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Archived: Fernwood Requires improvement

Reports


Inspection carried out on 17 November 2017

During a routine inspection

Fernwood provides residential care for up to three people with learning disabilities. There were two people living there at the time of our inspection. People needed support with communication and were not able to tell us their experiences, so we observed that they were happy and relaxed with staff. One person had physical disabilities that they needed staff support with.

There was a registered manager in post. 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 owner is also the registered manager of the home.

This is the third time the home has been rated requires improvement. At the last inspection in August 2016, a number of breaches of regulations were identified and requirement notices were issued. Breaches were in relation to a lack of good governance, person centred care and not having suitably qualified and competent staff. Following the inspection we met with the provider to discuss their report. We asked the provider to complete an action plan to show improvements they would make, what they would do, and by when, to improve the key questions in safe, effective, responsive and well lead to at least good.

This comprehensive inspection took place on 17 November 2017 to check the provider had made suitable improvements to ensure they had met regulatory requirements. We found that appropriate actions had been taken and issues had been addressed. The provider was now meeting the regulations and although still rated requires improvement in two areas, significant improvements had been made. However, further improvements were still needed in relation to person centred activities and record keeping to ensure they were embedded into everyday practice.

Appropriate checks had taken place before staff were employed to ensure they were able to work safely with people at the Fernwood. People’s needs were effectively met because staff had the training and skills they needed to do so. Staff were well supported with induction, training, supervision and appraisal. Staff knew how to safeguard people from abuse and what they should do if they thought someone was at risk. People’s medicines were managed safely.

People were treated with dignity and respect by kind and caring staff. Staff had a good understanding of the care and support needs of people and had developed positive relationships with people.

People had enough to eat and drink and the menus were varied and well balanced. Appropriate referrals were made to health care professionals when needed and people were supported to attend health appointments, such as the GP or dentist.

People were encouraged to be involved in decisions and choices when it was appropriate. Mental Capacity Act 2005 (MCA) assessments were completed as required and in line with legal requirements. Staff had attended MCA and Deprivation of Liberty Safeguards (DoLS) training.

There was good leadership in the home and the registered manager had an open door policy which staff valued. The organisation had effective systems to monitor and review the quality of the care provided. Further information is in the detailed findings below.

Inspection carried out on 25 August 2016

During a routine inspection

Fernwood provides residential care for up to three people with learning disabilities. There were two people living there at the time of our inspection. People needed support with communication and were not able to tell us their experiences, so we observed that they were happy and relaxed with staff. One person had physical disabilities that they needed staff support with.

There was a registered manager in post. 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 owner is also the registered manager of the home.

We carried out an unannounced inspection on 18 and 20 November 2015 where we rated the home as ‘Requires Improvement’ in three areas. We issued specific requirement notices in relation to safety and consent. We received an action plan from the provider that told us how they would make improvements. We carried out this comprehensive unannounced inspection 25 August 2016 to check the provider had made improvements and to confirm that legal requirements had been met. We found that improvements had been made in relation to consent and safety but additional concerns were identified in other areas.

There were enough staff to meet people’s needs. However, at the time of inspection the registered manager and one staff member were on leave which meant that two staff were working back to back to provide cover for shifts during this period. Over a two week period this meant that one person was not able to attend their day centre and there was no alternative activity programme in place during this time. There was no contingency plan in place should one staff member be unwell during this period.

Staff told us they did not feel supported. They had not received a supervision or appraisal for over a year and staff meetings were held infrequently. A staff member had recently been promoted to the role of senior but there was no job description in place and they were not clear about the extent of their responsibilities.

Although a range of health and safety audits had been carried out it was not always clear what action was taken. For example, although water outlets were regulated to a safe temperature, water temperatures were not checked periodically to make sure that the regulators were operating effectively. Staff training in some areas was not up to date and this had not been identified through regular monitoring. Whilst there were procedures to review care plan documentation some areas of documentation had not been reviewed for long periods.

Staff understood what they needed to do to protect people from the risk of abuse. Staff had assessed that restrictions were required to keep people safe and where appropriate referrals had been made to the local authority for authorisation to have Deprivation of Liberty Safeguards (DoLS) in place.

