Fernleigh Court Care and Nursing Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

People were not always safe using the service. We found a breach of regulations in relation to people’s safe care and treatment. People had historically not been supported safely and this had led to some poor outcomes for them. Risk assessments and care plans were not always detailed enough to guide staff to keep people safe. Staff were not consistently recording people’s support in daily records meaning there was a risk of unsafe care. Some areas of medicines management were unsafe. However, people and relatives told us they/ their loved ones were safe using the service. Staff understood how to safeguard people from abuse. Some care plans and risk assessments were detailed. There were enough staff to support people safely, and staff now had the training and competencies they needed. The environment at the service was safe. Staff followed good infection and prevention control (IPC) procedures. Some aspects of medicines administration were safe.

This service scored 56 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We received mixed feedback from people and relatives about how staff learned lessons. One person said, ‘‘I have bought up [issue] a few times, but things only change for a little while then go back again.’’ A relative told us, ‘‘I worry sometimes that staff do not talk about things that have happened. They are small things but important to [family member].’’ Staff told us they discussed incidents and accidents so lessons could be learned. However, this had only started happening recently. Staff were not recording people’s support consistently or in detail in records making it more difficult to monitor for trends and learn lessons about how best to support people. There were now detailed processes to review incidents and accidents and take learning from them. These had been put in place as a result of some issues affecting people’s experience of care and previously were not effective in identifying areas for improvement and in driving a learning culture. The management team had taken action and improved the processes of reviewing incident and accidents. They had also made sure learning lessons were discussed more regularly with staff in meetings and supervisions. Staff were able to give us examples of where they had changed practice to promote good support for people. For example, increasing the frequency of safety checks for a person who was independently mobile but at high risk of falls. One person said, ‘‘[Staff] seem to change how they do things if they need to.’’ A relative told us, ‘‘I am very happy with the actions staff took in relation to [aspect of family member’s support] It is clear they listened and changed things.’’

In the months before the senior management team started supporting at the service, staff were not always contacting health professionals so people could be supported to use other service in a timely fashion. This had led to poor experiences and outcomes for people. One relative said, ‘‘It was a difficult time as [family member] clearly needed the support from [health professional service] sooner than when they got it. I am glad it happened eventually, but it should not have been like this in the first place.’’ Staff did not always clearly record when people had seen health professionals and what their advice was. This made it more difficult for people to transition safely back to the service after using another service or seeing a health professional. One relative said, ‘‘In the past appointments have been made for [family member] and we have not been informed. It would be better for us all if we were made aware as we could have helped them feel better visiting [health professional].’’ The management team had taken action, and people were now being supported to safely transition between different services. Staff were clear about what signs would indicate a person may need support from another service and knew how to get in contact with other health professionals. Processes were in place to record and detail how to support people in line with any advice or guidance from other professionals. The management team were working on making care plans more detailed for when people used other services. One person said, ‘‘I need a lot of help with [aspect of support], and I know the staff will get hold of [health professional for me.’’ A relative told us, ‘‘[Family member] had to visit the hospital and this was all done safely. They came back and the staff supported them well, so they got better.’’

People had not always been safeguarded at the service. There had been occasions where people had not received the correct levels of personal care (including oral health care) and this had led to some poor outcomes for people. External professionals had raised several concerns recently and these were being investigated by the local authority safeguarding team. People’s care plans were not always detailed, and staff were not consistently recording people’s support in their daily records making it more difficult to see if people were being supported safely in line with their support needs. Some relatives gave us mixed feedback about whether their family member was always safe living at the service. Relative’s comments included, ‘‘I would say safety is a bit hit and miss just because staff do not always make sure [family member] has someone with them when they walk about. They put things in place to help them not fall but it would be better if they helped them when they were not in their room too.’’ and ‘‘I do worry sometimes about how quick the service reacts to what [family member] needs. It sometimes takes a few prompts from us to get things in place.’’ The senior management team had taken immediate action as a result of the safeguarding’s that had been raised and as a result people were now receiving safe care. For example, staff had received more training and support around supporting people with their specific care needs and incidents and accidents were thoroughly reviewed. Audits now took place to help ensure people’s care needs were being met. Staff were trained and understood safeguarding and knew how to report concerns both at the service and to external authorities such as the local authority and CQC. People’s comments included, ‘‘I always feel safe here and if I didn’t, I wouldn’t stay quiet about it.’’ and ‘‘I feel 100% safe.’’ A relative said, ‘‘[Family member] is incredibly safe and this give me a lot of reassurance.’’

