Fernleigh Court Care and Nursing Home

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

People were not always supported to have person centred care. People’s care plans did not always contain information about their likes, dislikes and preferences. There was limited evidence of people being supported to communicate in different ways such as using signs or pictures. Some people were not receiving regular interactions and social engagement with staff and staff were not recording how people were spending their time. This made it difficult to see if people were being supported to achieve their desired outcomes. Staff made an effort to support people as individuals. When they spoke with people, they engaged them in conversations about their interests and they knew how to offer choices to people. Activity coordinators were passionate and worked hard to improve the opportunities for people to be socially engaged. Processes were in place to support people at the end of their life when this support was necessary.

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People did not always receive person centred care. There had been recent examples at the service where people’s essential care needs such as personal and oral care had not been met. People’s care plans were not always detailed in relation to their individual support needs such as living with dementia or catheter care. Daily records were not always completed in line with people’s care plans and support needs. This made it difficult to see if people were being supported in line with their specific interests and preferences. One person said, ‘‘I used to enjoy [pastime] but have not been able to do this here. Not sure whether it is something that can be done or not.’’ A relative said, ‘‘I think if we are honest, we expect a little more from the service. The basics are done but nothing above and beyond, which is a bit disappointing.’’ The senior management team had taken action to make sure people’s essential care needs were met and care plans were being updated over the last three months. Staff knew people well as individuals and were passionate about providing person centred care. We observed staff engaged with people about their interests. Activity staff were discussing people’s interests with them and trying to work out how best to offer the best experiences to them. One person said, ‘‘You could not really ask for better staff. They really do care about me.’’ A relative told us, ‘‘[Staff] take on board how [family member] wants to be treated and I would say this is something they keep at the heart of everything they do. They seem to understand the little things make a big difference.’’

People had not been consistently supported to safely start living at the service as explained in the ‘assessing needs’ quality statement. This had led to people not being integrated into the service successfully in all cases. Staff were not recording people’s care consistently which made it more difficult for other staff or health professionals to know how people were feeling or what support they may need. Before the senior management team had started taking action at the service, people were not being supported by a consistent staff team making continuity of care more difficult. One person said, ‘‘It was very difficult at one point as it seemed like I saw a different face every day.’’ A relative told us, ‘‘I am sometimes concerned new staff take a long time to get to the same level as the staff who know [family member] well. I think staff need more time to get to know people.’’ Since the senior management team had been working intensively at the service over the last three months, they had changed staffing rotas and deployment. This had led to people having a consistent staff team and better continuity of care. They were also updating the assessment policy as discussed in the ‘Assessing needs’ quality statement. Staff told us they discussed people’s support needs in regular meetings and at daily handovers to help ensure they were supporting people consistently. One person said, ‘‘[Staff] all know what they are doing. I know them all by name and they know me.’’ A relative said, ‘‘We have got a good relationship with the staff and know a lot of them. They have been there for a little while and know [family member] really well.’’

People were not always supported in line with the Accessible Information Standard (AIS) to understand and communicate information. Care plans contained limited information about how to support people to communicate if they did not communicate verbally. There was limited or no evidence of care plans and policies being produced in accessible formats which people could understand. There were options such as pictures which could be used to support people to understand information. However, these were not consistently used to support people. One person said, ‘‘I find it difficult to read. I am not sure how I will talk to someone if I have a problem.’’ A relative told us, ‘‘[Family member] cannot communicate like they used to. The staff go off their care plan, but it would be nice if they were still able to offer choices to them.’’ Staff spoke confidently about how they supported people who could not communicate verbally such as using pictures or objects. The senior management team had started working to update care plans and make these more detailed. They also showed us evidence on how they planned to make people’s care plans and policies would be made more accessible. One person said, ‘‘[Staff] will always show me two options of what I can wear in the morning, and this is how I choose what I like to wear.’’ A relative said, ‘‘In the past [staff] have sat and gone through things with us and [family member]. We feel we are kept up to date.’’