Staff had worked in the home a long time and had a good understanding of people as individuals, their needs and interests. They knew how people liked to be supported. People had access to healthcare professionals when they needed specific support. This included GP’s, dentists and opticians. People were asked for their permission before staff assisted them with care or support.

We found a number of 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 this report.

Inspection carried out on 18 and 20 November 2015

During a routine inspection

Fernwood is registered to provide accommodation and personal care for up to three adults with a learning disability. People living in the service had some physical care needs and limited verbal communication and used gestures and body language to express their views. Two people lived at the service at the time of our inspection. Fernwood was located within a residential area of Hastings.

This inspection took place on 18 and 20 November 2015 and was unannounced.

The service had a registered manager who was also the registered provider. 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. Despite having positive feedback from people on the safety and management of the service. We found areas that could impact on people’s safety and care.

The registered manager had not ensured the service had been suitably risk assessed with suitable measures being put in place to ensure people’s health and safety. For example, windows above ground floor and radiators that had not been guarded had not been risk assessed and therefore any risk had not been identified with appropriate measures being taken to mitigate the risk.

The registered manager had not assessed people’s mental capacity following guidelines set out in

the Mental Capacity Act 2005 Code of Practice. There were no consent forms in people’s care records for the agreement as to how their care and treatment was provided. The registered manager had not documented any best interest meeting that had been held in relation to care and treatment.

Systems for effective management had not been fully established in all areas. For example up to date policies and procedures were not readily available to provide clear guidelines for staff to follow. Systems for planning the future of the service including the ongoing maintenance planning were not established.

All feedback received from people and their representatives through the inspection process was positive about the care, the approach of the staff and atmosphere in the home. Staff treated people with kindness and compassion and supported them to maintain their independence. They showed respect and maintained people’s dignity. People had access to health care professionals when needed.

Visitors told us they were warmly welcomed and people were supported in maintaining their own friendships and relationships.

Recruitment records showed there were systems in place to ensure staff were suitable to work at the home. Staff had a clear understanding of the procedures in place to safeguard people from abuse. Medicines were stored, administered and disposed of safely by staff who were suitably trained.

Staff were provided with an induction and training programme which supported them to meet the needs of people. There was a variety of activity and opportunity for interaction taking place, this took account of people’s preferences and choice. People were very complementary about the food and the choices available. Relatives were given information on how to make a complaint and said they were comfortable to raise a concern or complaint if need be.

There was an open culture at the home and this was promoted by the staff and management arrangements.

We found 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 this report.

Inspection carried out on 31 July 2013

During a routine inspection

We spent time and spoke with two of the three people who lived in the home. We used a number of methods to help us understand their experiences as they had complex needs and difficulties in communicating. We observed staff speaking kindly and that they waited for people�s responses before continuing.

We spoke with two members of staff as well as the manager. The manager was also the provider and on the rota working that day. The manager regularly worked alongside staff in the home.

We found that staff demonstrated an understanding of the consent process and that families were involved in the care of their relatives. People�s needs had been individually assessed and were reviewed on a regular basis. One person indicated to us that they liked living in the home.

We saw that the building was maintained and that safety checks had been undertaken. Staff had worked at the home for a number of years and felt well qualified for their role.

We found an effective complaints system in place with people who used the service and their relatives aware of the process.

Inspection carried out on 26 March 2013

During a routine inspection

We used a number of different methods to help us understand the experiences of the people living at Fernwood, because people had complex needs which meant they were not able to tell us their experiences. We observed staff communicating effectively with people. We saw that people appeared happy and at ease around the staff. We saw that planning of the day�s activities were altered to suit a person�s particular needs, which showed the staff were responsive to people�s needs.

In our discussions with staff they demonstrated a thorough knowledge of the people living at the service. This was confirmed by our observations and the record keeping.

Care records showed that people had been supported and their relatives involved to make decisions about their lives, including their care and support. When people�s needs changed, we found that records had been updated to reflect this.

Staff spoken with demonstrated good understanding of how to safeguard people from harm. Training records showed that staff received regular training to update their knowledge on abuse and safeguarding.

Records showed the provider regularly assessed and monitored the quality of the service and had made a plan to replace broken furniture. We saw that people�s relatives were asked their views about the home and information from other professionals were sought.

Reports under our old system of regulation (including those from before CQC was created)