We carried out an inspection at Fern Hill House Care Home on 21 and 22 August 2018. The first day was unannounced.

Fern Hill House Care Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as 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.

Fern Hill House Care Home provides accommodation and care and support for up to 24 people, some of who were living with dementia or mental ill health. There were 17 people accommodated in the home at the time of the inspection.

Fern Hill House Care Home is located on a main road close to the town centre facilities of Bacup. It is an older style property with facilities on three floors, which could be accessed by steep staircases or a number of chair lifts and a passenger lift. There was a small car parking area with a gated seating and smoking area to the front of the house.

The service was managed by a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

At the last inspection carried out on 13 and 14 February 2018, the service was rated as ‘Requires Improvement’. We found three breaches of the regulations in respect of medicines management, risk management and care planning. This was the third occasion the provider had failed to meet the regulations as they were also rated as requires improvement in January 2016 and March 2017. Therefore, following the inspection of 13 and 14 February 2018, we imposed conditions on the provider’s registration that required them to send us a monthly improvement plan to show what they would do and by when to improve the service.

Following the last inspection of 13 and 14 February 2018, regular meetings had been held with the registered persons, CQC, the local authority safeguarding team and the commissioners of services. The clinical commissioning group medicines optimisation team, infection control team and local commissioners of services had worked with the provider and the management team and staff to support them with improvements. The provider had voluntarily suspended admissions to the home and an agreement was made to allow a restricted number of admissions to the home until the commissioners were satisfied that significant improvements had been made. An action plan was available to support further improvements and was regularly updated by the provider and shared with local commissioners and CQC.

At this inspection, we found the rating had improved to ‘Good’.

The management of people's medicines had improved and they were managed in a safe manner. People had their medicines when they needed them. Staff administering medicines had received training and supervision to do this safely.

Records relating to people's care and support had improved. The information in people's care plans was sufficiently detailed to ensure they were at the centre of their care. We discussed how the information could be improved. People's care and support was kept under review and, where possible, people were involved in decisions about their care. Risks to people's health and safety had been identified, assessed and managed safely. Relevant health and social care professionals provided advice and support when people's needs changed.

Improvements had been made to ensure the home was a clean, safe and comfortable place for people to live in. However, there had been slow progress with further improvements to people’s bedrooms. Following the inspection, the registered manager sent us a detailed improvement plan with clear timescales. Appropriate aids and adaptations had been provided to help ma

We carried out an inspection of Fern Hill House Care Home on 13 and 14 February 2018. The first day was unannounced.

Fern Hill House Care Home provides accommodation and care and support for up to 24 people, some of who were living with dementia or mental ill health. There were 14 people accommodated in the home at the time of the inspection.

Fern Hill House Care Home is located on a main road close to the town centre facilities of Bacup. It is an older style property with facilities on three floors, which could be accessed by steep staircases or a number of chair lifts and a passenger lift. There was a small car parking area with a gated seating and smoking area to the front of the house.

Fern Hill House Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as 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.

At the time of our inspection the registered manager had not been managing the service since January 2018. A new manager had been recruited and was due to start working at the service from 26 February 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. In the interim period the service was being managed by an area manager and a deputy manager.

At the last inspection on 7 and 10 March 2017 our findings demonstrated there were four breaches of the regulations in respect of risk management, care planning, maintaining the environment and a continued breach relating to quality assurance systems. Following the last inspection we met with the provider and asked them to complete an action plan to show what they would do to improve the service to at least good and to identify the date when this would be achieved.

Following the last inspection regular meetings had been held with the registered persons, CQC, the local authority safeguarding team and the commissioners of services. The clinical commissioning group medicines optimisation team, infection control team and local commissioners of services had worked with the provider, the previous and current management team and staff to support them with improvements. Following recent concerns the provider had voluntarily suspended admissions to the home until they, the commissioners and CQC were satisfied that significant improvements had been made. Following the inspection the providers met with the commissioners and an agreement was made to allow a restricted number of admissions to the home; we were told this would be kept under review. An action plan was available to support further improvements; this was regularly updated by the provider and shared with local commissioners and CQC.

