The inspection took place on 6 December 2018 and it was unannounced. Fernleigh residential home is a ‘care home’ for older people. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. On the day of our inspection 25 people were using the service.

There was a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People felt safe living at the service. Staff knew how to recognise abuse and how to report it. Risks were assessed so that staff knew what action to take to keep people safe. They did this while also promoting people’s independence and autonomy.

There were sufficient numbers of staff, with the required knowledge, skills and experience to support people with their needs. Recruitment processes were safe and this meant that so far as possible only people of suitable character and experience were employed.

Medicines were managed in a safe way Staff had received training about this and knew the level of support people required with their medicine.

Staff were knowledgeable about the needs of the people they supported. People were supported to make choices around their care and daily lives. Staff had attended training to ensure they were able to provide care based on current practice when assisting people.

Staff always gained consent before supporting people. There were policies and procedures in place in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards and staff followed these.

People were supported to eat and drink enough and had a balanced diet. Staff understood and met people’s nutritional needs. They supported people in a sensitive way. People had access to the healthcare professionals they required.

The adaptation and decoration of the premises was designed to meet the needs of people who used the service and to support people living with dementia.

People were treated with kindness and compassion by the staff. Staff knew people well and knew the best way to communicate and offer reassurance when this was required. People’s social needs as well as their physical and emotional needs were incorporated into the plan of care and used to promote and maintain people’s abilities and independence.

People and their relatives were involved in making decisions and planning their care, and their views were listened to and acted upon. Staff treated people with dignity and respect. People knew how to raise concerns and had confidence that they would be listened to and action would be taken. Feedback provided was used to make improvements to the service.

People were complimentary about the registered manager and staff. It was clear that relationships between people and staff were positive and people had confidence in the service. Many of the staff had worked at the service for many years and this provided continuity for people who used the service. Staff were motivated and the culture was person centred and family orientated. There were effective quality monitoring systems. A variety of audits were carried out and this meant that any shortfalls were quickly identified and used to drive improvements.

We carried out our inspection visit on 8 June 2016. The inspection was unannounced.

The service provides accommodation and personal care for up to 27 older people living with dementia and similar health conditions. At the time of our inspection there were 25 people using the service.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People felt safe living at Fernleigh Care Home. They felt safe because they trusted staff’s ability to care for them. Staff knew their responsibility to keep people safe from harm and abuse. They followed the provider’s guidelines to support people and to report any concerns they had about people’s safety and wellbeing.

The provider had good practice guidance for staff to follow in the safe handling and reporting of medication.

Staff had the relevant skills they required to meet people’s needs. The provider completed relevant checks which ensured that staff had the right skills, experience and were safe to support people. Staff were provided with adequate training that they required to carry out their role effectively. The managers ensured that there was enough staff on duty to meet people’s needs.

People were supported in accordance with the Mental Capacity Act (MCA) 2005. Staff sought their consent to their care and treatment.

At the time of our inspection, the provider was in the process of refurbishing the home to give people access to an environment that met their needs and promoted their independence.

People were supported with their nutritional and health needs. They had access to a variety of healthy meals that they told us they enjoyed. They also had prompt access to healthcare services when they needed them.

Staff were kind and compassionate to people. They were knowledgeable about the needs of the people they supported and treated them with dignity and respect. They provided the support that people needed to be involved in decisions about their care.

People’s care plans did not always reflect the support that they received. The registered manager and deputy manager told us that they would address this. At the time of our inspection we found this to have minimal impact on the care people received as they were supported by staff who were knowledgeable about their needs and met them.

The provider listened to feedback from people using the service and their relatives. People told us that staff acted promptly on their feedback.

The provider had effective procedures for monitoring and assessing the service in a way that promoted continuous improvement. People and their relatives were satisfied with the service they received. Staff felt supported to contribute to the development of the service. They felt supported in their role which enabled them to deliver a good standard of care to people.

As part of this follow up to the review of compliance carried out on 25 June 2013, we looked at the records belonging to three people who were using the service. This was to see whether the required improvements had been made to ensure that these records were being completed in a consistent way and that they were up to date and accurate.

