We carried out a review of the data available to us about Fernbank Nursing Home on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Fernbank Nursing Home, you can give feedback on this service.
Fernbank Nursing Home is a nursing home providing personal and nursing care to older people, some of whom were living with dementia. Fernbank Nursing Home accommodates up to 30 people in one adapted building. At the time of the inspection there were 20 people living at the home.
People’s experience of using this service and what we found
People were comfortable and well supported at Fernbank Nursing Home. Relatives told us that they were assured that their family member was safe and received good, person centred care. Safeguarding processes were in place to help protect people from the risk of abuse.
Risks associated with people's care had been assessed and guidance was in place for staff to follow to keep people safe. People were protected from the risks associated with the spread of infection. The service was clean and well maintained.
There were enough staff deployed to meet people's needs and ensure their safety. Appropriate recruitment procedures ensured prospective staff were suitable to work in the home.
Medicines were managed and administered safely.
Staff received the required training and support and applied learning effectively in line with best practice.
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 were seen to eat and drink well and were supported to maintain a healthy and balanced diet. People were supported to maintain healthy lives and had access to health and social care professionals where required.
Staff were caring and kind and relatives confirmed this. We observed staff responding to people's needs with dignity and respect.
There were quality monitoring systems and processes in place to identify how the service was performing and where improvements were required.
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 requires improvement (published 24 March 2021) and there were breaches of regulations. 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 had been made and the provider was no longer in breach of regulations.
At our last inspection we recommended that the provider assessed and addressed health and safety issues identified as part of the inspection. We also recommended that the provider apply best practice guidance when recruiting staff. At this inspection we found that the provider had acted on both recommendations we had made and had implemented the required improvements.
Why we inspected
We carried out an unannounced focused inspection of this service on 21 January 2021. Breaches of regulations 9, person centred care; 11, need for consent; 12 safe care and treatment and 17, good governance were found.
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 changed from requires improvement to good. 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 Fernbank Nursing Home on our website at www.cqc.org.uk.
We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.
Follow up
We will continue to monitor information we receive about the service, which will help inform when we next inspect.
Fernbank Nursing Home is a nursing and residential care home providing nursing and personal care to people aged 65 and over, some of whom were living with dementia.
Fernbank Nursing Home accommodates up to 30 people in one adapted building. At the time of the inspection there were 18 people living at the home.
People’s experience of using this service and what we found
People were observed to receive appropriate care and support at Fernbank Nursing Home. Relatives were happy with the care their family member received. However, we found significant concerns around how the home was managed, documentation relating to care, health and safety and ensuring people were not placed at risk of harm.
Risk assessments identifying people’s risks were not always comprehensive, were generic and illegible. Guidance and direction to staff on how to minimise risk was not clear and detailed, placing people at risk of harm.
Health, safety and the environment were not always well managed. We found a number of issues which placed people at risk of harm. The environment and furniture were either unsafe or in a poor state of repair. Whilst the provider took immediate remedial action to address some of the urgent issues, there were inadequate systems in place to identify these prior to the inspection.
Staff recruitment checks were not robust and did not always provide assurance that staff employed had been appropriately assessed as safe to work with vulnerable adults.
People did not always have a choice of what they wanted to eat and were not involved in menu planning.
People may not have always been supported to maintain healthy lives. People were not always receiving effective support with their oral hygiene.
People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. Consent to care had not been recorded and best interest decisions had not been considered and documented.
There was a lack of managerial oversight of the home. Audits of care delivery were ineffective and did not identify the issues we found as part of this inspection. Written care records were illegible or were not always an accurate account of the care people received.
People received their medicines safely and as prescribed. Systems and processes in place supported this.
Staff understood safeguarding and how to keep people safe from abuse. Staff told us that they received training to support them in their role.
Relatives feedback about the registered manager and the way in which the home was managed was positive stating that staff were kind, caring and approachable.
We have made a recommendation about health and safety management and staff recruitment.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
The last rating for this service was good (published 05 March 2019).
Why we inspected
We reviewed the information we held about the service. We received very little information from the service through statutory notifications. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only to check and ensure people were receiving safe, good quality care.
We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.
During the inspection we identified concerns around risk management, the environment, person centred care provision, consent to care and management oversight processes. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.
