Archived: Ferringham House Limited Residential Care Home

Updated 5 July 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 is 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.

This inspection took place on 25 and 28 April 2017 and was unannounced.

The inspection was carried out by two inspectors and a pharmacist. Prior to this inspection we reviewed information we held about the service including previous inspection reports. This included statutory notifications sent to us by the registered manager about incidents and events that had occurred at the service. A notification is information about important events which the service is required to send to us by law. We used all this information to decide which areas to focus on during our inspection.

During the inspection we observed care provided by staff to people, including how medicines were administered to people and the lunchtime experience. We met with eight people living at the service. A district nurse who visited the home at the time of our inspection also shared their views on support provided to one person living at the home. They gave us permission to use information within our inspection report.

We spoke separately with a senior care worker, two care workers and the cook. The registered manager was on holiday at the time of our inspection. The provider was available throughout the inspection.

We spent time looking at records including eight care records, nine staff files and staff training records. We also looked at staff rotas, medication administration records (MARs), health and safety maintenance checks, compliments and complaints, accidents and incidents and other records relating to the management of the service. We shared our findings with the local authority.

Updated 5 July 2017

The inspection took place on 25 and 28 April 2017 and was unannounced.

Ferringham House Limited Residential Care Home is registered to provide accommodation and care for up to 14 older people with a range of health needs. At the time of our inspection, eight people were accommodated at the home, some of whom were living with dementia. Ferringham House Limited Residential Care Home is situated in a residential estate on the edge of Ferring village. All rooms are used as single occupancy and all have en-suite facilities. There is an open-plan sitting/dining room and people have access to gardens at the home.

There was a registered manager in post who registered in February 2017. They had been working as manager at the home since October 2016. 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 registered manager was on annual leave at the time of our inspection. We were joined by the provider for both days.

We found a significant lack of risk assessments in place and when information was provided it did not detail the exact support each person needed. Some risks had not been identified in the recent review of care plans. This included a lack of detailed guidance surrounding skin integrity, diabetes and mental health issues. Guidance was limited when advising staff how to support peoples specific needs. The lack of assessment and guidance available to staff meant risks were not managed safely putting people at risk of unsafe care and treatment.

Medicines were not managed safely. We found numerous concerns regarding how the home administered, stored and recorded medicines which were prescribed to people. This included gaps and errors in Medication Administration Records (MARs). One person did not receive their medicines for nearly two days. There was a lack of information in place to guide staff of what to do when people missed their medicines which meant the person was at risk from harm. The inspectors shared the incident of missed medicines with the local authority safeguarding team for their review.

During our inspection, a district nurse shared their concerns about one person's care and the potential delay in receiving the correct medical attention. They gave us permission to use their professional view in this inspection report.

Supervisions and training were provided to the staff team. The recently registered manager had commenced a supervision programme with the staff team. However, there were inconsistencies regarding the competencies of some staff in their knowledge and abilities to carry out their role and responsibilities safely and effectively. This included a lack of knowledge about managing medicines safely and risks associated with supporting people.

Care was not personalised. Care plans failed to offer the level of guidance required for staff to meet people’s physical and emotional needs. Information was limited regarding people’s preferences, likes and dislikes. Care plans were very similar to each other within the detail written about how people wished to be supported by staff. People living at the home had limited access to activities and other daily stimulation as their individual choices had not always been considered. There was very little detail available within each care plan about how people wanted to spend their day. This meant staff members supporting people may not of had information about people to enable them to be supported in a person-centred way.

Confidential sensitive information relating to people including their care plans and MARs were kept unlocked throughout our inspection. This meant private and personal information relating to individual people and their care was at risk of not remaining confidential.

We observed staff involving people in day to day decisions about the care they received. However, there were no records to suggest people had been involved with their own care. This meant people may not have had care delivered the way they preferred. We observed one occasion where a person's dignity was not respected.

Audits to monitor the quality of the health and safety of care provided were not accessible to the provider or inspectors at the time of our inspection. Audits received since the inspection had failed to highlight the potential risks to people within how medicines were managed. They had also failed to effectively assess gaps within care plans, risk assessments and the activities provided to people. Therefore, there was a failure to assess and monitor and to improve the quality and safety of the services provided to people.

There was a lack of governance and accountability in reviewing and checking the care being provided to people. This included decisions regarding which care staff were leading the shift in the registered manager's absence. There was a lack of knowledge from the provider about seeking guidance from health and social care professionals in accordance with safeguarding adults procedures and regulations. This meant the correct action to protect and support people was not always taken in a timely manner. The provider was advised to contact the local safeguarding team regarding one incident for their review.

Since 2014, Ferringham House has failed to deliver high quality consistent care and support to people. The provider had been unable to sustain improvements to the quality of care provided to people.

Records relating to health appointments people had attended were inconsistent and required improvement. Information was not always shared with staff regarding specific health conditions.

Staff gained consent from people prior to supporting a person and staff had some understanding of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards.

People had developed positive relationships with the staff supporting them and mostly enjoyed living at the home. The food cooked for people looked appetising. People spoke positively about their mealtime experience. No complaints had been received at the time of our inspection. Mostly, the home operated safe recruitment processes. Bedrooms were personalised with people's own belongings. The home smelt fresh and clean throughout our inspection.

Full information about CQC’s regulatory response to these concerns will be added to reports after any representations and appeals have been concluded.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve.

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made. Services placed in special measures will be inspected again within six months. The service will be kept under review and, if needed, could be escalated to urgent enforcement action.