Fernery House

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last inspection we rated this key question requires improvement. At this inspection the rating has remained requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

The service continued to be in breach of the legal regulation in relation to the way the service gained people’s consent and assessed their mental capacity to consent.

This service scored 42 (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 always make sure people’s care and treatment was effective because they did not always check and discuss people’s health, care, well-being and communication needs with them.

Preadmission assessments were being carried out prior to people moving into the service.The provider had a system in place for regular review, including review of people’s goals whichinvolved them and their representative.

However, some assessments and care plans were out of date. The shift to electronic records and legacy management issues had impacted the consistency and accessibility of assessment documentation. Electronic care records were not comprehensive although paper records were detailed, this meant it created inconsistencies for the staff team.

The transition to electronic records had caused fragmentation, making it difficult to locate, triangulate and cross-reference assessments, care plans, and daily logs during our inspection. This made it challenging to verify the completion and currency of assessments.

We saw examples of recent reviews and feedback provided by the relatives. There was evidence of engagement with people’s families and relatives confirmed this. Their comments included; “Once a year we go to reviews and are invited and consulted” and “I have picked up the phone many times, they [staff] discuss things, and the [acting manager] makes time and notes and follows up.”

The service did not plan and deliver people’s care and treatment with them. They did not follow legislation and current evidence-based good practice and standards.

There was no evidence people were supported with national screening such as cervical smear test, bowel screening, prostate bloods which are a range of tests investigations offered to the general population to detect disease and conditions early for prompt treatment and prevention.

Staff were not always following people’s guidelines, imposing restrictions in relation to people’s nutrition and hydration when these were either not formally agreed or were historical, and no longer in place. However, we were told that people were involved in designing their own menus by using pictorial aids.

The physical environment of people’s rooms was designed based on their preferences. We observed 1 person being involved in conversation with staff about upgrades they wished to make to their room. We saw documented evidence of how a person’s bedroom was designed when moving into the service to support and ease their transition.

However, the physical environment of the rest of the home, was not personalised and inviting. We were told that this was partially impacted by a person who found items being displayed on walls and doors challenging, however the service did not take any steps to find alternative solutions to maintain a homely environment. This also applied to curtain in the communal areas which were missing in 2 of the rooms.

Some people were living a long way away from family or the area they grew up in. Where this was the case, staff and leaders had planned with the person and the people who were important them, about how they could facilitate visits and support important relationships.

The service did not always work well across teams and services to support people. They did not always share their assessment of people’s needs when people moved between different services.

There were professionals involved in the assessment of people’s health, care, well-being and communication needs.

For example, there was good evidence of people linking in withprimary health care, acute services, specialist services for learning disabilities, speech language therapy, psychiatry and nutritionist.

While we saw evidence that people were attending medical appointments, records were not robustly and consistently kept of these. Where records were made, these contained good information stating the reason for the appointment, outcomes and follow up actions.

People’s relatives confirmed their loves ones were supported with any required medical appointments. A relative told us: “Endocrinologist annual visit, eyesight checked, goes to the dentist, sees physio privately to help with weight and core muscle condition. Gets support with all that.”

Feedback from health and social care professionals was positive in the main, with some areas of improvement suggested in relation to the consistency of staff support in some cases.

The provider did not fully support people to manage their health and well-being to maximise their independence, choice, and control. Staff were not consistently supporting people fully to live healthier lives and where possible, reduce their future needs for care and support.

While most feedback from health and social care professionals was positive, a healthcare professional told us that staff did not consistently implement their recommendations. Similar feedback was shared by some relatives.

We discussed these concerns with the acting manager who provided us with a robust overview of the people’s care and support and actions they have been taking.

People attended external appointments with reasonable adjustments being considered, planned for and communicated. This meant people had a positive experience, good outcomes and their disability did not prevent them from accessing prompt care and treatment. For example, the service was actively supporting a person to engage with medical professionals and attend external appointments by using a structure approach to accustoming them to these environments on a regular basis.

For another person, feedback from a healthcare professional indicated they were supported to attend the hospital rather than having a home visit, so the person was better prepared and engaged at the appointment.

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

People had allocated keyworkers, which was a designated member of staff who supported them and oversaw their care. However, we were told that people’s goals had not been reviewed since 2023-2024, but that key workers did some small pieces of work with individual people. We saw minimal evidence of monthly key worker meetings being maintained and this had been identified as an area of improvement by the acting manager.

Despite this, we found good outcomes, goals and community engagement for a person. The person proudly told us about their achievements and plans for the future. Another person also had some good outcomes to share such as going on holiday abroad to a country they enjoyed visiting which they had planned themselves.

The provider did not consistently tell people about their rights around consent or respect these when delivering care and treatment.

We identified some good examples of recent mental capacity assessment and best interest decisions completed where people lacked capacity to make specific decisions. For example, for flu vaccination, medication and care and support. However, we found it hard to navigate any specific examples other than those mentioned.

The service had a large backlog of assessments which required reviewing. This was a piece of work which the acting manager was in the process of doing and they were realistic in relation to the volume of work and length of time required to complete this.

The acting manager was very knowledgeable of the principles of mental capacity and were following a good process to assess people’s capacity. However, staff were not always confident in describing these principles and where to find information related to individual people’s mental capacity to make decisions.

Restrictive practices were in place in relation to some people’s personal snacks which were kept locked without evidence of consent or best interest decision making. This was addressed during the inspection, so people had access to them.

Staff told us and we saw evidence in incidents reports that they were guiding 1 person in relation to the amount of food they were eating for weight management reasons. However, there was no documentation in place to legally justify this restriction. They were awaiting to see a nutritionist; however, they had not yet had professional input around this. This placed the person at risk of harm.

People’s relatives told us staff asked people for their consent before they provided any support.