Fernlea

Fernlea is a residential care home providing care and support to autistic people and people with a learning disability. The home can accommodate a maximum of 13 people in one adapted building. At the time of our inspection there were ten people living in the home.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

People’s experience of using this service and what we found

Right Support

People were supported with their care needs in this home, but the environment needed improvements in the décor to be more reflective of the people living there as well as to help with effective hygiene. People were having their own rooms decorated, and had input in this, but this process was on-going. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. People were supported to maintain their health and wellbeing and had their choices respected.

Right Care

Staff received safeguarding training and could tell us how they protected people from abuse. However, improvements were needed to staff training as staff had not had specific training around the needs of people living in the home. Medicines were safely managed and the manager acted on feedback when areas of improvement were identified during the inspection. Some people wanted more meaningful activities to take part in on a regular basis. People who wanted to go on holiday were supported to pursue this.

Right Culture

Each person had a care and support plan. However, improvements were needed when recording information in care plans to ensure their language was appropriate and empowering to people living in the home. People felt the management was approachable and they would be able to raise concerns with them. Staff felt supported in their role and felt able to report concerns to management if they should arise. Most staff were familiar with people and their needs as they had been there for many years which helped with consistency in care. The home had recruited to all vacant posts to reduce agency use.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 25 September 2018).

Why we inspected

We received concerns in relation to staff training around mental capacity, specific health conditions and restrictions. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the home can respond to COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the effective and well led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Fernlea on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to staff training and quality assurance systems at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

People and staff were involved in being tested regularly for COVID-19 and the registered manager had checked staff had received the vaccination, unless exempt.

Some people had previously partaken in food hygiene training and the registered manager had plans to offer COVID-19 training to people who wanted it. Staff had also received training around infection prevention and control.

The registered manager carried out audits to check the home remained safe in relation to infection control.

Fernlea is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Fernlea are registered to provide accommodation and support for up to 13 people. People who use this service may have physical disabilities and/or learning disabilities. At the time of the inspection, the service supported 11 people.

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 were safeguarded from avoidable harm and abuse and people’s risks were assessed and managed. There were enough safely recruited staff to meet people’s needs. Medicines were managed safely and protocols were in place for staff to follow. People were protected from the risk of infection.

People’s needs were assessed and planned for and staff were suitably inducted and trained. People’s nutritional needs were met and the registered manager had systems in place to ensure people received consistent care. People’s consent was sought in line with the principles of the Mental Capacity Act 2005.

Staff were kind and caring and had good relationships with people. People were supported to make choices in line with their communication needs. People were treated with dignity and respect and their right to privacy was upheld.

The service delivered care that was person centred. People were supported with activities which took account of people’s preference and choices. People’s diverse needs were assessed and planned for and regular reviews were undertaken. There was a complaints policy in place and complaints were investigated in line with this policy.

The registered manager and provider had systems in place which enabled them to monitor the service and identify areas for improvement. People, relatives and staff spoke positively about the commitment of the registered manager and the provider who were open and approachable. The registered manager understood their responsibilities of their registration with us (CQC).

As a result of our last inspection, this provider was placed into special measures by CQC. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

Fernlea are registered to provide accommodation with personal care for up to 13 people. People who use the service may have physical disabilities and/or learning disabilities. At the time of the inspection the service supported 12 people.

There was a manager at the service, but they were not currently registered. 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 provider told us they had plans to submit an application for a registered manager.

Some further improvements were needed to ensure that staff had sufficient guidance when administering people’s ‘as required’ medicines.

We found that some further improvements were needed to ensure that effective systems were in place to consistently maintain care records that were accurate and up to date. When care records are not accurate and up to date, people are placed at risk of receiving inconsistent or unsuitable care.

We found some monitoring systems that had been implemented were effective. However, some further improvements were needed to ensure that care plan audits were effective in identifying and rectifying concerns.

People felt safe when they were supported. Staff understood how to recognise possible signs of abuse and the actions they needed to take if they had any concerns.

People’s risks were assessed and managed to keep people safe from harm.

There were enough suitably qualified staff available to keep people safe and the provider had a safe recruitment procedure in place.

People were supported by staff who had received training, which gave staff the knowledge and skills to provide appropriate care that met people’s needs.

People consented to their care where able and the provider followed the requirements of the Mental Capacity Act 2005 (MCA) where people lacked the capacity to make certain decisions about their care. Staff understood their responsibilities and followed the requirements of the MCA when they provided support.

People told us that they enjoyed the food. People’s nutritional needs were assessed and plans were in place to ensure risks when people were eating and drinking were lowered.

