CQC report explained · a residential care home
What the CQC found at Fernlea
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- People had individual risk assessments and care plans, and inspectors were assured about infection prevention and control. However, some medicines guidance and storage arrangements needed improvement, and call bells were not always answered quickly.
- Effective?
- Good
- Staff were trained and supervised, supported people's food and drink needs, and helped people access health professionals. An electronic care system had improved the recording of assessments, risks and care.
- Caring?
- Good
- This question was not assessed during this focused inspection. Its previous rating was carried forward.
- Responsive?
- Good
- This question was not assessed during this focused inspection. Its previous rating was carried forward.
- Well-led?
- Good
- The home had a clearer management structure, including a clinical lead, and had introduced more regular checks and audits. Inspectors found that the previous governance breach had been addressed.
What inspectors found, June 2021
Fernlea rated Good; inspectors found improvements in safety, care and management, but medicines storage and call-bell response needed attention.
This was an unannounced focused inspection on 04 May 2021. Inspectors checked whether the home had acted on problems found at the previous inspection. They spoke with people, relatives and staff, and reviewed care, medicines, recruitment and management records.
The home was rated Good overall and Good for Safe, Effective and Well-led. Inspectors found improvements in medicines management, nursing oversight, risk assessments, infection control and audits. People said staff cared for them well, and staff supported food, drink and access to health professionals.
There were still some issues. Written guidance was not always available for medicines given when needed, some creams and thickener were not securely managed, some potentially harmful products were not securely stored, and call bells were not always answered quickly.
This inspection did not assess Caring or Responsive. Those ratings from the previous comprehensive inspection were carried forward when calculating the overall rating.
Improved oversight
A clinical lead and new audits gave the management team better oversight of nursing care, medicines and the running of the home.
“The new electronic care system enabled the management team to analyse and keep a daily overview of operations of the service and this had greatly improved oversight of the service.” from the report
Infection control
Inspectors were assured that the home had suitable arrangements for preventing and managing infection, including safe use of protective equipment and visiting arrangements.
“We were assured that the provider was using PPE effectively and safely.” from the report
Food and drink support
Staff understood people's dietary needs, offered choices and supported people to eat and drink without rushing them.
“We observed staff supported people who needed assistance to eat and drink in an unrushed manner.” from the report
Training and support
Staff received induction, training and supervision. Staff also said they could access extra training and develop their roles.
“Staff received a programme of induction, training and ongoing supervision.” from the report
Positive relationships
People and staff spoke positively about the management team, which was described as visible and approachable.
“People and staff spoke very positively about the management team and told us they were visible around the home and always approachable.” from the report
Medicines guidance and storage
needs fixingSome creams and thickener were not managed through a proper storage system. Staff did not always have written instructions for medicines given when needed.
“Staff did not always have written guidance to follow when they administered medicines prescribed to be given "when required", this meant they did not have the information to tell them when someone may need the medicine.” from the report
Call-bell response
needs fixingStaff were not always available to respond to call bells quickly. Inspectors asked the manager to review call-bell response times and staffing levels.
“However, during our inspection we found staff were not always available to provide support to people in a timely way.” from the report
Storage of harmful products
needs fixingSome doors were open where products that might harm people were stored. Inspectors recommended that these products be kept securely.
“However, we found some doors were open where products were stored that may pose a risk to some people.” from the report
- 01What written guidance do staff now use for medicines given when needed?
- 02How are topical creams and thickener stored safely?
- 03How are potentially harmful substances kept secure from people living in the home?
- 04What have you found from reviewing call-bell response times, and have response times improved?
- 05How do the clinical lead and regular audits check that nursing care and medicines remain safe?
This was an unannounced focused inspection of Safe, Effective and Well-led; Caring and Responsive were not assessed and their previous ratings were carried forward. This explanation was written from the published report of 9 June 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, June 2020
Rated Requires Improvement; inspectors found kind and responsive care, but serious weaknesses in medicines, nursing practice, care records and management oversight.
