This inspection was unannounced and took place on the 23 and 24 October 2018.

We last carried out a comprehensive inspection of this service on 5 and 6 February 2018. Prior to that inspection we had issued warning notices due to breaches in relation to safe care and treatment and the lack of evidence to demonstrate good governance. At the February 2018 inspection we again found breaches of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulations 2014 with regards to person-centred care, safe care and treatment in relation to risks within the environment, staffing and good governance. Due to the breaches we rated the service inadequate in the Safe and Well-led domains and Requires Improvement in the Effective and Responsive domains. The service was given an overall rating of Inadequate and placed in Special Measures.

Following the inspection, we required the provider to complete an improvement action plan to show how they would improve four key questions; Safe, Effective, Responsive and Well led to at least good.

Services that are in Special Measures are kept under review and inspected again within six months of publication of the report. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements had been made and is no longer rated as Inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

Fernica is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a 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.

Fernica provides accommodation for up to fourteen people with enduring mental health needs who require support with personal care. Accommodation is provided on three floors. There is no passenger lift. On street parking is available to the front of the home. The home is situated close to Prestwich and Manchester town centres and is near to all local amenities and public transport. At the time of our inspection there were 11 people living at the home.

The service had a registered manager, who is also the one of the owners of the home. A registered manager is a person who has registered with the CQC 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 said the registered manager was approachable and they could talk with them.

Improvements had been made to demonstrate management oversight and monitoring of the service. Opportunities were made available for people and relevant parties to comment about their experiences and the service provided at Fernica. Comments received were positive. We have recommended that findings from the audits and feedback received continue to be reflected in the homes business improvement plan so that the experiences of people and the quality of service continue to be enhanced.

Action had been taken to ensure the safety of building. Up to date risk assessments, maintenance records and fire safety checks were in place to help keep people safe.

Appropriate action had been taken where people were being deprived of their liberty. Records had been expanded upon to demonstrate where restrictions were in place and why these decisions had been made. Where necessary people were supported by independent advocates so their views and rights were upheld.

A new staff appointment had been made so that flexibility in support could be provided. People followed activities and routines of their own choosing. Additional support was provided to facilitate external activities for those people needing support to access the local and wider communities.

Appropriate recruitment checks we

This was an unannounced inspection, which took place on the 5 and 6 February 2018. At our last inspection in June 2017 we identified five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Due to our concerns we issued warning notices in relation to people's care plans, risk assessments and quality assurance systems. Further breaches were identified with regards to staff training and development, need for consent and failure to complete the Provider Information Record.

Following the last inspection, we met with the provider to discuss what they would do and by when to improve the key questions, Safe, Effective, Responsive and Well-led, to at least good. We also asked the provider to complete an improvement action plan confirming the action to be taken.

During this inspection we found that improvements had been made with regards to the development of more personalised care records reflecting people’s needs and wishes and risk assessment to help keep people safe. Improvements were still required with regards to making sure the environment was safe as well as the development of good governance systems to demonstrate clear management and over sight of the service. Further improvements were needed in relation to staffing arrangements, activities and opportunities for people’s emotional and social development, records to support restrictive practice, health and safety and pre-admission assessments.

Fernica is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Fernica provides accommodation and personal care for people with mental health support needs.

Accommodation is provided over three floors and comprises of 14 single occupancy bedrooms with shared bathroom and toilet facilities. There is no passenger lift. The home is close to local shops and public transport between Bury and Manchester. At the time of the inspection there were eleven people living at the home.

The service has a registered manager, who is also the registered provider. 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.

Effective systems to monitor and review the quality of service had yet to be implemented to demonstrate continuous improvement of the service and ensure people are protected from the risks of unsafe or inappropriate care and support. We were concerned that the registered manager was working an excessive number of hours, which meant they were not able to effectively support people as well as manage and improve the service.

Sufficient numbers of staff were not available or provided flexibility in support so that people’s current and changing needs were effectively met and enabled them to achieve their individual goals and aspirations.

People’s records confirming consent to restrictions needed to be expanded to clearly record the reasons why.

Checks were completed with regards to fire safety. We recommend the provider refers to relevant guidance with regards to the fire risk assessment ensuring all necessary arrangements are in place for the safety and protection of people living and working at the home.

Effective systems were not in place to check water outlets were maintained at the correct temperature so that people were protected against the risk of harm or injury.

