We carried out a comprehensive inspection of Ferndale on 17 and 21 May 2018. This was an ¿announced inspection. We told the provider two days before our initial inspection visit that we ¿would be coming. This was because we wanted to make sure people and staff would be at the ¿service to speak with us. ¿

Ferndale provides care and accommodation for up to three people who have autism. It is part of ¿the Orchard Vale Trust, a charity which offers care and support to people with learning disabilities ¿and autism living in Somerset. At the time of the inspection two people were living at the service; ¿both had their own self-contained accommodation.¿

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. ¿

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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.¿

The service was last inspected in January 2017. At this inspection, we found four breaches of the ¿Health and Social Care Act 2008. This was due to governance systems not being adhered to by ¿not recording accidents, monitoring the service properly and not carrying out regular reviews of ¿people’s care. Risks to people were not being monitored regularly. There were restrictive control ¿measures in place for one person, which had not been adequately assessed. A financial ¿agreement had been made for one person without evidence of the person’s consent. At this latest ¿inspection we found the required improvements had been made.¿

We spoke with both people who lived at the home. As these discussions were limited, we also ¿used our observations and our discussions with people’s relatives and staff to help form our ¿judgements.

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Staff understood people’s needs and provided the care and support they needed. The home was ¿a safe place for people. People living at the home told us they were happy with their service.

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People interacted well with staff. Staff were skilled at communicating with people and in ¿identifying any changes in people’s mood. People made choices about their own lives. They were ¿part of their community and were encouraged to be as independent as they could be.

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Staffing levels were good. People received good support from health and social care ¿professionals. Staff had built close, trusting relationships with people over time. One relative said ¿their family member “Could not live in a more caring place than Ferndale. Kindness and ¿understanding are very much part of their [meaning staff’s] every day work.”

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People, and those close to them, were involved in planning and reviewing their care and support. ¿There was a close relationship and good communication with people’s relatives. Relatives felt ¿their views were listened to and acted on.

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Staff were well supported and well trained. Staff spoke highly of the care they were able to ¿provide to people. One staff member said, “It’s a very good service; very tailored to each person’s ¿needs. There’s always a positive atmosphere.”

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There was a management structure in the home which provided clear lines of responsibility and ¿accountability. All staff worked hard to provide the best level of care possible to people. The aims ¿of the service were well defined and adopted by the staff team.

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There were effective quality assurance processes in place to monitor care and safety and plan ¿ongoing improvements. There were systems in place to share information and seek people’s ¿views

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 mo

During our inspection, one person was out for the majority of the time and two other people were busy in their rooms or out with staff. We spoke with one person who uses the service and observed the other person as they interacted with staff. Both people appeared calm and relaxed and engaged well with staff.

We saw the documentation relating to the care of people and we spoke with the manager and three members of staff, who all demonstrated an excellent knowledge of the individual needs of the people who use the service.

We saw that the provider had trained staff in safeguarding and staff demonstrated a good knowledge of what abuse was and how to report it.

We saw that Ferndale was clean, bright and fresh smelling and that the service was provided in a predictable, planned, low arousal environment in line with people's needs based on their disabilities.

The provider had recently implemented a formal quality assurance audit programme and we saw evidence that this had started and was ongoing according to the plan for the year.

There were three people living at the home at the time of our visit and we were able to speak with each person. We also spoke with three staff; the Registered Manager, a Senior Support Worker and a Support Worker.

People who were using the service told us they were asked for their views about their care and treatment and their wishes were acted upon. One of the people using the services stated "I am loving it where I am, they take me shopping and I get my money every Friday."

People’s individual needs were assessed and we saw evidence of a robust risk assessment and plans in place to protect people from harm. These were jointly agreed with people using services, staff and provider. Staff had access to training and development opportunities in order to ensure that they had the required skills and knowledge to support people receiving care.

We found that the service had appropriate arrangements in place for staffing the service and meeting people’s needs. People using the service could be confident that they would be kept safe at all times.

There were a number of arrangements in place to monitor the quality of services provided. This included unannounced 'spot checks' and supervision of staff.

People who lived in the home were able to explain to us that staff provided the care and support they needed. They also told us they were involved in all of the decisions about the care and support provided to them.

People chose what activities they wish to take part in both inside and out of the home. They were supported to access a range of leisure activities, outings to places of interest, music and art therapy and to choose and attend holidays. People were responsible for keeping their house clean, were involved in preparing and cooking meals, shopping, DIY, gardening and laundry.

People who lived in the home confirmed they were well cared for and that staff were available when they need them. One person said “I’m fine thank you” when we asked them how they were. People looked well cared for and there was a very calm atmosphere within the home.

People were able to explain they felt safe living in the home. No concerns were raised with us during our inspection. Each member of staff we spoke with said the home was a “safe place” for people to live.

We saw that people were offered appropriate support by the staff team. Staff were confident in offering care and support to people who lived in the home.

People who live in the home were able to explain to us that staff provided the care and support they needed. They also told us they were involved in all of the decisions about the care and support provided to them. They told us about and showed us photos of their holidays, the places they had been and the activities they had chosen. People spoke with us about where they work.

People who live at the home were able to say what care and treatment they wished to receive. Their views are listened to and acted on by staff. They told us they were well cared for and that staff were available when they need them.

People told us they were involved in preparing meals and shopping. The home does not have set menus as such, as individuals are fully involved in choosing meals and shopping for the home.

People told us they helped keep their rooms or the communal areas of the house clean and tidy and they were seen cleaning areas of the home at various times during our visit. Each person was responsible for their own personal care and their laundry.

People who live in the home told us about their medicines. One person keeps and is responsible for taking their medicines. Another keeps their own medicines with staff checking they have taken them each day.

People we spoke with told us they liked their home and they were able to choose how to decorate both their own rooms and the communal areas.

The people who live in the home know they are able to complain if they are unhappy about any aspect of the home. No concerns were raised with us during our visit.

Some people who live in the home did talk to us about their records and showed us a selection of them. They knew they had records relating to them and appeared happy to talk with us about them.