Archived: Fermoyle House Nursing Home

Updated 25 April 2017

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

The inspection took place on 31 January 2017. The inspection was unannounced and was carried out by three inspectors.

Before the inspection we reviewed the evidence we had about the service. This included any notifications of significant events, such as serious injuries or safeguarding referrals. Notifications are information about important events which the provider is required to send us by law. We also reviewed feedback from the local authority, which had been carrying our regular monitoring visits since our last inspection. We had not asked the provider to complete a Provider Information Return (PIR) as we were following up concerns identified at the previous inspection. The PIR is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make.

During the inspection we spoke with eight people who lived at the service, one relative and a visiting healthcare professional. If people were unable to express themselves verbally, we observed the care they received and the interactions they had with staff. We spoke with nine staff, including the acting manager, care, nursing, catering, activities and housekeeping staff. We looked at the care records of five people, including their assessments, care plans and risk assessments. We looked at how medicines were managed and the records relating to this. We looked at the recruitment files of five staff and other records relating to staff support and training. We also looked at records used to monitor the quality of the service, such as the provider’s own audits of different aspects of the service.

Updated 25 April 2017

The inspection took place on 31 January 2017.

Fermoyle House Nursing Home provides accommodation, nursing and personal care for up to 32 older people, some of whom are living with dementia. There were 20 people living at the service at the time of our inspection.

At our last inspection on 28 July 2016, we found the provider was breaching legal requirements. Medicines were not managed safely and potentially harmful substances were not stored securely. There were not enough nursing staff on each shift to provide effective nursing care. Allegations of abuse were not appropriately reported. Staff had not been supported through training, supervision and appraisal. Restrictions had been imposed on people without legal authority. People were not supported to maintain adequate nutrition or to access treatment when they needed it. People were not always treated with dignity. Staff did not always respect people's privacy when providing personal care. There were not enough activities to keep people occupied and meaningfully engaged. There was inadequate management oversight of the service and records failed to demonstrate that people were receiving the care they needed. The overall rating for the service was 'Inadequate' and the service was therefore placed in 'Special measures'.

Following the inspection, the provider submitted an action plan telling us how they would make improvements in order to meet the relevant legal requirements.

The registered manager in post at our last inspection was no longer managing the service. Until a new manager was recruited, the service was being managed by an acting manager with support from the provider. 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 and associated Regulations about how the service is run.

Changes in the management of the service had led to a lack of clarity for staff about who they should take their lead from and who they should look to for leadership and advice. Monthly quality assurance checks failed to consider key aspects of the service, such as checks on care documentation and recruitment documentation. As a result the shortfalls identified during our inspection had not been identified through the provider’s quality monitoring process. There was insufficient evidence of learning from accidents and incidents or of actions taken to minimise risks to people. There were inconsistencies in the recorded information about people’s capacity. The daily care notes made by staff were task-focused. The provider had not established effective systems for people to contribute their views about the service or recorded any feedback they had received informally.

People were not adequately protected by the provider’s recruitment procedures.

Care plans did not record people’s preferences regarding end of life care, which meant their wishes were not known to the staff who cared for them. Two people told us one member of staff was not sufficiently careful when providing their care, which negatively affected their experience of receiving care. Although staff were being supervised they had not been observed in practice to ensure they were competent. People’s privacy was not always protected because one of the shared bathroom doors was not able to be locked or effectively shown to be in use to prevent others entering. We have made recommendations about these concerns.

People were not always able to exercise their choices regarding their care. Some people told us they did not have sufficient choice about when and how often they showered. They said they did not feel comfortable requesting a change to this regime. Care plans did not record sufficient information to enable staff to engage with people about their lives before they moved in to the service.

There were additional nursing hours on the rota each day, which meant nurses had more time to provide the care people needed. The management of medicines had improved and the risk of people coming into contact with potentially harmful substances had been removed. People were better protected against the risk of abuse because staff had attended safeguarding training and were aware of their responsibilities if they suspected abuse was taking place.

Supervision and appraisal had been introduced for staff, which meant they received feedback about their performance and were able to discuss their professional development needs. Staff had attended training in key areas such as safeguarding, dementia and falls prevention and training was available for registered nurses to keep their professional development up to date.

Staff had attended training in the Mental Capacity Act 2005 and understood how the principles of the Act applied in their work. Applications for DoLS authorisations had been submitted to the local authority where people were subject to restrictions to keep them safe. People were being supported to maintain a healthy weight. Staff monitored people’s weight and took appropriate action if people were at risk of inadequate nutrition. Although two people told us they did not feel they had the same choices of food when on a texture modified diet we found they were offered a choice. The cook had received training in providing special diets. People were supported to access advice and treatment when they needed it.

An activities co-ordinator had been employed, which had increased the range of activities available to people. There was a schedule of group activities and the activities co-ordinator said they also spent time each day visiting people in their rooms. Some people had been supported to engage with activities outside the service.

Some aspects of the management of the service had improved. The provider had begun to make monthly monitoring visits and produced a brief report of each visit. A monthly quality assurance check to be carried out by the manager had been implemented.

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.