Fern Court

Fern Court is a residential care home providing accommodation and personal care to up to 13 people. The service provides support to people who may have a learning disability, mental health condition or autism. At the time of our inspection there were 11 people using the service.

Accommodation was divided between 2 buildings; Fern Court and Fern Lodge. Some rooms provide en suite accommodation. Everyone living at Fern Court had access to a communal living room, kitchen and dining area and had access to a shower and bathroom. The grounds around the property were extensive, accessible and secure.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

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

Based on our review of safe and well-led the service was able to demonstrate how they were meeting the underpinning principles of right support, right care, right culture

Right Support

Staff supported people with their medicines. Staff followed recognised good practice in relation to medicine management.

People were being supported to have choice about their living environment and were being encouraged to personalise their rooms and communal spaces in the home. Changes had been made to the home to provide people with different areas they could enjoy.

Staff enabled people to access specialist health, dental care and social care support. Staff supported people living at Fern Court to access the local community and enjoyable activities which reflected their needs and interests.

The service had enough appropriately skilled staff to meet people's needs, keep them safe and support them to access the community.

Right Care

People's care, treatment and support plans reflected their range of needs. People’s care plans were detailed and reviewed. The provider was in the process of implementing an electronic care planning system.

People received kind and compassionate care. Staff protected and respected people's privacy and dignity. Staff understood and responded to their individual needs. Staff had received effective training and support to provide care effectively.

Staff understood how to protect people from poor care and abuse. Staff had training on how to recognise and report abuse and they knew how to apply it. A safeguarding lead had been nominated for Fern Court.

People could take part in activities of their choosing at home or in the wider community and pursue their own interests.

Right culture

People were now being supported to lead inclusive and empowered lives because of the ethos, values, attitudes and behaviours of the management and staff. The manager and provider recognised there was still room for improvement regarding this.

The provider had implemented a new management structure and continued to work with external professionals to help embed a stable and supportive management and staff team who support people to receive consistent care.

Mental Capacity Act

Staff supported people in the least restrictive way possible and in their best interests. Where people were living under Deprivation of Liberty Safeguards; staff understood the support they required.

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 service can respond to COVID-19 and other infection outbreaks effectively.

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 Requires Improvement (published 9 August 2022).

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 5 and 6 July 2022. A Breach of the legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements.

This report only covers our findings in relation to the Key Questions Safe, Responsive and Well-led which contain those requirements.

For the 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 to Good. This is based on the findings of this inspection.

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 service can respond to COVID-19 and other infection outbreaks effectively.

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

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Fern Court is a residential care home providing accommodation and personal care to up to 13 people. The service provides support to people who may have a learning disability, mental health condition or autism. At the time of our inspection there were 12 people using the service.

Accommodation was divided between two buildings; Fern Court and Fern Lodge. Some rooms provide en suite accommodation. Everyone living at Fern Court had access to a communal living room, kitchen and dining area and had access to a shower and bathroom. The grounds around the property were extensive, accessible and secure.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

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

Based on our review of safe and well-led the service was able to demonstrate how they were meeting some of the underpinning principles of right support, right care, right culture

Right Support

Staff supported people with their medicines. Staff had not always followed good practice in relation to medicine management, however this had not impacted on people’s medicine support.

People were being supported to have choice about their living environment and were being encouraged to personalise their rooms. The manager and provider had plans to redecorate and personalise the home to make it “homely” for people.

Staff enabled people to access specialist health, dental care and social care support. Staff were now supporting all people living at Fern Court to access the local community. For some people who had not left the service premises for nearly two years, there was early progress in supporting people in the community.

The service had enough appropriately skilled staff to meet people's needs and keep them safe.

Right Care

People's care, treatment and support plans often reflected their range of needs. People’s care plans sometimes provided conflicting information, which was raised to the manager and addressed.

People received kind and compassionate care. Staff protected and respected people's privacy and dignity. Staff understood and responded to their individual needs. Staff were starting to receive effective training and support to provide care effectively.

Staff understood how to protect people from poor care and abuse. Staff had training on how to recognise and report abuse and they knew how to apply it.

People could take part in activities of their choosing at home or in the wider community and pursue their own interests.

