to be effective in their roles. One staff member said, “We have a lot of training and it is helping me all the time.”

People spoke highly of the caring nature of the staff. One person said, “They really care here it’s not just an act.” A relative told us, “I’m blown away by the care.” Staff knew the people they were caring for well and understood their individual needs. People told us they were included in planning their care and support and that their views were listened to and valued. Staff understood how to protect people’s privacy and dignity, they spoke positively and the home and the people who lived there. One staff member said, “I would definitely be happy for a member of my family to live here if they needed dementia care.” People were supported to have enough to eat and drink. Staff were attentive and supportive to people who needed help with food and drink and managed any risks and nutritional needs appropriately.

Staff had a clear understanding of their responsibilities with regard to the Mental Capacity Act 2005 and sought consent from people before providing care. People’s preferences and views were included in their care plans. Staff used information about people’s backgrounds to engage with them and provide a personalised service. Staff told us that communication and co-operation within the staff team was good at all levels. A staff member said, “Our opinions and suggestions always count.”

People told us they were supported to have enough to do and spoke highly of the activities provided at the home. Staff spent time with people throughout the day and actively engaged with people even when going about their duties. Relatives told us they were welcomed at the home. A staff member said, “We offer tea and coffee as soon as someone comes in. It’s policy to make people welcome and provide a drink, because it should be like visiting their relative in their own home.”

People and their relatives told us that the provider asked for feedback on the service regularly. There was a formal complaints system and people said they would feel comfortable to raise any concerns with staff. The provider had a range of systems and processes in place for monitoring quality and where shortfalls were identified actions had been taken to address issues. There was clear leadership and staff understood their roles and responsibilities. Morale was said to be good and communication was effective. People and their relatives spoke highly of the management of the home. One person said, “I genuinely can’t think of anything that needs to be improved.” A relative told us, “The managers and owners are wonderful, very nice and you could talk to them anytime.”

There was an established 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.’

The service was previously inspected on 10 and 17 March 2015 and we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider submitted an action plan to address these shortfalls and we reviewed the effectiveness of this plan as part of our inspection.

At our previous inspection on 10 and 17 March 2015 we found that the provider did not always identify individual risks and that records of the care received were not always accurately maintained. At this inspection we found that individual risk care records had improved and individual risk had been identified appropriately. We also found that care records were an accurate reflection of care planned and care received.

At our previous inspection on 10 and 17 March 2015 we also found that the provider had not ensured that water was available and accessible to people at all times. Other drinks were not made available periodically throughout the day and night and people were not encouraged and supported to drink. At this inspection we found that improvements had been made and people were supported and encouraged to have sufficient to eat and drink. Cold drinks were freely available and accessible and a variety of hot drinks were offered to people throughout the day. Fluid and food charts had been completed for people at risk of malnutrition or dehydration and with their permission weights taken to ensure that people were maintaining adequate nutrition and hydration.

The management and administration of medicines was not always safe. People received their regular medicines safely and as prescribed. However, three people were prescribed, ‘as required’ medicines for pain but there was no guidance to staff on when these medicines should be administered or how to recognise when people were in pain. This meant that there was a risk of medicines being given inappropriately and has been identified as an area that needs improvement.

Staff understood the principles of the Mental Capacity Act 2005 (MCA) and sought people’s consent to care and treatment appropriately. However, where people were assessed as lacking capacity it was not clear how or why decisions had been made on their behalf. This meant that decisions made in people’s best interests were not recorded in line with legal requirements and this was identified as an area that needs improvement.

People were protected from harm. Staff had received safeguarding training, knew how to recognise the signs of abuse and understood their responsibilities to report any concerns or poor practice. There was a robust recruitment process in place to ensure that suitable staff were employed who were safe to work with people.

Individual risk assessments were in place to ensure that people’s health needs were appropriately managed and these were updated regularly and in accordance with any changes detailed in the daily notes. Planned care accurately reflected care delivered. Environmental risks were managed through regular checks and servicing and there were emergency plans in place for the service and individuals.

There were sufficient suitable staff employed to keep people safe and meet their needs. A member of staff said, “There is more than enough staff.” Staffing was calculated according to people’s needs using a dependency score. The registered manager told us they also listened to feedback from people, staff and relatives when determining staffing levels at the service. One person told us, “I press the call bell that is what it is there for, no waiting around.”

There was an infection control champion and processes in place to ensure that the environment was kept hygienic and tidy. Staff had received training in infection prevention and control and used personal protective equipment such as gloves and aprons appropriately.

Staff had the knowledge and skills to meet people’s needs. One person told us, “I am very well looked after.” There was a training plan in place to ensure that all staff received essential training such as moving and handling and health and safety. The annual training schedule also included training specific to the needs of people such as dementia care and oxygen therapy training. Staff were supported and developed through regular, documented supervision and appraisal.

Staff monitored people’s health and wellbeing and supported people to access health care services such as chiropody, optical and dental services. They recognised if people were unwell or required further assessment or support and made appropriate and timely referrals to the GP or other health care services such as physiotherapy or the Tissue Viability Service.

People were treated with kindness and compassion. One person said, “They are nice to me.” Staff delivered support sensitively and discreetly and encouraged and supported people to make day to day choices and to maintain their independence. Relatives and visitors told us that the service was, “Friendly and welcoming.”

People received personalised care that was responsive to their needs. The registered manager held a weekly ‘open surgery’ and an annual relatives survey demonstrated that families were generally happy with the service and the way it was run.

The registered manager had been in post for a number of years and had a ‘hands on’ approach. Staff told us they enjoyed their sense of humour and described them as supportive and approachable. One member of staff said, “He is there for us, to guide us.”

There were systems in place to monitor the quality of the service and improvements made since the last inspection had been successfully embedded into every day practice. The provider was working in partnership with other organisations to improve the quality of the service and had implemented champions to the staff team to support different areas of practice.

During our inspection there were 28 people living at the service. We noticed that there was a pleasant rapport between staff and the people who were using the service. We were told by the people who used the service, " the staff are nice, one can be a bit stroppy ", " the food is great ". Three residents stated " I'm bored ". We found people nutritional needs were being met and people who used the service stated " the food is lovely " and " I eat everything ".

We found evidence by talking to people and looking at records that people who used the service who did not have capacity to consent were supported to make choices regarding their care or treatment. We found evidence that the people using the service were not protected from the risk of healthcare related infection and the provider did not have effective systems in place for managing the risks of healthcare related infections.

We found concerns in the inconsistency and storage of people's records

People's needs were assessed and where possible they were consulted and involved in the planning of their care. Staff spoke with their relatives if they were unable or choose not to be involved. Peoples individual needs were being met by staff with the relevant skills, knowledge and up to date training.

Staff told us they received regular supervision and the senior team are available for advice and support. one person said "The managers are approachable and very supportive. We saw the provider regularly assesses and monitors the quality of the service provided to protect people from the risk of inappropriate or unsafe care and treatment.

Monthly audits are carried out on, care plans, risk asessment, medication, accidents, incidents, compliments and complaints, fire safety and the building environment. Any areas for improvement are identified and the appropriate action taken to address any concerns.

An annual customer survey was conducted in June 2012, the majority of the questionnaires were completed by people who used the service with their relatives or by the relatives. Overall the results were positive with 92% of the people stating that they enjoyed the food.