CQC report explained · a residential care home
What the CQC found at Fern Hill House Care Home
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Requires improvement
- Risk management had improved, but some risk records were not accurate or detailed enough, and equipment servicing had not always been kept up to date. Medicines recording also needed improvement.
- Effective?
- Good
- This question was not inspected during this visit. Its previous rating was used in calculating the overall rating.
- Caring?
- Good
- This question was not inspected during this visit. Inspectors did observe kind and respectful interactions.
- Responsive?
- Good
- This question was not inspected during this visit. Care records reflected people's choices, preferences and diverse needs.
- Well-led?
- Requires improvement
- Management systems and audits had improved but were not yet robust or embedded. Shortfalls were identified, but action plans were not always in place.
What inspectors found, April 2021
Rated Requires Improvement; inspectors found clear progress since an Inadequate rating, but safety and management systems were not yet reliable.
This was an unannounced focused inspection on 16 and 17 March 2021. Inspectors checked whether the home had acted on an earlier action plan, warning notice and breaches about safety and management. They observed care, spoke with people, staff, a visitor and relatives, and checked care, medicines, recruitment and management records.
The home had improved its risk management, staff training, infection control, incident reviews and care records. People appeared settled and were treated with kindness and respect. Relatives said communication was good and had no concerns about their family members' safety.
Important problems remained. One person's falls risk score was out of date, another person's behaviour support plan lacked enough guidance, and lift servicing had been overdue. Medicines records were incomplete, fire safety work was not fully signed off, and quality audits did not always lead to action plans.
The overall rating improved from Inadequate to Requires Improvement, and the home left Special Measures. However, the home was still in breach of Regulation 12 about safe care and treatment and Regulation 17 about good governance.
Kind and respectful care
People looked settled and happy. Inspectors saw staff providing attentive, kind and patient care.
“People looked settled and happy and we observed them being treated with respect.” from the report
Improved infection control
The home had appropriate protective equipment and visiting arrangements. Inspectors found no COVID-19 outbreaks during the inspection period.
“There had been no COVID-19 outbreaks at this service.” from the report
Better incident management
The home had improved how it recorded and reviewed accidents and incidents. Actions were taken to reduce risks and lessons were shared with staff.
“Improvements had been made to the way accidents and incidents were recorded, analysed and acted on.” from the report
Staffing and recruitment
Recruitment checks were in place and records showed consistent staffing levels. Relatives spoke positively about staff knowledge and support.
“Records showed there were consistent numbers of staff available to meet people's needs.” from the report
Risk records and equipment checks
seriousA falls risk score did not reflect recent falls, and a behaviour support plan lacked enough guidance. The lift had an overdue service, creating a continued safety breach.
“one person's fall risk score was not reflective of the number of recent falls despite a recent review” from the report
Medicines records
needs fixingRecords did not always show that creams had been applied as prescribed. Records of medicines ordered were not maintained, and the home was asked to follow best practice.
“Medicine administration records (MARs), in relation to the application of external creams were not always completed” from the report
Quality monitoring
seriousAudits identified problems, but action plans were not always created. The quality monitoring system was not yet robust enough to ensure improvements were sustained.
“The provider had failed to operate a robust quality monitoring system, which could potentially impact on people's safety and wellbeing.” from the report
Outstanding fire safety work
seriousThe serious concerns in the fire safety enforcement notice had been addressed, but further work still needed to be completed and signed off by the fire officer.
“However, additional work was required to ensure compliance with the fire safety notice.” from the report
- 01Have the outstanding fire safety works now been completed and signed off by the fire safety officer?
- 02How do you now check that falls risk scores and behaviour support plans remain accurate and give staff enough guidance?
- 03Has the lift been serviced, and how do you make sure all equipment servicing stays up to date?
- 04How are cream applications, medicines ordered and medicines for disposal recorded and checked?
- 05What action plans now follow each audit, and how do you check that improvements are sustained?
This was a focused inspection of Safe and Well-led, including infection control; the other key question ratings carried over from the previous comprehensive inspection. This explanation was written from the published report of 9 April 2021 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, December 2020
Rated Inadequate and placed in special measures; inspectors found serious fire, risk-management, infection-control and leadership failures.
Inspectors visited on 10 and 12 November 2020. They spoke with relatives, staff and a visiting professional, and reviewed care, medicines, recruitment, training and management records. They could not speak directly to residents because of COVID-19 restrictions.
The home was not safe. Fire escapes and fire safety arrangements were not adequate, important risks such as choking and dehydration were not properly assessed, and some staff had not completed required training. Infection-control and cleaning arrangements also put people at risk of infectious disease.
