Archived: Ferney Lee Services for Older People

Ferney Lee is a residential care home providing personal care for up to 31 people aged 65 years and over. The service provides permanent places, intermediate care, transitional, emergency and respite care. There were 10 people using the service when we visited. Accommodation is provided over two floors and the intermediate care is provided on a separate unit. The intermediate care provision ends on 30 September 2019.

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

People and relatives were unanimous in their praise of the staff and the consistently high standards of care and support provided. People described staff as ‘marvellous’ and ‘first class’. Staff were exceptionally thoughtful and kind with people, putting people’s needs first and frequently going above and beyond their role. Staff consistently treated people with respect and maintained their privacy and dignity.

People received person centred care which was responsive to their needs. Staff understood how to manage any risks to people and knew the processes to follow to manage any allegations of abuse. Care records provided detailed information about people’s needs and preferences. People’s health care and nutritional needs were well managed and they received their medicines when they needed them.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

There were enough staff to meet people’s needs without rushing. Recruitment processes ensured staff were suitable to work in the care service. Staff were trained and had the required skills to meet people’s needs. Staff told us they loved their jobs and felt well supported.

The service was well run. Everyone spoke highly of the registered manager and the improvements they had made, working alongside the staff supporting them and making sure the quality of care was maintained.

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 23 February 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We inspected this service in January 2016 and rated it ‘Inadequate’ and in ‘Special Measures’. We took enforcement action and when we went back to inspect on 28 June 2016 we rated the service as ‘Requires Improvement’ and it remained in ‘Special Measures’. This was because although we found some improvements had been made, there remained three regulatory breaches which related to staffing, safe care and treatment and good governance. We told the provider they must improve. Following the inspection the provider sent us an action plan which showed how the breaches would be addressed. This inspection was to check improvements had been made and to review the ratings.

Ferney Lee provides accommodation and personal care for up to 31 older people, some of who are living with dementia. Accommodation is provided in single bedrooms over two floors. Ferney Lee offers a mixture of placements which includes permanent places, intermediate care, transitional, emergency and respite care. There were 20 people using the service when we visited. Accommodation is provided over two floors and the intermediate care is provided on a separate unit. There are communal areas throughout the home including lounges, dining rooms, a large central kitchen and separate smaller kitchens.

The home does not have a registered manager. 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 left in September 2016. An interim manager had been appointed and they were present at this inspection.

It was clear from our observations and feedback from staff and people who used the service that significant improvements had been made since our last inspection in June 2016.

Changes had been made to the way medicines were managed which meant people now received their medicines safely and when they needed them. Where possible, people were encouraged and supported to manage their own medicines.

Staffing levels had stabilised and were kept under constant review and adjusted according to people’s dependencies and needs. We saw there were enough staff to support people without rushing them and staff had time to sit and chat with people.

There were better systems in place to monitor accidents and incidents and make sure people were kept safe. We saw risks to people were assessed and managed well, keeping them safe while at the same time maximising their independence. People told us they felt safe. Staff had a good understanding of safeguarding procedures and we saw incidents had been reported, dealt with and referred to the local authority safeguarding team.

The service was clean, comfortably furnished and well maintained.

Safe staff recruitment processes were in place with thorough checks being completed before new staff began working at the home. New staff completed an induction and those who had no previous care experience also completed the Care Certificate. Staff had received training updates and further training was booked. Systems were in place to ensure staff received regular supervision and appraisal.

The manager was meeting the legislative requirements of the Mental Capacity Act 2005 [MCA] and the Deprivation of Liberty Safeguards [DoLS].

People told us they enjoyed the food and we saw people were provided with a range of food and drinks during the inspection. Mealtimes were sociable, pleasant occasions with staff available to provide people with the support they needed.

People told us they were happy with the care they received and praised the staff who were said to be kind and very good. People were involved in planning their care and we saw care records were personalised and centred on what people could do for themselves and how they preferred any support to be given. People we spoke with had no concerns but knew who to speak with if they had any issues and had confidence these would be addressed.

Staff knew people well, were patient and kind in their interactions and took time to engage with people. People’s privacy and dignity was respected and their independence promoted.

People told us there was plenty for them to do. A range of activities were advertised and we saw people enjoyed participating in activities during the inspection.

