Fern Lodge is a care home providing support for up to eight people who have a learning disability and or associated mental health needs. The service is located close to a number of supported living flats and staff from this service also support people living in the flats. The supported living service is separately registered under Braintree Health Care Limited. When we last inspected Fern Lodge in June 2015 we rated this service good. At this inspection we found that the service remained good.

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.

Staff understood the need to protect people from harm and the steps they should take if they suspected abuse. Staff were aware of their responsibilities to keep people safe and we saw that they look steps to protect people and reduce the likelihood of harm

There were sufficient numbers of staff available to keep people safe and meet their needs. The staff team was relatively stable and they worked in a flexible way, according to people’s needs and preferences. Recruitment procedures were thorough and reduced the likelihood of the service employing individuals who were unsuitable to work in this type of service.

Staff were well motivated and supported. Staff had a good understanding of healthy eating and we saw that they sought advice appropriately from health professionals and followed their recommendations.

People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible. Staff had been provided with training in the Mental Capacity Act (MCA) 2015 and Deprivation of Liberty Safeguards (DoLS) and understood the principles of consent and best interests. The MCA and DoLS ensure that, where people lack capacity to make decisions for themselves, decisions are made in their best interests according to a structured process.

Staff knew people well and treated them with kindness. Care plans were detailed and informative. Daily recordings were undertaken along with handovers to ensure good communication and continuity of care.

People were supported to have an active live and maintain contacts with those important to them. There was a complaints procedure in place, and concerns were responded to in an open way.

The manager provided stable leadership and was visible and accessible. Quality assurance systems were in place to monitor the delivery and safety of the service.

For a more comprehensive report regarding this service, please refer to the report of our last visit dated 03 June 2015.

The inspection was unannounced and took place on 03 June 2015.

Fern Lodge is a care service without nursing, providing accommodation and personal care support for up to eight people who have a learning disability and/or associated mental health needs.

A registered manager was in post at the service. 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.

People were safe this was because the staff supported people to know and understand how to keep safe. The staff were aware of their responsibilities in managing risk and identifying abuse. People received person-centred safe care because their individual specific needs had been assessed and care planned accordingly. The care plans contained information about risk assessments and plans to minimise while supporting people to pursue their individual aspirations.

Staff had received training regarding safeguarding people and the service had a whistle-blowing policy. Staff had received and continued to update their knowledge of medicines that were prescribed to people. The service had a policy and procedure designed for staff to administer medicines safely.

There were sufficient staff to meet people’s needs who had been recruited safely and who had the skills and knowledge to provide care and support to people in ways that they preferred.

The service had a robust recruiting procedure and the staff were provided with on-going training, supervision and yearly appraisal.

People’s health and emotional needs were recognised and the staff consulted with relevant health care professionals to provide appropriate support. Staff supported people to have a varied diet and that met their individual needs.

People were treated with kindness and respect by staff who knew them well and who valued their views and supported them with their individual interests. The staff supported people to pursue and enjoy social activities in the wider community.

People contributed to their own care plans via organised reviews as did their and families as appropriate. The service had a complaints system which was in user friendly format so that people could inform staff if they had any concerns.

There was an open culture and the management team demonstrated good leadership skills. Staff felt highly valued and enjoyed working on a one to one basis with people.

The management team had devised and used systems to check and audit the quality of the service.

We spoke with two people who used the service and four members of staff and the manager as part of this inspection. People who used the service told us they were very happy with the care they received and that they felt safe. They told us they enjoyed the range of activities provided.

One person told us, "I like living here and the staff help me and are kind to me." They also told us, "I love Christmas and my holidays."

We saw several examples where staff supported and cared for people in a dignified and respectful way. We found that the service was meeting the personal, emotional and healthcare needs of people who used the service.

We found that staff were appropriately recruited and inducted into the service and there was an appropriate and effective system in place to manage complaints.

We found that the service being managed effectively. All four staff told us that they considered the manager to be both supportive and professional and supported them to carry out their role effectively and safely. One person told us that working at Fern Lodge was like " One big family where everyone helped to make the service a happy place in which to live and work.

We found that staff were appropriately recruited and inducted into the service and there was an appropriate and effective system in place to manage complaints.

