Fernleigh Court Care and Nursing Home

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Before the senior management team had started supporting at the service, people’s needs had not been thoroughly assessed when they started living at the service leading to poorer outcomes for people. There had not always been good working relationships with external health professionals. Staff were not always completing records to help ensure people were being supported to stay healthy in line with their needs. Some people lacked capacity but did not have records in place to help staff support them in line with the Mental Capacity Act (MCA). Improvements had been made by the senior management team in these areas and the assessment process had been updated. People were being supported to achieve good health outcomes such as maintaining health weights. Staff had a good understanding of the MCA and supported people in line with this legislation.

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People’s needs had not always been thoroughly assessed before they started using the service. As a result, people who needed support with nursing care needs had been admitted to the service and their needs had not always been made clear to nursing staff. Some people had been admitted to the service and staff were told they did not need nursing care however they did. In some cases, people’s assessment paperwork at the time they started using the service had not been completed. As a result of this some people had poor experiences when they started using the service as their needs were not always met safely. One person said, ‘‘I moved in but I didn’t really get asked about how I wanted things to be done or how I needed the be supported for a few weeks.’’ A relative told us, ‘‘It took a long time for everything to get sorted out when [family member] used the service. I had to keep chasing things up to make sure staff had what they needed to support them safely.’’ When concerns about the assessment process came to light, the senior management team took the decision to stop admitting people to the service and update their admissions processes to make sure they were safe. They had also completed a root cause analysis of why people were not always admitted safely to the service. They had identified where improvements could be made and acted. For example, they had discussed with the registered manager as to where they could improve the assessment process and supervised them to help ensure admissions would only happen safely and if the persons needs could be met. The new assessment processes in place were thorough and ensured people’s needs were able to be met by the staff team. One person said, ‘‘It was great when I started living here. It felt like coming from one home to another.’’ People’s needs were reassessed regularly.

People were not always supported in line with evidence-based care and treatment. When people were living with specific health conditions, they did not always have detailed care plans in place to explain to staff how to support them with these needs. Staff had not always had the training to support people living with specific health conditions, although this had now been actioned recently by the senior management team. One relative said, ‘‘I am not sure if the staff really know how to support [family member] with all their support needs, especially the newer ones. I think things could be better.’’ Another relative told us, ‘‘I think staff training is a little bit inconsistent. Some of the staff know just what to do and other times I am a little more worried.’’ The senior management team had started to review people’s care plans and risk assessments to ensure they provided sufficient detail how to support people effectively. They had organised training for staff about specific health conditions and staff fed back they had learnt a lot from this. They told us how they would support people with their health conditions based on what they had learned from this training. The registered manager and the senior management team attended forums and researched best practice in relation to supporting people. This meant they could update care plans and train the staff team in line with evidence-based care and treatment. One person said, ‘‘[Staff] know how to help me when I am feeling a bit down. I think they are really good.’’ A relative told us, ‘‘[Staff] always react really well if [family member] needs anything in relation to [support need].’’

There had recently been some breakdowns in relationships between the staff team and some external health professionals. This had led to some poor experiences for people. In some cases, staff had not referred people to health professionals in a timely manner. When people did see health professionals, this was not always clearly recorded in their care plans or daily records. Advice from health professionals was not always clearly recorded in their care and support plans. One relative said, ‘‘It was frustrating when [family member’s appointments] was organised and we didn’t really know what happened as a result. This was not recorded anywhere, and we did not know about it until we asked.’’ We also received some mixed feedback about how well the staff team worked together. One person said, ‘‘It would be better if all the staff did the same thing, but I am not sure how often they talk with one another.’’ A relative told us, ‘‘There does not seem to be a lot of talking between the staff. I think they could work a bit better together to make sure they are all on the same page.’’ However, we observed staff worked well together and communicated effectively to ensure they supported people in a timely manner and in the best way possible. The senior management team had met with external health professionals and now worked well with them. Staff now supported people to see health professionals in a timely manner when they needed it. The senior management team had completed workshops with staff to help them understand the importance of recording health professionals’ advice in their records. One person said, ‘‘Whenever I need to see [health professional] the staff organise this straight away.’’ A relative told us, ‘‘I am assured that staff react really quickly when [family member] needs to see a health professional and there has never been any issue with this.’’

People were not always supported to live healthy lives in line with their known individual support needs. Some people needed support in relation to having aspects of their care recorded in a regular basis such as repositioning for pressure area care support needs or the amount of food and fluid they were having throughout the day. Staff were not monitoring and recording this support in line with people’s care needs. This made it difficult to make sure people were being supported to live healthily. Before the senior management team had acted some people were not receiving regular support in areas of personal care such as oral care and personal hygiene. One relative said, ‘‘There used to be problems with staff not supporting [family member] to drink enough. We were worried they would get quite poorly. This has got much better now.’’ The registered manager and management team had started working with the staff team, over the last three months to support them to record people’s care more consistently. Despite this action records were still not always being completed in line with people’s support needs. However, we observed staff supporting people to stay healthy by offering them regular food and drink and supporting them in line with their specific dietary needs. Staff told us how often people needed support with aspects of their support such as repositioning to reduce the risk of skin pressure damage. People had been supported to be healthy in ways such as no longer having pressure sores and being supported to maintain healthy weights. One person said, ‘‘There is always something to eat and drink here and the staff always help me out if I need to move around. I feel much better than when I didn’t used to live here.’’ A relative told us, ‘‘[Family member] has been supported to be much healthier than what they were at home. They have put on weight and are much happier as a result.’’

People had not always been supported to achieve good health related outcomes. There had been several safeguarding concerns raised in the past about poor levels of essential care such as personal and oral hygiene. Staff were not always recording people’s support needs in daily records which made it hard to see if outcomes were being monitored and improved. Audits were not being completed to monitor people’s outcomes. One person said, ‘‘When I first came here it took a little while before I felt like the staff really started to support me with [support need] how I wanted them to.’’ A relative told us, ‘‘It has been frustrating when appointments have happened and yet we have not been told how [family member] is afterwards or what will be done differently to help them get better.’’ The management team had taken action to start improving how people’s health related outcomes could be monitored and improved over the last three months. Audits now monitored care records to help make sure people were being supported in line with their support needs. People had been supported to eat a wide variety of foods and people were positive about the meals at the service. Kitchen staff were knowledgeable and passionate about supporting people with their meals and knew how to support people to achieve good outcomes in relation to their meals. People’s comments included, ‘‘The food here is fantastic. It tastes like eating at a high-class restaurant.’’ and ‘‘I think the kitchen staff do a great job. There is such a variety, and everything tastes fresh and homemade.’’ A relative told us, ‘‘[Family member] always goes on and on about how good the food at the service is. They eat really well which is something they weren’t doing [at home] so this is testament to how good it must be.’’

People were not always supported in line with the MCA. In some cases where people lacked capacity, assessments had not been completed to help make sure people were always being supported in line with their best interests. However, we observed people supporting people in line with the MCA. They asked people for consent before supporting them and knew how to offer choices to them to make sure they were involved in all aspects of their care. Staff had a good understanding of the MCA and how to apply this when they supported people. When capacity assessments and best interest decisions had been completed for people, these were detailed. One person said, ‘‘[Staff] are very polite. They know how to do things and what I like but they still always ask.’’ A family member said, ‘‘[Family member] is living with [support need] and so find it more difficult to make their own decisions. I must say staff have been excellent and really make sure they are still involved. This means a lot to [family member] and to us.’’