It was clear the interim manager provided strong and supportive leadership. Staff spoke positively about the management of the service and told us things were better organised. Recent survey results showed people were satisfied with the service provided. The regulatory breaches identified at the previous inspection had been addressed. Quality audits systems were effective and showed where issues had been identified action had been taken to ensure improvements were made and sustained.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

At the last inspection on 13 January 2016 we rated the service as ‘Inadequate’ and in ‘Special Measures’. We identified six regulatory breaches which related to safeguarding, staffing, consent, safe care and treatment including medicines, person-centred care and good governance. We issued warning notices for the breaches of safeguarding and safe care and treatment with a compliance date of 29 February 2016 and for good governance with a compliance date of 31 March 2016. We issued requirement notices for the breaches relating to staffing, consent and person-centred care. Following the inspection the provider sent us an action plan which showed how the breaches would be addressed. This inspection was to check improvements had been made and to review the ratings.

Ferney Lee provides accommodation and personal care for up to 31 older people, some of who are living with dementia. Accommodation is provided in single bedrooms over two floors. Ferney Lee offers a mixture of placements which includes permanent places, intermediate care, transitional, emergency and respite care. There were 20 people using the service when we visited. This included eight people who lived there permanently, two people receiving respite care and ten people receiving intermediate care. Accommodation is provided over two floors and the intermediate care is provided on a separate unit. There are communal areas throughout the home including lounges, dining rooms, a large central kitchen and separate smaller kitchens.

The home has a registered manager who registered with the Commission in May 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.

Overall we found some improvements had been made to the care people received and areas such as safeguarding, care planning, consent and leadership were better than we had found at the last inspection. However, we still had concerns in relation to the management of medicines, risks to people, staffing levels and good goverance.

Although some improvements had been made we found the systems in place to manage medicines were not always safe. For example, one person had not been given their medicines as prescribed for several days which staff had recorded but no one had reported this to the person’s GP until we raised the matter at the inspection and it was then addressed.

People told us they felt safe. There were better systems in place for managing safeguarding concerns. Staff had received safeguarding training and we saw incidents were being reported to the Local Authority safeguarding team. Although we found some of these incidents had not been notified to the Care Quality Commission.

There had been a high number of falls since the last inspection and although these were well recorded there had been no analysis to look at how risks could be reduced. A significant number of the falls had occurred at night when there were only two staff on duty, although the registered manager told us there should be three staff on duty. This had not been investigated further by the provider.

People raised concerns about staffing levels and said there were sometimes not enough staff. Although people dependencies were recorded the registered manager was unable to provide any evidence to how the staffing levels had been determined.

People and relatives praised the staff who they described as kind and excellent. There was a relaxed and friendly atmosphere in the home and we saw staff took every opportunity to engage with people. People told us they were treated with respect and this was confirmed in our observations. The home had achieved an award in April 2016 from the Dementia Care Matters team for providing a high level of person-centred care to people living with dementia. The environment in the main part of the home provided comfortable and homely seating areas with many items of interest to stimulate and interest people such as an old Singer sewing machine and gramophone player.

People told us there were plenty of activities taking place in the home and we saw people enjoying a themed coffee morning during our inspection. People also told us about trips they had been on.

Safe recruitment procedures were followed which made sure checks had been completed before new staff started work. Staff training had improved and systems were in place to ensure staff received supervisions and appraisals.

People told us they enjoyed the food. We saw mealtimes were generally a pleasant and sociable occasion, although one person had a less positive experience with their breakfast . A choice of meals, snacks and drinks were provided throughout the day.

People were aware of how to make a complaint and we saw complaints received had been dealt with appropriately.

People’s care records had improved. We found the care files were well organised and care plans were personalised. We saw people had access to healthcare professionals such as GPs and district nurses.

People and staff told us improvements had been made since the last inspection. We found the home was more organised and the registered manager was open and transparent. However, quality assurance systems were not fully embedded or always effective which is evident from the continued breaches we found at this inspection.

We identified three breaches in regulations – regulation 18 (staffing), regulation 12 (safe care and treatment) and regulation 17 (good governance). The Care Quality Commission is considering the appropriate regulatory response to resolve the problems we found. 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

The overall rating for this service is ‘Requires improvement’. However, we are placing the service in 'special measures'. We do this when services have been rated as 'Inadequate' in any key question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services in special measures.

Ferney Lee provides accommodation and personal care for up to 31 older people, some of who are living with dementia. Accommodation is provided in single bedrooms over two floors. Ferney Lee offers a mixture of placements which includes permanent places, intermediate care, transitional, emergency and respite care. There were 30 people using the service when we visited. This included nine people who lived there permanently, ten people receiving respite care, five emergency placements and four transitional placements. Accommodation is provided over two floors and the intermediate care is provided on a separate unit. There are communal areas throughout the home including lounges, dining rooms, a large central kitchen and separate smaller kitchens.

