CQC report explained · a residential care home
What the CQC found at The Ferns Care Home
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
What inspectors found, July 2023
Rated Requires Improvement; inspectors found safer staffing and infection control, but safeguarding, medicines guidance and management oversight still needed improvement.
This was an unannounced focused inspection on 22 June 2023. Inspectors checked whether the home had followed its previous improvement plan. They spoke with people, relatives, staff and professionals, observed care, and reviewed care, medicines and management records.
The home had enough staff, had reduced its use of agency staff, and had improved cleanliness and infection control. Medicines were mostly managed safely. People and relatives generally said they felt safe, and staff were described as patient and kind.
However, lessons were not always learned from safeguarding incidents. There were delays in reporting concerns, and checks of incidents did not reliably identify patterns. Guidance for medicines given when needed, care plan reviews and communication between leaders and staff also needed improvement.
The overall rating remains Requires Improvement. Safe and Well-led were both rated Requires Improvement. The home was no longer in breach of the regulations found at the previous inspection, but inspectors said further work was needed.
Improved infection control
The home had completed refurbishment work, improved cleaning arrangements and had systems in place to manage infection risks.
“Shower room refurbishment work had been completed. The provider had ensured there were sufficient cleaning and housekeeping staff, and the service was clean throughout.” from the report
Enough staff
Inspectors found enough staff to meet people’s needs safely. The reduced use of agency staff meant more familiar staff and better continuity were expected.
“There were sufficient staff to meet people's needs safely. The provider had significantly reduced the reliance on agency staff recently” from the report
Kind interactions
Staff were patient, respectful and compassionate when supporting people. The atmosphere was described as calm and welcoming.
“The atmosphere was calm and welcoming. Staff interacted patiently and compassionately throughout.” from the report
Mostly safe medicines systems
Medicines were ordered, stored, given and disposed of safely in most respects. Staff were trained and their competence was checked.
“Medicines were ordered, stored, administered and disposed of safely. Staff had a good understanding of people's medicines needs.” from the report
Safeguarding delays
seriousSafeguarding concerns were not always reported quickly. Inspectors said this had placed one person at risk and left others at risk because lessons had not been identified and acted on.
“Lessons had not always been learned from previous safeguarding incidents. Delays in reporting safeguarding concerns had put people at higher risk.” from the report
Weak incident oversight
needs fixingAudits of incidents were basic and did not reliably identify trends. This limited the home’s ability to spot and prevent repeated risks.
“The auditing of incidents was basic and not effective in identifying trends.” from the report
Care plan reviews
needs fixingCare plans were reviewed, but the reviews did not add enough useful information about people’s changing needs. The provider planned further training and electronic records.
“Care plans had been reviewed regularly but these reviews did not add meaningful value to people's care.” from the report
- 01How quickly are safeguarding concerns now reported, and how do you check that lessons have been learned?
- 02What calming or de-escalation approaches do staff try before giving medicines prescribed when needed?
- 03How do managers now analyse incidents to identify repeated patterns or risks?
- 04How are care plan reviews made meaningful and specific to each person’s changing needs?
- 05What written protocol do staff follow for sharing important information after incidents, including head injuries?
This was a focused inspection of Safe and Well-led only; the other ratings were carried forward from the previous inspection. This explanation was written from the published report of 22 July 2023 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, November 2022
Rated Requires Improvement; inspectors found better medicines and consent processes, but infection control and management oversight were still unsafe or unreliable.
This was an unannounced focused inspection on 18 and 24 October 2022. One inspector spoke with people, a relative and staff, and reviewed care plans, staff files and management records.
People generally said they felt safe and staff tried hard to help. Medicines records had improved, care plans were detailed, staff training and supervision had improved, and health professionals were involved when needed.
However, infection control was not managed reliably. Cleaning records were poor, some rooms were not cleaned for several days, laundry was sometimes left unattended, and staff did not always use masks or store protective equipment safely.
The home remained without a registered manager. Audits and daily checks did not reliably identify or follow up problems. The overall rating stayed Requires Improvement, with Safe and Well-led also Requires Improvement, while Effective improved to Good.
