About the service

Fernbank Nursing Home is a nursing home providing accommodation and personal care to 23 adults and older people at the time of the inspection.

People’s experience of using this service

People were very happy living at the home because they felt safe and all their needs were met by kind and caring staff. Relatives were pleased with the service provided to their family members and staff enjoyed working at the home.

Everyone we spoke with praised the registered manager and agreed that they were approachable, knowledgeable, fair and did their job well. A staff team who worked well together supported the registered manager. The provider employed enough staff to make sure people’s need were met in a timely way. The provider had designed a recruitment process to make sure they only employed suitable staff.

The staff team was committed to providing a high-quality service and keeping people safe. They had undertaken training in a wide range of topics so that they were skilled and knowledgeable to effectively meet people’s needs. Staff understood their responsibilities to report any concerns.

Staff encouraged people to be as independent as possible and respected people’s privacy and dignity. All staff welcomed relatives and visitors warmly and treated them as part of ‘the family’.

Staff knew people well. They followed the guidelines in each person’s care plan so that they delivered care and support in the way each person wanted. Staff managed the risks to people’s health and welfare well.

The home was clean, fresh and hygienic. Staff used effective infection control measures to protect people from the spread of infection. Equipment was available when needed to help staff support people in a safe way.

An activities coordinator organised a range of activities for people to do. The home provided nutritious meals and external healthcare professionals supported people to maintain their health.

The registered manager actively sought the views of people and their relatives about the running of the home and they dealt promptly with any concerns that people raised.

The provider had a thorough system in place to monitor and improve the quality and safety of the service provided.

More information is in the full report

Rating at last inspection

At the last inspection we rated this service Good. The report was published on 26 June 2017.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor this service.

This focused inspection took place on 12 June 2017 and was unannounced.

We carried out an unannounced comprehensive inspection of this service on 7 December 2016 and 4 January 2017. Breaches of legal requirements were found, in respect of safe care and treatment, and meeting nutritional and hydration needs. We rated the service as Requires Improvement.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach. We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection by selecting the 'all reports' link for this service on our website at www.cqc.org.uk.

Fernbank Nursing Home is registered to provide accommodation and personal care for up to 34 people and specialises in dementia care. The home is run by a private partnership. There were 23 people using the service at the time of this inspection.

The service had a registered manager, which 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 this inspection, we found that the provider had followed their plan and legal requirements had been met. Records and feedback showed that people were supported to eat and drink enough, and that they were provided with more choice around meals and snacks. There was good oversight of their malnutrition and dehydration risks, and we found that action was taken where concerns were identified.

Procedures to minimise the risks of people developing pressure ulcers were now consistently followed. Individual choking risk assessments had been developed. Staff followed people’s individual care plans in relation to choking risks.

Referrals to community specialists for support with concerns relating to people’s care and treatment took place where appropriate. Procedures had been reviewed and streamlined to enable quicker access.

The way the service was being managed identified risks to people’s safety and welfare, and took action to address concerns arising from this. There was a willingness to learn from audits and concerns so as to improve services to people.

People we spoke with told us they would recommend the service to others, which matched the sentiments of recent online feedback we saw from relatives. Staff spoke highly of the support they had for their roles in the service.

This was an unannounced inspection that took place on 7 December 2016 and 4 January 2017. Fernbank Nursing Home is registered to provide accommodation and personal care for up to 34 people and specialises in dementia care. The home is run by a private partnership. There were 23 people using the service at the time of this inspection.

At the last inspection on 1 May 2014, we asked the provider to take action to attend to maintenance matters around the building. The provider subsequently wrote to us to say what they would do in relation to this breach of legal requirements. At this visit, we found these matters to have been addressed.

The service had a registered manager, which 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.

People and their relatives reported a caring service, which we saw to be the case. Along with the pleasant approach of staff, effort was made to understand how people communicated and to respond to them effectively. There was a broad range of activities that were adjusted to people’s abilities, cultures and life histories. The service encouraged community relations and so there were frequent visitors, entertainers and religious services at the premises. The service promoted a positive culture that tried to enhance the lives of people using it.

People’s medicines were safely managed, and there were enough staff working at the service. The service was kept clean and infection control procedures sufficiently protected people. There was a willingness to learn from quality auditing processes and concerns raised by anyone, so as to improve services to people.

