This inspection was carried out on 17 July 2018 and was unannounced.

Fern Lea is a care home for four adults with a learning disability. The home is in a secluded semi rural location on the outskirts of Chester. Transport is required to access local shops and other amenities.

The home has 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 a legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At the last inspection in February 2016, the service was rated Good.

At this inspection we found the service remained Good. The service is rated Good as it had met all the requirements of the fundamental standards.

Recruitment systems at the home continued to be safe and robust. There were sufficient trained and competent staff to meet people's individual assessed needs. All staff undertook an induction at the start of their employment and completed shadow shifts to fully understand their role and the people they supported. The staff were supported by the management team through on-going supervision and team meetings.

Staff described procedures that were in place to safeguard the people they supported. They fully understood the safeguarding policies and procedures and felt confident to raise a concern and thought they would be listened to.

Medicines were ordered, stored, administered and disposed of in accordance with best practice guidelines. All staff had undertaken medicines training and had their competency regularly assessed. The registered provider had medicines policies and procedures in place.

People living at the home had an individualised care plan and risk assessments in place to meet their assessed needs. People's needs that related to age, disability, religion or other protected characteristics were considered throughout the assessment and care planning process. Clear guidance was included within the care plans the staff to follow that ensured people's needs were met. Staff had a good understanding of people's histories and were able to describe each person they supported in detail. People were supported to undertake activities of their choice and their independence was promoted.

People were supported with their nutrition and hydration needs. Clear guidance was available for staff to follow when people had specific dietary needs. People spoke positively about their mealtime experiences and told us they were always offered choice.

Staff knew people well and demonstrated kindness and compassion. People's privacy and dignity was respected. Relatives were consistently complimentary about the staff and management team.

The registered provider had a clear complaints policy and procedure that relatives were familiar with and felt confident any concerns would be listened to.

The Care Quality Commission is required by law to monitor the operation of the Mental Capacity Act (MCA) 2005 and report on what we found. We saw that the registered provider had policies and guidance available for staff to follow in relation to the MCA. Staff demonstrated a basic understanding of this and had all completed training. The registered provider had made appropriate applications for the Deprivation of Liberty Safeguards (DoLS). Care records reviewed included mental capacity assessments and best interest meetings.

Fern Lea was well maintained overall and was awaiting some redecoration. All required health and safety checks and documentation were in place as well as fire safety equipment checks.

The registered provider had quality monitoring systems in place that were followed by the management team to identify areas for development and improvement. Audits were regularly undertaken as part of the governance process.

The registered provider had up to date policies and procedures available

We carried out an unannounced inspection of Fern Lea on 21 January 2016.

Fern Lea is a care home for four adults with a learning disability. Although close to a busy main road the home is in a secluded semi-rural location on the outskirts of Chester. Transport is required to get to shops and other local amenities.

The service had 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. The registered manager was on leave during our visit yet the registered provider made arrangements for another registered manager within the organisation to assist us during our visit.

Our last inspection of the service took place in April 2014. At that time the registered provider had met all of our standards.

People who used the service told us that they were happy living at Fern Lea, felt safe and considered that staff cared about them. This was reinforced by observation of the care practice provided to those who could not necessarily provide us with a direct account of their experiences.

Staff explained to us what they would do to keep people safe and how they protected their rights. Staff had been provided with training and showed an understanding about safeguarding adults from abuse, Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS).

Staff practice was focussed completely on the needs of people and this was delivered in a friendly yet dignified manner. People had full access to other medical services as well as advocacy when required.

There were opportunities for people to take part in group activities but they were also encouraged to develop personal interests and this was evident throughout the building and through individual discussions.

Staff protected people from the risks associated with poor nutrition and hydration as they encouraged people to eat and choose a balanced diet. Staff ensured that people were able to eat independently but with discreet supervision to ensure that this was done safely.

Records that we looked at were comprehensive and kept up to date. Support plans contained detailed information on each person and how their care and support was to be delivered. The information was regularly reviewed with the person who used the service and significant others. Care plans were presented in a format that was appaopriate to the communication needs of each person. This meant that people received personalised care in line with their wishes and preferences.

People were supported by staff who were robustly recruited, well trained and regularly supervised.. The service was run by a registered manager and registered provider who were open and transparent in their practice, responsive to the views of staff and people alike and monitored the quality of care in an objective and transparent manner.

We have made two recommendations about the standard of decoration in corridor areas and the management of medicines.

Summa

For this visit we looked at five questions; These questions are below and include a summary of our findings.

Is the service safe?

People were treated with respect and dignity by the staff. People told us they felt safe. Safeguarding procedures on how to safeguard the people they supported were understood by staff. The home had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards although no applications had needed to be submitted. Policies and procedures were in place to make sure that unsafe practice was identified and people were protected.

Is the service effective?

People had access to advocacy services. People’s needs were agreed with them and their representatives. Dietary needs had been identified in care plans where required.

Is the service caring?

People were supported by staff whose work was centred on their needs. People commented, “The staff are good”. Our observations noted positive interactions between staff and people which were respectful and light hearted.

Is the service responsive?

The service had a system of quality checks identifying those areas which needed improvements. Any issues identified were acted upon. Complaints received about the service were investigated thoroughly.

Is the service well-led?

The service worked well with other agencies in particular with safeguarding authorities. Referrals had been made which were made promptly and full co-operation was evidenced.

The nature of the disability of the people who lived at Fern Lea is such that it was not always possible to gain a detailed view of their experiences of living there. Despite this we were able to talk with two individuals about the support they received. Both said that they were happy living there and thought that the staff looked after them well. We were able to observe the support provided to people. Interactions were positive between staff and individuals with staff focussing on the needs and wishes of individuals. The atmosphere remained relaxed during our visit with individuals appearing comfortable with the staff team. Staff and individuals were able to engage in light hearted banter with each other.

We spoke with staff during our visit. Staff considered that they felt supported by the provider to perform their role and enjoyed promoting the needs and rights of the people using the service.

We spoke to two members of staff. Both felt supported in their role and considered that the opportunity for people to access their local community had improved of late.

We were able to talk to people who used the service. They commented:

"I like living here"

"Staff respect me"

"I like the staff"

"I feel safe here"

For other people who were not able to communicate their experiences directly, our observations noted that they appeared to be very comfortable and at ease with the staff team and others living with them.

When we visited Fern Lea we had the opportunity to observe the support that was being given to two people living at the home. We saw many examples of good communication and patience by care staff. Staff interacted with the people they supported in a positive manner. Staff were friendly and respectful to the people they were supporting.

We met everyone living at Fern Lea when they arrived home throughout the day.

People told us they liked the staff. They knew the staff’s names and who was their key worker.

Comments received included:

“everything’s ok I’m happy”.

“I’m going out soon, I go out in the bus, I like going out with the staff”.

“I like Christmas I like the Christmas tree”.

We had also contacted the local authority contracts and monitoring team for Cheshire West and Chester before we visited the service. They had no issues of concern to report.