The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.
We have found evidence that the provider needs to make improvement. Please see the safe, effective and well-led sections of this full report.
Enforcement
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.
We will continue to monitor the service to keep people safe and to hold providers to account where it is necessary for us to do so.
We have identified four breaches of regulation around person centred care, safe care and treatment, consent to care and good governance. The failings found are detailed in the main body of the report.
In response to the breach identified regarding good governance, regulation 17, we will be writing to the provider asking them to provide an action plan in response to the issues identified and to provide time specific updates on the progress of actions taken.
With regards to the breaches found regarding person centred care, safe care and treatment and need for consent, please see the action we have told the provider to take at the end of this report.
Follow up
We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
About the service
Fernbank Nursing Home is a nursing home providing accommodation and personal care to 23 adults and older people at the time of the inspection.
People’s experience of using this service
People were very happy living at the home because they felt safe and all their needs were met by kind and caring staff. Relatives were pleased with the service provided to their family members and staff enjoyed working at the home.
Everyone we spoke with praised the registered manager and agreed that they were approachable, knowledgeable, fair and did their job well. A staff team who worked well together supported the registered manager. The provider employed enough staff to make sure people’s need were met in a timely way. The provider had designed a recruitment process to make sure they only employed suitable staff.
The staff team was committed to providing a high-quality service and keeping people safe. They had undertaken training in a wide range of topics so that they were skilled and knowledgeable to effectively meet people’s needs. Staff understood their responsibilities to report any concerns.
Staff encouraged people to be as independent as possible and respected people’s privacy and dignity. All staff welcomed relatives and visitors warmly and treated them as part of ‘the family’.
Staff knew people well. They followed the guidelines in each person’s care plan so that they delivered care and support in the way each person wanted. Staff managed the risks to people’s health and welfare well.
The home was clean, fresh and hygienic. Staff used effective infection control measures to protect people from the spread of infection. Equipment was available when needed to help staff support people in a safe way.
An activities coordinator organised a range of activities for people to do. The home provided nutritious meals and external healthcare professionals supported people to maintain their health.
The registered manager actively sought the views of people and their relatives about the running of the home and they dealt promptly with any concerns that people raised.
The provider had a thorough system in place to monitor and improve the quality and safety of the service provided.
More information is in the full report
Rating at last inspection
At the last inspection we rated this service Good. The report was published on 26 June 2017.
Why we inspected
This was a planned inspection based on the previous rating.
Follow up
We will continue to monitor this service.
We carried out an unannounced comprehensive inspection of this service on 7 December 2016 and 4 January 2017. Breaches of legal requirements were found, in respect of safe care and treatment, and meeting nutritional and hydration needs. We rated the service as Requires Improvement.
After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach. We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection by selecting the 'all reports' link for this service on our website at www.cqc.org.uk.
Fernbank Nursing Home is registered to provide accommodation and personal care for up to 34 people and specialises in dementia care. The home is run by a private partnership. There were 23 people using the service at the time of this inspection.
The service had a registered manager, which 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 this inspection, we found that the provider had followed their plan and legal requirements had been met. Records and feedback showed that people were supported to eat and drink enough, and that they were provided with more choice around meals and snacks. There was good oversight of their malnutrition and dehydration risks, and we found that action was taken where concerns were identified.
Procedures to minimise the risks of people developing pressure ulcers were now consistently followed. Individual choking risk assessments had been developed. Staff followed people’s individual care plans in relation to choking risks.
Referrals to community specialists for support with concerns relating to people’s care and treatment took place where appropriate. Procedures had been reviewed and streamlined to enable quicker access.
The way the service was being managed identified risks to people’s safety and welfare, and took action to address concerns arising from this. There was a willingness to learn from audits and concerns so as to improve services to people.
People we spoke with told us they would recommend the service to others, which matched the sentiments of recent online feedback we saw from relatives. Staff spoke highly of the support they had for their roles in the service.
At the last inspection on 1 May 2014, we asked the provider to take action to attend to maintenance matters around the building. The provider subsequently wrote to us to say what they would do in relation to this breach of legal requirements. At this visit, we found these matters to have been addressed.
The service had a registered manager, which 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.
