The Ferns

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

At our last assessment we rated this key question requires improvement. At this assessment the rating has remained requires improvement.

Requires improvement: This meant the management and leadership was inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care.

The provider was in breach of legal regulation in relation to the governance of the service.

This service scored 54 (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 have a clear shared vision, strategy and culture which was based on transparency, equity, equality and human rights, diversity and inclusion, and engagement. They did not always understand the challenges and the needs of people and their communities. We identified shortfalls in the provider’s reporting of incidents to external stakeholders, including the Care Quality Commission (CQC). This did not demonstrate an open and transparent culture within the service.

We also found that a blanket approach to restrictions within communal areas such as the kitchen did not adequately reflect the provider’s responsibilities to uphold people’s equality, diversity, and human rights.

In addition, one person’s records relating to the structure and operation of the service contained information relevant to another service operated by the provider and did not accurately reflect the arrangements in place at The Ferns. As a result, staff did not have access to clear and relevant guidance and information needed to support the individual appropriately.

Not all leaders understood the context in which the provider delivered care, treatment and support. They did not always embody the culture and values of their workforce and organisation. Leaders did not always have the skills, knowledge, experience and credibility to lead effectively, or they did not always do so with integrity, openness and honesty. While the registered manager was regularly present at The Ferns, systems and processes were not sufficiently effective to identify, address and mitigate all risks within the service. This lack of effective oversight impacted the provider’s ability to ensure good governance, regulatory compliance, and consistent improvements in the quality and safety of care.

However, staff were positive about the management team and felt engaged by them in all aspects of the care delivered. One relative told us about the registered manager and said, “I would recommend the Ferns and Autism Together to anyone. What an amazing place. I’ve never had any issues. None. No concerns or queries.”

Following concerns raised during our assessment, the registered manager was receptive to our feedback, they accepted the issues and assured us that appropriate actions would be taken to address and rectify the concerns identified.

The provider fostered a positive culture where people felt they could speak up and their voice would be heard. People were engaged about their home and the support they received and had meetings with staff and managers. Staff members were aware of policies and procedures which supported their employment including the whistle blowing policy. Staff generally felt they would be supported if they ever had to raise concerns.

The provider valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who worked for them. Staff felt they worked as part of an inclusive and effective team. People were supported by a diverse staff team. Staff told us they felt supported and did not share any concerns about the way they were treated. One staff member told us, “Management is good and proactive. The Ferns can be a busy and challenging place to work but it feels like a family environment, as we all work together.”

Policies and procedures were in place to support staff in their role.

The provider did not have clear responsibilities, roles, systems of accountability and good governance. They did not act on the best information about risk, performance and outcomes, or share this securely with others when appropriate. The provider did not have clear responsibilities, roles, systems of accountability and good governance. They did not act on the best information about risk, performance and outcomes, or share this securely with others when appropriate.

There was a lack of effective governance systems and processes in place within the service, as well as at provider level within the organisation. Although quality audits were in place, these had not identified the concerns we found during our assessment.

For example, we identified issues relating to infection prevention and control, restrictive practices, the analysis of safeguarding concerns, and staff training. The failure of the provider to identify and address these concerns placed people at increased risk of harm.

Governance and quality assurance systems had not demonstrated sustained improvement since our last assessment.

The provider did not always understand their duty to collaborate and work in partnership, so services worked seamlessly for people. They did not always share information and learning with partners or collaborate for improvement. Although the provider worked with external services, we identified that the local authority had not been informed of the change in the service’s operational model to that of a care pathway service. This lack of notification had a significant impact on individuals placed at The Ferns. The Ferns is registered as a residential care home intended to provide permanent placements for people.

The provider did not always focus on continuous learning, innovation and improvement across the organisation and local system. They did not always encourage creative ways of delivering equality of experience, outcome and quality of life for people. They did not always actively contribute to safe, effective practice and research. For example, our review of governance and management information showed that issues identified during this inspection had previously been raised with the provider following a local authority infection prevention and control assessment. These issues had not been addressed, and the registered manager said this had been overlooked, which placed people at unnecessary risk.

The provider had systems to review incidents within the home; however, there were no effective arrangements to review the use of PRN medicines. This meant learning could not be identified or used to reduce reliance on these medicines.

Although no harm was identified during the inspection, safeguards to prevent misuse of PRN medicines were not in place. These concerns were raised, and management agreed to introduce appropriate review processes.

The registered manager also took some positive action to learn from our assessment and share information across their organisation. This supported open communication and the sharing of good practice.