We carried out a comprehensive inspection of Ferndale on 15 January 2017. This was an announced inspection. We told the provider three days before our inspection visit that we would be coming. This was because we wanted to make sure people would be at the service to speak with us. The service was last inspected in January 2014. The service was meeting regulations at that time.Ferndale provides care and accommodation for up to three people who have autistic spectrum disorders. It is part of the Orchard Vale Trust group which offers care and support to people with learning disabilities and autistic spectrum disorders living in Somerset. At the time of the inspection two people were living at the service. Both people were living in their own self -contained living areas, with their own independent access as well as access from the main house. The main house had a central kitchen area as well as office space. The first floor contained living space for another person as well as including a staff sleep in area.
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.
Accidents and incidents were not always being recorded. This meant staff might not be aware of when an accident had occurred or if additional support or monitoring was necessary following an incident. It also meant there was not a true reflection of accidents or incidents if the records were not accurate.
The service had not gained consent in respect of a person’s care and support. The service had introduced a monetary rewards system for not displaying behaviours which challenged. Tasks included carrying out household jobs. However where the person displayed behaviours which challenged the service, financial penalties were imposed. For example small monetary amounts deducted from the daily allowance. There was no evidence to demonstrate this had been developed and discussed with the person in order to give them choices and consent to the design of their care and support.
Care records were person centred and contained specific information to guide staff who were supporting people. There were some parts of the care plans which included information about the person in a format which was meaningful for people. This included large print and pictorial information. However this was not always consistent, specifically around risk assessments. Staff said they knew people’s needs because they had been supporting them for a long time and information was shared daily between the registered manager and staff. There was information about people’s levels of risk and how it might be managed, also routines and personal preferences including some situations which might cause anxiety or stress.
Where appropriate people were assessed in line with the Deprivation of Liberty Safeguards (DoLS) as set out in the Mental Capacity Act 2005 (MCA). Where a person had limited mental capacity but no DoLS authorisation in place, there was no evidence of their involvement in their care planning and review. The service relied on annual review information from the placing authority. However these reviews did not always take place in a timely manner, resulting in some care planning information not being reviewed since 2015. This meant information might not be accurate in reflecting the person’s current needs and adapting care plans to meet the changes which may have occurred.
Quality assurance systems were limited in that no recent surveys had taken place to gain the views of all stakeholders of the service including people living there, families, staff and other professionals who worked alongside the service. Staff told us they had ‘round the table’ meetings every three to six months.
People had access to a range of other professionals to support their health and wellbeing. Staff had motivated a person to lose weight by focussing on a healthy eating programme and increasing exercise including swimming and using an exercise bike.
Staff were supported by a system of supervision and training. New staff were required to complete a formal induction programme introducing them to the service’s policies and procedures as well as working with other staff before working alone. Staff also undertook the Care Certificate within their first 12 weeks of employment if new to the role.
Staff recognised the importance of family relationships and friendships. People were encouraged and supported to develop and maintain social networks. People had access to a range of activities which supported them individually. Both people took a holiday in the summer months and were supported by staff to choose where to go and plan the holiday. People were supported by two staff members when they went on holiday due to the level of need.
The layout of the building was organised in a way which meant people were able to spend private time alone if they wished. There was also a shared dining kitchen area within the main house where people could socialize. For example, on the day of the inspection one person came into the main kitchen to talk with staff on duty.
Staff completed a recruitment process to ensure they had the appropriate skills and knowledge to carry out their role.
Staff members were available to support peoples’ needs and engage in activities. Staffing levels were flexible so they could respond to people who at times required additional support. Staff on duty supported people respectfully. People told us that staff supported them to maintain their independence and we saw evidence of this within the care documentation we viewed. For example supporting people to develop life skills including cooking and supporting people to maintain links with the local community.
We identified breaches of the regulations. You can see what action we told the provider to take at the back of the full version of the report.