People and their relatives reported a caring service, which we saw to be the case. Along with the pleasant approach of staff, effort was made to understand how people communicated and to respond to them effectively. There was a broad range of activities that were adjusted to people’s abilities, cultures and life histories. The service encouraged community relations and so there were frequent visitors, entertainers and religious services at the premises. The service promoted a positive culture that tried to enhance the lives of people using it.
People’s medicines were safely managed, and there were enough staff working at the service. The service was kept clean and infection control procedures sufficiently protected people. There was a willingness to learn from quality auditing processes and concerns raised by anyone, so as to improve services to people.
However, we found some concerns about the safety and effectiveness of the service. Charts used to record the treatment of people at risk of pressure ulcers, malnutrition and dehydration were not consistently completed. There were no individual choking risk assessments. Referrals to community specialists for support with these matters were not always timely. This all failed to demonstrate safe care and treatment of some people using the service, and that some people’s nutritional needs were consistently met.
There were overall two 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 the report.
Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.
If you want to see the evidence supporting our summary please read the full report.
Is the service safe?
People were protected from the risks of inadequate nutrition and dehydration. We saw that people were provided with drinks throughout the day. One person told us, 'You're always asked if you want a drink.'
We noted poor electrical maintenance in several areas of the building; therefore people were not always protected from the risk of unsafe or unsuitable premises.
Is the service effective?
Staff received appropriate support and supervision to enable them to deliver care and support to people to an appropriate standard.
Is the service caring?
Most people we spoke to told us that staff were caring and responsive to people's needs and people told us that staff treated them well.
Is the service responsive?
We saw that staff had identified people's cultural and religious needs. We saw that weekly church services took place to attend if they wished to. One person told us that they enjoyed listening to the service.
Is the service well-led?
We reviewed several monthly audits that took place and spot checks that took place at the service. However these were not always effective in identifying issues, such as electrical maintenance.
Staff told us they were clear about their roles and responsibilities. Staff we spoke with showed that they understood the needs of individual people they cared for. People were cared for by staff who understood their needs.
There was a warm and positive atmosphere at the service. The service was clean and presented well with photos of social events on display. We observed staff working kindly and carefully with people using the service. They spoke with people who use the service without rushing. The people we spoke with said they felt safe at the service. Staff told us that they were supported in their work and there was good teamwork. We saw that staff had received regular staff supervision and appraisal. Staff were knowledgeable about safeguarding matters and we were shown evidence that staff had received safeguarding training
We were shown evidence that a range of quality checks and audits were carried out and the manager described what further work was being planned such as relatives meetings, surveys and staff training.
The arrangements for the provision was meals was satisfactory and people who use the service stated that they were satisfied with the quality and variety of meals provided.
People who use the service stated that staff wore gloves and apron when needed. The home had appropriate infection control procedures.
The arrangements for the administration of medication were well managed and there was evidence that people had been given their medication.
People who use the service informed us that the premises had been kept clean and they were pleased with their accommodation. The premises were well maintained.
"Staff treat me with respect and they ask my permission before entering.'
'They show respect for me and talk nicely to me.'
'Yes, I feel safe here.'
We observed that staff were respectful when talking to people who use the service and they knocked on doors before entering.
A few people who use the service however, made negative remarks about some staff. One stated that some staff talked down to them while another indicated that a staff member had been intimidating in his behaviour. One person stated that staff seldom attempted to interact with people who use the service.
The manager reassured us that the home had provided training for staff to ensure that they treat all people with respect and dignity. She indicated that she would look at the concerns expressed.
The home had suitable arrangements to safeguard people who use the service. Staff had received training on safeguarding and were aware of the procedure to follow if they were aware or suspected that people were being abused. We noted that the registered manager had co-operated fully with social services staff in responding to a recent concern raised.
"The staff treat me with respect. They talk to me and discuss my care with me.'
'Yes, I feel safe here.'
'They take good care of me.'
We observed that people who use the service were well cared for. Staff were observed to be interacting regularly and talking with people who use the service. They were also observed to be offering drinks to people who use the service.
We were able to speak to relatives in the home. The feedback received was positive and indicated that people who use the service were well cared for and their needs had been met. Their views can be summarised by the following comment:
'The staff are pleasant and helpful. The care is good.'