Fernwood Court is a residential care home for 59 older people. At the time of our inspection 39 people were living at the home. At the last inspection in February 2015, the home was rated ‘Good’. At this inspection we found the home remained Good.

People continued to receive safe care. People told us they felt safe. Risks to people’s safety had been assessed and care and support was delivered in a way that kept people safe from harm. Sufficient numbers of staff were available to meet people’s needs. Staff had appropriate employment checks in place. People received their medicines as prescribed.

The care people received continued to be effective. Staff had the skills and knowledge to meet people’s needs. People were asked for their consent before care was provided. People are supported to have maximum choice and control of their life's and staff support them in the least restrictive way possible; the policies and systems in the service support this practice. People were able to choose what they would like to eat and drink and were happy with the choices provided. People had access to appropriate healthcare professionals when they required.

People continued to receive support that was kind and caring. People’s choices were respected and their dignity and privacy maintained. People were encouraged to be as independent as possible.

The service people received continued to be responsive to their needs. People were involved in the planning and review of their care needs. Staff were aware of people’s individual needs and supported them according to their preferences. People and their relatives were aware of how to raise issues or concerns and these were responded to.

The home continued to be well-run. People and staff were complimentary about the registered manager. The registered manager promoted an open culture within the home. Staff were aware of their roles and responsibilities. Systems were in place to assess and monitor the quality of service people received which included seeking feedback from people and their relatives about the quality of service provided.

We carried out an inspection on the 7 October 2013 and found that the provider was not meeting the regulations for respecting, involving and promoting the care and welfare of people who used services and supporting workers. The provider wrote to us and told us what actions they were going to take to improve. Prior to the inspection we had received concerns relating to staffing levels, so we looked at the concerns and what improvements had been made.

Below is a summary of what we found. The summary is based on our observations during the inspection. There were 53 people living at the home on the day of the inspection. There were 27 people living in the mental health unit and 26 people living in the dementia unit. Due to the complex care needs of the people we were only able to speak with one person. We observed how most people were supported to help us understand their experiences of care. We spoke with four members of staff who supported people, the manager who was supporting the inspection process and five relatives. We looked at four people's care records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

We found that people were not being supported by staff in a safe manner. On arrival to the home we observed there were not enough staff to meet people's needs at breakfast time. We saw people being left for unacceptable periods of time with no staff to support them. We saw one member of staff trying to support people in the dining room and lounge area on their own. This meant that during breakfast times there was not enough staff to support people safely.

A person we spoke with said, "I do feel safe living here". A relative said, "I do feel staff support X safely". Another relative said, "There is not always enough staff, due to sickness".

We found that the home had a system in place in relation to the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). This is legislation that makes provision relating to people who lack capacity, and how decisions should be made in their best interests. We found that where people lacked capacity the appropriate assessments were taking place as part of determining people's capacity to make decisions. The manager had a good understanding of the MCA and DoLS and confirmed that there was someone living in the home who had an application approved through the local authority under the DoLS legislation. The staff we spoke with were aware of the DoLS application and the reason for it being in place. The staff we spoke with told us they had received training in the MCA and DoLS and they were able to explain it to us. Records we saw confirmed the training had taken place.

Is the service effective?

We found that the people's care records we looked at all had the appropriate documentation. Assessments and care and or support plans were in place. These records ensured that people's needs were being identified and met as they wanted. Where health professionals were needed to meet people's needs we saw that this was in place. For example, the records in place for someone who needed their meals supplemented showed that a Speech and Language Therapist had been involved. This meant people were able to receive the support they needed.

We found that the service had a system in place to ensure the appropriate staffing levels were in place to meet people's needs. However the system in place was not effective in ensuring the appropriate staffing levels were in place where people needed support from more than one member of staff. On the day of the inspection our observation was that there was not always enough staff working during meal times to ensure people could be supported safely on the dementia unit. We observed during the inspection that people with complex support needs and were at risk of falling were being left for long periods of time on their own in the lounge area. This was due to a lack of available staff during meal times. This meant that there was not always enough staff to meet people's needs.

Is the service caring?

We found that staff were caring. One person we spoke with said, "The staff are very nice". One relative said, "I am very happy with the home. The staff are absolutely wonderful". The staff we spoke with all understood people's needs and knew how to meet them. Where people had specific needs, staff knew this, even where staff were just covering due to staff sickness. This meant that the service was caring in meeting people's needs.

Is the service responsive?

We found since our previous inspection action had been taken to improve areas of concern. For example, staff were now all having an appraisal once per year as part of ensuring they had the right skills and knowledge to support people appropriately.

People living on the mental health unit were now able to get a drink and a snack at night time, where they were unable to at the last inspection. This meant that the service was able to respond appropriately where concerns were identified.

Is the service well-led?