Staff were now supporting all people living at Fern Court to access the local community. For some people who had not left the service premises for nearly two years, there was early progress in supporting people in the community.

Right culture

People were now being supported to lead inclusive and empowered lives because of the ethos, values, attitudes and behaviours of the management and staff. The manager and provider recognised there was still room for improvement regarding this.

The provider had sought support from external professionals to help implement a stable and supportive management and staff team who support people to receive consistent care.

Mental Capacity Act

Staff supported people in the least restrictive way possible and in their best interests. Where people were living under Deprivation of Liberty Safeguards; staff understood the support they required.

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 service can respond to COVID-19 and other infection outbreaks effectively.

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 Inadequate (published 30 March 2022).

Why we inspected

This was a focused inspection based on the rating of the service and the service being in Special Measures. We followed up on enforcement action taken following our February 2022 inspection and the improvements the provider told us they were going to make.

We undertook this focused inspection to check if they now met legal requirements. This report only covers our findings in relation to the safe, responsive and well led.

Exiting special measures

This service has been in Special Measures since 30 March 2022. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

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

Follow up

We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Fern Court is a residential care home providing accommodation and personal care for up to 13 people. The service provides support to people who may have a learning disability, mental health condition or autism. At the time of our inspection there were 12 people using the service.

Accommodation was divided between two areas; the annexe and the main house. Some rooms provide ensuite accommodation. Everyone living at Fern Court had access to a communal living room, kitchen and dining area and had access to a shower and bathroom. The grounds around the property were extensive, accessible and secure.

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

The provider had made some improvements to the service. However, not all the requirements of the warning notice had been met.

The management had implemented a system to investigate and learn from incidents and accidents. However, this system was not fully embedded as staff had not always investigated incidents and taken effective action to prevent a reoccurrence.

People's care plans, risk assessments and positive behaviour support plans were in the process of being reviewed and rewritten by the management. At the time of our inspection, not all of these documents had been updated. The manager had prioritised which documents required completion first.

Infection prevention and control standards had improved; however, more work was needed to ensure visitors and staff were not placed at avoidable risk of harm from infection. Improvements were being made to the environment in relation to fire safety and legionella.

Monitoring systems were being implemented; however, they were not yet effective at driving improvements. The manager and deputy manager were developing leadership skills and a person-centred culture, however further action was required to ensure related systems were embedded. The management and provider were working closely with the local authority and other partners to address shortfalls.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

Based on our review of safe and well led, the service was not fully able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

Right support: The provider was not always able to demonstrate how they met the needs of people with a learning disability in line with best practice guidance.

Right care: Care was not always person-centred, however changes were being made to the culture of the service to address this. We saw examples where people’s dignity and privacy were being promoted.

Right culture: The management of the service were implementing audits and responsibilities for staff, however, these weren’t fully embedded.

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 Inadequate (published 30 March 2022).

Why we inspected

We undertook this targeted inspection to check whether the Warning Notice we previously served in relation to Regulation 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. The overall rating for the service has not changed following this targeted inspection and remains Inadequate.

We use targeted inspections to follow up on Warning Notices or to check concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

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 service can respond to COVID-19 and other infection outbreaks effectively.

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 Fern Court on our website at www.cqc.org.uk.

Follow up

We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Fern Court is a residential care home providing accommodation and personal care to up to 13 people. The service provides support to people who may have a learning disability, mental health condition or autism. At the time of our inspection there were 12 people using the service.

Accommodation was divided between two areas; the annexe and the main house. Some rooms provide en suite accommodation. Everyone living at Fern Court had access to a communal living room, kitchen and dining area and had access to a shower and bathroom. The grounds around the property were extensive, accessible and secure.

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

People were not always protected against avoidable harm. Incidents and accidents were not investigated in a robust way and learning from events was not used to prevent recurrence of the same issue. We saw people's care plans, risk assessments and positive behaviour support plans were out of date and contained inaccurate or conflicting information. Infection prevention and control was unsatisfactory. This placed people, visitors and staff at risk of infections. Service users were not always protected from the risks of their environment. The provider had not undertaken effective measures to ensure that service users would be protected from risks associated with fire safety and legionella.

