Ferndale Nursing Home provides accommodation and care, including nursing care, for up to 28 older people and /or people living with dementia. Accommodation is provided over three floors with a dining area and large lounge. There are five double bedrooms and 18 single bedrooms with en-suite facilities. There is a passenger lift to the first and second floor. The home is situated in a residential area of Crawley. One the day of the inspection there were 27 people living at the home.

The home’s provider was also the 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 the last inspection on 20 August 2016, the home was rated as Requires Improvement overall. This was because we found some areas of practice that needed to improve. There were not clear guidelines for staff in administering PRN (as required) medicines and decisions made in people’s best interest had not been recorded in line with the legislation. At this inspection we found that improvements had been made and the provider had addressed these concerns.

People and their relatives were positive about care at the home and told us that they felt safe. Risks were assessed and managed effectively and staff understood how to keep people safe. People received their medicines safely and were supported to access the health care services they needed. There were enough staff on duty and people told us that their call bells were always answered promptly. Recruitment processes were robust and staff received the training and support they needed to be effective in their roles. One staff member said, “We have a lot of training and it is helping me all the time.”

People spoke highly of the caring nature of the staff. One person said, “They really care here it’s not just an act.” A relative told us, “I’m blown away by the care.” Staff knew the people they were caring for well and understood their individual needs. People told us they were included in planning their care and support and that their views were listened to and valued. Staff understood how to protect people’s privacy and dignity, they spoke positively and the home and the people who lived there. One staff member said, “I would definitely be happy for a member of my family to live here if they needed dementia care.” People were supported to have enough to eat and drink. Staff were attentive and supportive to people who needed help with food and drink and managed any risks and nutritional needs appropriately.

Staff had a clear understanding of their responsibilities with regard to the Mental Capacity Act 2005 and sought consent from people before providing care. People’s preferences and views were included in their care plans. Staff used information about people’s backgrounds to engage with them and provide a personalised service. Staff told us that communication and co-operation within the staff team was good at all levels. A staff member said, “Our opinions and suggestions always count.”

People told us they were supported to have enough to do and spoke highly of the activities provided at the home. Staff spent time with people throughout the day and actively engaged with people even when going about their duties. Relatives told us they were welcomed at the home. A staff member said, “We offer tea and coffee as soon as someone comes in. It’s policy to make people welcome and provide a drink, because it should be like visiting their relative in their own home.”

People and their relatives told us that the provider asked for feedback on the service regularly. There was a formal complaints system and people said they would feel comfortable to raise any concerns with staff. The provider had a range of systems and pro

The inspection took place on 2 August 2016 and was unannounced. Ferndale Nursing Home provides accommodation, nursing and personal care for up to 28 people living with dementia. At the time of inspection there were 28 people living at the service. People were mostly older with complex needs associated with living with dementia requiring assistance with personal care and nursing support. Accommodation is provided in an older style building over three floors with a dining area, small lounge and larger lounge situated on the ground floor. There are 18 single and five shared bedrooms some of which had ensuite facilities. All rooms on the first and second floors could be accessed by a passenger lift. The service is located in a residential area with a secure, accessible garden to the rear of the building.

There was an established registered manager in post. 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 previously inspected on 10 and 17 March 2015 and we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider submitted an action plan to address these shortfalls and we reviewed the effectiveness of this plan as part of our inspection.

At our previous inspection on 10 and 17 March 2015 we found that the provider did not always identify individual risks and that records of the care received were not always accurately maintained. At this inspection we found that individual risk care records had improved and individual risk had been identified appropriately. We also found that care records were an accurate reflection of care planned and care received.

At our previous inspection on 10 and 17 March 2015 we also found that the provider had not ensured that water was available and accessible to people at all times. Other drinks were not made available periodically throughout the day and night and people were not encouraged and supported to drink. At this inspection we found that improvements had been made and people were supported and encouraged to have sufficient to eat and drink. Cold drinks were freely available and accessible and a variety of hot drinks were offered to people throughout the day. Fluid and food charts had been completed for people at risk of malnutrition or dehydration and with their permission weights taken to ensure that people were maintaining adequate nutrition and hydration.

The management and administration of medicines was not always safe. People received their regular medicines safely and as prescribed. However, three people were prescribed, ‘as required’ medicines for pain but there was no guidance to staff on when these medicines should be administered or how to recognise when people were in pain. This meant that there was a risk of medicines being given inappropriately and has been identified as an area that needs improvement.

Staff understood the principles of the Mental Capacity Act 2005 (MCA) and sought people’s consent to care and treatment appropriately. However, where people were assessed as lacking capacity it was not clear how or why decisions had been made on their behalf. This meant that decisions made in people’s best interests were not recorded in line with legal requirements and this was identified as an area that needs improvement.

People were protected from harm. Staff had received safeguarding training, knew how to recognise the signs of abuse and understood their responsibilities to report any concerns or poor practice. There was a robust recruitment process in place to ensure that suitable staff were employed who were safe to work with people.

