This full comprehensive inspection took place on 27 and 28 September 2018 and 2 October 2018. The previous inspection took place on 25 September 2017. The inspection was a focused inspection to check if the service was safe and well-led. We found breaches of Regulations 18 Staffing and 17 Governance of the Health and Social Care Act Regulations 2008 (Regulated Activities) 2014. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve and meet the breaches in Regulations 18 Staffing and 17 Governance of the Health and Social Care Act Regulations 2008 (Regulated Activities) 2014.
The provider’s action plan had all actions signed off by the previous registered manager dated 21 December 2017. This meant that the provider confirmed to us in their action plan that they would have completed all their actions to meet the legal requirements of Regulations of 18 Staffing and 17 Governance of the Health and Social Care Act Regulations 2008 (Regulated Activities) 2014 by 21 December 2017.
On this inspection we found the provider had not ensured that sufficient numbers of suitably qualified, competent skilled and experienced persons were being deployed effectively. The registered provider had also failed to ensure that their systems were being implemented or followed effectively to assess, monitor and improve the quality of the service. Furthermore, the registered person had failed to maintain an accurate, complete and contemporaneous record in respect of each service user, including a complete record of complaints.
We found the provider had not met their legal responsibility to meet the breaches from the last inspection namely, Regulation 17 Governance and Regulation 18 Staffing of the Health and Social Care Act Regulations 2008 (Regulated Activities) 2014 by 21 December 2017. This was due to the provider’s governance systems not being effective in ensuring continuous improvements were being made or sustained. Staffing numbers/deployment of staff was having an impact on the care delivery for people living at the home. In addition to these continued breaches of the regulations we also found the provider was in breach of Regulation 9, 10, 11, 12, 13, 14, 15 and 16 on this inspection.
You can see what action we told the provider to take at the back of the full version of the report. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.
Ferndale Court Nursing Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
The care home provided care and treatment for up to a maximum of 58 people. Ferndale Court Nursing Home has two floors with a passenger lift up to the first floor. People living at the home required nursing or residential care. There were people receiving care who were living with dementia.
A registered manager who was present during our inspection had registered with us on 10 May 2018. 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 service was not always ensuring people received a safe level of care. Staffing numbers/deployment of staff was not effective in always meeting people’s care needs. For example, we observed one person had not had personal care in a timely manner.
People’s dignity was not always being upheld with a mixed approach observed by staff. Some staff were heard speaking over people whilst rushing the care being delivered. One warm, positive, interaction was observed between staff and a person living at the home.
People were not always receiving enough to eat and drink which we viewed in the records and from our own observations.
Only one person was receiving End of life care at the time of our inspection. We found they were not receiving person centred care which was taking into account their wishes or preferences.
We had concerns regarding the cleanliness of the first floor within the home and regarding repairs not being actioned in a timely manner. The provider took action and by the third day of the inspection the home smelt fresher and actions were taken to make repairs as quickly as possible.
The staff we spoke with told us they wanted to deliver person centred care but they were unable to due to the increasing high dependency needs of people and because there was not enough staff. We observed task led care being provided on this inspection.
We observed unsafe moving and handling techniques used by staff on this inspection. We found 20 staff’s training in moving and handling had expired.
Staff were not receiving regular supervision or appraisals. We found staff had received an induction.
The service had a Mental Capacity Act 2005 policy in place however, we found there was no Mental Capacity Act 2005 framework in place within the records for people who lacked capacity or who had fluctuating capacity to be supported in making decisions.
Not all appropriate Deprivation of Liberty authorisation applications had been sent to the local authority. We also found there were a high number of statutory notifications not sent to the Care Quality Commission which is a legal requirement.
The provider’s own safeguarding system was not being followed consistently to always ensure people were being protected from alleged abuse. For example, we observed unexplained bruising/marks which had not been recorded or reported to the safeguarding authority. We found 21 staff’s safeguarding training had expired. The provider responded to our concerns immediately. They checked everyone living at the home and completed a body map.
We found there were complaints being made within the home with no record of the actions being taken by the registered manager.
There were not enough activities for people within the home and people were not being provided with enough stimulation. The design of the premises and the building’s interior was not providing a homely environment for people.
There were quality audits being completed within the home by the registered manager and the provider, however, they were not effective in ensuring actions were completed to ensure improvements were being made.
During the inspection we found medicines were being managed and stored appropriately however, we were provided with notifications following the inspection informing us of some medication errors highlighted to them by a visiting nurse. The provider confirmed to us how they were dealing with these errors.
Recruitment files we checked demonstrated robust practices including Disclosure Barring Service (DBS) checks being undertaken.
Advocacy services were in place within the home. Relatives meetings were being undertaken alongside the local authority.
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, it 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.