Monitoring systems were not always effective as the records supporting the management of the service were not always reliable. There was an action plan in place for improvements which had been compiled by the local authority. The service had not always sent required notifications to the Care Quality Commission (CQC) without delay. The management and provider were working closely with the local authority and other partners to address failings.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

Based on our review of safe and well led, the service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

Right support: The provider was not always able to demonstrate how they met the needs of people with a learning disability in line with best practice guidance.

Right care: Care was not always person-centred and we saw examples where people’s dignity and privacy were not promoted.

Right culture: The lack of effective quality audits had meant that the support provided was at risk of becoming a closed culture. A closed culture is one where people's needs are not placed at the heart of care practices and people not being involved in their support.

We sign posted the provider to the Right support, Right care, Right culture information on the guidance for providers page on our website.

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 20 February 2019).

Why we inspected

We received concerns from commissioners in relation to staffing and risks to people’s safety. As a result, we undertook a focused inspection to review the key questions of safe 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 service can respond to COVID-19 and other infection outbreaks effectively. This included checking the provider was meeting COVID-19 vaccination requirements.

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 inadequate based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe 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 Fern Court 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 safe care and treatment, good governance, person centred care and reporting incidents at this inspection.

Please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

Fern Court can accommodate up to 13 people who may have a learning disability, mental health condition or Autism. At the time of our inspection 12 people were living there. Accommodation was divided between two areas; the annexe and the main house. Some rooms provide en suite accommodation. Everyone living at Fern Court had access to a communal living room, kitchen and dining area and had access to a shower and bathroom. The grounds around the property were extensive, accessible and secure.

We found the following examples of good practice at Fern Court.

¿ The provider had purchased additional waste containers and had placed these outside the service for the ease of removal of PPE for visitors.

¿ The provider had ensured that daily temperature checks were completed for all visitors, staff and people living at the service to minimise the risk of infection. Staff working at the service ensured clothing worn was changed and laundered to prevent cross contamination.

¿ A person showing symptoms of COVID 19 was supported to isolate in a ground floor room that had external access to allow for the safe movement of the person and staff, and to minimise the risk of cross infection.

¿ The registered manager had worked with a range of health care professionals to manage the safe discharge of people returning to the service following a hospital admission. Anyone returning to the service from a hospital admission was isolated for a period of at least 7 days to protect people from the risk of cross infection.

¿ The service had worked well with people's relatives where people had experienced fear or anxiety around the staff use of personal protective equipment (PPE).

¿ The provider had arranged for the deputy manager to access training delivered by the fire brigade at another of the providers locations as it was unsafe to complete the training at the service. The training was then passed on to staff working at the service by the deputy manager when it was safe and appropriate to do so.

¿ The provider had robust systems to ensure there was clear oversight of staff training in relation to infection prevention and control.

¿ The provider and registered manager had ensured that all information and guidance in relation to COVID 19 had been printed out and displayed in a file for staff.

Fern Court can accommodate up to 13 people who have a learning disability, mental health condition and Autism. At the time of our inspection 12 people were living there. Accommodation was divided between two houses; the annexe could provide en suite accommodation for up to four people with a living room, kitchen and dining area. People living in the annexe had full access to the facilities in the main house. People living at Fern Court had their own bedrooms with en suite facilities and had access to a shower and bathroom. They shared two lounges and a dining room. The grounds around the property were accessible. A shed in the garden was being converted into a sensory environment.

Fern Court had been developed and designed in line with the values that underpin the Registering the Right Support, Building the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service lived as ordinary a life as any citizen.

This inspection took place on 5 February 2019. At the last comprehensive inspection in August 2016 the service was rated as Good overall. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At this inspection we found the service remained Good.

There was a registered manager in post. They had been registered with the Care Quality Commission (CQC) in 2015. 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’s care and support was individualised, reflecting their personal wishes, routines and lifestyle choices. They were treated with kindness and care. They had positive relationships with staff, who understood them well. People sought out the company of staff. Staff knew how to keep people safe and how to raise safeguarding concerns. Risks were assessed and encouraged people’s independence. There were enough staff to meet people’s needs. Staff understood and respected people’s diverse needs. People who became anxious were helped to manage their emotions. Staff recruitment and selection procedures were satisfactory with the necessary checks being completed prior to employment.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. They made choices about their day to day lives. People and those important to them were involved in the planning and review of their care and support. They chose the activities they wish to take part in. People went horse riding, swimming, trampolining and to the cinema. They went on day trips, to social clubs and a local place of worship. People kept in touch with those important to them. People used information technology to keep in touch with relatives.

