The Ferns

The Ferns is a residential care home providing accommodation and personal care to five people with a learning disability. A maximum of six people can live at The Ferns.

The Ferns is a large terraced home over three floors and has a cellar. Three people had their own bedrooms and two people shared a large bedroom. There was a shared lounge, dining room, kitchen and two bathrooms. Staff used a downstairs room as an office and sleep-in room. This room could also be used by people living at the home during the day, for example to use the games console or pool table.

People’s experience of using this service and what we found

Considerable improvements had been made in all areas following our last inspection. Safety concerns had been addressed and a lot of maintenance work had been completed in the building. Further re-decoration was planned. Quality audits had been reviewed and issues identified were acted upon. Current COVID-19 guidelines were being followed and the staff team used the correct personal protective equipment.

People had been involved in their care plans, which had been re-written in a person-centred way. Risks to people’s safety had been assessed and plans were in place to manage them. People’s end of life wishes had started to be discussed with people but had not been completed and recorded.

People were taking part in more activities as more staffing was available and people interacted well with the staff. Relatives were positive about the support their relatives received at The Ferns. Records were written in a dignified way.

Staff had completed required training, with additional training planned. Staff felt well supported and had regular supervision meetings. People received their medicines as prescribed and their health and nutritional needs were being met.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. Where people were able to make some decisions and not others (called variable capacity), the provider said they would use a recognised capacity assessment tools to assess the person's capacity to make each separate decision.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

This service was able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture. We have made a recommendation that further support is provided for the staff team so the key principles of 'Right support, right care, right culture' are followed.

Additional staff hours were available to support people to access their local community and activities. Maintenance work had been completed to make the service more homely. A person-centred approach was being promoted by the management team. Discussions had been held in team meetings and staff training had been completed. Daily records were now written in a respectful way. Further support is required to embed this culture in the staff team.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was inadequate (published 22 January 2021), there were multiple breaches of regulations and CQC took enforcement action. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Where a service has been rated inadequate at the previous inspection, improvements must be made and shown to be sustained within the service to be rated as good. The Ferns have made improvements in all areas where issues had been identified at our last inspection. We will continue to work with the service and the local authority, so the improvements seen at this inspection are sustained.

This service has been in Special Measures since 22 January 2021. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This comprehensive inspection was carried out to follow up on the enforcement action we took following the last inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The Ferns is a residential care home providing accommodation and personal care to five people living with a learning disability. A maximum of six people can live at The Ferns.

The Ferns is a large terraced home over three floors and has a cellar. Three people had their own bedrooms and two people shared a large bedroom. There was a shared lounge, dining room, kitchen and two bathrooms. Staff used a downstairs room as an office and sleep-in room. This room could also be used by people living at the home during the day.

People’s experience of using this service and what we found

The service was not well managed; quality audits were not acted upon and repairs to the property had not been completed. Risks to people’s health and wellbeing were not always assessed and managed, for example fire risk assessments. Staff had not received the training or supervision to support them in their role.

The service was not person-centred in its approach; people were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests. The service had decided people could not go out on their own during the COVID-19 pandemic. People had not been involved in this decision or supported to make their own choices. This was legally authorised for two people through Deprivation of Liberty Safeguards (DoLS). Staffing was insufficient to support people to go out into the community during the COVID-19 pandemic.

Records reflected a lack of person-centred care and dignity. Risk assessments and care plans emphasised the negative; things people were not able to do, rather than detailing what they could do and where they needed support.

People received their medicines as prescribed.

We expect health and social care providers to guarantee autistic people and people living with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the guidance CQC follows to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was not able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right support:

During the COVID-19 pandemic the service had taken a blanket decision that people could only go out with staff support. A Deprivation of Liberty Safeguards (DoLS) had been authorised for two people which legally allowed the service to prevent people from going out on their own. A DoLS was not in place for three people. Additional staffing had not been provided during the COVID-19 pandemic to enable people to be regularly supported to go out of the home if the chose to do so. Whilst there were some leisure opportunities within the home, such as craft items, board games and computer games we found they were not frequently used.

Right care:

People did not receive person centred care and support. Care plans and risk assessments focused on things people were not able to do rather than on their strengths and skills. The home was in need of maintenance work to be undertaken so it was suitable for people to live in.

Right culture:

The management lacked oversight of the home and did not promote a person-centred culture where people were involved in making choices and decisions about their own lives.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Good (published 17 October 2019).

