CQC report explained · a residential care home
What the CQC found at Fern House
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Requires improvement
- Medicine systems, staffing, safeguarding and infection control had improved. However, some medicine records were incomplete, medicine storage had not always been shown to be safe, and actions after repeated falls were not always followed up.
- Effective?
- Good
- This focused inspection did not assess the Effective key question.
- Caring?
- Good
- This focused inspection did not assess the Caring key question.
- Responsive?
- Requires improvement
- This focused inspection did not assess the Responsive key question.
- Well-led?
- Requires improvement
- Leadership, communication and quality monitoring had improved. However, the home was still recruiting a manager, and further work was needed on accident investigations and care records.
What inspectors found, October 2021
Fern House is rated Requires Improvement and is no longer in Special Measures; inspectors found progress but medicines records, risk follow-up and management systems still needed work.
This was an announced, focused inspection. Inspectors visited the home on 10 August 2021 and reviewed records and information until 20 August. They spoke with people, relatives and staff, observed care, and checked medicines, care records, recruitment and management systems.
The home had improved since its previous Inadequate rating. Inspectors found enough staff, better safeguarding, improved medicines systems, safer premises and good infection control. People and relatives generally spoke positively about the care and staff.
Some important systems were still not reliable enough. Records for creams and some when-required medicines were incomplete, fridge temperatures raised concerns about medicine storage, and follow-up after repeated falls was not always effective. Care records and accident investigations also needed more work.
The overall rating and both inspected areas, Safe and Well-led, were Requires Improvement. The home was previously in Special Measures and had breached regulations at the last inspection, but inspectors found it was no longer in breach and had left Special Measures.
Enough staff
Inspectors found enough staff to meet people's needs. People and relatives said staff were available and responded quickly.
“Our observations showed staff were available and responsive to people and this was confirmed in discussions with people and relatives.” from the report
Safeguarding
Systems for recognising, reporting and managing safeguarding concerns had improved. Staff had received training and understood what to do if abuse was suspected.
“Systems for monitoring and reporting safeguarding incidents had improved.” from the report
Infection control
Inspectors were assured that the home had suitable arrangements for infection prevention, including PPE, testing, cleaning and visits during the COVID-19 pandemic.
“We were assured the provider was using PPE effectively and safely.” from the report
Positive views from people
People and relatives generally spoke warmly about the care, staff and atmosphere in the home.
“I would recommend this home as you get well looked after, fed well and my room is bright and airy.” from the report
Improved monitoring
The provider had introduced stronger audits and a governance committee to monitor the improvement plan and provide oversight.
“Quality audits had improved. Issues were identified and actions completed.” from the report
Incomplete medicine records
needs fixingRecords for creams were not always completed. Guidance and some supporting information for when-required and variable-dose medicines were also missing.
“However, the records for topical preparations such as creams were not always completed, and guidance was not always in place.” from the report
Medicine storage
seriousFridge records showed temperatures above the recommended maximum for the first ten days of August. The provider acted during the inspection, but inspectors could not be sure medicines had been stored safely.
“The records for fridge temperatures showed a maximum temperature above that recommended for the first ten days in August 2021 so we could not be sure that medicines were stored safely.” from the report
Follow-up after falls
seriousRisk management had improved, but actions intended to reduce the risk for a person with repeated falls had not always been followed up.
“one person had repeated falls and actions identified to mitigate the risk had not been followed up.” from the report
Care records needed updating
needs fixingSome care records were better, but one person's records had not been updated after they moved from extra care housing into the care home.
“we saw care records had not been updated for a person who had moved into the care home from extra care housing.” from the report
- 01How are you checking that records for creams and when-required medicines are completed correctly?
- 02What action was taken after the fridge temperatures went above the recommended level, and how do you now monitor medicine storage?
- 03How do you make sure actions after falls are completed and checked?
- 04Who is currently responsible for managing the home while a new manager is being recruited?
