Archived: Ferndale

Ferndale is a residential home that provides accommodation and personal care for up to 13 people with autism and learning disabilities. At the time of our inspection there were 11 people living at the service. There was a registered manager in post. 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 widespread and significant shortfalls in the service.

People were not protected from harm due to managers not recognising and reporting safeguarding incidents to the local authority. Risks to people were not always identified, recorded and known to staff; therefore risks were not always managed and reduced in order to keep people safe. Medicines were not always managed safely.

People were not always protected due to unsafe recruitment practices. People’s needs were not always considered when training staff members. Staff were given access to training but had not been trained in important areas such as risk or autism awareness. Staff member’s competency was not checked to ensure they were effective in their roles.

People were enabled to provide consent to day to day tasks and activities. Where people did not have the ability to provide consent we found that decisions were not always made in line with the Mental Capacity Act 2005. People were supported to have sufficient quantities of food and drink. People’s day to day health needs were met and they were supported to see healthcare professionals when required. Where more specialist support was needed managers were not always proactive in seeking this support.

People were not always supported in a caring, dignified and respectful way. The staff team listened to people’s basic choices and preferences and gave day to day options for people to choose from. The provider had not considered ways to involve people in their care plans and advocacy was not always made available to people. People’s care and support plans did not always reflect their needs and preferences. People could access a structured activities programme although minimal work had been done to develop individualised programmes of activity for people based on their own preferences.

People were not supported by a strong management team who could identify and manage risks within the service to keep them safe. The provider had not developed effective quality assurance systems to ensure that issues within the service were identified and improvements were made where required.

We found that the provider was not meeting all of the requirements of the law. We found multiple breaches in regulations. You can see what action we told the provider to take at the back of the full version of the report.

The overall rating for this service was 'Inadequate' and the service was therefore placed into 'Special measures'. Services in special measures are kept under review. Following the inspection we took urgent action to cancel the registration of the provider. At the time of the publication of this report, our action had been completed and there were no people living at the service.

Below is a summary of what we found. The summary is based on our observations during the inspection, observations of people using the service, the staff supporting them and from looking at records. We used the evidence we collected during our inspection to answer the five questions.

Is the service safe?

From our observations and the information we saw in care plans, policies, procedures and audits, the provider's safety monitoring systems were adequate. The training records showed that the staff received regular training on safeguarding. The staff showed that they had a clear understanding of their role in providing care and in safeguarding the people they supported. The staff demonstrated that they knew the people well and understood their support needs.

We saw evidence that when people lacked the capacity to make decisions on important areas of their lives, best interests, safeguarding and deprivation of liberty discussions had taken place.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We saw that all the people who lived at the home had a mental capacity assessment. There was one current Deprivation of Liberty Safeguarding order in place. The records were correct and up to date with review dates in place. The provider was reviewing the safeguarding requirements for all the people who lived at the home in the light of the recent changes to the DoLS legislation at the time of our inspection.

The staff rotas showed that the management had taken people's care needs into account when making decisions about the number of staff required and the skills and experience staff would need. The night time staffing levels and on call system showed that the provider had taken steps to ensure the staffing provision was safe.

There were systems in place to make sure that management and staff learned from events such as accidents and incidents, complaints, concerns and investigations. This meant that people were benefiting from a service that was taking on board lessons learnt.

Is the service effective?

People's care needs had been assessed and detailed care plans were in place. There was evidence that people and their families were involved in the assessments of their needs and care plan reviews as much as possible.

The staff we spoke with, and activity plans we looked, at provided evidence that people were supported to live active lives and participate in activities within the community.

All care, activity plans and risk assessments were reviewed regularly. We saw evidence in care plans that the care provided was constantly adapted to meet people's needs.

We saw evidence that people were supported by a wide range of health and social care professionals. This meant their health and welfare needs were being met.

Is the service caring?

We observed that the staff supported each person in a way which met their individual needs. The staff showed warmth, consideration and respect for people. One member of staff we spoke with said, 'I really enjoy my work and I hope that I support the people to have a good life'. Another member of staff said, 'We are a good staff team, we all know what we need to do and we try to make the place like home for the people who live here'. We saw that staff ensured people's dignity was maintained at all times.

We spoke with one of the people who lived at the home, they said, 'It is ok here. I can do what I want. I like to spend time in my room and watch my TV. I have a season ticket to the football and to go to home games".

The acting manager and staff we spoke with told us they were committed to provide a good caring service to support and look after people so they could have a good life. The staff we spoke with demonstrated that they were aware of potential risks, people's rights and their responsibilities.

Is the service responsive?

We saw the care plans were focused upon the needs of the individual and contained detailed information about people's choices and preferences. The information showed that each person had an individual support plan which was adapted regularly to meet their changing needs. We saw that people's health and support plans were regularly updated to reflect people's changing health care needs.

There was evidence of regular support provided from external social care and health professionals. This meant that people's health and welfare was regularly reviewed and monitored.

The staff we spoke with said if they had any concerns, they could always talk with the senior staff and that, they would always listen and address anything they raised. We saw that the provider had a complaints policy and procedure in place and the two complaints received this year had been fully investigated and resolved.

We saw that staff received regular training which equipped them with the knowledge and skills to meet people's support needs.

We saw that people who lived at Ferndale had access to information which was written in an easy read format. This helped them to learn and understand information.

Is the service well-led?

The home had a clear management structure in place. The acting manager and the staff we spoke with were very knowledgeable about the people who used the service, changes to legislation and developments in care provision.

We saw on the staff rota that senior staff were around to give advice and support. One of the staff we spoke with said, 'The team are very good and the new manager has made a real difference. They are very supportive and know what needs to be done'. We saw that there were systems in place to provide feedback to staff about changes and developments. The acting manager had ensured that a regular program of staff supervision and appraisal was in place.

We observed people as they waited for staff to take them out to different activities. We saw that people were comfortable and relaxed in their home and with being around one another. We saw that there was a mood of excitement and anticipation about going out. One person smiled and chattered. They were affectionate with the staff member who was to take them out. We saw that the staff member responded in an appropriate way. Another person told us about outings and holidays they had enjoyed. We found that people were eager to participate in the activities.

We saw that people were treated with consideration and respect by staff members. When we looked at three people's care plans, we found that assessments were detailed and provided clear guidance about the delivery of care.

Since our previous inspection, safeguarding concerns had been raised with us. Investigations had been concluded at the time of this inspection. No current staff were involved in any ongoing safeguarding concerns. There had been staffing changes at Ferndale. When we visited we saw enough skilled staff to meet people's needs. Staff were not however, receiving formal support through supervision.

The assessment of people's needs and care planning was personalised and thorough. The delivery of care that we observed was appropriate, professional and respectful. Care workers were kind, friendly in their approach and knowledgable about the particular needs of people with autism. To underpin this, this service had improved systems for reviewing the quality of the service.

The home managers had made developments to safeguarding procedures and when a possible safeguarding incident was raised, the registered manager responded appropriately. There was no evidence that any abuse had or had not taken place. Safeguards remained in place to protect the people who lived at Ferndale and to support care workers when a vulnerable person says words which cannot be interpreted with confidence.