Fernlea

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

People were not always kept safe from potential harm. Initial assessments which assessed whether people were suited to live in group living environments were not always available. Relatives and staff raised concerns over initial assessments. They told us people who recently moved into the home were not suited to communal living and caused distress to people who had been living in the home for several years. The provider had not learned lessons from the previous inspection and similar concerns continued to be found. Lessons learnt from incidents involving distressed behaviour and debrief of staff were not recorded. People told us they felt safe with the staff who supported them. People told us they could take risks and had choice and control over their lives.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People told us the culture was open and staff listened to them and recognised their right to take risks. One person said, "I know I can go to the registered manager if I need to. The registered manager helped me understand the risks from drinking too much." Another person told us how staff encouraged them to eat more and recognised their right to take risks, such as smoking. People told us staff respected their choices and promoted their independence. One person told us, "I choose not to go to the dentist. I can go to the doctors when I need to." Relatives did not always feel the culture was open and honest. One relative told us, "I'm not confident they act quickly on concerns. I am concerned over how they respond to incidents. The provider is not very proactive." Another relative told us, "My concerns are ignored, they will sugar coat the issue."

The registered manager told us incidents involving distressed behaviours were reviewed and discussed with staff. However, these were not recorded, this meant the provider could not be assured lessons were being learnt from incidents involving distressed behaviours. This contributed to a breach in Regulation 17 (good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Please see the well led section of this report for more details. Staff told us the culture was positive and incidents were discussed, 1 staff member said, "We complete incident forms and if the registered manager is concerned, we will be pulled in for a discussion." Another staff member said, "We complete incident forms, the registered manager will update the care plans and risk assessments based on the information. We talk through the incident afterwards." Staff understood the importance of keeping update with people's changing needs. One staff member said, "Staff must read the care plans and risk assessments to keep updated. Things can change such as people’s dietary requirements." We received feedback from 4 visiting professional who told us the provider was open and honest with them. They told us how concerns were shared openly and promptly.

The learning culture did not always promote learning from incidents involving distressed behaviours. Incident analysis was not taking place, this meant the provider could not be assured patterns involving distressed behaviours were being investigated to ensure people were receiving appropriate support. Incident records did not document any debrief with the staff involved. This meant the provider could not be assured staff were learning from incident management and reviewing alternative strategies to support people when they experienced distressed behaviours. During the last inspection, the provider completed an action plan in response to breaches of regulation. This action plan was not fully implemented, this meant the provider had not learnt lessons when things went wrong. The provider acted on all concerns raised in this inspection. New incident forms were developed which included follow-on action and debrief of staff. New incident analysis audits were developed to monitor patterns of behaviours and responses from staff. We will review the success of these new systems in the next inspection.

People’s needs were not always initially assessed to ensure they safely transitioned into the home. Initial assessments were not available for 1 person who recently moved into the home. Initial assessments are important when assessing whether people are best suited to move into care homes and live communally with other people living in the home. The registered manager told us they completed initial assessments on any new person prior to moving into the home. However, they were unable to locate 1 initial assessment. This meant the provider could not be assured people were best suited to live in the home. However, the provider took appropriate action when it became evident 1 person was not suited to live in the home, supporting them to transition safely out of the home. Some initial assessments were in place and 1 relative told us how the provider supported their family member to feel at home when they first moved in.

Visiting professionals told us the provider worked in partnership with them and other services. One visiting professional said, "Since the person has moved into Fernlea, they have engaged positivity with the registered manager and the staff. The person’s health has significantly improved with support from the provider and many other services."

Staff told us people were not always safely assessed to move into the home. One staff member said, "1 person was not assessed properly prior to moving into the home." Relatives told us this person should not have moved into the home due to the level of support required to manage their distressed behaviours. Staff told us, when a new people move into the home, they read the risk assessment and the care plan. One staff member said, "We are given the care plans to discuss. Someone is appointed as keyworker, and they can really get to know the person."

Not all staff had completed safeguarding training. However, staff told us how they would respond to concerns and report abuse. One staff member said, "I have received safeguarding training. This taught me how the law protects adults." Another staff member said, "I would report all safeguarding concerns to the registered manager if nothing was done, then I can go to CQC or the local authority safeguarding team."

Safeguarding referrals were made in a timely manner to the local authority and other professionals. During the onsite assessment, 1 person raised a safeguarding concern. The provider reported this concern to the local authority safeguarding team and steps were taken to ensure the person remained safe from harm. Not all staff received safeguarding training despite working in the home for many months. The registered manager responded to our feedback by contacting the staff who had not completed the training and putting in steps to ensure they completed safeguarding training. Supervisions and appraisal forms were updated to include any outstanding training.