The home does not have a registered manager. The registered manager left in December 2014. A new manager was appointed who is intending to register with the Commission. This manager was present when we carried out the inspection. 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.

Although people told us they felt safe in the home we found risks to people were not always well managed. For example, equipment identified as needed to keep one person safe and to reduce the risk of falls was not being used. Safeguarding incidents were not always recognised by staff or reported to the local safeguarding team which placed people at risk of harm.

People told us they received their medicines when they needed them yet we found staff were not acting in accordance with the medicine policy which meant medicines were not always managed safely.

People and staff told us the home had been short staffed over Christmas. We saw staffing had improved recently with an influx of staff from another service which ensured people’s needs were being met. We saw some documentation which showed recruitment checks had been completed, however application forms, references and interview records were not seen and although the provider agreed to forward these to us after the inspection they were not received.

At the last inspection we had identified concerns in relation to the premises. We found improvements had been made at this visit and the premises were well maintained.

There was a stable staff team and many of the staff had worked in the home for many years and as a result knew people’s needs well. However, we found some gaps in the training matrix which meant we could not be assured all staff had received the training they needed. We also found care records varied. Those we saw on the intermediate care unit were detailed and up to date, yet other people’s care plans and risk assessments had not been updated or reviewed for three months and some people had no care plans. This placed people at risk of receiving unsafe or inappropriate care.

We found staff and the manager lacked understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). We found an accumulation of restrictions indicated some people who lacked capacity may require a DoLS application, yet none had been made.

People said they enjoyed the food and we found mealtimes were a pleasant experience and staff gave people support and encouragement to ensure a good dietary intake. We found people had access to health care services such as GPs, chiropody and optical services. People told us they knew how to make a complaint and would speak with staff if they had any concerns.

People and relatives praised the staff and the care that was given. People described how staff treated them with respect, promoted their independence and were kind and considerate in all their interactions. Staff had embraced the learning they had gained from training in Dementia Care Matters and spoke enthusiastically about changes which had been introduced as part of the Butterfly Project which embraces person-centred care for people living with dementia. We saw the benefits this had brought to some people such as the use of doll therapy to bring comfort and contentment to two people.

There was no organised activity programme, though we saw activities taking place. Most people told us they were satisfied with the activities provided although two people felt there could be more going on.

Staff told us the manager was supportive and worked with them to make improvements. The manager told us they had struggled over the Christmas period as they had been without administrative support which had impacted on their work. We found there had been lapses in the quality assurance systems over the last nine months which meant issues we identified at this inspection had not been picked up or addressed by the provider. Providers are required by law to inform us of certain events that occur in the care service. We found notifications had not been made on three occasions when they should have been.

We identified six breaches in regulations – regulation 18 (staffing), regulation 12 (safe care and treatment), regulation 13 (safeguarding), regulation 11 (consent), regulation 9 (person-centred care) and regulation 17 (good governance).

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.

The registered manager was on long term sick leave at the time of our inspection. The temporary unit manager told us they had been in post since February 2014.

When we visited Ferney Lee in January 2014 we found an assessment of need and risk assessments had not been carried out for one person who lived at the home. We asked the provider to make improvements. We went back on this visit to check whether improvements had been made.

We considered all the evidence we had gathered under the outcomes we inspected.

We used the information to answer the five key questions we always ask;

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

This is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, their relatives and the staff told us.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

We found the premises and grounds at the home were not adequately maintained. This meant people who lived at the home were not living in safe surroundings that promoted their wellbeing. We have asked the provider to make improvements.

Staff we spoke with told us, 'The whole place needs updating. For example when you arrive at the home you see the outside all needs painting. I try to keep my eyes closed.'

There were systems in place to deal with emergencies and people were cared for in a clean, hygienic environment. We saw that people who lived at the home looked clean and well-cared-for.

There were enough staff to meet the needs of the people who lived at the home. Staff were suitably qualified and had the skills and knowledge needed to support people. One person told us, 'The staff are very good, we have a laugh.' Staff told us, 'We have enough staff but it's always busy, especially during the mornings.' and 'It would be nice to have more time to spend with people.'

This showed us people were protected from avoidable harm.

Is the service effective?

People and relatives we spoke with told us the care provided at the home was very good, and their treatment and support needs were being met.

From our observations and from speaking with staff, people who lived at the home and their relatives we found staff knew people well and were aware of peoples care and support needs.

