Archived: Fernwood

There was a 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 owner is also the registered manager of the home.

This is the third time the home has been rated requires improvement. At the last inspection in August 2016, a number of breaches of regulations were identified and requirement notices were issued. Breaches were in relation to a lack of good governance, person centred care and not having suitably qualified and competent staff. Following the inspection we met with the provider to discuss their report. We asked the provider to complete an action plan to show improvements they would make, what they would do, and by when, to improve the key questions in safe, effective, responsive and well lead to at least good.

This comprehensive inspection took place on 17 November 2017 to check the provider had made suitable improvements to ensure they had met regulatory requirements. We found that appropriate actions had been taken and issues had been addressed. The provider was now meeting the regulations and although still rated requires improvement in two areas, significant improvements had been made. However, further improvements were still needed in relation to person centred activities and record keeping to ensure they were embedded into everyday practice.

Appropriate checks had taken place before staff were employed to ensure they were able to work safely with people at the Fernwood. People’s needs were effectively met because staff had the training and skills they needed to do so. Staff were well supported with induction, training, supervision and appraisal. Staff knew how to safeguard people from abuse and what they should do if they thought someone was at risk. People’s medicines were managed safely.

People were treated with dignity and respect by kind and caring staff. Staff had a good understanding of the care and support needs of people and had developed positive relationships with people.

People had enough to eat and drink and the menus were varied and well balanced. Appropriate referrals were made to health care professionals when needed and people were supported to attend health appointments, such as the GP or dentist.

People were encouraged to be involved in decisions and choices when it was appropriate. Mental Capacity Act 2005 (MCA) assessments were completed as required and in line with legal requirements. Staff had attended MCA and Deprivation of Liberty Safeguards (DoLS) training.

There was good leadership in the home and the registered manager had an open door policy which staff valued. The organisation had effective systems to monitor and review the quality of the care provided. Further information is in the detailed findings below.

There was a 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 owner is also the registered manager of the home.

We carried out an unannounced inspection on 18 and 20 November 2015 where we rated the home as ‘Requires Improvement’ in three areas. We issued specific requirement notices in relation to safety and consent. We received an action plan from the provider that told us how they would make improvements. We carried out this comprehensive unannounced inspection 25 August 2016 to check the provider had made improvements and to confirm that legal requirements had been met. We found that improvements had been made in relation to consent and safety but additional concerns were identified in other areas.

There were enough staff to meet people’s needs. However, at the time of inspection the registered manager and one staff member were on leave which meant that two staff were working back to back to provide cover for shifts during this period. Over a two week period this meant that one person was not able to attend their day centre and there was no alternative activity programme in place during this time. There was no contingency plan in place should one staff member be unwell during this period.

Staff told us they did not feel supported. They had not received a supervision or appraisal for over a year and staff meetings were held infrequently. A staff member had recently been promoted to the role of senior but there was no job description in place and they were not clear about the extent of their responsibilities.

Although a range of health and safety audits had been carried out it was not always clear what action was taken. For example, although water outlets were regulated to a safe temperature, water temperatures were not checked periodically to make sure that the regulators were operating effectively. Staff training in some areas was not up to date and this had not been identified through regular monitoring. Whilst there were procedures to review care plan documentation some areas of documentation had not been reviewed for long periods.

Staff understood what they needed to do to protect people from the risk of abuse. Staff had assessed that restrictions were required to keep people safe and where appropriate referrals had been made to the local authority for authorisation to have Deprivation of Liberty Safeguards (DoLS) in place.

Staff had worked in the home a long time and had a good understanding of people as individuals, their needs and interests. They knew how people liked to be supported. People had access to healthcare professionals when they needed specific support. This included GP’s, dentists and opticians. People were asked for their permission before staff assisted them with care or support.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

We spoke with two members of staff as well as the manager. The manager was also the provider and on the rota working that day. The manager regularly worked alongside staff in the home.

We found that staff demonstrated an understanding of the consent process and that families were involved in the care of their relatives. People's needs had been individually assessed and were reviewed on a regular basis. One person indicated to us that they liked living in the home.

We saw that the building was maintained and that safety checks had been undertaken. Staff had worked at the home for a number of years and felt well qualified for their role.

We found an effective complaints system in place with people who used the service and their relatives aware of the process.

In our discussions with staff they demonstrated a thorough knowledge of the people living at the service. This was confirmed by our observations and the record keeping.

Care records showed that people had been supported and their relatives involved to make decisions about their lives, including their care and support. When people's needs changed, we found that records had been updated to reflect this.

Staff spoken with demonstrated good understanding of how to safeguard people from harm. Training records showed that staff received regular training to update their knowledge on abuse and safeguarding.

Records showed the provider regularly assessed and monitored the quality of the service and had made a plan to replace broken furniture. We saw that people's relatives were asked their views about the home and information from other professionals were sought.