Archived: Fermoyle House Nursing Home

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.

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 27 people living at the service at the time of our inspection.

There was a registered manager in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

At our last inspection in July 2015 we found breaches of Regulation 9, Regulation 12, Regulation 17 and Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider sent us an action plan telling us how they would make improvements in order to meet the relevant legal requirements.

At this inspection, we found the provider had taken insufficient action to meet the relevant legal requirements and was continuing to breach Regulation 9, Regulation 12, Regulation 17 and Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We identified that the provider was also breaching Regulation 10 and Regulation 14 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The system used to administer medicines had improved but shortfalls existed in other aspects of medicines management. People were at risk because medicines were left unattended for long periods of time. There were no protocols in place to support staff to know when to administer medicines prescribed ‘as required’.’ There was no process for recording and checking the administration of topical medicines. Staff did not have an understanding of how to report medicines errors.

There had been no increase in the number of nursing staff deployed on each shift since our last inspection. The registered manager told us that additional nurses were deployed only when a nurse attended a healthcare review. We found evidence of the impact of nurses’ time being limited, such as deterioration in people’s health not being acted upon.

People were at risk because potentially harmful substances were not stored securely. Cupboards containing products including bleach and bait used for pest control had been left open and therefore accessible to people.

People were not protected against the risk of abuse because incidents were not appropriately reported. Six safeguarding referrals had been made to the local safeguarding authority in 2016 by professionals that had contact with people living at the service. In none of these cases had the provider recognised that people were at risk of abuse and reported the incidents themselves to the local safeguarding authority.

Staff had not been appropriately supported through training, supervision and appraisal or had opportunities to discuss their professional development needs.

Restrictions had been imposed without legal authority on people who had the capacity to make their own decisions. We also found there were restrictions on people’s freedom of movement within the service.

People were not supported to maintain adequate nutrition. No action had been taken when people lost significant amounts of weight. Where people had been identified as severely underweight, no referrals for advice and guidance had been made to healthcare specialists, such as a speech and language therapist or dietitian.

Overall, people enjoyed the food provided but they told us there was an insufficient choice of hot meals.

People were not supported to access treatment when they needed it. Staff had failed to arrange an appointment with a doctor for a person who had been unwell for several weeks. We told the registered manager to arrange an urgent appointment with a GP.

People were not always treated with dignity. Staff did not always respect or maintain people’s privacy when providing personal care.

There were not enough activities arranged to keep people occupied and meaningfully engaged. The activities that did take place were inappropriate.

There was inadequate management oversight of the service. The registered manager had been unaware of the concerns identified during our inspection until these were outlined during feedback. Some areas of the service were audited periodically but there was no service improvement plan in place to address any shortfalls identified. The provider did not carry out or record monitoring visits to the service.

The culture within the service did not promote effective communication or information sharing. Concerns about people’s health and welfare were not shared amongst the staff team. Where feedback was given by people and their relatives, this was not always acted upon.

The quality of recording was not always adequate. Records failed to demonstrate that people were receiving the care they needed. The training record indicated that no staff had attended record-keeping training in the last three years.

There were sufficient numbers of care staff deployed to provide people’s care. There were plans in place to ensure people’s care would not be interrupted in the event of an emergency. Accidents and incidents were recorded, including details of any action taken following an event. The provider had made appropriate recruitment checks on new staff.

Most staff were kind and caring. People said they had good relationships with almost all the staff who cared for them.

There were appropriate procedures for handling complaints. People and their relatives told us the registered manager was approachable and willing to meet with them if they wished. Staff told us the registered manager was available for support if they needed it.

The overall rating for this service is ‘Inadequate’ and the service is therefore 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.

We carried out this desk top review to check that the provider had taken the necessary action to ensure robust recruitment procedures were in place in order to meet the necessary requirements. The provider supplied us with evidence that they had updated personnel files to comply with Schedule 3 and we found that the provider was now meeting this standard.

All of the people who lived at the service who we spoke with were happy with the care they received and liked living in Fermoyle House. They told us 'It's top notch' and 'Really good here.'

We saw the care (by observation and looking at records) that people received care was in line with their care plan. For example, we saw that one person had a severe allergy to a certain food and this was being appropriately handled by staff.

We reviewed staff recruitment records during our visit and found that more work was needed to ensure all the correct documentation was on file.

People told us they had no reason to complain but would feel confident that they could speak to staff if they had any concerns.

However two people were sitting at the dining room table and were keen to tell us that they were waiting for lunch and they always enjoyed this meal. They talked to us about the food at the home and that they had chosen what they would eat that day.