Fernery House

Fernery House is a residential care home providing personal care for up to 7 people with a learning disability and/or autistic people. At the time of the inspection 6 people were living at the home. The service is a residential property based in Burnham on Sea. Local shops, the beach and the town are within a close proximity to the home.

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

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.

Right Support

People had plans in place to guide staff on how to support them if they became anxious or upset. However, the plans were not always regularly reviewed or updated. People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not always support this practice. Some improvements were required to ensure people were supported to make decisions following best practice in decision-making. The service did not always give people care and support in a clean environment. Staff did not always support people with their medicines in a way that achieved the best possible health outcome.

Staff supported people to play an active role in maintaining their own health and wellbeing. The service gave people care and support in a safe and well-furnished environment that met their sensory and physical needs. People had a choice about their living environment and were able to personalise their rooms. The service supported people to have choice, control and independence. People were able to pursue their chosen interests.

Right Care

Improvements were required to ensure risks to people were fully assessed and mitigated. Staff understood how to protect people from poor care and abuse. The service worked well with other agencies to do so. Staff had training on how to recognise and report abuse, not all staff were able to tell us where they would report abuse outside of the organisation. There were some shortfalls in staff training. The service had enough staff to meet people’s needs and keep them safe. People received kind and compassionate care. Staff protected and respected people’s privacy and dignity. Staff understood and responded to people’s individual needs.

Right Culture

The systems to monitor the quality of the service were not fully effective in ensuring shortfalls were actioned. Staff understood people well and were responsive to their needs. People’s quality of life was enhanced by the service’s culture of improvement and inclusivity. Staff valued and acted upon people’s views.

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 17 October 2019).

Why we inspected

We received provider level concerns. During the inspection we identified concerns relating to the management of risk, medicines, infection control, the application of the Mental Capacity Act 2005, staff training and governance.

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 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 safe, 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 Fernery House on our website at www.cqc.org.uk.

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.

People were safe and well-supported at Fernery House. There were enough staff to meet people’s needs. Risks to people’s health and well-being were managed with minimum restriction. Medicines were managed safely and the service was clean and fresh throughout. Accidents or incidents were investigated and measures put in place to reduce re-occurrence.

People received an effective service. Their needs and preferences were assessed, and care was delivered by a staff team who were trained and supervised. Staff supported people to live healthy lives and to eat and access health care when needed. People chose what to eat and drink and were supported to be involved in shopping for and preparing their meals. People’s rooms were designed and decorated to their taste; they had keys to their rooms and were able to refuse access if they chose.

People received individualised care. Staff at the service were caring, warm and respectful. People were involved in decisions about their care and encouraged to be as independent as possible.

The registered manager followed up concerns and complaints and used them to improve the running of the service. Staff and relatives were complimentary about the registered manager and the deputy. Staff morale was good and relatives were pleased with the service delivered.

People were supported to have maximum choice and control of their lives and staff them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

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 24 October 2018).

Why we inspected

This was a planned inspection based on the previous rating.

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Fernery House is a large house which is situated on the sea front and is close to the town’s shops and leisure facilities. Accommodation is arranged over three floors with stairs giving access to each floor. The home can accommodate up to seven people and it provides support to people who have autism. All bedrooms are for single occupancy and the home is staffed 24 hours a day.

At the time of our inspection there were four people living at the home. Some people were not able to tell us about their experiences of life at the home so we therefore used our observations of care and our discussions with staff and other stakeholders to help form our judgements.

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 registered manager was not available on the day of our inspection. Staff described the registered manager as open and approachable. A member of staff told us “The home is really well-managed, organised and runs very smoothly.” Staff told us the provider’s management team were accessible, approachable and supportive.

There were enough staff deployed to help keep people safe. People were supported to live the life they chose with reduced risks to themselves or others. There was an emphasis on supporting people to develop and maintain independent living skills in a safe way.

There were policies and procedures which helped to reduce the risks of harm or abuse to the people who lived at the home. These were understood and followed by staff. These included recognising and reporting abuse, the management of people’s finances, staff recruitment and the management of people’s medicines.

People were supported by a caring staff team who knew them well. Staff morale was good and there was a happy and relaxed atmosphere in the home. One member of staff said “Everyone here is wonderful and I feel lucky to be able to spend time with them.” A relative said “It is a wonderful place and the staff are just great.” One person smiled and responded “Yes. I like [staff member’s name]. They are good.” When we asked if they liked the staff member who was supporting them.

People were treated with respect and their views were valued. For example in a satisfaction questionnaire one person had written that they wanted to have more activities outside of the home and this had been facilitated.

People were always asked for their consent before staff assisted them with any tasks and staff knew the procedures to follow to make sure people’s legal and human rights were protected.

People were involved in developing and reviewing the care they received. Each person had a care plan which detailed their needs, abilities and preferences. These had been regularly reviewed with each person to make sure the plan of care reflected their needs and aspirations.

People accessed various activities in the home and local community. People were supported to maintain contact with the important people in their lives. A relative told us staff helped their relative to have weekly face to face internet contact with them.

There were systems in place to monitor and improve the quality of service people received.