We saw windows had been restricted to ensure peoples safety however these were not those recommended within the Health and Safety Executive (HSE) published guidance on the use of window restrictors in care homes. We were made aware following the inspection that

This was an unannounced inspection, which took place on the 5 and 6 June 2017. At our last inspection in January 2016 we identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to lack of information detailed with people’s care plans and risk assessments. We asked the provider to send us an action plan telling us what action they were to take to meet the regulations. This was not provided. During this inspection we checked to see if the breaches in regulation had now been met. Relevant action had not been taken.

Fernica provides accommodation and personal care for people with mental health support needs. Accommodation is provided over three floors and comprises of 14 single occupancy bedrooms with shared bathroom and toilet facilities. There is no passenger lift. The home is close to local shops and public transport between Bury and Manchester. At the time of the inspection there were nine people living at the home.

The service has a registered manager, who is also the registered provider. 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's care records did not contain enough information to guide staff on the care and support required. Whilst records showed that risks to people's health and well-being had been identified, plans to help reduce or eliminate the risk were not in place.

The providers had failed to ensure the premises were kept safe. We saw the fire risk assessment had not been kept under review, several windows were not adequately restricted, water temperatures were not routinely checked and there were no records in place to confirm a satisfactory periodic inspection of the electrical installation had been undertaken. This placed the health and safety of people who lived, worked and visited the home at risk of harm.

Lawful authorisations were in place where people were being deprived of their liberty. However information did not demonstrate the principles of the MCA were being followed.

Opportunities for staff training and development needed improving to ensure staff had the knowledge and skills needed to meet the specific needs of people safely and effectively.

Pre-inspection information requested from the provider, which is required by law, had not been provided to CQC as requested.

There was no effective system in place to assess, monitor and improve the quality and safety of the service so that improvement were identified and acted upon. Better opportunities could be provided for people and their relatives to comment on the service provided.

Notifiable events such as accidents or incidents, which CQC should be made aware of, had been notified to us. Authorisations to deprive people of their liberty had recently been agreed. Notification forms were sent to CQC during the inspection.

During this inspection we identified breaches in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Breaches identified at the previous inspection also remained outstanding. You can see what action we have told the provider to take at the back of the full version of the report. We are considering taking enforcement action in relation to the breaches identified.

Adequate numbers of staff that had been appropriately recruited were available to support people

Staff were aware of their responsibilities in protecting people from abuse and knew the procedure to follow so that people were kept safe.

Improvements were being made to enhance the standard of accommodation provided for people. Relevant checks were carried out to the fire alarm and equipment to help keep people safe. Hygiene standards were maintained to help minimise the risks

Fernica provides accommodation and personal care for people with mental health support needs. Accommodation is provided over three floors and comprises of 14 single occupancy bedrooms with shared bathroom and toilet facilities. There is no passenger lift. The home is close to local shops and public transport between Bury and Manchester.

This was an unannounced inspection of Fernica on the 25 January 2016. There were 10 people living at the home at the time of the inspection.

We last inspected Fernica in August 2014. All regulations reviewed at that time were met.

Fernica is owned by two proprietors. One of the owners was also the registered manager and was in day to day control of the service. A registered manager is a person who has registered with the CQC to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

We found breaches in the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulation 2014. You can see what action we have told the provider to take at the back of the full version of the report.

Care records did not contain sufficient information about people’s needs, wishes and preferences to ensure the plans clearly guided staff on the care and support required. Areas of potential risk to people had not been assessed and planned for to ensure their health and well-being was maintained.

Checks were made to the premises and servicing of equipment. Suitable arrangements were in place with regards to fire safety so that people were kept safe. The home was found to be clean, and free from any unpleasant odour. The registered manager was addressing areas of damp within the home.

We found the management and administration of people’s medicines was safe.

People were supported by adequate numbers of staff. Relevant recruitment checks were carried out to make sure people applying to work at the service were suitable.

People living at Fernica were involved and consulted with on decisions about how they wished to be supported. The registered manager was aware of her responsibilities in relation to the Deprivation of Liberty Safeguards.

Opportunities for on-going staff training and development were provided to help ensure staff had the relevant knowledge and skills needed to support people safely.

People were offered adequate food and drink throughout the day, ensuring their nutritional needs were met. On-going support was accessed from relevant health care professionals so that people’s health and well-being was maintained and people received any treatment they needed.

People were happy with the care and support they received and said staff were caring and friendly. Routines were relaxed, with people spending their time as they chose. Staff encouraged people to be as independent as possible.

