The Ferns

The Ferns is a ‘care home’. 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.

At our previous inspection in March 2016 the service was rated as good. At this inspection the service was rated requires improvement in responsive and well-led and overall rating is requires improvement.

In June 2017, CQC published Registering the Right Support. This along with associated good practice guidance sets out the values and standards of support expected for services supporting people with a learning disability and or autism.

There was evidence that people had benefitted from the support offered to them; however, in its strategy and delivery of support the provider was not always following current best practise guidance, including but not limited to Registering the Right Support. In particular promoting as much as possible that people receiving support are independent and live as ordinary a life as any other citizen.

The Ferns was in a time of change and was being used as people’s home, for short breaks and for people who used the home for a few hours before and after day services. Whilst there was a nice atmosphere in the building it did not feel like people’s home and at peak times it was very busy with lots of distractions.

The home accommodates up to eight people in one purpose built building on a campus with another five registered premises, all providing accommodation and care for people with autism. A total of 59 people can stay on the campus known as ‘Raby’ at any one time. There are also day services provided on the same site. Current best practise guidance promotes housing models that increase opportunities for people’s independence, choice and control.

Some aspects of people’s support and accommodation were institutionalised. When speaking about people and in documents, staff providing support used a lot of organisation based language and jargon that inadvertently promoted a difference between the people supported and other people.

The service requires and 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.

The registered manager contributed to a friendly and relaxed atmosphere at the home. It was clear from their interactions that the registered manager knew people well and had positive relationships with them; they were comfortable around him and enjoyed his company. Staff members and people’s relatives told us that they had confidence in the registered manager. One people’s family member told us, “He is an incredible manager, absolutely outstanding…”

People and their relatives told us that they had confidence in the service provided at The Ferns and they thought that the home was safe. One person told us, “They look after me here. I get on well with staff.” Another person’s family member told us, “He really bonds with the staff; which makes me feel more relaxed. He took to it here like a duck to water.”

There was a relaxed atmosphere at the home and people appeared comfortable in all areas of the building, including the office area. We saw friendly interactions between people living at The Ferns and staff members. It was clear that people felt relaxed and comfortable at the home and the use of appropriate humour helped create a friendly atmosphere. People were communicated with and supported to express their views and helped to make decisions in a way that best enabled them to understand and express themselves.

The service had systems and processes in place to help protect vulnerable adults from abuse. Each person had individualised risk assessments that helped staff members to keep people safe and the home’s environment was clean and safe.

Some people at The Ferns had previously lived in a more intensive support setting. We saw that their transition into the home had been thoughtfully done in a person-centred way, at a pace that was best for people. Some people had been supported to set out personal goals that they wanted to achieve and worked towards these. People had grown in confidence and tried new things since spending time at The Ferns and some people had made quick progress towards these goals.

One indicator of the success of people’s support was the sharp reduction in some people using medication to reduce anxiety since moving to The Ferns. One person’s family member told us that before coming to The Ferns their relative spent over two years in assessment and treatment units. They told us, “Autism Together have changed his life since he moved here.”

Staff told us that they felt well supported and they enjoyed working at the home. One staff member said, “Its a rewarding place to work. With great staff and people supported.” Staff received support with daily briefings, supervision meetings, regular training, team meetings and annual appraisals.

The Ferns is a single-storey, modern and purpose-built home in the grounds of Raby Hall. It has a large secure garden and had been designed by a specialist architect, specifically for people with autism. It has wide corridors and a lot of natural light and is neutrally decorated. It has seven bedrooms which are all ensuite, communal rooms such as lounges and a kitchen and also had a sensory room. The service provides respite care for over 70 people with autism and their families. The service offers short stay, emergency, urgent and respite support for people with an autistic spectrum condition and their families. This support is provided for varying amounts of time ranging from an overnight stay to several weeks or even months at a time

The service is required to have a registered manager and one was in post and had been for several years. 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.

We found that the home was safe and secure and tailored to the needs of people with autism. Staff have been trained in safeguarding adults and in medication administration and they were able to tell us about these processes.

There were appropriate fire prevention systems in the building and staff had been trained to use these and they had been checked regularly.

Staff have been recruited using safe methods of recruitment and the rotas reflected the appropriate level of staff for the numbers and needs of the people they were supporting throughout each day. We found the medication had been administered and stored correctly and checks made to ensure that this had happened.

Staff had been trained to perform their role and supervised regularly. Part of this training was mental capacity act training and staff are able to tell us about the Mental Capacity Act and the deprivation of liberty safeguards.

The design of the house was airy light and appropriate for people with autism. There were two sides to the building which enabled a more intimate feel to people's accommodation.

The kitchen was well-designed and people could choose what they want to eat and help prepare and cook food if they wanted to.

We saw that staff were caring, considerate and approachable and they provided information and explanations to people as necessary and tried to involve them in as much as possible.

The care was person centred and care plans were updated frequently. Many documents were in easy read format which enabled people to understand them.

Activities were tailored around the individual, were varied and often involved going out into the community or into the providers other premises.

There was a registered manager in post who had been in post for some time and we saw that they were open and transparent and supportive of their staff. Policies and procedures were up-to-date and quality of the service had been regularly checked.

Staffing was built around meeting individual needs and most people had one to one staff support during the daytime. People were given information about how to make a complaint and any complaints received were recorded in full.

We looked at records of comments that had been received from people who used the service and their families. One relative had written to say that their family member had benefited from being encouraged to participate in a wider variety of activities whilst staying at The Ferns. A service user had written 'Because of The Ferns I am more confident in myself with trying new things and meeting new people. The Ferns has excellent facilities'. A relative had commented on 'positive changes in mood and willingness to participate'.

We saw that a range of communication aids had been developed to enable people using the service to express their needs and choices. We saw that the whole service was built around meeting individual needs and most people had one to one staff support during the daytime.