The inspection began as a focused visit on 27 January 2020 after concerns about pressure care. Inspectors then returned on 25 and 26 February 2020 for a full inspection because they found further concerns about records and clinical and management oversight.
The home was rated Requires Improvement overall. Safe, Effective and Well-led were also Requires Improvement. Caring and Responsive were rated Good. Inspectors found risks from inaccurate care plans, staff not always following risk instructions, unsafe medicines management and concerns about nursing competence.
People and relatives spoke positively about kindness, dignity, food, activities and how complaints were handled. Staff received training and supervision, and the home was clean. However, the provider had not always sent required notifications to CQC and had not identified problems through its own checks.
The provider breached Regulation 12 on safe care and treatment and Regulation 17 on good governance. CQC required an action plan, said it would monitor progress with the local authority and planned to inspect again.
Kind and respectful care
People and relatives consistently described staff as caring, compassionate and respectful. Inspectors saw established and respectful relationships between staff and people.
“People were supported by staff who showed utmost empathy and it was clear there were established, respectful relationships between staff and people.” from the report
Activities and relationships
The home offered varied group and one-to-one activities seven days a week. People were also supported to keep in contact with family and avoid isolation.
“There was a comprehensive programme of events that included group activities and personal one-to-one time with staff.” from the report
Food and nutrition
People's dietary needs were assessed and the kitchen understood special diets. People and visitors were very positive about the food and choice available.
“People and visitors were complimentary about the dining experience at the home.” from the report
Clean environment
The home was clean and tidy, and staff used personal protective equipment where appropriate. People and visitors were happy with its cleanliness.
“The home was very clean and tidy and we observed staff wearing personal protective equipment (PPE) where appropriate.” from the report
Medicines were not always safe
seriousInspectors found medicines left unattended and doses given that were higher or lower than prescribed. Checks had not reliably found or prevented these errors.
“We found staff had administered doses of medicines lower and higher than what had been prescribed by a doctor increasing the risk of a medicine being ineffective or an overdose.” from the report
Wound and pressure care
seriousSome wound care plans were incomplete, dressings were not always applied as instructed and repositioning plans were not always followed. This placed people at risk of skin damage or worsening pressure ulcers.
“This placed people at risk of skin breakdown or a deterioration of an existing pressure ulcer.” from the report
Nursing competence and oversight
seriousThe provider had not satisfied itself that nurses had the right competence, skills and experience. The registered manager did not always have a full overview of the nursing care being delivered.
“The provider had not always ensured that nurses caring for people with wounds had the competence, skills and experience to do so safely.” from the report
Care records were inaccurate
needs fixingCare plans and risk assessments did not always reflect people's current needs or contain all the information staff needed. Staff did not always follow the actions recorded in those plans.
“Care plans did not always accurately reflect people's care needs.” from the report
Required notifications were missed
needs fixingThe home had not always told CQC about serious injuries as required. CQC identified this as a potential breach and said it would consider the regulatory response separately.
“We found people living at the home with injuries that had not been notified to CQC” from the report
- 01What changes have been made to medicines storage, administration and checking since the inspection?
- 02How are nurses' wound-care and medicines competencies now assessed, and who provides their clinical supervision?
- 03How do you check that wound dressings and repositioning are carried out exactly as each person's care plan requires?
- 04How are care plans and risk assessments checked against people's current needs and advice from other professionals?
- 05Have all required notifications and consent forms now been completed and sent or signed by the correct person?
The inspection began as a focused review of Effective and Well-led, then became a comprehensive inspection of the service after further concerns were found; all five key questions were rated. This explanation was written from the published report of 4 June 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 Fernlea
4 rated inspections over 5 years: the service has held its Good rating throughout.
- June 2021Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- June 2020Requires improvementdown from GoodSafe: Requires improvementEffective: Requires improvementWell-led: Requires improvement
- June 2019Goodstayed GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- November 2016GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- October 2014
Registered with the Care Quality Commission on 8 October 2014.
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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Most charge £980 to £1,260 a week. 88 can care for a couple. 10 years' experience on average.
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