The service was led by a registered manager, who was supported by their line manager. We met both of them who were present at the time of our inspection and assisted us with any information we needed.

We found that the service had the appropriate systems in place to monitor quality. Staff we spoke with told us the manager was regularly on the units as part of checking on how care and support was being delivered.

We completed this inspection to check the progress the home had made to address the concerns we had raised at our last inspection. We spoke with people that lived at the home, relatives, care staff and the manager.

People we spoke with were happy with the care they received. One person said: "I like it here. The staff are a good bunch". Relatives we spoke with were pleased with the care provided.

The home was taking people's preferences into account. Some people that could not make decisions had not had their capacity assessed to ensure that decisions were taken in their best interest.

We saw that care for people in the dementia care units had improved. People were well supported and were having their health and personal care needs met. Some practices within the mental health units were not making sure that people's individual needs were fully met.

Staffing levels had improved since our last inspection. However the provider should note that the experience of staff and the lay out of the home should to be taken in account when determining the number of staff needed to provide people with the care they need.

People were supported by staff that were trained and supervised. An appraisal system that assessed staff's performance and identified training and development needs was not yet in place.

The home had systems for checking the quality of care people received. People's views were sought and acted upon.

This was an unannounced inspection. During this inspection we spoke with people that lived at the home, relatives, care staff and managers.

The registered managers named in this report were not managing this service at the time of the inspection. Their name appears as they were registered at the time.

People we spoke with said they were happy with the care they received. Some people could not tell us about the care they received and we observed that people looked presentable and appropriately dressed and groomed.

People's privacy was promoted and the staff spoke with them in a respectful way. People were not always consulted about their care and their choices and wishes were not always acted upon.

People's needs were assessed and plans of care were developed. However, these did not always contain the information for care staff to be sure they were providing people with care that met their needs.

Training for some care staff was not up to date and they did not receive the support and supervision to provide people with appropriate care.

The home had systems in place to review and monitor the service. Where shortfalls were identified there was not always evidence to show these had been acted upon. People's views about care were sought through surveys and relative's meetings.

A complaints procedure was available for people to raise concerns and complaints about their care. There had not been any formal complaints in the last 12 months

We visited the service to check on the care and welfare of people who were living at Fernwood Court. The visit was unannounced and neither the home nor the provider knew that we would be visiting. This was the first inspection of the home since its ownership changed in November 2011.

During our visit we used a number of different methods to help us understand the experiences of people using the service, because some people had complex needs which meant they were not able to tell us their experiences. We observed people's care and looked at care records. We also spoke with visitors, staff members and the manager.

We spoke to six people who live at the home and four relatives. People we spoke with were all positive about the care and support that they or their relative received. One person told us, "It's a good place to live".

We found that the home was comfortable and spacious and that people were able to personalise their bedrooms as they chose to reflect their taste and interests.

People were consulted about their care. People told us how they spend their day and that their friends and relatives were able to visit them.

People told us that staff were kind and caring. They told us that staff assisted them when they needed it. One relative said, "Staff always do their best", they are very caring”.

This inspection took place on 18 and 19 February 2015 and was unannounced. We last inspected this home on 4 September 2014 there was one breach of legal requirements at that inspection. Following this inspection the provider sent us an action plan to tell us the improvements they were going to make. During this inspection we found that the provider had taken steps to comply with the regulations.

Fernwood Court Care Home is a residential home providing accommodation and personal care for up to 59 people. The home is split across three floors with the ground and first floor providing care for older people who may have dementia. The other floors provide support to people who may have mental health needs.

The service had a registered manager, as required by the terms of its registration. 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.

There were systems and processes in place to protect people from harm. People and relatives told us they felt the home was safe. Staff were able to demonstrate a good understanding of procedures in connection with the prevention of abuse.

There were sufficient numbers of staff on duty to meet people’s physical and social needs. Staff received training and support that ensured people’s needs were met effectively.

People’s medicines were managed, stored and administered safely.

The manager and staff understood their responsibility to comply with the requirements of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS).

Staff offered people a choice of meals. People were appropriately supported and had sufficient food and drink to maintain a healthy diet. Staff understood the importance of offering meals that were suitable for people’s individual dietary needs.

People were supported to access healthcare services to maintain and promote their health and well-being. The home worked closely with healthcare professionals to make sure there was a joined up approach to meeting health needs.

People told us staff were kind and caring. Staff understood people’s needs and preferences and respected their dignity and privacy when supporting them.

People were supported in a wide range of interests and hobbies which suited their needs.

People and relatives told us they found the management team approachable and felt comfortable to raise any complaint or concern should they need to.

There were management systems in place to monitor the quality of the home. The provider’s quality monitoring systems included regular checks of people’s care plans, medicines, accident, incidents, falls and complaints. Information was regularly monitored to identify trends and actions were taken to minimise the risk of a re-occurrence.