Archived: Fern House

Fern House is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Fern House provides accommodation and care and support for up to six people with a learning disability. The service does not provide nursing care. There were five people living in the home at the time of the inspection.

At the time of our inspection, we were informed the ownership of the home was changing from Mr Shaun Martin Brelsford & Mrs Amanda Jane Brelsford to Affinity Supporting People Limited. Appropriate applications had been forwarded to CQC for consideration. This meant new systems and records were being introduced at the time of our inspection.

Fern House is a large mid terraced house, situated in a quiet residential area close to Burnley town centre. There is an enclosed patio/garden area to the rear of the home. Street car parking is available.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

There was a registered manager in place. 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.

At the last inspection on 18 and 19 October 2017 our findings demonstrated there were three breaches of the regulations in respect of risk management processes, medicines management and lack of compliance with the Mental Capacity Act 2005. The service was rated Requires Improvement. Following the last inspection, we asked the provider to complete an action plan to show what they would do to improve the service to at least good and to identify the date when this would be achieved.

During this inspection, we found some improvements had been made to address the breaches in regulation. However, whilst we did not consider the provider to be in breach of the regulations, we found further development was needed in the management of age related risks, the environment and with the management of people’s medicines.

This is the second consecutive time the service has been rated Requires Improvement.

We were aware the proposed new provider was committed to an extensive programme of development which would improve people’s lives. This included changes to the environment, policies and procedures and to the records and systems. During this inspection, we found changes were in progress.

The management of people’s medicines had improved and shortfalls noted at the last inspection had been addressed. However, improvement was needed with regards to the ordering process to ensure people's medicines were always managed safely. The registered manager acted on this at the time of our inspection to prevent this from re-occurring. Staff administering medicines had received training and were deemed competent to do this safely. Policies and procedures had been revised and would guide staff with good practice.

People were happy living in the home and were happy with the facilities provided. They had personalised their bedrooms as they wished and we saw personal touches in the communal areas. However, we found the general cleanliness of the home could be improved and improvements were needed to the environment. We noted that a development plan was in place and extensive refurbishment was due to commence this month (October 2018). We asked the provider to keep us up to date with changes that impact on people’s lives.

Risks to people's safety had been identified, assessed and managed safely. Further consideration and improvements were needed with regards to identifying and managing age related risks. Relevant health and social care professionals had provided advice and support when people's needs changed.

Monitoring of the service had improved since our last inspection visit. However, we noted some matters that had been identified by the provider’s checks, particularly in relation to the environment, had not yet been actioned. The registered manager and the representative from the new provider were aware of where further improvements were needed; there was a plan in place to support this and shortfalls were being addressed by policies and procedures, changes to the environment and with the introduction of new records. There were effective systems to obtain the views of people, their visitors and staff. People felt their views and choices were listened to. They told us they had been fully consulted and involved regarding the recent changes.

The staff team was stable and there had been no new staff recruited; this meant we were unable to determine whether recruitment processes were safe. A safe and robust recruitment procedure was being introduced to ensure new staff were suitable to care for vulnerable people. Arrangements were in place to make sure staff were trained and competent and additional training, from the new provider, was underway.

People were happy with the conduct and availability of staff and they were happy with the care and support they received. They told us they felt safe in the home and that staff were caring and kind. Staff understood how to protect people from abuse. People told us they did not have any complaints and knew how to raise their concerns. People's privacy, individuality and dignity was respected.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Staff sought people’s consent, respected people's diversity and promoted people's right to be free from discrimination.

Each person had a care plan, describing their individual needs and choices, which provided guidance for staff on how to provide people with support. Care and support was kept under review and people were involved in decisions about their care. Relevant health and social care professionals provided advice and support when people's needs changed.

People were supported with a range of activities that met their needs and preferences and had opportunities to maintain and develop their skills both inside the house and in the local community. People enjoyed their meals and were involved in menu planning, food shopping and meal preparation.

Fern House is owned by Shaun and Amanda Brelsford. It is a care home which is registered to provide care and accommodation for up to six adults with a learning disability and does not provide nursing care.

