Archived: The Ferns Residential Home

Updated 14 April 2022

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This included checking the provider was meeting COVID-19 vaccination requirements. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The Inspection was carried out by two inspectors and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

The Ferns Residential Home is a care home. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement dependent on their registration with us. The Ferns Residential home is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. The provider was not requested to complete a provider information return (PIR). This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection-

During the inspection, we spoke with nine people who used the service, to ask about their experience of the care provided and 12 family members. We spoke with ten members of staff, which included the registered manager, senior staff, care staff, catering and domestic staff. We observed staff providing support to people in the communal areas of the service. This was so we could understand people's experiences. By observing the care received, we could determine whether they were comfortable with the support they were provided with.

We reviewed a range of records. These included five people’s care records and multiple medication records. We looked at three staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including quality assurance records were reviewed.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We looked at training data and requested additional policies and procedures.

Updated 14 April 2022

About the service

The Ferns is a residential care home providing support with personal care needs for older people. The service can accommodate up to 36 people. At the time of the inspection there were 36 people living there. Accommodation was provided in one adapted two storey building. There were two communal lounges and one large dining room.

People’s experience of using this service and what we found

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. People had not had Deprivation of Liberty Safeguards applications made which put them at risk.

Staff did not receive adequate support in the form of regular supervision and appraisal.

There were systems to monitor safety and the quality of the service people received. However, these were insufficient to monitor changes in people’s mental capacity and whether a Deprivation of Liberty Safeguard was required.

Staff had received regular training, although their understanding of the principles of mental capacity were insufficient to meet peoples needs.

We received mixed feedback from people and staff regarding whether they felt included within the service. Some people and staff told us they felt confident to express their views and raise concerns, others told us they did not feel comfortable to speak out.

Health and safety risk assessments were in place to ensure people's safety and environmental hazards were monitored and regularly reviewed.

Infection prevention control measures were robust. Visitors were checked before being permitted into the service and the provider had regular clean schedules in place. There were processes in place to protect people from the risk of the spread of infection and measures were in place to mitigate the risks associated with COVID-19.

Staff received safeguarding training, they told us how they protect people against abuse and how they would report any concerns.

The provider worked in partnership with other health and social care professionals to achieve good outcomes for people.

Medicines were stored and administered in a safe way. Quality audits were in place to ensure medicines were safely managed.

Staff were recruited safely, the registered manager ensured that all relevant staffing checks were conducted prior to employment.

Relatives told us people were safe living at the home and with the staff who supported them.

Health and safety checks were regularly carried out and contingency plans were in place to keep people safe.

Relatives felt involved in the service, they told us the registered manager was approachable and they had confidence in their abilities.

The mealtime experience was a sociable event. The food smelt and looked appetising. People told us how much they enjoyed their meals.

The home was decorated to a high standard, people’s photographs were placed in communal places and each person’s room was personalised to their own preferences.

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 11 December 2019).

Why we inspected

We received concerns in relation to the way the home was managed, communication and restrictions being placed on people. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. We inspected and found there was a concern with the absence of Mental Capacity assessments. A decision was made for us to inspect and examine those risks. We widened the scope of the inspection to include the key question of effective.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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. This included checking the provider was meeting COVID-19 vaccination requirements.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the effective and well led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Ferns Residential Home on our website at www.cqc.org.uk.

Enforcement and Recommendations

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 and will take further action if needed.

We have identified a breach in relation to consent at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.