- Care home
Fernery House
We served a warning notice on National Autistic Society (The) on 15 December 2025 for failing to ensure good governance at Fernery House.
Report from 13 October 2025 assessment
Contents
Ratings
Our view of the service
Date of assessment: 28 October to 21 November 2025. Fernery House is a residential care home for people with a learning disability and autistic people. This service is registered to accommodate up to 7 people. At the time of the assessment there were 6 people living there.
At the last inspection, the service was rated requires improvement and found to be in breach of 4 legal regulations. At this assessment we found that although the provider had made some improvements in areas identified by us and set down in their action plan, these had not consistently been sustained and embedded. The service remained in breach of regulations in relation to safe care and treatment, staffing, the way they gained people’s consent and assessed their mental capacity to consent and good governance. We identified an additional breach of legal regulation in relation to person centred care. The provider must send us an action plan detailing how they will address these breaches.
We assessed the service against ‘Right support, right care, right culture’ guidance to make judgments about whether the provider guaranteed people with a learning disability and autistic people respect, equality, dignity, choices, independence and good access to local communities that most people take for granted. The service did not consistently uphold these principles.
Care documentation was fragmented due to the transition to electronic records, and risk assessments were not always reviewed or updated, although work was in progress to complete these actions.
Safeguarding systems lacked robust oversight, and restrictive practices were not consistently reviewed in line with the Mental Capacity Act. Environmental safety required urgent attention, with some outstanding fire safety actions and poor maintenance in various areas of the home. Recruitment checks were incomplete, and gaps in records related to staff training and qualifications continued, including the Care Certificate, refresher courses in key areas such as dysphagia (swallowing difficulties) and mandatory autism training.
While medicines were generally managed safely, improvements were needed in areas of quality monitoring such as audits and staff competency updates. Infection prevention and control procedures required improvement, and staff did not consistently follow best practice.
Governance systems were ineffective, with audits failing to identify or address key areas. Leadership instability impacted continuity of care and progress on improvements.
Although some positive outcomes were achieved for people, these were not experienced consistently across the service. Opportunities for independence and meaningful engagement were limited for some people, and care plans and goals were not regularly reviewed.
People's experience of this service
During our inspection we observed and interacted with people across 3 days. We had an Expert by Experience who had a background in learning disabilities speak with relatives.
Despite our findings from our assessment of processes, feedback from staff, leaders and professionals and observation; feedback from people’s relatives was mostly positive. Areas for improvement included the need to provide more structure to people’s daily routines, supporting independence with tasks like cooking, the maintenance of the garden at the home and improving communication about staff changes. Despite these points, families expressed high levels of satisfaction, describing the home as calm and caring.
Relatives told us people were happy living at Fernery House and felt safe. They knew who to contact if they had concerns and praised the acting manager for being approachable and responsive, especially during management changes. Staff were described as kind, caring, and respectful. Families said staff knew people well and supported them to make choices about daily life, including meals and activities.
People were encouraged to go out with staff for walks, shopping, and visits to family. Activities included art, jigsaws, swimming, and trips to local events. Some people were supported to volunteer and attend clubs, which relatives felt were meaningful and person-centred. Bedrooms were personalised, and the home was clean and well maintained.
Meals were generally well received, and people had choices, including vegetarian options. Snacks and drinks were available, and staff supported those who needed reminders to eat or drink. Relatives felt there were usually enough staff, though noted reliance on agency workers and frequent management changes. Core staff were seen as knowledgeable and responsive. Staff contacted healthcare professionals promptly and supported people to attend appointments.