The Ferns Care Home

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. 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 service was in breach of legal regulation in relation to the governance of the service, the failure to improve on previous issues and the failure to ensure appropriate checks were in place to keep people safe.

This service scored 43 (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 shared vision, strategy and culture based on transparency, equity, equality and human rights, diversity and inclusion, and engagement. They did not make improvements to meet the needs of people.

The culture was not person-centred, some staff failed to treat people with dignity and respect. The nominated individual and senior management team had failed to embed improvements and act on previous failings effectively. The service has been rated requires improvement at the previous 3 inspections, falling short of the expected standard, with infection control issues and governance being a theme throughout.

The provider did not have inclusive leaders at all levels who understood the context in which they delivered care, treatment and support, or who embodied the culture and values of their workforce and organisation. Leaders did not have the skills, knowledge, experience and credibility to lead effectively, and they did not do so with integrity, openness and honesty.

There had been a recent change in the management of the home, the new home manager was not yet fully established. Other local managers supported the service however; they had not identified the issues we found during the assessment when carrying out audits and checks. A staff member said, “There have been a lot of managers that come and go, this can make things difficult.” One person commented on the visibility of the manager, “[The home manager] doesn’t talk, she just walks past and says ‘Hi’”.

The provider fostered a positive culture where people felt they could speak up and their voice would be heard.

Most staff we spoke to said it was easy to speak up when needed and the management team were accessible.

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.

Management worked to ensure equality and diversity for staff by making policies, support systems and opportunities accessible to everyone. Staff raised no concerns about discrimination in the workplace.

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.

Audits and checks were in place but had failed to identify the concerns we found during the assessment. The provider had not acted in a timely way on issues that had been raised with them previously. Audits in relation to medicines were effective.

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.

Health and social care partners gave mixed feedback about the way the service and provider interacted with them. Where issues had been identified by partners, the service initially took action, but these were not always embedded and sustained. A partner said, “[The Ferns] have had significant support over the last 24 months but training and supportive advice has been difficult to maintain due to staff turnover and changes within the structure.”

The provider did not focus on continuous learning, innovation and improvement across the organisation and local system. They did not encourage creative ways of delivering equality of experience, outcome and quality of life for people. They did not actively contribute to safe, effective practice and research.

The provider and home management team had not implemented learning from incidents or partners effectively. When improvements were made, they were not sustained, this meant that people were at risk of receiving sub-standard care.