We spoke with two people who used the service. One person spoken with told us, “I love it here, the staff are lovely.” Another person told us, “I trust staff.”

We also spoke with a relative who was visiting at the time of our inspection. They told us, “I can’t fault what they do here. We are very pleased.”

Where people were unable to provide a verbal response to tell us about their experiences, for example as a result of their limited verbal communication or cognitive ability, we noted their non verbal cues and these indicated that people found their experience of the service positive. We saw that staff interacted with people who used the service in a respectful, caring and professional manner.

We spoke with three care staff. Staff spoken with told us they felt well supported to carry out their role. One staff member told us, “Senior staff are approachable and supportive.” Staff recently employed by the service told us they had received a comprehensive induction programme with training relevant to their role. Training provided included; manual handling, safeguarding vulnerable adults, food hygiene and health and safety.

We used an expert by experience at this review of compliance. An expert by experience is an individual who has a personal experience of using or caring for someone who uses a health, mental health and/or social care service.

Under s62 (2) of the Health and Social Care Act 2008, CQC may authorise experts by experience to enter premises, and carry out our powers of inspection for the purposes of any of our regulatory functions.

The experiences of people who use services are central when we make a judgement about the quality of a service. The purpose of involving experts by experience in compliance reviews is to help us to get a clearer picture of what it is like to live in or use the service.

Where people were unable to provide a verbal response or tell us verbally their experiences, for example as a result of their limited verbal communication or poor cognitive ability, we noted their non verbal cues and these indicated that people were generally relaxed and comfortable and found their experience at the service to be positive.

People with whom we spoke told us that generally they were able to make choices about aspects of their care. For example, one person spoken with told us. "I like it at Fern Lodge and "Staff are nice.” They went on to tell us that they can talk to staff when they want to and staff listen. For example they were involved in compiling their own care plan and have a weekly planner of what to do. Goal plans are set, for example going to a concert in London with transport arrangements. This is because they usually go to London by train and this can be quite complicated because the wheelchair has to be taken apart and put back together. We were told "It is big with a lot of parts."

Another person spoken with told us "Staff listen to me and act on my choices." For example, they are arranging a holiday at the moment with a member of staff of their choice. Walking is their favourite activity and they see animals, so they want to go to Centreparks as they enjoyed it a lot last year.

People spoken with indicated that they were satisfied with the level of care and support they received at Fern Lodge.

Those people with whom we spoke indicated they could choose whether or not to join in activities and could spend time alone in their room pursuing their own interests if they preferred.

The people with whom we spoke made the following comments "Staff support us to be as independent as possible." One person spoken with told us "They decide on their food, room decoration, (they went to B&Q for this) and where they want to go.", They also told us "I do my own food." and “Staff just help and they help me make my bed. Staff here are good.”

Another person spoken with told us they wrote in their own care plan and fills in their weekly planner on Sundays or Thursdays with the activities they want to do. Staff support them with this and they type it up on the computer in the lounge.

One person spoken with told us "I feel safe in the house and have not seen anyone in the house get hurt." Another person spoken with told us "I have been supported to understand what risk is and how to keep myself safe in the community."They added “Staff always take any worries seriously” and “Help keep me safe.”

People spoken with indicated that they were happy with their rooms and found them comfortable. One person told us they were currently choosing their favourite colour for their room. and another person said "I can make my own coffee and do cooking. I like making cakes. Staff go through recipe books with me, so I can choose which cake to make. If they don’t have all the ingredients they go shopping for them. Monday and Thursday are the big shopping days." They go to a farm to see chickens, geese and horses. Barbecues are held there in summer.

People told us that they feel well looked after by the staff at Fern Lodge. One person with whom we spoke said "I like the staff here they are very kind"

One person spoken with told us "I can write and spell well. Staff support me to practise my spelling twice a week which I really enjoy." Staff also go to church with people. They also attend college and attend “Writing” and “Pottery” classes. Positive feedback received provides a clear sense of purpose and structure for people, which may be similar to the lifestyle the individual had prior to coming into the service. We were told that Queen Victoria was the project last term, this term it is horses and Black Beauty.

Two people spoken with told us they were involved in meetings about the service and at the last meeting they discussed "Holidays". Another told us "If I am not happy about something I would speak to the manager or my key worker. I know they would listen to me."