Archived: Fernleigh House

Updated 14 September 2018

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.

The inspection took place on 6, 7 and 13 August 2018 and was unannounced. The inspection was carried out by two inspectors.

Prior to the inspection, we received a concern that despite an allegation of abuse against a staff member, they had been enabled to continue working at the service. We did not investigate this concern but used the information to inform our inspection planning.

Prior to the inspection we reviewed the records held on the service. This included the Provider Information Return (PIR) which 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. We also reviewed notifications. Notifications are specific events registered people have to tell us about by law.

During the inspection we spoke with everyone living in the care home, two people using the domiciliary service and two relatives. We also spoke with a community healthcare assistant who was visiting the home. We reviewed four people’s records in detail. We also spoke with six staff and looked at four personnel records and the training records for all staff. Other records we reviewed included the records held within the service to show how the quality and safety of the service was monitored and maintained. This included audits, minutes of meetings and policies and procedures.

Updated 14 September 2018

The inspection took place on 6, 7 and 13 August and was unannounced.

Following the last inspection, the Commission considered its enforcement policy, and took enforcement action, which was to impose a condition on the provider's registration. This meant on a monthly basis, the provider was requested to submit a report detailing action they had taken to improve medicines management, the assessment and management of people’s health and safety needs, infection control, the cleanliness and maintenance of the environment, governance systems, their recruitment process and ensuring staff employed were suitable for the work and to ensure staff received the training and supervision necessary to meet people’s needs. We also met with the provider.

The Commission had been receiving and reviewing the provider's monthly returns, which had demonstrated ongoing improvement at the service. The findings of this inspection found the information which had been provided had not always been fully accurate and did not always reflect the current regulatory position within the service.

Fernleigh House accommodates up to 11 people in one adapted building. It is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. At the time of the inspection 9 people were living at the service.

Fernleigh House also provides a domiciliary service from the same location, providing personal care to people living in their own homes in the community. Not everyone using the domiciliary service received regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided. At the time of the inspection 15 people were receiving personal care from the service.

There was no registered manager employed to run the service. 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 provider told us they were in the process of recruiting a new manager. A staff member, who described themselves as the deputy manager had taken on some managerial responsibilities but had also been providing care to people using the domiciliary service due to lack of staffing. This had reduced the number of hours they had been available to provide management support to the service.

People were not safe living at the service. People were supported by staff who had not all been recruited safely; for example some staff did not have appropriate references in place or had not provided information about their previous job roles. Staff had received safeguarding training but when staff had raised allegations of abuse, the provider had not ensured people were protected until a proper investigation had been completed. Staff did not always have up to date information to keep people safe. Risks that might affect people, relating to their needs or to the environment, had not all been assessed, recorded or updated effectively.

People’s health needs were not always monitored properly and staff did not always have the skills or knowledge to support people safely with their health care needs. Staff had not received training related to people’s individual needs, such as diabetes or skin care. People were not always supported in line with the principles of the Mental Capacity Act 2005.

People were not supported by sufficient numbers of staff to ensure their safety. Due to staff shortages, staff were working long hours to cover shifts and staff who had not been trained to provide care, were being used to support people’s care needs.

Medicines were not always managed safely. During the week of the inspection, there was not always a staff member trained to administer medicines, working in the home. People told us their medicines were often late and when people had run out of medicines, these had not been re ordered.

People’s preferences had not always been sought or recorded. People were not enabled to fulfil any aspirations they had. They had not been consulted about what food they would like to eat, how they liked to spend their time, or how they wanted to be cared for at the end of their life. People’s records did not always reflect their current needs. Staff knew how to communicate with each person but this information had not been recorded to ensure consistency between staff.

People’s confidential information was not always protected and people were not always treated with dignity and respect. The home had not been maintained or upgraded in a way that met people’s needs. People’s needs had not always been considered in relation to the design of the environment. People using the domiciliary service told us staff were kind.

The provider had not taken sufficient action to ensure the service improved. People’s views about the service had not been sought and information provided by other organisations relating to gaps in the quality of the service had not been acted upon.

The provider had not monitored the service effectively to identify areas for improvement. Where changes had been made, they had not checked to ensure staff had implemented these. The monitoring they had completed had not identified all the concerns identified during the inspection. Where work had been delegated to members of staff they had not ensured staff had the skills and knowledge to complete the work and had not checked it had been done to the correct standard.

People using the domiciliary service told us staff were caring and did not miss visits.

During the second day of the inspection, the local authority reviewed the needs of the people living in the home and decided they would no longer commission with the service. By the final day of the inspection, everyone living in the residential home had been found alternative accommodation by the local authority.

Following the inspection, the provider decided to apply to cancel their registration of the care home and the domiciliary care agency. This is being processed. No one is now receiving a service from this provider at this location.

We found breaches of regulation. You can see what action we told the provider to take at the back of the full version of the report.