Fernery House

On this page

• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

Caring – this means we looked for evidence that the service involved people and treated them with compassion, kindness, dignity and respect.

At our last inspection we rated this key question good. At this assessment the rating has changed to requires improvement. This meant people did not always feel well-supported, caredforor treated with dignity and respect.

This service scored 55 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not treat people with kindness,empathyand compassion, or respect their privacy and dignity. Staff treated colleagues from other organisations with kindness and respect.

The interaction we observed between staff and people who used the service were not always warm, respectful and inclusive. While people seemed comfortable around staff, we found that interactions were not consistently the same, particularly for people who were not forthcoming in communicating with staff or engaging in communal areas. For example, we observed staff who were supporting 2 people on a 1:1 basis in one of the lounges. After a long period of non-engagement with the 2 people, the staff started a private conversation with a third staff member without involving people or including them in a suitable conversation.

We also observed people being supported on a 1:1 basis during mealtimes due to being at risk of choking. These interactions or the ambient were not always person centred, as the staff member just watched the person eat and did not engage with them.

We also observed positive interactions between staff and people who were more confident with their verbal communication. For example, a person was engaging in planning the decorations for the upcoming Halloween party while another person was supported to plan their costume for this.

We found files with people’s personal information that were unsafely stored in the communal sitting room.

People’s relatives confirmed that permanent staff knew people and provided care to reflect their personal needs.A relative told us; “[We are] very lucky a lot of staff [have] been there a long time and know [person] inside out.” They also told us that staff were kind and caring towards their loved ones. Another relative said; “[Staff are] very kind and caring and understand and are good with [person].”

The provider treated people as individuals and made sure people’s care, support and treatment met people’s needs and preferences. They took account of people’s strengths, abilities, aspirations, culture and unique backgrounds and protected characteristics.

People care records indicated they were offered choices in activities and daily routines, such as when to get up and what to do. Grab pack style folders were in place which contained person-centred plans and positive behaviour support strategies, although some plans were overdue for review.

Some people experienced care that promoted independence and personal development. For example, 1 person talked to us about the work they did to support staff learn 1 of their preferred communication styles. They also talked to us about how they established links within the local community where they could go in case of an emergency while out, as well as attending a club without staff support as part of their journey towards accessing places independently as well as the volunteering work they were doing.

People’s relatives provided us with a lot of examples of activities people would usually get involved in. A relative told us: “[Person] can do painting, art and craft work available, goes to the library once a week to choose books, jigsaws and probably most of it watch a lot of tv. [Person]has got their own laptop and goes on the web, and he looks at maps and Google earth. Reasonable range of activities, [Person]doesn’t seek anything else, [person is] encouraged. Got a good care worker who tries to keep [person] interested.”

Feedback from social care professionals working with the service was positive in relation to the support people received, particularly in relation to working towards certain goals. A professional told us; “Overall, myprofessionalimpression is that the service provides a supportive environmentfor[person]. [They are] involved in a variety of different activities throughout the week, which appear to be positive and beneficial to them.”

The service did not promote people’s independence, so people did not know their rights and have choice and control over their own care,treatmentand wellbeing.

There was a staff communication board in place together with an activity board for each person. Activities and opportunities were offered to people daily with allocated safe staffing to support people both inside and out in the community.

Care plans included person-centred information about people’s likes, dislikes, and the best ways to support them. However, incomplete and fragmented records made it difficult to evidence consistency, and some risk assessments and care plans required updating.

The service did not hold regular meetings where people were encouraged and empowered to have their say. The acting manager told us this was an area identified for improvement and keyworkers did some small pieces of work with individual people.

For 1 person, a specialist observation was carried earlier in the year which made recommendation in relation to opportunities to develop. We did not observe staff use communication methods recommended such as keychains and photo symbols, nor a sensory box. We were told that these were available but not used and that the communication documentation for the person was in progress but not completed. This meant that the person was not being effectively supported by staff to express their choices and needs.

During out visit we observed people being supported outside of the service, for example to visit the local town centre, café and horse riding. We also observed a person being involved in cooking the evening meal and a thematic activity taking place 1 evening. However, for others, staff were not proactive in offering creativeopportunities for in house activities leaving them spending time unoccupied in front of the TV or sleeping in the communal areas, despite having identified in house activities they liked to do.

Restrictive practices had not been identified by staff or acted upon which reduced people’s autonomy and control.

Feedback from relatives was positive. A relative told us; “One of [person’s] big goals [is] to be more independent when going out and [staff are] working on that sensitively.” Another relative said; “[Staff] take [person] for walks, [person] likes a daily walk. [Staff] take [person] shopping and talk about budgets and not buying multiples of items. [Staff] are good with [person].”

The provider listened to and understood people’s needs, views and wishes. Staff respond to people’s needs in the moment and acted to minimise any discomfort, concern or distress.

A disability distress assessment tool was being used to support people who could not articulate pain, illness or discomfort. People’s care notes evidenced proactive positive behaviour support methods used by staff.

We observed a person approach the acting manager upset and distressed due to a potential medical issue. The acting manager took time to support the person in a calm and reassuring manner and offer the option of consulting a medical professional. They talked to the person about supporting them to organise this, so they could make an informed choice and guided them through the steps they needed to complete in their routine to prepare for this. Another staff member took care of organising an appointment without delay by exploring various options in the local areas.

People’s relatives told us staff were responsive to their loved ones’ needs.

The provider cared about and promoted the wellbeing of their staff and supported and enabled staff to always deliver person-centred care.

There were systems in place to offer support to staff if needed such as an employee assistance helpline. Well-being was being discussed in staff supervisions.

Staff felt listened to and thought the acting management was responsive to their suggestions, views or concerns.