The registered manager/provider was in day to day control of the service and was able to monitor and review the service provided. Opportunities were provided for people and staff to comment about the service and people felt confident any issues or concerns brought to the registered manager’s attention would be taken seriously.

Information in respect of people’s care was held securely, ensuring confidentiality was maintained.

We considered all the evidence we gathered under the outcomes we inspected. We used the information to answer the five questions we always ask: Is the service safe? Is the service caring? Is the service effective? Is the service responsive to people’s needs? Is the service well led?

Below is a summary of what we found. The summary is based on speaking with seven people who lived at Fernica, and the owners who supported them as well as observation and looking at records.

Is the service safe?

The people we spent time with told us they would speak to the Registered Manager or any of the staff if they had any worries or concerns. They were confident they would be listened to and that the problem would be sorted out. One person commented that, “If there is a problem they get to the bottom of it.”

Is the service effective?

Two people told us about the improvements in the quality of their lives because of the support they had received from staff at the home. They felt their anxiety had reduced because some the stress they had been experiencing, for example taking their medication and some daily living tasks such as prompting them to maintain good personal care. One person told us they were now able to manage their behaviours better and had developed coping strategies. They said “This is the longest place I have ever stayed and I would not want to go anywhere else.”

Is the service caring?

The majority of the people who lived at the home had done so for a long time. The people we spoke with told us that the group got on well together most of the time. We saw that more able people offered to help those who were less able than themselves, for example doing errands for them. One person told us, “I love it here. I go with the flow. I like to do jobs for the others who need more help like shopping and it keeps me busy.”

Interactions between people and the staff supporting them were seen to be frequent, friendly and the atmosphere was calm and relaxed.

Everyone we spoke with who lived at the home spoke highly about the staff team. One person commented that the staff were “Kind and reliable. I get on with everyone.” Another said that the staff were, “Very good. They don’t let me down. If they say they are going to do something they do.”

Is the service responsive to people’s needs?

Wherever possible people who lived at the home were encouraged to maintain contact with their family and friends. Some of the people we spoke with gave us examples which included visits to relative’s and friend’s homes and attending family gatherings and celebrations as well as weekly telephone calls from abroad and regular letters and photographs.

Some people we spoke observed the Jewish faith and culture. They total us that the Rabbi visited every Friday and although attendance at the ceremony was not compulsory those who did attend said they were encouraged to take part, for example saying prayers in Hebrew.

Is the service well-led?

The home has two owners. One of the owners was also the manager of the home and was registered with the Care Quality Commission (CQC).

Both owners were registered mental health nurses (RMN) with active registrations with the Nursing and Midwifery Council (NMC). They have many years’ experience supporting people with mental health needs.

We talked with seven people who lived at the home. Three people privately and four people in a group. People told us that they were happy living at the home and that most people had lived there for a long time. One person said that “we all get on well together.” Another person told us that it was “calm and relaxed” and “really nice people live here.”

One person talked about their complex health needs and told us that they had a lot of appointments to see various healthcare professionals in the coming week. Another person told us that they had had the same community psychiatric nurse for a long time and that they had moved to a downstairs bedroom recently because they had become unsteady on the stairs.

People told us that if they had any worries or concerns they would speak to the registered manager. They said that they were confident that they would be listened to and the problem would be sorted out. Some people told us that they had not got “any worries.”

People we spoke with said that they were happy with their bedrooms and that they were personalised in a way that they wanted them to be. One person described the home as “cosy.”

One person told us that the staff were “brilliant” and had helped them a lot. Other people described the staff as “wonderful” and “lovely.”

Everyone had lived at the home for many years and knew each other well. We saw frequent and friendly interactions between people and staff. The atmosphere was relaxed. People appeared well cared for.

People were provided with a choice of suitable and nutritious food and drink. We looked in the fridges, freezers and cupboards at the home and found them to be well stocked.

People were cared for in a clean environment. There were effective systems in place to reduce the risk and spread of infection.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

We saw that the house was comfortable, homely and maintained to a satisfactory standard. One person said that they thought the house was “lovely.”

There were enough qualified, skilled and experienced staff to meet people’s needs. Both providers were qualified and registered Mental Health Nurses (RMN) and they worked directly with people living at the home. We were told that both support workers had completed a National Vocational Qualification (NVQ) Level 3 in care.

We saw a copy of the home’s complaints policy and procedure was seen on the service user’s notice board near the kitchen. People said that they had no worries or concerns.

Before our visit we contacted the local commissioning and safeguarding teams. They informed us they had no concerns about Fernica.