Individual risk assessments were in place to ensure that people’s health needs were app

We used a number of different methods to help us understand the experiences of people who used the service, because some of the people who used the service had complex needs which meant they were not able to tell us their experiences. We spoke with five people who used the service and they told us, " It's alright " and " Why can't' they open the windows to let some fresh air in ", " it's a nice place to live by the sea ".

During our inspection there were 28 people living at the service. We noticed that there was a pleasant rapport between staff and the people who were using the service. We were told by the people who used the service, " the staff are nice, one can be a bit stroppy ", " the food is great ". Three residents stated " I'm bored ". We found people nutritional needs were being met and people who used the service stated " the food is lovely " and " I eat everything ".

We found evidence by talking to people and looking at records that people who used the service who did not have capacity to consent were supported to make choices regarding their care or treatment. We found evidence that the people using the service were not protected from the risk of healthcare related infection and the provider did not have effective systems in place for managing the risks of healthcare related infections.

We found concerns in the inconsistency and storage of people's records

We saw staff listening to people who used the service, responding to them in a polite and courteous way. Staff supported and gently encouraged people to eat and drink at their own pace. People we spoke to told us that the food was ok and that they had alternative choices if they so wished.

People’s needs were assessed and where possible they were consulted and involved in the planning of their care. Staff spoke with their relatives if they were unable or choose not to be involved. Peoples individual needs were being met by staff with the relevant skills, knowledge and up to date training.

Staff told us they received regular supervision and the senior team are available for advice and support. one person said "The managers are approachable and very supportive. We saw the provider regularly assesses and monitors the quality of the service provided to protect people from the risk of inappropriate or unsafe care and treatment.

Monthly audits are carried out on, care plans, risk asessment, medication, accidents, incidents, compliments and complaints, fire safety and the building environment. Any areas for improvement are identified and the appropriate action taken to address any concerns.

An annual customer survey was conducted in June 2012, the majority of the questionnaires were completed by people who used the service with their relatives or by the relatives. Overall the results were positive with 92% of the people stating that they enjoyed the food.

We spoke with two people who live at Ferndale Nursing Home. They told us they were very happy with the care afforded to them. One person told us, “This place is fine. It suits my requirements.” Another person told us, “I am very happy with the care I am given. The staff are kind and considerate.”

We also spoke to two relatives who were visiting the care home. They also confirmed they were satisfied with the care that had been provided. One relative told us, “I have no concerns about the home.” Another relative said, “I am very happy with the care Mum is given.”

We spoke with a trained nurse and two care assistants who were on duty. They demonstrated they knew about the level of care that each person required. They also told us they had been well supported by the manager.

The inspection took place on the 10 and 17 March 2015 and was unannounced.

Ferndale provides accommodation and care including nursing care for up to 28 older people. The accommodation is over three floors with a dining area, small lounge and larger lounge. People living at the home had a range of health and support needs associated with living with dementia.

The service had 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. In this instance the registered manager is also the provider.

At our previous inspection in September 2013 we asked the provider to take action to make improvements to ensure there were effective systems in place to ensure people were protected by the prevention and control of infection. The provider sent us an action plan to tell us the improvements they were going to make. At this inspection we saw that these actions had been completed.

At our previous inspection in September 2013 we asked the provider to take action to make improvements to records as the information was not adequate for staff to plan appropriate care or treatment for people. We also asked the provider to make improvements to ensure that records were kept securely. The provider sent us an action plan to tell us the improvements they were going to make. At this inspection action had been taken to store records securely and some improvements made to records in order to provide information for staff to deliver care or treatment for people. However, information about people’s care and treatment was not always recorded accurately and people and staff were not prevented from avoidable harm or risk as the relevant health and safety concerns were not included in care or treatment plans.

People were supported to eat sufficient to their needs but drinks were not always readily available and records not accurately maintained in relation to the assessment of people’s risk of malnutrition or dehydration.

Relatives were positive about the home. One relative told us, “It is excellent can’t fault it”. They told us that the home had improved since our last visit. One relative said, “It has improved 100% since (deputy manager) came back”. The provider had introduced a number of quality assurance measures since our last visit and action had been taken in response to any issues identified.

People were cared for by kind and compassionate staff who maintained their dignity, respect and privacy. Relatives told us they could visit when they wished and were always made to feel welcome. The provider employed enough trained, qualified and trained staff to keep people safe and followed safe recruitment practices when they employed new staff. Staff knew what action to take if they suspected abuse and had received training in safeguarding adults. Arrangements were in place to keep people safe in the event of an unforeseen emergency. Staff felt supported and were positive about their roles. Staff received training to meet the needs of people living at the home.

The provider had arrangements in place for the safe ordering, administration and disposal of medicines. People were supported to get the medicine they needed when they needed it. People were supported to maintain good health and access to health care services when needed./

Staff followed the requirements of the Mental Capacity Act 2005 (MCA). People’s capacity to make decisions in different areas of their life had been assessed. The registered manager had made applications to the Deprivation of Liberty Safeguards (DoLS) Team to ensure that people who could not make decisions in relation to where their care and treatment was provided had the appropriate safeguards in place.

We found a number of breaches of the Health and Social 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.