People were not consistently supported to feed back about their care and support. People were invited to larger meetings but there was no evidence people who chose not to attend these had been supported to voice their opinions too. It was unclear how feedback from people was being used to drive improvements at the service. One person said, ‘‘[Staff] invite us to meetings, but I don’t go. They don’t really ask my how things are going.’’ We received mixed feedback from relatives about how well the service listened to them and gained their feedback. One relative said, ‘‘We only really hear from the service if something has happened. We have not been asked for our thoughts other than this.’’ Relatives also told us they were not asked to take part in reviews of their loved one’s care plans. One relative told us, ‘‘I have never seen or been asked to talk about care plans so I wouldn’t be able to tell you if the staff are supporting [family member] with all their needs.’’ We observed staff speaking and listening to people whilst they supported them. The management team were passionate about improving this area. They had started to speak with people and relatives on a one-to-one basis to work out how best to support them to be involved with goings on at the service. Processes were in place and there was evidence feedback from relatives and the staff team was being listened to and incorporated into improvement plans for the service. One person said, ‘‘[Staff] are always stopping by for a chat. I think they are really good listeners.’’ A relative told us, ‘‘We are invited to meetings, but we can also request a chat at any time.’’

Before the senior management team had started taking actions people had not always been supported to access healthcare service when they needed to use them in a timely manner. People had some opportunities to leave the service and explore their preferred past times and interests. However, these were inconsistent. Staff did not consistently record how often people had the chance to access other services making it more difficult to see if they were being fully supported in this area. One person said, ‘‘[Staff] do offer to take us out and about, but it is cancelled quite a lot. I think they sometimes have issues with staff sickness to maybe change their minds.’’ A relative said, ‘‘[Family member] needs a lot of motivation to get out and about. I do not think staff have the time to fully work with them and give them the support they need to leave the service and try new things.’’ The senior management team had taken action, and people now saw healthcare professionals as soon as they needed the support. The activities staff team were focusing on working with people and the management team to provide more opportunities to access the community for people. One person said, ‘‘When we go out, we always have a good time. There is always something going on.’’ A relative told us, ‘‘I think there has been a real effort recently to support [family member] out and about more. [Staff] always make sure they attend their appointments.’’

As explained throughout this report, people had not always been supported to achieve good outcomes in the past. The senior management team had to react and had made a lot of improvements to help ensure people had better experiences of their care. People’s care plans were not always detailed in relation to what outcomes people wanted from their care and support. Daily records did not detail when or how people were being supported to achieve their outcomes. We received mixed feedback about the social opportunities available for people. One person said, ‘‘I don’t have a lot of interest in what is going on or what’s of offer, so I just keep to myself.’’ A relative told us, ‘‘We were under the impression there would be a lot of opportunities for [family member] at the service but these have not started to happen yet.’’ We observed people to go long periods of time without staff interaction and if people did not engage in the ‘group activities’ that had been organised an alternative was not offered to them. Activity staff were passionate about their job roles and the senior management team had employed more people in these roles. They had plans to have more activities available to people including community outings. The senior management team were meeting with people on a 1:1 basis to see how best to support them to achieve their individual goals and outcomes. One person said, ‘‘We went [out on activity] recently and it was just brilliant. It really made me feel better.’’ A relative said, ‘‘I think staff are really trying to get [family member] more involved in things.’’ Recently people had been supported to achieve good health related outcomes, for example maintaining healthy weights.

People were not consistently supported to have good experiences at the end of their life. One person had a poor experience of this, and this was being considered and dealt with by the senior management team. Some people’s end of life care plans were either not in place or were not sufficiently detailed. The senior management team had taken actions to help ensure this did not happen again. This included training and supervising staff on end-of-life care and how to support people with dignity and respect at this time. They were also reviewing care plans to make sure they were detailed. We received positive feedback from relatives of people who had been supported with end-of-life care by the staff team.