However, we found some concerns about the safety and effectiveness of the service. Charts used to record the treatment of people at risk of pressure ulcers, malnutrition and dehydration were not consistently completed. There were no individual choking risk assessments. Referrals to community specialists for support with these matters were not always timely. This all failed to demonstrate safe care and treatment of some people using the service, and that some people’s nutritional needs were consistently met.

There were overall two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

We considered our inspection findings to answer questions we always ask; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People were protected from the risks of inadequate nutrition and dehydration. We saw that people were provided with drinks throughout the day. One person told us, “You’re always asked if you want a drink.”

We noted poor electrical maintenance in several areas of the building; therefore people were not always protected from the risk of unsafe or unsuitable premises.

Is the service effective?

Staff received appropriate support and supervision to enable them to deliver care and support to people to an appropriate standard.

Is the service caring?

Most people we spoke to told us that staff were caring and responsive to people’s needs and people told us that staff treated them well.

Is the service responsive?

We saw that staff had identified people’s cultural and religious needs. We saw that weekly church services took place to attend if they wished to. One person told us that they enjoyed listening to the service.

Is the service well-led?

We reviewed several monthly audits that took place and spot checks that took place at the service. However these were not always effective in identifying issues, such as electrical maintenance.

Staff told us they were clear about their roles and responsibilities. Staff we spoke with showed that they understood the needs of individual people they cared for. People were cared for by staff who understood their needs.

People using the service told us that they liked it at the home and that staff were kind. One person said, “it is always good. The staff are nice, friendly and helpful.” Another person said, “the staff look after people properly. When you call them they come. I have good relations with staff.” One of the relatives we spoke with said, “It’s very good. They do their best.” The visiting health professional said, “staff are very cooperative and welcoming. They did what I asked them to do.”

There was a warm and positive atmosphere at the service. The service was clean and presented well with photos of social events on display. We observed staff working kindly and carefully with people using the service. They spoke with people who use the service without rushing. The people we spoke with said they felt safe at the service. Staff told us that they were supported in their work and there was good teamwork. We saw that staff had received regular staff supervision and appraisal. Staff were knowledgeable about safeguarding matters and we were shown evidence that staff had received safeguarding training

We were shown evidence that a range of quality checks and audits were carried out and the manager described what further work was being planned such as relatives meetings, surveys and staff training.

People who use the service informed us that they were satisfied with the services provided and they were well cared for. They stated that staff had treated them with respect and dignity. We observed that people who use the service appeared comfortable and staff were caring and attentive towards them.

The arrangements for the provision was meals was satisfactory and people who use the service stated that they were satisfied with the quality and variety of meals provided.

People who use the service stated that staff wore gloves and apron when needed. The home had appropriate infection control procedures.

The arrangements for the administration of medication were well managed and there was evidence that people had been given their medication.

People who use the service informed us that the premises had been kept clean and they were pleased with their accommodation. The premises were well maintained.

People who use the service indicated that staff had treated them with respect and dignity. This was confirmed by a relative we spoke to. They spoke positively of staff and indicated that staff were caring towards them. Their views can be summarised by the following comments :

"Staff treat me with respect and they ask my permission before entering.”

“They show respect for me and talk nicely to me.”

“Yes, I feel safe here.”

We observed that staff were respectful when talking to people who use the service and they knocked on doors before entering.

A few people who use the service however, made negative remarks about some staff. One stated that some staff talked down to them while another indicated that a staff member had been intimidating in his behaviour. One person stated that staff seldom attempted to interact with people who use the service.

The manager reassured us that the home had provided training for staff to ensure that they treat all people with respect and dignity. She indicated that she would look at the concerns expressed.

The home had suitable arrangements to safeguard people who use the service. Staff had received training on safeguarding and were aware of the procedure to follow if they were aware or suspected that people were being abused. We noted that the registered manager had co-operated fully with social services staff in responding to a recent concern raised.

People who used the service were satisfied with the care provided and they indicated that their needs had been attended to. They spoke positively of staff and stated that staff had treated them with respect and dignity. Their views can be summarised by the following comments :

"The staff treat me with respect. They talk to me and discuss my care with me.”

“Yes, I feel safe here.”

“They take good care of me.”

We observed that people who use the service were well cared for. Staff were observed to be interacting regularly and talking with people who use the service. They were also observed to be offering drinks to people who use the service.

We were able to speak to relatives in the home. The feedback received was positive and indicated that people who use the service were well cared for and their needs had been met. Their views can be summarised by the following comment:

“The staff are pleasant and helpful. The care is good.”