CQC report explained · a nursing home
What the CQC found at Fernhill 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
- Inspectors found problems with topical creams, covert medicines, expired DoLS authorisations and wound-care information. They also found safeguarding systems, staffing, recruitment and infection-control arrangements were satisfactory.
- Effective?
- Good
- This question was not inspected during this focused visit. Its previous rating was carried forward when calculating the overall rating.
- Caring?
- Good
- This question was not inspected during this focused visit. Its previous rating was carried forward when calculating the overall rating.
- Responsive?
- Good
- This question was not inspected during this focused visit. Its previous rating was carried forward when calculating the overall rating.
- Well-led?
- Requires improvement
- The home's audits did not identify important problems with records, consent and medicines. Inspectors also found an open culture and management that responded to feedback.
What inspectors found, January 2024
Fernhill House is Rated Requires Improvement; inspectors found concerns about medicines, consent and record keeping, despite kind care and responsive management.
This was an unannounced focused inspection on 20 and 23 November 2023. Inspectors looked only at Safe and Well-led, after concerns about medicines, falls and a possible delay in emergency medical care. They spoke with people, relatives and staff, and reviewed care, medicines, recruitment and management records.
The home was not always safe. Some creams were unsecured, lacked risk assessments or had incomplete labels. One person received medicines covertly without the required best-interest process or evidence of pharmacist advice. Some DoLS authorisations had expired, and some care plans and risk assessments were out of date.
The home was not always well-led. Audits had not found problems with records, medicines and consent. Inspectors also found limited improvement in wound-care plans. However, people and relatives spoke positively about the staff and management. The overall rating changed from Good at the previous inspection, published in October 2018, to Requires Improvement.
Safeguarding
People were protected by safeguarding systems, and staff had received training about abuse.
“People were safeguarded from the risk of harm or abuse.” from the report
Staffing and recruitment
Inspectors found enough staff to meet people's needs and safe recruitment checks.
“Safe recruitment practices were in place to ensure only staff suitable to work with vulnerable people were employed.” from the report
Open management
People, relatives and staff described managers as approachable and willing to listen. The manager was involved in the day-to-day running of the home.
“There was an open and positive culture.” from the report
Infection control
Inspectors were assured that the home had suitable arrangements for preventing and managing infections.
“We were assured that the provider was using PPE effectively and safely.” from the report
Medicines and creams
seriousSome topical creams were not securely stored, and some lacked risk assessments, prescription labels or opening dates. Inspectors also found concerns about medicines given covertly.
“There were no risk assessments for paraffin based topical creams.” from the report
Consent and legal safeguards
seriousThe home did not always follow the Mental Capacity Act. Covert medicines were started without evidence of a best-interest decision, and three DoLS authorisations had expired without evidence of re-application.
“The covert procedure had already been implemented without a DoLS or best interest decision prior to this being commenced.” from the report
Care records
seriousSome care plans and risk assessments were overdue. Inspectors also found limited evidence that wound-care plans had improved after earlier local authority feedback.
“Some people's care plans, and risk assessments were out-of-date on the first day of our inspection.” from the report
Quality checks
seriousThe home's audits had not identified the problems found during the inspection. This meant the provider's systems were not reliably driving improvement.
“Governance at the service was not always effective because the provider's system did not always effectively monitor the quality of care provided to drive improvements.” from the report
- 01What has changed in the process for giving medicines covertly, including best-interest decisions, DoLS applications and pharmacist advice?
- 02How are paraffin-based creams now risk assessed, labelled, dated and stored securely?
- 03Have all care plans and risk assessments been reviewed, and how will you keep them up to date?
- 04What specific improvements have been made to wound-care plans and communication with district nurses?
- 05What evidence can you show that your audits now identify and correct these problems?
This was an unannounced focused inspection of Safe and Well-led only; the other key-question ratings were not inspected and the previous ratings were used to calculate the overall rating. This explanation was written from the published report of 16 January 2024 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, October 2018
Rated Good overall; inspectors found kind, responsive care, but medicines management was not consistently safe.
Inspectors visited the home without warning on 9 and 15 August 2018. They spoke with people living there, relatives, staff and a visiting healthcare professional. They also checked care plans, medicine records, recruitment files, training records and quality checks.
The overall rating was Good. Effective, caring, responsive and well-led were all rated Good. People were treated kindly, involved in daily choices and supported with food, activities, health needs and end-of-life care.
Safe was rated Requires Improvement. Medicine records were sometimes incomplete or did not match the expected amounts. This made it difficult to confirm that some medicines had always been given at the right time or recorded accurately. The home started a new electronic medicines system during the inspection.
Kind relationships
People and relatives described staff as kind and caring. Inspectors saw staff communicating gently and supporting people's dignity and emotional wellbeing.
“People had developed caring relationships with the staff who provided support and showed us they liked the staff who cared for them.” from the report
Enough staff
The home monitored staffing against people's individual needs. Inspectors saw staff providing help without rushing people, and staff were recruited with the required checks.
“There was enough staff to meet people's care needs.” from the report
Choice and activities
People could choose when to get up, what to eat and which activities to join. Activities included music, exercise, trips, poetry and bridge.
“There was a broad range of social activities for people to participate in as they chose.” from the report
Management oversight
The management team used audits, meetings, surveys and feedback to check care and identify improvements. People, relatives and staff were involved in developing the home.
“The provider and registered manager had effective systems in place to assess the quality of service provided with an ambition to achieve outstanding outcomes for people.” from the report
Medicine records
seriousSome medicine records did not show the correct dates or times. Other records did not match the expected medicine amounts, and some handwritten entries lacked a second check.
“We found medicine records were not consistently completed in line with good practice and national guidance and could increase the risk to people's safety.” from the report
Sharing health information
needs fixingWhen one person moved to another area of the home, staff records were unclear about the person's current diagnosis. The management team said it would strengthen how information was shared.
“However, for one-person staff had not fully worked together in an effective way when the person moved to another area of the home.” from the report
- 01How is the electronic medicines system working now, and how do you check that staff record times, doses and controlled drugs correctly?
- 02What checks are made when handwritten medicine records are used, including the required second signature?
- 03How do you make sure current diagnoses and health information are shared when someone moves to another area of the home?
- 04How do you use residents' and relatives' feedback to change care, activities or daily routines?
- 05Which activities and communication support would be available for my relative's particular needs and interests?
This was a comprehensive, unannounced inspection covering all five key questions, with visits on 9 and 15 August 2018; it was the home's first CQC inspection. This explanation was written from the published report of 3 October 2018 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 Fernhill House
2 rated inspections over 5 years: the service has slipped, from Good to Requires improvement.
- January 2024Requires improvementcurrent ratingdown from GoodSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- October 2018GoodSafe: Requires improvementWell-led: Good
- June 2018
Registered with the Care Quality Commission on 22 June 2018.
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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