Archived: Fernlea

At the time of this inspection there were two people using the service. Both individuals were moving to alternative placements by 1 August 2014. We spoke with one person who was using the service, three support workers, the deputy manager and a senior manager who was the School Principle of the Priory Group. We looked at support records for three people, one of who had been using the service until recently.

This is a summary of what we found '

Is the service safe?

The provider had taken action to help ensure that people who use the service, staff and others were safe. This included improved systems for recording and reporting incidents and safeguarding concerns. Staff we spoke with were aware of their responsibilities in relation to reporting any safeguarding concerns and were confident that any concerns they raised would be acted on appropriately. We saw that staff had access to an effective management on-call system that included senior managers.

We saw evidence that care and support plans had been reviewed and updated. The records included individual risk assessments for each person, which identified risks related to the provision of support and gave clear guidance on how risks would be managed. Support plans and risk assessments now contained more detail and specific guidance, for example to assist staff in responding to behaviours that put people who use the service or others at risk.

Staff we spoke with were clear about the organisation's policy on physical interventions and said that, since the last inspection, there had been no further instances when such intervention had been required. This demonstrated that people were supported in ways that respected their dignity and protected their human rights.

We observed there was a relaxed atmosphere in the home and staff worked in ways that promoted people's choice, control and inclusion. We spoke with one of the people who use the service. They said they 'Had always felt safe' living at the home.

Is the service effective?

The service was now included on the organisation's training schedule, which included training for staff to support young adults and children. Staff confirmed that they had the guidance and training they needed to support people effectively and safely and said they felt confident in applying it.

Staff were more involved in reviewing the support plans with people who use the service. A person using the service who we spoke with confirmed they were aware of and involved in their support plan. One member of staff expressed the view that people's support was 'Well documented, updated and accurate' and said there had been a 'big improvement'.

Is the service caring?

Is the service responsive?

Is the service safe?

Is the service effective?

Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records. This inspection was initiated in response concerns raised with the Care Quality Commission.

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

Is the service safe?

Judgements about new admissions to the home were not based on robust assessments which considered the impact on the existing residents or whether the staff team had the necessary skills and knowledge to safely meet people's needs. Staff told us that the service did not feel safe.

There was a system in place to report events such as incidents and accidents, however these systems had not ensured that risks to people's safety were managed, or in identifying where improvements to the service were required.

Staff said they did not feel supported in their roles. The service had an on-call system to provide management support to night staff, however there were occasions when there was no response from the on-call manager. This meant that there was a risk that decisions might not be made by people with the correct skills and experience.

The service had a safeguarding policy and staff understood their role in safeguarding vulnerable people, however we found that people who use the service had not always been protected from the risk of abuse because the provider had not taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to safeguarding vulnerable people from abuse and monitoring risks and learning from incidents and events.

Is the service effective?

People were not always receiving effective care as their support needs had not been adequately identified, assessed and planned for. Assessments did not provide sufficient information about how risks to people's health and wellbeing were to be managed.

We found that some records about people's care included historical information which meant there was a risk staff could follow incorrect guidance.

People told us that the service was not effectively supporting them to achieve their goals, aims and objectives. For example, one person told us, 'I'm not sure what this place offers, it was sold to me as way of supporting me to build-up to living on my own, but it's more like a care home that encourages dependence'.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to assessing and planning for people's needs.

Is the service caring?

We observed that people using the service were treated with respect. One person told us, 'The staff are kind, they treat me with respect'. Another person told us, 'The staff are good'.

We observed some good interactions between staff and people using the service, although we also observed that at times staff lacked confidence to positively challenge inappropriate behaviour and reinforce boundaries regarding personal space.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to supporting workers to deliver care to an appropriate standard.

Is the service responsive?

We found that the provider had not ensured that there were always sufficient numbers of staff with the right competencies, knowledge and skills to meet the needs of people at all times. We found that the service was not always making an effective response to unexpected changing circumstances such the sickness of absence of staff.

We found that the service had not responded to the concerns of staff about the safety of the service or their suggestions for how the service might improve. One support worker told us, 'It's really frustrating, we don't really have a say in anything, we have all just given up'.

There was some evidence that the service worked with other professionals to ensure appropriate support planning took place, however we were not always able to see that their advice and recommendations were acted upon.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to ensuring that there are sufficient staff on duty to meet people's needs.

Is the service well led?

The service had an established internal management structure in place. Staff received regular supervision and appraisals and team meetings had been held on a frequent basis. We saw that staff had received training which supported them to carry out their roles. However, we saw records that showed not all staff had received the training they needed.

From our review of support plans and risk assessments, we found that the service had not ensured these were monitored and audited effectively to ensure that they contained an accurate, up to date and robust record of people needs and the risks associated with delivering their care.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to ensure that they have suitable systems in place to monitor the quality and safety of the service.

We met with the new staff team who were attending a training session in the home. They told us they had received a good induction and training since their appointment in March 2013.Staff showed knowledge of the new service; the needs of the person who used the service and confirmed that the manager was supportive and approachable.

The provider had ensured that there were enough qualified, skilled and experienced staff to meet the current needs of the individual accommodated and in preparation for new admissions to the service.

People who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. This included provision of staff training and policies and procedures in place.

There was a complaints procedure in place and systems to regularly assess and monitor the quality of the service that people received.