Medicines were better managed
Medicines records were up to date, and staff had clear instructions for medicines given when needed. The previous medicines-related shortfall had been addressed.
“Medicine records were up to date and well completed.” from the report
Consent processes improved
The home had improved how it assessed capacity and recorded best-interest decisions for sensor mats, alarms and medicines given covertly.
“Where sensor mats or alarms were in place then a best interests decision had been taken to ensure it was right for the individual.” from the report
Care planning and health support
Care plans were detailed, risks were reviewed, and staff worked with health and social care professionals to support people's wellbeing.
“Care records demonstrated professionals visited the home frequently and staff contacted health and social care professionals for advice and support.” from the report
Staff support had improved
Staff reported regular supervision, and training records showed good uptake of training. The recommendation from the previous inspection had been acted on.
“At this inspection we found supervision processes had improved.” from the report
People's views were used
Residents' meetings and staff meetings were held, and suggestions about food had led to changes.
“Suggestions for changes had been made and these had been acted upon.” from the report
Infection control and cleaning
seriousCleaning records were poor, some rooms were not cleaned for several days, and infection control procedures were not followed consistently during a COVID-19 outbreak. This was a breach of Regulation 12.
“We found no evidence that people had been harmed however, systems were either not in place or robust enough to demonstrate infection control and cleanliness were effectively and safely managed.” from the report
Protective equipment was not handled safely
seriousStaff did not always wear masks in line with guidance, and protective equipment was left on handrails instead of being stored in suitable containers.
“PPE was left on handrails in some area of the home rather than stored in appropriate containers.” from the report
Weak management checks
seriousAudits, daily walkarounds and senior staff meetings did not reliably identify or follow up problems. This was a continuing breach of Regulation 17.
“At this inspection not enough improvements had been made to address these issues and the provider remained in breach of this regulation.” from the report
No permanent manager
needs fixingThere was no registered manager at the inspection, and staff said the home needed long-term leadership and consistency.
“Staff said they service needed a long-term manager who could provide leadership and consistency.” from the report
Food choice and mealtime support
needs fixingOn one day both lunch choices contained fish, with no immediate alternative. Staff did not always have enough time to actively encourage people to eat.
“Staff did not always have the time to sit and actively encourage people to eat, although supported people during the course of the mealtime.” from the report
Staffing pressures
needs fixingPeople and staff said staffing levels were sometimes difficult, with frequent use of agency staff. This could affect consistency and the time available for support.
“People and staff told us staffing levels were sometimes a struggle and there was frequent use of agency staff.” from the report
- 01What has been done to make sure rooms, high-touch areas and soiled laundry are cleaned and dealt with every day?
- 02Are staff now consistently wearing and storing protective equipment correctly, and how is this checked?
- 03Has a permanent registered manager been appointed, and who is responsible for the home until then?
- 04How are audits and daily checks now identifying and following up cleaning, staffing and other safety problems?
- 05What alternatives are available at every meal, and how will staff make sure people receive encouragement and support to eat?
This was a focused inspection of Safe, Effective and Well-led; Caring and Responsive were not inspected, and their ratings were not given in this report. This explanation was written from the published report of 19 November 2022 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 The Ferns Care Home
9 rated inspections over 8 years: the service has held its Requires improvement rating throughout.
- July 2023Requires improvementcurrent ratingstayed Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- November 2022Requires improvementstayed Requires improvementSafe: Requires improvementWell-led: Requires improvement
- March 2022Requires improvementstayed Requires improvementSafe: Requires improvementEffective: Requires improvementWell-led: Requires improvement
- September 2019Requires improvementdown from GoodSafe: Requires improvementWell-led: Requires improvement
- March 2018Goodup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- July 2017Requires improvementstayed Requires improvementSafe: Requires improvementEffective: Requires improvementWell-led: Requires improvement
- January 2017Requires improvementstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- July 2015Requires improvementstayed Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: Requires improvementWell-led: Good
- January 2015Requires improvementSafe: InadequateEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- May 2020
Registered with the Care Quality Commission on 13 May 2020.
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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