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The Ferns Requires improvement


Inspection carried out on 13 December 2018

During a routine inspection

This unannounced comprehensive inspection took place on the 13 December 2018 and the 7 January 2019. On the first day of our inspection we visited the home and spoke with people, their relatives and staff members. On the second day we visited the offices of Autism Together to access various records to complete our inspection.

The Ferns is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

At our previous inspection in March 2016 the service was rated as good. At this inspection the service was rated requires improvement in responsive and well-led and overall rating is requires improvement.

In June 2017, CQC published Registering the Right Support. This along with associated good practice guidance sets out the values and standards of support expected for services supporting people with a learning disability and or autism.

There was evidence that people had benefitted from the support offered to them; however, in its strategy and delivery of support the provider was not always following current best practise guidance, including but not limited to Registering the Right Support. In particular promoting as much as possible that people receiving support are independent and live as ordinary a life as any other citizen.

The Ferns was in a time of change and was being used as people’s home, for short breaks and for people who used the home for a few hours before and after day services. Whilst there was a nice atmosphere in the building it did not feel like people’s home and at peak times it was very busy with lots of distractions.

The home accommodates up to eight people in one purpose built building on a campus with another five registered premises, all providing accommodation and care for people with autism. A total of 59 people can stay on the campus known as ‘Raby’ at any one time. There are also day services provided on the same site. Current best practise guidance promotes housing models that increase opportunities for people’s independence, choice and control.

Some aspects of people’s support and accommodation were institutionalised. When speaking about people and in documents, staff providing support used a lot of organisation based language and jargon that inadvertently promoted a difference between the people supported and other people.

The service requires and had a registered manager. 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 contributed to a friendly and relaxed atmosphere at the home. It was clear from their interactions that the registered manager knew people well and had positive relationships with them; they were comfortable around him and enjoyed his company. Staff members and people’s relatives told us that they had confidence in the registered manager. One people’s family member told us, “He is an incredible manager, absolutely outstanding…”

People and their relatives told us that they had confidence in the service provided at The Ferns and they thought that the home was safe. One person told us, “They look after me here. I get on well with staff.” Another person’s family member told us, “He really bonds with the staff; which makes me feel more relaxed. He took to it here like a duck to water.”

There was a relaxed atmosphere at the home and people appeared comfortable in all areas of the building, including the office area. We saw friendly interactions between people living at The Ferns and staff members. It was clear that people felt relaxed and comfortable at the home and the use of appropriate humour he

Inspection carried out on 16 March 2016

During a routine inspection

This announced inspection took place on the 14 and 16 March 2016. On the first day of the inspection we visited the headquarters of Wirral Autistic Society to view some records relating to The Ferns which were kept there and on the second day of our inspection we visited the service.

The Ferns is a single-storey, modern and purpose-built home in the grounds of Raby Hall. It has a large secure garden and had been designed by a specialist architect, specifically for people with autism. It has wide corridors and a lot of natural light and is neutrally decorated. It has seven bedrooms which are all ensuite, communal rooms such as lounges and a kitchen and also had a sensory room. The service provides respite care for over 70 people with autism and their families. The service offers short stay, emergency, urgent and respite support for people with an autistic spectrum condition and their families. This support is provided for varying amounts of time ranging from an overnight stay to several weeks or even months at a time

The service is required to have a registered manager and one was in post and had been for several years. 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.

We found that the home was safe and secure and tailored to the needs of people with autism. Staff have been trained in safeguarding adults and in medication administration and they were able to tell us about these processes.

There were appropriate fire prevention systems in the building and staff had been trained to use these and they had been checked regularly.

Staff have been recruited using safe methods of recruitment and the rotas reflected the appropriate level of staff for the numbers and needs of the people they were supporting throughout each day. We found the medication had been administered and stored correctly and checks made to ensure that this had happened.

Staff had been trained to perform their role and supervised regularly. Part of this training was mental capacity act training and staff are able to tell us about the Mental Capacity Act and the deprivation of liberty safeguards.

The design of the house was airy light and appropriate for people with autism. There were two sides to the building which enabled a more intimate feel to people's accommodation.

The kitchen was well-designed and people could choose what they want to eat and help prepare and cook food if they wanted to.

We saw that staff were caring, considerate and approachable and they provided information and explanations to people as necessary and tried to involve them in as much as possible.

The care was person centred and care plans were updated frequently. Many documents were in easy read format which enabled people to understand them.

Activities were tailored around the individual, were varied and often involved going out into the community or into the providers other premises.

There was a registered manager in post who had been in post for some time and we saw that they were open and transparent and supportive of their staff. Policies and procedures were up-to-date and quality of the service had been regularly checked.