During this inspection we found improvements had been made to address the shortfalls in the environment and quality assurance and auditing systems. However, our findings demonstrated a breach of regulation relating to medicines management and continued breaches of regulation in relation to risk management and care planning. The home was rated as requires improvement in January 2016 and March 2017. This is therefore the third occasion the provider has failed to meet the regulations.

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.

There had been a lack of consistent management and a lack of effective communication which had slowed progress to make improvements. The current management team had been in post for a short time and it was clear that they and the staff had worked hard as a team to introduce ch

We carried out an inspection of Fern Hill House Care Home on 7 and 10 March 2017. The first day was unannounced.

Fern Hill House Care Home changed its name from Burwood Care Home in June 2016 and amended their registration to accommodate younger people and people with mental ill health.

Fern Hill House Care Home provides accommodation and care and support for up to 24 people, some of who were living with dementia or mental ill health. There were 22 people accommodated in the home at the time of the inspection.

Fern Hill House Care Home is located on a main road close to the town centre facilities of Bacup. It is an older style property with facilities on three floors, which could be accessed by steep staircases or a number of chair lifts and a passenger lift. There was a small car parking area with a gated seating area to the front of the house. A dining room and two lounges were available on the ground floor with quiet seating areas around the home. Bathroom, shower rooms and toilet facilities were available. One bedroom had ensuite bathroom facilities and others were located near to toilet facilities or were provided with commodes.

The service was managed by 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.

At our last inspection on 20 and 24 January 2016 we found the service was not meeting all the standards assessed. We found shortfalls in the management of medicines, infection control processes, recruitment practices and a lack of effective quality assurance and auditing systems. Following the inspection we contacted the local authority infection control lead who visited the home and provided support and advice to help them improve cleanliness and infection control.

We also recommended the improvement plan dates were followed to make sure people lived in a comfortable and suitable environment and that the provider should consider the relevant guidance and principles associated with the implementation and use of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.

Following the inspection of 20 and 24 January 2016 we asked the provider to take action to make improvements and to send us an action plan. In addition following our inspection a number of safeguarding concerns had been raised about the care and support people were receiving and about the environment. The local authority safeguarding team, medicines management team, infection control lead nurse, fire safety officer and local commissioners had visited the home and worked with management and staff to support them to make improvements.

During this inspection, we found some improvements had been made to the management of medicines, infection control processes and recruitment practices. Limited progress had been made in providing effective quality monitoring systems and in meeting the recommendations. Our findings demonstrated there were four breaches of the regulations in respect of risk management, care planning, maintaining the environment and quality assurance systems. 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 any concerns found during inspections is added to reports after any representations and appeals have been concluded.

We also made recommendations about ensuring people were able to participate in decisions relating to their care and ensuring assessments and decisions relating to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards were recorded.

People told us they felt safe and staff were kind and caring. Safeguarding adults’ procedures were in place and staff understood how to safeguard people from abu

We carried out an inspection of Burwood House on the 20 and 25 January 2016. The first day was unannounced. This was the first inspection of the service following registration with the commission on 10 April 2015.

Burwood House provides accommodation and personal care for up to 24 people. There were 20 people accommodated in the home at the time of the inspection. The home is an older type property located just off the main road close to the town centre of Bacup, Lancashire. The service is mainly provided to older people with needs relating to old age and for people living with dementia.

The service was managed by 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 had been in post since June 2015 and registered with the commission in October 2015.

During this inspection visit we found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, relating to ineffective quality assurance and auditing systems, management of people’s medicines, infection prevention and control and recruitment processes. You can see what action we told the registered provider to take at the back of the full version of the report.

We also made recommendations about maintaining and developing the environment and developing and improving processes with regards to the Mental Capacity Act 2005 (MCA).