The home was not well-led. Audits had not found or resolved serious problems, and there was no registered manager at the time of the inspection. The overall rating fell from Good at the previous inspection to Inadequate.
The inspection was focused on Safe and Well-led. The other three key question ratings were not inspected and were carried over from the previous comprehensive inspection.
Safe recruitment
The home had recruitment checks in place before staff started working there.
“The service had safe recruitment systems and processes in place.” from the report
Medicines
Inspectors found medicines were administered, stored and recorded safely, with checks on staff competence.
“Medicines were managed safely. Staff administered people's medicines in line with current guidance and medicines records included all necessary information.” from the report
Professional support
The home worked with a range of outside professionals to support residents' care.
“The service worked in partnership with a range of professionals to ensure people received the care and support they needed.” from the report
Safeguarding referrals
Records showed that safeguarding concerns had been notified to the relevant bodies, although staff training in this area was incomplete.
“Records showed notifications had been completed for any safeguarding concerns and sent to the relevant bodies.” from the report
Fire safety
seriousFire escapes were dangerous, fire equipment was not properly managed and an earlier fire service notice had largely not been acted on. The fire service took immediate steps and agreed an improvement plan.
“An official fire service notice from November 2018 identifying a number of areas of concern had not been acted upon and most of the issues remained at this CQC inspection.” from the report
Unmanaged care risks
seriousSome residents had risks such as choking, weight loss or dehydration, but care plans did not always explain how these risks would be managed. Accident records were not reviewed to identify follow-up action.
“The risks to people's health and wellbeing had not always been appropriately managed.” from the report
Infection control
seriousSome staff had not completed infection-control training. Inspectors also found problems with PPE waste and dirty equipment, although these areas had improved by the second day.
“People were being put at risk from the transmission of Covid-19 and other infectious disease because of inadequate infection prevention, cleaning and control processes.” from the report
Staff training
seriousStaff were working together without completing required training in areas including safeguarding, fire safety, infection control, health and safety, and moving and handling.
“We reviewed training records and found multiple occasions when staff were working together without having undertaken the provider's mandatory training.” from the report
Weak oversight
seriousManagement audits and action plans did not identify or resolve the serious problems found. The provider had not shown that the new manager was being given enough support.
“Audits were not effective and did not identify the issues we found during this inspection.” from the report
Communication
needs fixingSome relatives said they were not kept informed and there were no relatives' meetings. Resident meetings had covered very little, and staff surveys had not been analysed.
“We do not get any updates in writing or any newsletters or emails.” from the report
- 01What action has been completed to make the fire escapes, fire equipment and fire risk assessment safe, and can we see the latest fire service findings?
- 02How are choking, weight loss, dehydration and other individual risks assessed, reviewed and followed up after accidents or incidents?
- 03How many current staff have completed safeguarding, fire safety, infection control, health and safety, and moving and handling training?
- 04What has been done to improve cleaning, PPE waste disposal and infection-control checks since the inspection?
- 05How are relatives now kept informed, and how are residents' and relatives' views used to improve the home?
This was a focused inspection of Safe and Well-led only; Effective, Caring and Responsive were not inspected and their previous ratings were used. This explanation was written from the published report of 25 December 2020 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Fern Hill House Care Home
6 rated inspections over 5 years: the service has held its Requires improvement rating throughout.
- April 2021Requires improvementcurrent ratingup from InadequateSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- December 2020Inadequatedown from GoodSafe: InadequateWell-led: Inadequate
- September 2018Goodup from Requires improvementSafe: GoodWell-led: Good
- April 2018Requires improvementstayed Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- September 2017Requires improvementstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- March 2016Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- April 2015
Registered with the Care Quality Commission on 7 April 2015.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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85 live-in carers within about an hour of Lancashire
These are self-employed carers on PrimeCarers, the introductory agency that runs this directory. Each has a profile with their own rates and reviews from families, and you choose who to talk to.
Most charge £980 to £1,260 a week. 78 can care for a couple. 11 years' experience on average.
“She understands the needs of an elderly person in the early stages of dementia and has treated my mother with great kindness and skill.”
“Thanks to Tracy, Dad was always immaculately dressed and clean, his meals were all home cooked and nutritionally well balanced and his home was always kept really clean and tidy.”
Every carer has had an enhanced DBS check in the last 18 months, ID and right-to-work checks and an online interview. Their skills and training are for you to check with them. Carers set their own rates, and who is free changes week to week.