Background to this inspection
Updated
6 March 2019
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
This unannounced comprehensive inspection took place on the 13 December 2018 and the 7 January 2019. On the first day of our inspection we visited the home and spoke with people, their relatives and staff members. On the second day we visited the offices of Autism Together to access various records to complete our inspection.
The inspection was completed by an adult social care inspector. Prior to our visit we looked at any information we had received about the home including notifications about events that the service is required to send to the Care Quality Commission, along with any contact from people using the service and their relatives and speaking with the local authority. This included the Provider Information Return (PIR). This is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make. We used this information to plan how the inspection should be conducted.
During the inspection we spoke with two people who used the service and three friends and relatives of people who use the service. We spoke with five staff members including the registered manager. We looked at the care and medication records for three people and the employment and training files for three members of staff. We also spent time observing the day to day care and support provided to people.
Updated
6 March 2019
This unannounced comprehensive inspection took place on the 13 December 2018 and the 7 January 2019. On the first day of our inspection we visited the home and spoke with people, their relatives and staff members. On the second day we visited the offices of Autism Together to access various records to complete our inspection.
The Ferns is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
At our previous inspection in March 2016 the service was rated as good. At this inspection the service was rated requires improvement in responsive and well-led and overall rating is requires improvement.
In June 2017, CQC published Registering the Right Support. This along with associated good practice guidance sets out the values and standards of support expected for services supporting people with a learning disability and or autism.
There was evidence that people had benefitted from the support offered to them; however, in its strategy and delivery of support the provider was not always following current best practise guidance, including but not limited to Registering the Right Support. In particular promoting as much as possible that people receiving support are independent and live as ordinary a life as any other citizen.
The Ferns was in a time of change and was being used as people’s home, for short breaks and for people who used the home for a few hours before and after day services. Whilst there was a nice atmosphere in the building it did not feel like people’s home and at peak times it was very busy with lots of distractions.
The home accommodates up to eight people in one purpose built building on a campus with another five registered premises, all providing accommodation and care for people with autism. A total of 59 people can stay on the campus known as ‘Raby’ at any one time. There are also day services provided on the same site. Current best practise guidance promotes housing models that increase opportunities for people’s independence, choice and control.
Some aspects of people’s support and accommodation were institutionalised. When speaking about people and in documents, staff providing support used a lot of organisation based language and jargon that inadvertently promoted a difference between the people supported and other people.
The service requires and 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.
The registered manager contributed to a friendly and relaxed atmosphere at the home. It was clear from their interactions that the registered manager knew people well and had positive relationships with them; they were comfortable around him and enjoyed his company. Staff members and people’s relatives told us that they had confidence in the registered manager. One people’s family member told us, “He is an incredible manager, absolutely outstanding…”
People and their relatives told us that they had confidence in the service provided at The Ferns and they thought that the home was safe. One person told us, “They look after me here. I get on well with staff.” Another person’s family member told us, “He really bonds with the staff; which makes me feel more relaxed. He took to it here like a duck to water.”
There was a relaxed atmosphere at the home and people appeared comfortable in all areas of the building, including the office area. We saw friendly interactions between people living at The Ferns and staff members. It was clear that people felt relaxed and comfortable at the home and the use of appropriate humour helped create a friendly atmosphere. People were communicated with and supported to express their views and helped to make decisions in a way that best enabled them to understand and express themselves.
The service had systems and processes in place to help protect vulnerable adults from abuse. Each person had individualised risk assessments that helped staff members to keep people safe and the home’s environment was clean and safe.
Some people at The Ferns had previously lived in a more intensive support setting. We saw that their transition into the home had been thoughtfully done in a person-centred way, at a pace that was best for people. Some people had been supported to set out personal goals that they wanted to achieve and worked towards these. People had grown in confidence and tried new things since spending time at The Ferns and some people had made quick progress towards these goals.
One indicator of the success of people’s support was the sharp reduction in some people using medication to reduce anxiety since moving to The Ferns. One person’s family member told us that before coming to The Ferns their relative spent over two years in assessment and treatment units. They told us, “Autism Together have changed his life since he moved here.”
Staff told us that they felt well supported and they enjoyed working at the home. One staff member said, “Its a rewarding place to work. With great staff and people supported.” Staff received support with daily briefings, supervision meetings, regular training, team meetings and annual appraisals.