Fern Hill House Care Home

Updated 9 April 2021

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 Care Act 2014.

This was a focused inspection to check whether the provider had met the requirements of the Warning Notice in relation to Regulation 17 (Good Governance) of the Health and Social Care Act 2008 (Regulated Activities) and the breaches of Regulation 12 (Safe Care and Treatment).

As part of this inspection we also looked at the infection control and prevention measures in place. 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 one inspector.

Service and service type

Fern Hill House Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

The service did not have a manager registered with CQC. This means the provider was legally responsible for how the service is run and for the quality and safety of the care provided. The new manager had submitted their application to us and was awaiting their interview.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed the information we received about the service since the last inspection. We received feedback from local commissioners including the medicines management team and the local authority safeguarding team. We looked at the information from the fire safety inspection and the action taken to address the safety issues. We reviewed information from statutory notifications sent to us by the service about incidents and events that had occurred at the home. A notification is information about important events, which the service is required to send us by law.

The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.

During the inspection

We observed care practices and spoke with three people living in the home about their experience of the care provided. We also spoke with one visitor to the home. We spoke with various members of staff including, the nominated individual, manager, deputy manager, senior care workers, care workers, the housekeeper and the chef. The nominated individual is responsible for supervising the management of the service on behalf of the provider.

We reviewed a range of records. This included three people's care records and multiple medication records. We looked at two staff files in relation to recruitment. We also reviewed a variety of records relating to the management of the service, including policies and procedures.

After the inspection

We spoke with three family members over the telephone. We continued to seek clarification from the provider to validate evidence found.

Updated 9 April 2021

About the service

Fern Hill House Care Home is a residential care home providing accommodation, care and support for up to 24 people aged 65; some people using the service were living with dementia. Accommodation is provided over three floors. During our inspection the top floor was not in use. There were 17 people living in the home.

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

Since the last inspection, there had been improvements made but time was needed to embed new systems to ensure they were effective and could be sustained. The provider had addressed the serious concerns raised in the fire safety enforcement notice. However, additional work needed to be completed and signed off by the fire safety officer. Quality monitoring systems had improved with evidence shortfalls had been identified and acted on. However, further improvements were needed in areas such as developing action plans and ensuring care records, equipment servicing and medicines management audits were fully effective.

The management of risks to people's health, safety and wellbeing had improved. However, we found areas that could be improved further to ensure staff were provided with guidance about how to provide care in a safe way. Accident and incident management had improved, and lessons were learnt from any incidents. Staff had been provided with the provider’s mandatory safety training. Training and supervision sessions were used to ensure learning and improvements took place. The manager and staff were clear about when to report incidents and safeguarding concerns to other agencies. Relatives had no concerns about the safety of their family members. We observed good interactions between staff and people.

People's medicines were managed and stored safely, and records were clear. However, improvements were needed in relation to recording the application of creams, medicines for disposal and keeping records of medicines ordered. We were assured the provider was preventing visitors from catching and spreading infections and there had been no COVID-19 outbreaks in the home. The service was clean and odour free. During the inspection, the cleaning schedules were reviewed to ensure staff were following safe guidance.

Staff were recruited safely, and records showed there were consistent numbers of staff available to meet people’s needs. Relatives made positive comments about the care and support provided by staff particularly during the pandemic. New care planning records reflected people’s choices and considered people’s diverse needs. People looked settled and happy and we observed them being treated with care and respect. People's views and opinions were sought through day to day discussions and surveys; resident meetings were due to recommence. Relatives confirmed they had been kept up to date and involved in any changes and decisions.

The manager and provider understood their responsibility to be open and honest when something went wrong. Staff said the manager was approachable. The manager and staff worked in partnership with a range of professionals to ensure people received the care and support they needed. The manager was supported by the management team and had enrolled on training to support him with the role. Staff told us they were supported and enjoyed working at the service. Staff and relatives made positive comments about the manager’s contribution to improvement and ongoing communication.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was Inadequate (published 15 December 2020).

During this inspection, we noted improvements had been made but needed to be further embedded into daily practice. Therefore, we have identified continued breaches in relation to the management of risk and effective quality assurance systems. We have made a recommendation regarding safe management of medicines.

This service has been in Special Measures since 16 December 2020. During this inspection, the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This was a planned inspection based on the previous rating.

On 10 and 12 November 2020, we carried out an announced focused inspection of this service. Breaches of legal requirements were found with regards to good governance, fire safety, risk management, training and infection prevention control practices. We made recommendations in relation to safeguarding, lessons learned and involvement.

We also served a warning notice for non-compliance with Regulation 17 Good Governance and we made a referral to the fire service who visited and served a fire safety enforcement notice.

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

We undertook this focused inspection to check they had followed their action plan and whether the Warning Notice we previously served in relation to Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

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.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from Inadequate to Requires Improvement. This is based on the findings at this inspection.

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

Enforcement

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 continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

Please see the action we have told the provider to take at the end of this report.

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.