People told us they felt safe living in the home with the staff who supported them, one person said "I've been here a long time. I feel safe." Another person said, "I feel safe here. The staff look after me well." Another person told us, "I feel safe. If I'm not happy I can mention it." The service worked within the principles of the Mental Capacity Act 2005. Staff told us about people’s capacity and demonstrated how they respected people’s choices and made best interest decisions where appropriate.

We observed staff members hoisting people safely and respectfully. We observed staff members discussing risks with people and supporting people in accordance with their preferences and choices.

We observed staff actively promoting people's rights to take risks. People could make their own choices and take risks, for example some people chose to drink alcohol or smoke cigarettes. People were able to leave the home and access the community on their own or with support from staff.

Staff recognised the importance of people making their own decisions and taking risks. One staff member said, "It's important to recognise people can make their own choices." Another staff member told us about how they supported a person to take their own risks, they said, "We prompt the person about the risks and the benefits from their decision." A visiting professional told us, "The provider is really proactive with positive risk taking. They monitor this and with agreement from the person concerned, they help the person to make the right decisions for themselves."

People’s risk assessments and care plans were updated in accordance with their changing needs. People told us they felt supported to take their own risks. One person told us the staff team discussed risks to their health openly and supported them to manage these risks. Another person told us, “I smoke sometimes. I like smoking. I'm an adult.”

Risk assessments were in place to support people to make their own decisions. Care plans were regularly updated to reflect people's preferences and choices. Staff were knowledgeable about people's risks and how to support them safely.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

There were enough staff on duty. We observed staff supporting people promptly when required and we observed the registered manager engaging with people and assisting staff when needed. The registered manager recently increased the numbers of night staff to reflect the support required for people experiencing distressed behaviours. Observations showed staff work well together. Staff told us they worked as a team ensuring people were supported safely.

People told us they had confidence in the staff members who supported them. One person said, "The help is so good, all the staff are great." Another person said, "I think there is enough staff. They come quickly if I need them."

Provider failed to ensure staff were competently trained and did not take appropriate action when staff had not completed their training. This placed people at risk of harm. During the last inspection (21 October 2022), the provider failed to ensure staff received all necessary training to support people safely. This breached Regulation 18 (staffing) of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. In response to the breach of regulation, the provider completed an action plan to show how they intended to become compliant with the law. The provider failed to implement this action plan; staff remained unskilled within several areas such as, safeguarding, oral health, and epilepsy, this placed people at risk of harm. We found no evidence people had been harmed. However, systems were either not in place or robust enough to demonstrate staff were competently trained. This was a continued breach of Regulation 17 (good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider responded to our feedback. They introduced a new supervision record to address training needs, a new action plan, a new starter checklist and they amended the appraisal all to include training. Staff were recruited safely. The provider completed all pre-employment checks prior to staff commencing their care duties.

Staff had not always completed their mandatory training. Two staff members commented training was mostly online and they felt the staff team would benefit from more face-to-face training, especially around distressed behaviours. Staff told us there were enough staff on duty to keep people safe. However, 3 staff told us at times they felt rushed, especially when carrying out certain tasks such as hoisting people, carrying out personal care or supporting people who are experiencing distressed behaviours. Although, staff commented how the registered manager provided support during these tasks and told us the registered manager allocated extra staff when people had appointments outside of the home, for example, attending hospital.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

People received their medicines in a safe and dignified way. However, medicines were not always stored safely. For example, staff recorded the temperature of the medicine’s fridge daily. However, when temperatures exceeded the maximum temperature, the provider did not take appropriate action to address these concerns. Whilst no one was harmed, people were at risk of harm should they require their medicines refrigerated. The registered manager responded to our feedback. New audits were introduced, and new medicine fridge thermometer was installed. Medicines matched the stock quantities identified and medicines audits were in place, although these had not identified the fridge temperature concerns.

People told us they were supported to receive medicine safely. One person told us, "I am aware what medicines I am taking; I get them quite frequently. I know the meaning of every single one." Another person told us, "I have no issues with taking medicines, I am supported by the staff team."

Staff received safe administration of medicines training and had their skills regularly checked. One staff member told us, "We have competency checks. I made a mistake when administering medicines. I was suspended from administering until they renewed all my competencies.” Another staff member said, "I have received medication administration training. I was asked if I was confident or whether I needed more support." Staff told us about ‘Stopping Over Medication of People with a learning disability, autism or both’ (STOMP). STOMP is a national project involving many different organisations which are helping to stop the overuse of these medicines. One staff member said, "This is about stopping over medication of people. This is abuse. It’s against the law."