People were supported to access other health professionals in a timely manner to maintain their health and wellbeing.

People were supported in a caring and compassionate way by staff who knew people well. People’s privacy and dignity was protected when staff provided support and staff promoted and listened to people’s choices in care.

People were involved in their care. People received care that met their preferences because staff knew people well and knew how they liked their care to be provided.

People were encouraged to be involved in meaningful hobbies and interests within the service to promote their emotional wellbeing.

The provider had a complaints policy available and people knew how to complain and who they needed to complain to.

There was an open and honest culture within the service and the manager was approachable to people and staff.

Plans were in place to ensure improvements to the service were continually reviewed and changes were made where needed.

Fernlea are registered to provide accommodation with personal care for up to 13 people. People who use the service may have physical disabilities and/or learning disabilities. At the time of the inspection the service supported 13 people.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

There was a registered manager at the service. 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.

At this inspection we identified breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

Risks to people’s health and wellbeing were not consistently identified, managed or followed by staff to keep people safe from the risk of harm.

People were not always protected from the risks of abuse because appropriate and timely action was not taken by the registered manager when concerns were raised and the appropriate authorities were not always informed of potential safeguarding concerns.

We found that medicines were not administered and stored in a consistent and safe manner and they were not always administered as prescribed.

The provider did not have effective systems in place to consistently assess, monitor and improve the quality of care. This meant that poor care was not identified and rectified by the registered manager and provider.

People’s care records did not contain an up to date and accurate record of people’s individual needs. This meant that people were at risk of receiving inconsistent care.

Systems in place to monitor accidents and incidents were not being followed or managed to reduce the risk of further occurrences.

Staff told us they received training. However, we found that some of the training they had received was not effective. There were no systems in place to ensure that staff understood and were competent to support people safely and effectively.

We found people were not consistently treated with dignity when receiving support.

When people did not have the ability to make decisions about their care, we saw the legal requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS) were not consistently followed. These requirements ensure that where appropriate, decisions are made in people’s best interests when they are unable to do this for themselves. We found that staff were not always aware of people who were subject to a DoLS and where best interest decisions were made it was not always clear who had been involved in the decision making process.

Advice sought from health and social care professionals was not always followed to ensure people’s health needs were met effectively.

We found there were not always enough staff available to deliver people’s planned care and staff were not always available to supervise people with their nutritional needs.

People told most staff treated them in a caring way. However, some people felt that they were not listened to and choices were not always promoted.

Improvements were needed to ensure that people were able to access hobbies and interests that were important to them. We found that improvements were needed to ensure that staff were available to support people with hobbies and interests when the dedicated worker was unavailable.

Effective systems were not in place to investigate complaints and act upon people's concerns in a timely manner.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Fernlea on our website at www.cqc.org.uk

At this inspection we found that the provider had made the required improvements to meet the legal requirements.

We saw there were enough suitably qualified staff available to meet people’s needs and the provider had systems in place to assess and monitor their staffing levels.

People were protected from harm because staff knew how to keep them safe and understood how to report allegations of alleged abuse.

People’s risks were assessed and staff understood how to support people with their risks whilst maintaining their independence.

People were supported to access hobbies and interests that met their needs and preferences.

People told us and we saw that staff were available to support people and were responsive to their individual needs.

Staff were motivated and enthusiastic about their role and they felt supported by the management.

Feedback was sought from people, their relatives, staff and other professionals and issues raised were acted on to bring around improvements.

There were systems in place to monitor the quality of the service and these had been maintained by the registered manager.

Records showed that people had consented to the care and support they received. A person who used the service said, "They always ask. They are always nice'.

The service cooperated with the wider health community. A member of staff said, "We have a really good relationship with the doctor and district nurses".

Systems were in place to prevent and control the spread of infection.

The provider had a recruitment system which ensured that only staff that were of good character and with appropriate skills qualifications and ability were employed.

The provider monitored and assessed the quality of the service provided.

The financial arrangements had been reviewed and systems were in place to record how people using the service spent their money. People we spoke with confirmed they had access to their money and were satisfied with the arrangements.

We saw financial records were not completed accurately and money held for people living in the home did not correspond to the home's financial records. Receipts were not always available to demonstrate how people spent their money. This meant the service could not demonstrate systems were in place to protect people from financial abuse.

Systems were in place to ensure people using the service received their prescribed medicines. A new medication system had been introduced into the service and tablets had been dispensed into a blister pack by the pharmacy. Staff told us, "This means there's less room for error, as the pharmacist has already put the all the tablets into one blister. We then have all the tablets ready to give people." People we spoke with, were confident they were receiving the right medicines at the correct time.