For two people who had recently moved into the service, an Initial assessment had been completed and this had been appropriately signed and dated. From the initial assessment, care plans had been devised and these had been reviewed to ensure that they remained up to date and relevant to each person’s needs.

Food and fluid charts, completed for people who had been assessed as at risk of malnutrition and dehydration, were up to date and demonstrated the support given, to ensure that they received the nourishment they needed.

We checked the environment and it was obvious that work had got underway to improve the facilities within the service.

During our visit we were able to speak with three people who use the service and two relatives. This enabled us to gather their thoughts of the care and support being provided. People told us that they were very happy with the service received at Fernleigh. One person told us: “They’ve been very good to me.” A relative explained: “We can’t fault it, they [care workers] treat him gently and respectfully and everything that needs to be done is done.”

During our visit we were able to speak with four people who were using the service. They told us that they were happy with the service that they were provided with. One person told us: “I am very happy here, they treat us very well.” Another explained: “I can’t fault it, they [the staff] let me potter and they let me help them.”

We were also able to speak with one visitor and five members of the staff team. This enabled us to gain their views of the overall service provided. One relative explained: “They [the staff] look after her really well, and they are always really nice.” A member of staff told us: “I love working here, it is so interesting and there’s always someone to help you if you need it.”

We looked at some care plans and found that although most contained the actions the care workers needed to take to meet the person’s individual needs, some didn’t fully reflect the person’s current behaviours and how care workers should address these.

Records checked did not always reflect the care carried out by the staff or show that action with regard to a person's health care, had been taken in a timely manner.

During our visit we noted that some areas of the service were in need of improvement and refurbishment to ensure that it was suitable for the people using it.

We were told that the staff were kind and caring and we observed them carrying out their duties in a relaxed and patient manner, interacting well with people throughout our visit.

During our visit we were able to talk to five people who were living at the service, four members of staff and five people who were visiting.

Everyone spoken with explained that they were happy with the care and support they were currently receiving and they told us that the staff were kind and helpful. One person told us, “The staff are very good, always there if you need them, always willing to help.”

We were told that the staff were supportive and we observed them carrying out their duties in a kind and patient manner. During lunch time, staff were seen assisting people in a dignified manner and at a pace that suited them.

Everyone spoken with told us that they were happy living at Fernleigh and that they felt safe there. One person told us, “the staff understand me, I rang the bell and they came quickly.” A relative spoken with explained, “The overwhelming thing for us, is knowing that she is safe.”

At the time of our visit we noticed a strong odour in the main entrance. This was discussed with the manager and deputy manager and we were informed that this was being dealt with. New flooring had been placed in the main corridor and plans were in place to replace the carpet on the stairs.

Staff working at Fernleigh told us how much they enjoyed working for the service. One staff member explained, “It’s a really nice place to work, the manager is wonderful and the deputy is a breath of fresh air.”

People told us that they were happy with the care and support they received at Fernleigh. They told us that the care staff gave them the help and support they needed and this was provided in a comfortable and unhurried way.

We were told that the food provided was satisfactory and there was always enough of it to eat.

People told us that should they feel unwell or tired then the staff would allow them to rest a little more, but ensure that they had washed and ate some breakfast before going back to bed.

We spoke with three people who were using the service at the time of our visit. They told us that they were happy with the care and support they were receiving and they were happy with the staff who supported them. One person explained, “I like living here”. Another person told us, “The staff are very good, they are very helpful”.

People told us that they liked the food that was provided, they had a choice at meal times and they could choose were to take their meals. One person told us, “The foods not bad at all, it is quite reasonable”. Another person explained, “The foods ok, it’s lovely”.

People spoken with told us that the staff treated them with respect. One person told us, “The staff are very good at treating you with respect, very good indeed”. Another person explained, “They treat you very well here”.

People told us that they felt safe living at Fernleigh and they knew what to do if they were unhappy about something. One person told us, “I feel very safe and it’s nice to have people around”. Another person explained, “She comes round often, [the manager] I would talk to her if I had any complaints”.