Inspection carried out on 6 December 2013

During a routine inspection

The Ferns was purpose built and incorporated many features designed to provide a therapeutic and safe environment for people with autism. The Ferns provided a flexible service to support people who had autism and their families. Parents of a person who had used the service since it opened told us that it was �absolutely fantastic� and they had seen �many incidents of staff who really care about our son�. A detailed support plan was in place for each person who used the service. People�s individual dietary needs were catered for. People's medicines were stored and handled safely.

Staffing was built around meeting individual needs and most people had one to one staff support during the daytime. People were given information about how to make a complaint and any complaints received were recorded in full.

Inspection carried out on 28 December 2012

During a routine inspection

The Ferns was purpose built and the building incorporated many features that had been designed to provide a therapeutic and safe environment for people with autism. The Ferns provided a flexible service to support people who had autism, and their families. These were mainly young people. Before a new service user had a stay at The Ferns, there was a full assessment of their needs and lifestyle which involved their social worker, their family and any other relevant professionals. People were given information about the service, and could have short �taster� visits to find out whether the service would suit them. One person had found the service himself using the internet.

We looked at records of comments that had been received from people who used the service and their families. One relative had written to say that their family member had benefited from being encouraged to participate in a wider variety of activities whilst staying at The Ferns. A service user had written �Because of The Ferns I am more confident in myself with trying new things and meeting new people. The Ferns has excellent facilities�. A relative had commented on �positive changes in mood and willingness to participate�.

We saw that a range of communication aids had been developed to enable people using the service to express their needs and choices. We saw that the whole service was built around meeting individual needs and most people had one to one staff support during the daytime.

Inspection carried out on 30 December 2010

During a routine inspection

The comments we received from the families of people who use this service told us that they were very satisfied with the way that the person's individual needs had been respected and catered for. One person told us �Whilst as parents our views are important what really matters is how the clients themselves feel. With that in mind, if you knew our son you would know just by looking at him that he is extremely happy with the support etc that he receives from WAS, (no verbal communication would be necessary)�.

The relative of a service user told us that the staff go out of their way to make sure that he gets meals that he enjoys. She received a written report following his stay at The Ferns and the manager phoned her to check that everything had been alright for him. He is very sensitive to the time he has his prescribed medication and adjustments were made to the staff rota to ensure that he would be able to have his medicines at a time that suited him.

A relative of a service user told us that she experienced a booking misunderstanding, for which the manager apologised and it has not happened since.

The week before our visit the unit manager received a letter from the parents of a young person who uses the service. In the letter they write:

P has a wonderful time at WAS and during his respite he is able to access so many opportunities which would not be available to him anywhere else. Your levels of knowledge and expertise in autism are world class as are the standards of the service you provide.

It is very hard as parents to trust anyone to look after your children, even more so when they are particularly vulnerable. The biggest compliment we can give you is that we trust you 100% when you look after and take care of P. What you have been able to provide for the whole of the family is priceless. Wirral Autistic Society is an extraordinary organisation who cares very much about the individuals who access your services.

Comments that we received by email from the family of another service user included:

Our son's experience at the Ferns has been very positive and we are extremely pleased with how well he was looked after and how happy he seems to be whilst there. J is profoundly autistic and is extremely complex and challenging, he suffers from anxiety and the Ferns have a high knowledge of autism and how to help him manage it.

Comments we received from another parent were:

My son began receiving respite at the Ferns in July. It is the 1st time he has had respite (he is 21). Previously he has had some unhappy times away on respite breaks so we knew he would need to have quite a special type of provision if it was going to work for him and us. If we had been able to find a suitable provision in Liverpool we would have used it for him but because of his ASD and communication needs the local adult service would have been very stressful for him and consequently us. At Wirral Autistic Society the staff have worked together to provide consistent support which continues into the respite service, all the signs, pecs symbols and gestures he uses are made known to the staff supporting him. The standard of care is excellent and he has made steady progress since being at WAS.

We could use the money provided for respite for my son to use local services which would give him 4 weeks respite a year, but we would prefer to buy in 2 weeks respite and know that he is being well cared for as well as stimulated and encouraged to develop independence skills � he is not just happy but he looks forward to it.

The facilities at The Ferns are amazing, the detail and thought in the unit design makes it a really lovely place for him to go to. He loves the sensory room, and participating in everything from games, craft to washing up! Michelle and all the staff couldn�t do more to make his stays relaxing and happy. They are very attentive to small details to make it work, eg now he has a set of CD�s that we�ve copied to keep there for him to play when he comes.