Archived: St Anne's Community Services - Fernlea

After the last inspection we issued a warning notice for Regulation 17, good governance and told the registered provider to make improvements. The registered provider sent us an action plan telling us what they were going to do to make sure they were meeting the regulations. On this inspection we checked to see if improvements had been made.

Fernlea has seven beds providing accommodation, care and treatment to adults aged between 18 and 65 who have a learning disability and other complex health care needs. The home is split into two sections. One section has three beds for people with a learning disability and behaviours that may challenge others and the other section has four beds offering accommodation for people with a learning disability and physical health needs. At the time of our inspection there were six people using the service.

The service 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.

Relatives we spoke with told us they were confident their relative was safe at Fernlea.

Staff had a good understanding of how to safeguard adults from abuse and who to contact if they suspected any abuse. The provider had safe recruitment and selection procedures in place.

At our last inspection we found not all risk assessments were up to date and reflective of people’s current needs and risks. On this inspection we found improvements had been made and all the risk assessments we sampled provided detailed direction for staff when providing support in order to reduce risks to people.

At our last inspection we found there were not always enough staff to provide a good level of interaction for people who used the service and keep them safe. At this inspection we found improvements had been made and the registered provider had taken action to increase staffing, although familiar agency staff were still used due to problems with staff recruitment.

At the time of this inspection the registered provider was planning to change the service from a service providing nursing care to one providing non-nursing care in a supported living setting and the process of change had impacted on staff morale and sickness levels.

Medicines were managed in a safe way for people and gaps in the recording of administration of medicines had been picked up and explored.

Staff had received an induction, supervision, appraisal and specialist training to enable them to provide support to the people who used the service.

People’s consent to care and treatment was always sought in line with legislation and guidance. People were supported to have maximum choice and control over their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Meals were planned on an individual basis and people were supported to eat a balanced diet. A range of healthcare professionals were involved in people’s care.

Staff were caring and supported people in a way that maintained their dignity, privacy and human rights. People were supported to be as independent as possible throughout their daily lives.

Evidence of people’s access to activities in line with their care plans had improved although activities outside the home for some people were still limited.

People were able to make choices about their care. People’s care plans detailed the care and support they required and included information about peoples likes and dislikes. Individual needs were met through the development of detailed personalised care plans.

Relatives we spoke with told us they were very happy with the service and were complimentary about the management of the service.

The registered manager had improved governance and worked hard to improve the service to benefit the people who used it. The registered manager was visible in the home and knew the needs of the people who used the service.

The registered provider had an overview of the service and took action to improve the quality and safety of the service provided.

People, their representatives, and staff were asked for their views about the service and they were acted on.

Shortly after this inspection the service was decommissioned and people using the service were transferred to other services. The service is no longer in operation.

Fernlea has seven beds providing accommodation, care and treatment to adults aged 18-65 who have a learning disability and other complex health care needs. The home is split into two sections. One section has three beds for people with learning disability and challenging behaviours and the other section has four beds offering accommodation for people with a learning disability and physical health needs. At the time of our inspection there were six people using the service.

The service 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.

Relatives we spoke with told us they were confident their relative was safe at St Anne's Community Services Fernlea.

Some risk assessments had not been updated to reflect one person’s current moving and repositioning needs. This presented a risk of unsafe or inappropriate care being delivered. This was a breach of Regulation 12 (2) (b) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

There were not always enough staff to provide a good level of interaction for people who used the service and keep them safe. This was a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Medicines were not always managed in a safe way for people because gaps in the recording of administration of medicines had not been picked up and explored. This was a breach of regulation 12 (2) (g) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Staff had a good understanding of safeguarding adults from abuse and who to contact if they suspected any abuse and the provider had safe recruitment and selection procedures in place.

Staff had received an induction, supervision, appraisal and specialist training to enable them to provide support to the people who used the service; however some staff training in moving and positioning was not up to date. This meant some staff may not have the knowledge and skills to support the people who used the service effectively, however plans were in place to minimise the impact.

People’s consent to care and treatment was always sought in line with legislation and guidance.

Meals were planned on an individual basis and people were supported to eat a balanced diet. A range of healthcare professionals were involved in people’s care.

Staff were caring and supported people in a way that maintained their dignity, privacy and human rights. People were supported to be as independent as possible throughout their daily lives.

Some activities were provided but this was not at a level which would meet the assessed needs of all the people who used the service. This was a breach of Regulation 9 (1) (c) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

People were able to make choices about their care. People’s care plans detailed the care and support they required and included information about peoples likes and dislikes. Individual needs were assessed through the development of detailed personalised care plans.

Comments and complaints people made were responded to appropriately.

Relatives and advocates we spoke with told us they were happy with the service. Some representatives and staff felt the service had been impacted by a lack of consistent management in recent years.

The registered manager had some audits in place, but this system was not robust enough to identify and address the problems we found.

The registered provider had an overview of the service; however the service’s quality assurance systems had not addressed the problems we found. This was a breach of Regulation 17of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The culture of the organisation was open and transparent. The registered manager was visible in the service and knew the needs of the people who used the service.

People who used the service, their representatives, and staff were asked for their views about the service and they were acted on.

You can see what action we told the provider to take at the back of the full version of the report.

Care records recorded information on people's daily routine. They described what time people liked to get up, what they liked to eat and drink, and how they liked to spend their day. We saw that care records recorded information on maintaining people's dignity.

We spoke to two family members who said they were very happy with the care their relatives were getting. One person said 'I have always been happy with the care he gets here'. Another relative said 'Everybody is very good in the home. He is well looked after'.

People's needs were assessed and care and treatment was planned in line with their individual care plan. We looked at four care records and saw that records recorded information on people's daily routine.

Care plans had information on assessments being carried out in areas such as personal care, mobility, communication and eating and drinking. We saw that risk assessments had been carried out and covered areas such as moving and handling, nutrition, tissue viability and falling.

We saw from training records that all staff had received training in safeguarding and were able to demonstrate a clear understanding of the learning.

We saw that an up to date safeguarding and whistleblowing policy was in place, and that an easy read version was available. We saw that safeguarding incidents had been processed in the correct manner.

We saw that training records had information on staff attending training in areas such as safeguarding, fire safety, first aid, food safety and infection control. The manager may wish to note that it was difficult to identify what training people had received and the development of a training matrix may help resolve this.

We asked how the provider monitored the quality of the care delivered. We spent time observing the care and interaction between staff and people who use the service. We spoke with staff and the manager about the care and wellbeing of people who use the service. We gathered evidence of people's experiences of the service by reviewing care records and quality assurance documentation.

Our observations of the service found that the environment was clean and tidy and that people's bedrooms were personalised in a way that reflected their taste.

The staff we spoke to told us they were very happy working at the home. They told us that they felt people were treated with dignity and respect. We saw that interaction between the staff and people who lived in the home was positive and respectful.

We looked at the care plans of four people. They were comprehensive and detailed. Each care plan was tailored made for the individual and ensured the safety and well being of the people who use the service. Each care plan had a corresponding risk assessment that reflected the needs of the service user.

Staff told us that they felt supported by the manager, the team and received regular supervision and training.