One person, who was in a wheelchair, told us, 'I want to stand up and walk. I'm having physiotherapists and an occupational therapist assessment. I'm hoping they'll sort me out. Everything else is alright.' Another person, in the rehabilitation unit, told us, 'I've walked to the sink and back this morning; I couldn't have done that a week since.'

This showed us that peoples' care treatment and support at the home achieved good outcomes and promoted a good quality of life for the people that lived there.

Is the service caring?

People were supported by kind and attentive staff who obviously knew people well. We saw that care workers were patient and encouraging when supporting people.

People who lived at the home and relatives told us they were happy with the care at the home and people were supported by kind and attentive staff. Our observations during the visit confirmed this. One person told us, 'It's not bad at all. The food is reasonable and the staff are all very good. There's nothing bad at all' another person said, 'I've got everything I need, and I've got no complaints.'

One relative we spoke with said, 'We're very pleased with the care here. X (temporary manager's name) is extremely professional. We were very anxious for dad to be able to come back here after he had been in hospital.'

The care workers we spoke with told us they felt confident the service provided to people who lived at the home was good and they had a good staff team. Comments from staff included, 'I enjoy my job; I really enjoy working there,' 'Yes, I think the care is very good there for people,' 'It's a pity they're not taking on more permanent residents. One person had been in a transitional bed for 12 months and has to move out, we're all upset' and 'We've got a lot of care staff that really do care.'

When we looked around the home we saw people's bedrooms had been personalised and contained personal items such as family photographs and furniture.

This meant staff treated people with compassion, kindness, dignity and respect. Staff told us they respected peoples' privacy and dignity and encouraged people who lived at the home to be independent.

Is the service responsive?

We saw the service carried out an assessment of needs before people moved in to the home. We saw people's preferences, interests and diverse needs were taken into consideration.

We looked at three peoples' care records. We found care and support was provided in accordance with peoples' wishes. One person told us, 'They're getting me some fish I asked for; some gurnets.' A relative we spoke with said, 'They've moved dad to a bigger room with a special bed to accommodate his mobility needs.'

People had access to activities and were supported to maintain relationships with their friends and relatives. We saw some people continued to pursue previous community involvement and social interests. For example one person told us they liked to go and watch the cricket in the summer at the local pitch. The manager told us this person's son had bought him a season ticket so that he could do this.

This meant the home was organised so that it met peoples' needs.

Is the service well-led?

People were protected against the risks of inappropriate or unsafe care because the provider had effective systems in place to assess and monitor the quality of the service people received.

The temporary unit manager told us they had been in post since February 2014, as the registered manager at the home was on long term sick leave.

Staff we spoke with told us they were clear about their responsibilities and felt well supported by the temporary unit manager and the staff team. They told us their views were taken into consideration. One care worker said, 'It works a lot better at the moment with X (manager's name); they're a very good manager. We all get to know what's happening.' Another care worker said, 'We have supervisions and staff meetings. The temporary manager is very approachable and has an open door policy.' This showed us the service was being well-led, while the temporary manager was in position.

What we saw and heard on the inspection showed us the leadership and management of the home assured the delivery of high quality care and promoted an open and fair culture.

We spoke to five people who used the service and two relatives. One person said 'They are very good. It's alright here. I go out every day when its fine'. Another person said' I have only just arrived but I have had a very nice welcome by staff and everything has been carefully explained to me'.

We looked at five care records and saw that some people's needs were assessed and care and treatment was planned in line with their individual care plan. Care plans had information on assessments being carried out in areas such as personal care, mobility, and communication.

We did however, see one care record which had no information on any assessment of needs being carried out, nor was there any information on risk assessments been carried out. The person had used the service for six weeks.

We looked at five care records and saw that four care records had information on people's nutritional needs and dietary preferences. We saw that one care record had no information on the person's nutritional needs even though they were an insulin dependent diabetic. One member of staff said that this person was fully aware of their dietary requirements and were able to make decisions about what they ate.

We saw that a three week menu was in place which offered a balanced, varied and nutritious menu. We saw that people who did not want what was on the menu were offered alternatives.

We looked at two staff records which demonstrated that effective recruitment and selection procedures were in place.

Our observations of the service found that the environment was clean and tidy and that people's bedrooms, for those that were living in the home on a permanent basis, were personalised in a way that reflected their taste.

We saw that the manager carried out internal audits across a number of care areas. We saw that actions from audits had been taken to address any issues.