CQC takes action to protect people at Fernside Hall Care Home in Halifax

The Care Quality Commission (CQC) has taken action to protect people living at Fernside Hall Care Home after rating it as inadequate following an inspection in May and June.

Fernside Hall is a residential care home providing personal care for up to 24 older people.

At this inspection CQC found that the service was in breach of four regulations in relation to safeguarding, safe care and treatment, person-centred care and good management of the service.

CQC has taken enforcement action by serving three warning notices to Fernside Hall Care Home, highlighting where CQC expects to see an action plan on how they will make rapid and widespread improvements.

As a result of this inspection, how well-led the service is has been downgraded from good to inadequate. Safe has declined from requires improvement to inadequate. Effective, caring and responsive have all declined from good to requires improvement.

The service has also been placed in special measures which means they will be closely monitored while making improvements to keep people safe. Special measures also provides a framework within which CQC can use its enforcement powers in response to inadequate care and provide a timeframe within which organisations must improve the quality of the care they provide.

Linda Hirst, CQC's deputy director of operations in Halifax, said:

"When we inspected Fernside Hall Care Home, we found leadership had failed to create a culture of safety and openness. This failure meant people were exposed to avoidable harm and had very little control over their daily lives or how their care was delivered.

"Because important risks were not identified or acted on, people's safety and dignity were compromised. For example, we saw a person sat in a wheelchair in the lounge for over an hour, visibly distressed and repeatedly shouting out for help, while staff did nothing to support them. It was only after a long period of distress that staff eventually moved the person, showing a lack of compassion and urgency in their care.

"Restrictive practices also limited people's independence and freedom. People who were mobile were told repeatedly to sit down and were blocked from leaving the lounge. This is unacceptable in a place people should feel safe and free to make choices about their daily lives.

"Care records and risk assessments were incomplete, inaccurate or missing altogether. This left staff without the guidance they needed to provide safe and consistent support. As a result, people didn't always get the right medicines, were left at risk of injury from unsafe equipment such as bed rails or weren't given the care they needed when distressed or unwell.

"We expect health and social care providers to protect people's safety, dignity and human rights. It was unacceptable that this provider allowed a culture to develop where people's needs went unmet and their voices were ignored.

"We've told leaders at this service where they must make urgent and significant improvements. We will monitor them closely to make sure people are protected while these changes happen. CQC has also begun the process of taking further regulatory action against this provider."

Inspectors found:

• Leaders ignored repeated fire safety concerns and allowed unsafe storage of records, mattresses and electrical items in the attic.
• Staff did not always recognise or report safeguarding incidents, leaving people at risk of abuse and neglect.
• Staff didn't give medicines correctly, with one person receiving the wrong dose for four days and no system in place to prevent this happening again.
• The home didn't carry out risk assessments for dangerous equipment such as heaters and bed rails, exposing people to significant harm.
• Care plans did not reflect people's needs, leaving staff without guidance to respond when people were distressed, unwell or at risk.