People’s preferred forms of communication were recognised. Staff were observed effectively communicating with people, taking time to engage with them. Good use was made of easy to read information which used photographs and pictures to illustrate the text. People had access to easy to read guides about safeguarding, complaints, activities and menus.

People’s health and wellbeing was promoted. A weekly menu encouraged people to have vegetables and fruit in their diet. They helped to prepare and cook their meals. People at risk of choking had special diets and the support of staff to keep them as safe as possible. People had access to a range of health care professionals and had annual health checks. People’s medicines were safely managed. People had expressed their wishes about how they would like to be cared for at the end of their life.

People’s views and those of their relatives and staff were sought to monitor the quality of the service. This was provided through quality assurance surveys, reviews, complaints and compliments. People had information about how to raise a complaint. The registered manager completed a range of quality assurance audits to monitor and assess people’s experience of the service. Any actions identified for improvement were monitored to ensure they had been carried out. The registered manager worked closely with local and national organisations and agencies to keep up to date with current best practice and guidance. Comments about Fern Court included, “I love this place,” “It’s very nice living here” and “I don’t think the service can be improved.”

Further information is in the detailed findings below.

Fern Court is a care home for up to 13 people with learning disabilities and autism. At the time of our inspection visit there were 11 people living at Fern Court.

Fern Court had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 improvements to staff recruitment procedures. Risks to people’s safety were identified, assessed and appropriate action taken. People’s medicines were safely managed. People’s individual needs were known to staff who had achieved positive relationships with them. People were treated with kindness, their privacy and dignity was respected and they were supported to develop their independence and keep in contact with relatives. People were involved in the planning and review of their care and took part in a range of activities.

Staff received support to develop knowledge and skills for their role and were positive about their work with people. The registered manager was accessible to people using the service and staff. There were improvements to systems to check the quality of the service provided including questionnaires for people using the service, their representatives and staff.

In this report, the name of a registered manager appears who was not in post and not managing the regulated activity at this location at the time of the inspection. Their name appears because they were still a registered manager on our register at the time. We have advised the provider of what they need to do to remove the individual's name from our register.

We used different methods to help us understand the experiences of people using the service because some people had complex needs which meant they were not able to tell us their experiences. We reviewed policies, spoke with staff, checked the premises and looked at staff records.

Concerns had been raised with us prior to the inspection about a lack of evidence to support the provider being a financial appointee for some people, a lack of training around challenging behaviour and a lack of risk assessments for staff with a criminal record.

We found the provider had followed appropriate steps to become the financial appointee for people. Staff knew how to support people when they were anxious and physical restraint was only used as a last resort. Staff had received training to help them support people when they were distressed.

The provider had made improvements to the premises and infection control procedures in line with the action plans to address previous non-compliance.

We found some recruitment checks were not being completed, including the risk assessment of employing staff with a criminal record.

We found improvements to staff recruitment and improved staffing levels at weekends. The person we spoke to told us how they were able to go out of the home on trips and commented that the staffing levels at weekends were, 'much better'. Staff were receiving appropriate support through training and supervision. We also found that quality monitoring systems were in place that included seeking the views of people using the service. When we asked for them, documents and records were produced promptly.

We found that the management of medicines needed to be improved so that people were protected against the risks associated with the handling and administration of medicines.

We found that the views of people about how the service was delivered were not always being sought. However we found that assessments were in place relating to consent and a person's metal capacity.

Some people did not have Health Action Plans in place and this had been highlighted at a previous inspection. We also found that the service had not reported allegations of abuse to us or to the local authority.

Some records relating to staff were missing including training records so we were not able to check if staff had received suitable training. We also found that effective recruitment procedures were not being used. Staffing at weekends may have prevented people from taking part in activities outside of the home.

Work needed to be carried out to the environment of the home as well as measures to protect people against the risks from infection.

Effective checks were not being made on the quality of the service provided.