Why we inspected

This inspection was prompted by concerns found during an inspection at the provider’s other service on 27 November and 1 December 2020. These included a lack of person-centred care, the environment, staffing and management of the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

The overall rating for the service has changed from good to inadequate. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Ferns on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to the governance and auditing, risk management and maintenance of the property at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider and request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

The Ferns is a residential care home set within a local community. The home is registered to provide support for up to six people with a learning disability and associated mental health needs.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

People’s experience of using this service

People told us they felt safe and had the capacity to make decisions about their day to day lives and what they did with their time.

We saw that the property was clean, comfortable and homely. However, the home remains tired in parts. People told us that they enjoyed the food provided and choose what they wanted to eat.

People said they were treated with respect and felt well cared for. They spoke positively about the staff who supported them, who knew them, and their support needs well.

The atmosphere was relaxed and friendly and people who lived at The Ferns told us that in the main they got on well together as a group. People had active lifestyles. They accessed a range of community facilities, used public transport and their independence was promoted wherever possible.

People and staff told us that the registered providers were approachable and supportive, and they were confident that they would act on any concerns they raised. We found there were adequate systems in place to monitor the quality of the service provided to people.

Rating at last inspection: The last rating for the service was Good (report published in March 2017).

Why we inspected: This was a planned inspection based on the rating of the service at the last inspection.

Follow up: We will continue to monitor the service through information we receive and future inspections.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

At our last inspection on 29 October 2014 we found that The Ferns was not meeting the regulatory requirement to ensure that effective systems were in place to monitor and assess the quality of the home. We returned to the home on 15 October 2015 and found that improvements had been made and the regulatory requirement had been met.

The Ferns is registered to provide accommodation for up to 6 people who have a learning disability and mental health needs who require support with personal care. There were five people living at the home when we completed this inspection.

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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. There were two registered managers for the home who share this role, one of whom was a registered provider.

People and staff said that they felt safe at The Ferns. Staff we spoke with knew what action to take if they were concerned about a person who used the service being at risk of harm or the practices of a colleague. They were confident that if they raised concerns with the providers they would be listened to and action would be taken to address the issue.

Recruitment and selection procedures were in place to help protect vulnerable people from staff who may be unsuitable to work with them. Staff knew people well, and there were enough staff on duty to meet people’s needs.

There were procedures in place to ensure people received the appropriate support to manage their medicines. People were cared for in a safe and clean environment.

We saw that the home was comfortable, homely, clean and tidy. Some areas of the home had recently been decorated and the provider was aware that the home appeared tired in parts of the hall and stairways.

People who used the service had the capacity to make decisions about what they did and the choices they made. The staff we spoke with had a good understanding of people’s risks and personal preferences so that they could support people safely and effectively.

People had been asked about what they wanted to eat and were involved in menu planning and shopping for food to help promote choice and independence.

Everyone who used the service had the capacity to make decisions about what they did and how they spent their time.

Staff received the training and support from the providers to help support people safely and effectively.

People had access to the healthcare professionals that they needed, and were supported to attend routine appointments to help maintain their wellbeing.

The relationships we saw between people who used the service and support workers were warm, frequent and friendly. The atmosphere was calm and relaxed.

People were involved in developing their own person centred care plan, which included their personal preferences and wishes.

People chose which individual activities they wanted to be involved in and were able to take part in group activities if they wanted to, both in the home and in the community.

Systems were in place to record and review complaints. People no longer attend residents meetings and this was at their request. We saw people were encouraged to express their views about the service and we saw that they did so freely and openly.

Staff members we spoke with said that the registered manager and the providers were very approachable and supportive and they enjoyed working at The Ferns.

There were six people living at the home at the time of our visit. Three people were at home and three people were out either visiting family, attending a doctor's appointment or at a local outreach or day centre. Two people were watching television in the lounge. One person said that they were enjoying their retirement from work and liked to watch a movie on television in the afternoon.

People told us that they liked the food provided at the home. The support worker said that if a person did not like what was on the menu then an alternative meal would be provided.

People living at the home told us that support workers helped them to clean their bedrooms and changed their bedding every week. To help maintain their independence people who were able also took responsibility for other household tasks such as washing and drying the pots and bringing in the milk and putting out the bins.

We saw that there were frequent and friendly interactions between people and the support worker. The atmosphere was relaxed and friendly.

Before our visit we contacted the local commissioning and safeguarding teams. They informed us that they had no concerns about the service.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

People we spoke with told us that they liked and got on well with the staff. We saw people living at the home speaking openly and freely giving their opinions to staff during our visit.

People we spoke with told us that they could speak to the manager or a staff member if they had any problems or concerns. They said that they were confident that they would be taken seriously and they would do their best to sort the problem out. Some people also said that they could speak to a relative and they would help them.

Prior to our visit we contacted the local safeguarding and commissioning teams about the service. They informed us that they had no concerns about The Ferns.