People told us they did not have any concerns about the way they were cared for. They told us they felt safe and were looked after. Relatives told us they had no cause for concerns. One relative said, “I am confident (my relative) is safe here.” We observed people were comfortable around staff. We observed staff responding to people in a patient, good humoured and caring manner and we observed good relationships between people.

We looked at how the service managed people’s medicines. We found areas where improvement was needed. Staff who administered medicines were undertaking appropriate training. However, regular checks on their practice had not been undertaken to ensure they were competent to manage people’s medicines. We were told night care staff did not administer medicines during the night. We were told people did not require medicines during the night but we were concerned they would not receive medicines such as for pain relief during the night. We found processes were in place for the ordering and receipt of medicines although improvements were needed to ensure storage was appropriate and to ensure disposal of medicines was safe.

We did not look at all areas of the home but found some areas of the home were not clean and hygienic. We noted some improvements had been undertaken but other areas were in need of maintenance, redecoration and refurbishment. However, people were satisfied that improvements were being made. One person said, “The layout isn’t brilliant although I have noticed other improvements are being made.” A development plan was in place for the next 12 months; this was updated following our inspection. People told us they were happy with their bedrooms and some had created a homely environment with personal effects.

The number of shortfalls we found indicated quality assurance and auditing processes had been ineffective as matters needing attention had not always been recognised or addressed. This meant the registered providers had not identified risks to make sure the service ran smoothly. We were told that audits had only recently been introduced to check the quality of the service.

We looked at how staff were recruited and found areas where improvement was needed. We found relevant checks had not been carried out before two staff members started working in the home. This meant a fair and safe recruitment process had not always been followed.

People using the service, their relatives and staff told us there were sufficient numbers of staff to meet people’s needs in a safe way. Staff told us any shortfalls due to leave or sickness were covered by existing care staff or by the registered manager. This ensured people were cared for by staff who knew them.

People made positive comments about the staff that cared for them. Comments included, “The staff are marvellous; they will do anything for you” and “I’m treated properly, with respect. Staff are always kind and caring.” A health professional said, “The staff are passionate about people’s care.”

Staff were able to describe the action they would take if they witnessed or suspected any abusive or neglectful practice. We found most staff had not received training on the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS). This meant they had limited knowledge of the principles associated with the legislation and people’s rights.

People felt staff had skills and knowledge to provide them with effective care and support and were happy with the care they received. There were no records to demonstrate the training that staff had undertaken which made it difficult to determine when and whether staff had received a range of appropriate training. Staff told us their training had been kept up to date under the previous provider and that mandatory training was now booked.

Staff told us they were able to voice their opinions and share their views. They felt there was good communication with the management team and they were supported by a manager who listened to them.

People told us they enjoyed the meals. One person told us, “The meals are very good; we have a choice.” The menus and records of meals served indicated people were offered meal choices and also alternatives to the menu. People were served drinks and snacks throughout the day. People’s dietary preferences and any risks associated with their nutritional needs were recorded and appropriate professional advice and support had been sought when needed. People’s healthcare needs were met and appropriate referrals had been made to specialist services as appropriate.

All people had a care plan, which had been reviewed and updated on a monthly basis. Information was included regarding people’s likes, dislikes and preferences, routines, how people communicated and risks to their well-being. Additional information was needed to ensure people received the care and support in a way they both wanted and needed. People told us they were kept up to date and involved in decisions about care and support but had not always been formally involved in the review of their care.

There were opportunities for people to engage in suitable activities both inside and outside the home. People said, “I always have things to do and people here can be very good company” and “We do a few things now and then and sometimes go out.”

People were aware how to make complaints and were confident the manager would listen and take appropriate action. People told us they had not needed to complain and that any minor issues were dealt with informally and promptly.

People living in the home and relatives spoken with made positive comments about the management of the home and were happy about the necessary improvements being made to the service. People told us, “The manager has made a number of changes since she started; things are improving” and “Things are improving week on week.”