People’s risk assessments and care plans were not always detailed enough to help guide staff to support them safely. Some risk assessments in relation to people’s specific medical support needs were not in place or did not contain enough information for them to be supported safely. Some people who may become upset or communicate in different ways did not have care plans or risk assessments in place to guide staff how to support them in these areas. Staff did not always follow people’s risk assessments by recording their care in records in line with their support needs. Relatives gave us mixed feedback about whether they were involved in discussing their family members care plans and risk assessments. One relative said, ‘‘I have never seen a care plan or been asked to discuss anything like that.’’ Another relative said, ‘‘[Family member] is now living with [support needs] but I am not sure if the care plan has been updated.’’ The senior management team were aware care plans and risk assessments needed further work and updating to make sure people were being supported safely at all times. They had started working on this and the care plans and risk assessments that had been updated were detailed and gave a good overview of how to support people safely. Staff were knowledgeable about the risks people faced and knew how to support them to mitigate risks as far as possible. One person said, ‘‘I always feel so safe and am confident [staff] know how to support me with [support need.]’’ A relative told us, ‘‘[Family member] was having a lot of falls so they put measures in place which has been really effective. They are much safer now. People and some relatives also told us they were involved in discussing care plans and risk assessments. One person said, ‘‘[Staff] will always show me my care plan and check to make sure I am happy with it.’’

The environment at the service was safe. Staff and the management team completed checks and audits to ensure the service was safe. This included fire safety checks. Staff told us how they would report concerns about equipment and the environment to the management team and anything that needed rectifying was done in a timely manner. Staff were knowledgeable about what to do if there was an emergency such as a fire. When issues relating to health and safety were found in audits swift actions were taken to rectify the issues. One person said, ‘‘It is beautiful here. Like living in a hotel really. Everything you could ask for.’’ A relative told us, ‘‘I think the service is great. It feels very homely in [family member’s] room and everything feels very nice and modern. I know the staff fix things if they go wrong. I have no complaints.’’

Staff had training to support people safely in areas such as supporting people living with dementia, moving and handling and eating and drinking. They also had competencies completed in some areas such as moving and handling and catheter care. However, training and competencies had been completed only very recently and previously were either not being completed or were not completed regularly. These had been completed in response to some of the issues at the service and the safeguarding concerns that had been raised. People and relatives gave us mixed feedback about staffing levels at certain times of the day or on some days of the week. One person said, ‘‘It can get a little lonely here. Sometimes it can be a while between seeing [staff].’’ Relative’s comments included, ‘‘I think they could do with a couple more staff members as sometimes [family member] has to wait a long time if they need 2 staff to help them.’’ and, ‘‘I think they are a little understaffed. [Family member] tells me in the evenings and at weekends they have to wait a long time. Sometimes when I visit there does not seem to be [staff] about.’’ People sometimes went for extended periods of time without being engaged with by staff throughout the day. However, we observed there were enough staff to support people safely. Call bells were answered in a timely fashion and people did not have to wait a long time to have their needs met. Staff told us they felt there were enough staff to meet people’s needs. They were knowledgeable about their training and told us how they applied this when they supported people. They told us the management team were completing competencies with them to help make sure training has been effective. Processes were in place to monitor staffing levels and make sure they were still appropriate to meet people’s needs. One person said, ‘‘No problems getting hold of [staff]. There is always someone about.’’ A relative said, ‘‘[Family member] never has to wait for anything.’'

The service was clean and free from unpleasant odours. Staff were trained and followed good IPC measures. Staff whose role it was to keep the service clean were passionate about their job roles and enjoyed their jobs. They felt well supported by the management team. The management team completed checks and audits to monitor IPC practices and make sure the service was clean. One person said, ‘‘[Staff] are always in here cleaning my room and keeping everything clean. It is spotless here.’’ A relative told us, ‘‘I think staff do a great job keeping the service clean and tidy. We have never had any worries.’’

The service was clean and free from unpleasant odours. Staff were trained and followed good IPC measures. Staff whose role it was to keep the service clean were passionate about their job roles and enjoyed their jobs. They felt well supported by the management team. The management team completed checks and audits to monitor IPC practices and make sure the service was clean. One person said, ‘‘[Staff] are always in here cleaning my room and keeping everything clean. It is spotless here.’’ A relative told us, ‘‘I think staff do a great job keeping the service clean and tidy. We have never had any worries.’’