Fern House is a large mid terraced house in a residential area in Burnley. There are communal rooms; including a lounge and a dining kitchen. All the bedrooms are single and two had en-suite shower facilities. There is an enclosed patio/garden area to the rear of the home. Street car parking is available at the front of the premises. At the time of the inspection there were five people accommodated at the service.

The service was managed by 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.

At our last inspection on 30 June 2015 the overall rating of the service was ‘Good.’ However the service was ‘requires improvement’ in one domain. We therefore made a recommendation on ensuring service is appropriately decorated to meet the needs of the individuals accommodated. At this inspection we found sufficient improvements had been made.

At this inspection we found the provider was in breach of three regulations of the Health and Social Care Act (Regulated Activities) Regulations 2014. They related to the provider having unsafe processes for the management of medicines, insufficient risk assessments and risk management processes and a lack of compliance with the Mental Capacity Act 2005. You can see what action we told the provider to take at the back of the full version of the report.

We found there were management and leadership arrangements in place to support the day to day running of the service. However the providers need to have better oversight of the service and improved checking systems, to make sure the service is safely and effectively run.

Recruitment practices made sure appropriate checks were carried out before staff started working at the service. There were enough staff available to provide care and support and we were told staffing arrangements were kept under review.

Staff were aware of the signs and indicators of abuse and they knew what to if they had any concerns. Staff had received training on safeguarding and protection matters.

Systems were in place to maintain a safe environment for people who used the service and others. However we found some matters were in need of attention.

We found people were supported to make their own decisions and choices. They were effectively supported with their healthcare needs and medical appointments. Changes in people’s health and well-being were monitored and responded to.

People were satisfied with the meals provided at Fern House. Arrangements were in place to offer a balanced diet. People were actively involved with devising menus, which meant they could make choices on the meals provided.

People made positive comments about the care and support they received from staff. We observed positive and respectful interactions between people using the service and staff.

Arrangements were in place to gather information on people’s backgrounds, their needs, abilities, preferences and routines before they used the service.

Each person had a care plan, describing their individual needs and choices. This provided guidance for staff on how to provide support. People’s privacy, individuality and dignity was respected.

People were supported with their hobbies and interests, including activities in the local community and to keep in touch with their relatives and friends. Their well-being was monitored and reviews of their needs were held.

There were processes in place for dealing with complaints. There was a formal procedure to manage, investigate and respond to people’s complaints and concerns. People could also express concerns or dissatisfaction during their care reviews and during residents meetings.

There were systems in place to consult with people who used the service and staff, to assess and monitor the quality of their experiences.

Throughout the inspection we saw staff were regularly interacting with people who lived at the home, helping them to go out to appointments and undertake various other personal tasks.

People were not left alone for long periods and were given time to spend quietly, if preferred. We saw that staff treated people with respect and communicated with them regularly.

We reviewed information about two people's care. We found that the staff understood people's care needs and how to protect them from risk and harm. Records we looked at showed people's needs were assessed and care and treatment was planned and delivered in line with the individual care plan. We found that the care plans were accompanied by risk assessments and risk management plans to ensure people were protected from unsafe care practices.

We found that there were effective systems in place for the safe storage and administration of medicines.

We saw that there were effective recruitment procedures in place to ensure that people who used the service were protected from harm through good staff recruitment processes.

We found that people were given a choice about what care and support they received. Staff had been trained in assessing people's mental capacity and people's right to make decisions about their care and support for themselves.

Medical and personal needs for each individual were noted in their care plans. Staff were trained in handling medical emergencies and were briefed on the specific medical needs of individuals using the service.

Appropriate numbers of skilled staff were assigned to each shift to meet the particular needs of the individuals using the service. Staff received appropriate training in providing care and support, as well as specific training in caring for people with a learning disability.

Accurate records were kept of what medications people had taken and when. Care plans contained full details of people's medical and personal needs, their preferences for how they wanted to be cared for and supported, as well as what care and support had been provided.