Archived: Ferns Nursing Home

Updated 7 July 2022

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

Three inspectors and an Expert by Experience undertook this inspection. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Ferns Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Ferns Nursing Home is a care home with nursing care. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This service is required to have a registered manager. A registered manager is a person who has registered with the CQC to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

At the time of the inspection there was not a manager registered with CQC at the service. A new manager had been appointed and told us they would be making an application to CQC to become the registered manager.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make. The provider did implement a service improvement plan which they regularly reviewed and sent to CQC to demonstrate the improvements being put in place.

Since May 2021 Somerset County Council and Somerset Clinical Commissioning Group (SCCG) have suspended any new placements at The Ferns. We have received reports of visits made by the local authority and SCCG about the care provision at the home. We have kept in touch with the local authority quality team and SCCG throughout this time.

We used all this information to plan our inspection.

During the inspection

During our visit to the home we observed the care and support people received. We spoke with six people about their experience of the care provided. We visited everybody in their rooms as most people were being nursed in bed or sat in a chair. Only a few people were able to express their views about the service, so we observed the care they were receiving. We also spoke with five relatives and a visiting GP.

We spoke with the new manager, clinical lead/deputy manager, head of care, four care staff, a laundry worker, housekeeper, two assistants and two cooks. We also spoke with two nurses who were from a local agency working at the home.

On the second day of the inspection we met the new clinical lead/deputy manager on her first day in her new position at the home.

We also spoke with the provider’s nominated individual, group quality and compliance manager, regional manager and a peripatetic manager.

We reviewed six staff files in relation to recruitment and staff supervision, five people’s care records, and medicines end to end process. A variety of records relating to the management of the service, including policies and procedures, maintenance records, staff rotas, fire documents and external servicing records, training matrix and mee

Updated 7 July 2022

Ferns Nursing Home is a nursing home in the town of Yeovil. They are registered to provide personal and nursing care for up to 39 people. At the time of the inspection 21 people were living in the home.

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

This inspection was over two days. On the first day we visited there were not always enough staff on duty to meet people’s needs in a timely and appropriate way. Staff were not responding to call bells promptly which placed people at risk of not receiving care when they needed it.

Most people were being nursed in bed when they did not have a physical need or didn’t choose to stay in bed. A lot of these people required support with their meals and had to wait for assistance and their meals were going cold. Staff explained it took time to assist some people with meals as they could not be rushed.

People were not always regularly repositioned to ensure their comfort, and this could pose a risk to their skin integrity.

Risks to people were not being managed in relation to their nutrition and fluid intake.

People were placed at risk of cross infections because staff had poor infection control practices.

Although staff had received training regarding infection control, some staff were observed carrying soiled laundry around the home.

Cleaning was not taking place regularly around the home and in the kitchen.

The provider’s quality monitoring processes had not identified these concerns.

We raised these concerns at the end of the first day with the provider’s management team. They told us they would develop an action plan and work with the manager to implement it.

On the second day of the inspection, we observed improvements. People had been and were being assessed regarding having the opportunity to get up. During our visit nine people were enjoying time sat out in their rooms or in the communal areas.

People were having their call bells responded to promptly by staff and the management team. The provider was looking to add a device to the call bell system to be able to regularly audit call bell response times

Staff were seen wearing PPE and no poor practice was observed in relation to infection control. Cleaning schedules had been replaced and cleaning was taking place regularly.

People’s mealtime experience was improved. People were being shown sample plates of the menu, there were personalised individual menu cards on each person’s tray and new crockery and glasses had been purchased. We made a recommendation that the provider continue to review people’s mealtime experience in line with appropriate good practice guidance

Improvements had been made to improve the quality and variety of the food offered to people. A new head cook had been recruited and a new four-week menu was being trialled.

Staff were using the provider’s new monitoring charts, for food and fluid and repositioning. New improved guidance about people’s individual needs was made available to staff in different places. This ensured they had clear up to date information about people’s individual needs.

Care plans were being transferred to the provider’s new care plan paperwork. In the meantime, staff had access to the old care system as well to ensure they had information about people’s needs.

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.

The manager and management team were working with the staff team to improve the culture at the home. People said they were supported by staff who were kind and respectful towards them. On the whole staff interactions with people were respectful. However, on the first day of our inspection staff were not always knocking on doors before they entered people’s rooms. Improvements were seen on the second day as all staff were seen to knock on people’s doors.

Staff monitored people's on-going health conditions and made sure they had access to the local GP's and other healthcare services as needed. Each week a healthcare team connected to the GP surgery visited the home and reviewed all of the people there and then met with the GP.

Improvements were needed in medicine management at the home. We made a recommendation that the provider ensure medicine management at the home was in line with the National Institute for Health and Care Excellence (NICE) guidance ‘Managing medicines in care homes.’

At the beginning of the inspection it was not clear staff were always recruited safely. The management team told us they had completed an audit of staff files and identified where there were gaps. By the end of the inspection we were assured recruitment checks had been completed.

There was not a robust induction programme in place to evidence new members of staff had completed an induction which ensured their competency for their role. A new induction workbook was implemented, and six staff had started using this induction workbook by the second day of the inspection.

People were cared for by competent staff who had received training to safely care for them.

All staff had received a supervision and told us they felt supported. One staff member told us how they had been supervising a small team and how it was effective.

The provider had taken action to ensure people were protected from risks associated with the building because improvements had been made in the testing and servicing of equipment.

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 inadequate (published 8 December 2021). 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 were being made, however the provider was still in breach of regulations.

This service has been in Special Measures since May 2021. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate in well led or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We carried out an unannounced responsive inspection of this service on 6,7 and 13 October 2021. We identified three continuing breaches in relation to safe care and treatment, staffing and governance. We issued a requirement for regulations 12 and 18 and a warning notice for the breach of Regulation 17.

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, 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 has remained requires improvement. This is based on the findings at this inspection.

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

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.