- 05What is the timetable for updating care records and completing accident investigations?
This was a focused inspection of Safe and Well-led only; the other three key questions were not assessed in this report. This explanation was written from the published report of 7 October 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, February 2021
Fern House was rated Inadequate and placed in special measures after inspectors found people were at risk and leadership systems were not effective.
This was an unannounced focused inspection. Inspectors visited between 15 and 29 January 2021, spoke with people, relatives and staff, and checked care, medicine, staffing and management records.
Inspectors found serious safety problems. Medicines were not always recorded or given safely, risks and accidents were not managed properly, safeguarding procedures were inconsistent, and staffing levels were not formally calculated. The home was clean, infection control was strong, and recruitment checks were completed safely.
The home had not made enough improvement since its previous inspection, when it was rated Requires Improvement. Problems with medicines, risk management and governance continued. Inspectors also found failures to notify CQC about some significant events.
The overall rating and the ratings for Safe and Well-led were Inadequate. The home was placed in special measures, meaning CQC said it would keep the service under review and re-inspect within six months unless enough improvement was made.
Infection control
Inspectors were assured that infection prevention arrangements were effective during the COVID-19 pandemic.
“We were assured that the provider was using PPE effectively and safely.” from the report
Positive views from people
People and relatives spoke positively about the care and praised the staff.
“People and relatives we spoke with gave positive feedback about the care they received and praised the staff.” from the report
Safe recruitment
The required recruitment checks were completed before new staff started work.
“Recruitment processes were safe with all required checks completed before new staff started employment.” from the report
Clean surroundings
The care home was described as clean and pleasant.
“People lived in a clean and pleasant environment.” from the report
Medicines
seriousMedicine records were incomplete and instructions for some medicines were unclear. This included prescribed creams, pain patches and medicines used when people were anxious or agitated.
“Medicines management was not always safe.” from the report
Risks and accidents
seriousRisk assessments were not always updated after falls or changes in need. Accidents and incidents were not consistently recorded or reviewed, so repeated harm was not always prevented.
“The lack of robust risk management processes meant people were not protected from harm or injury.” from the report
Safeguarding
seriousSome safeguarding incidents were not reported to the local authority or CQC, and investigations were not always carried out when people were harmed or had unexplained injuries.
“The provider failed to ensure people were protected from the risk of abuse.” from the report
Staffing levels
needs fixingThere was no formal method for calculating safe staffing levels. Records showed the expected staffing levels were not always maintained, and staff said they were sometimes rushed.
“The provider had no formal system in place to calculate safe staffing levels.” from the report
Weak management oversight
seriousThe provider's audits and reviews failed to find or fix repeated problems. Incident records seriously understated what had happened, and care records and risk assessments were not always accurate or up to date.
“We found systems to assess, monitor and improve the service were not sufficiently robust.” from the report
- 01What specific changes have been made to medicine records, including topical medicines and medicines given when needed?
- 02How are falls, unexplained injuries and incidents between people now reported, investigated and reviewed?
- 03How do you calculate the number of staff needed on each shift, and how do you respond when staffing falls below that level?
- 04What evidence can you show that risk assessments and care plans are updated when people's needs change?
- 05How do you now make sure all deaths, safeguarding concerns and serious injuries are reported to CQC and the local authority?
This was a focused inspection of Safe and Well-led, with infection control also checked under Safe; the other ratings were carried over from the previous comprehensive inspection. This explanation was written from the published report of 24 February 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.
Every inspection of Fern House
4 rated inspections over 3 years: the service has held its Requires improvement rating throughout.
- October 2021Requires improvementcurrent ratingup from InadequateSafe: Requires improvementEffective: GoodCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- February 2021Inadequatedown from Requires improvementSafe: InadequateWell-led: Inadequate
- January 2020Requires improvementstayed Requires improvementSafe: Requires improvementWell-led: Requires improvement
- October 2018Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- July 2017
Registered with the Care Quality Commission on 5 July 2017.
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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