We completed an unannounced inspection at Fernlea on 4 September 2018 and 6 September 2018. At our last inspection of this service in May 2017 we rated the 'safe' domain as requires improvement because we found that staff had not received sufficient guidance to safely administer ‘as required’ medications. We also rated the ‘well led’ domain as requires improvement because we found that care records were not always accurate and up to date and that there was not sufficient and effective audits in place to identify and address concerns. At this inspection we found that the provider had made the required improvements.

Fernlea is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Fernlea are registered to provide accommodation and support for up to 13 people. People who use this service may have physical disabilities and/or learning disabilities. At the time of the inspection, the service supported 11 people.

The service had 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.

People were safeguarded from avoidable harm and abuse and people’s risks were assessed and managed. There were enough safely recruited staff to meet people’s needs. Medicines were managed safely and protocols were in place for staff to follow. People were protected from the risk of infection.

People’s needs were assessed and planned for and staff were suitably inducted and trained. People’s nutritional needs were met and the registered manager had systems in place to ensure people received consistent care. People’s consent was sought in line with the principles of the Mental Capacity Act 2005.

Staff were kind and caring and had good relationships with people. People were supported to make choices in line with their communication needs. People were treated with dignity and respect and their right to privacy was upheld.

The service delivered care that was person centred. People were supported with activities which took account of people’s preference and choices. People’s diverse needs were assessed and planned for and regular reviews were undertaken. There was a complaints policy in place and complaints were investigated in line with this policy.

The registered manager and provider had systems in place which enabled them to monitor the service and identify areas for improvement. People, relatives and staff spoke positively about the commitment of the registered manager and the provider who were open and approachable. The registered manager understood their responsibilities of their registration with us (CQC).

We completed an unannounced inspection at Fernlea on 10 May 2017 and 12 May 2017. At the last inspection on 21 November 2016, we found breaches of the regulations. After the last inspection, the provider wrote to us to say what they would do to meet the legal requirements. We undertook an inspection to check that they had followed their plan and to confirm that they now met legal requirements.

As a result of our last inspection, this provider was placed into special measures by CQC. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have 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.

Fernlea are registered to provide accommodation with personal care for up to 13 people. People who use the service may have physical disabilities and/or learning disabilities. At the time of the inspection the service supported 12 people.

There was a manager at the service, but they were not currently registered. 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 provider told us they had plans to submit an application for a registered manager.

Some further improvements were needed to ensure that staff had sufficient guidance when administering people’s ‘as required’ medicines.

We found that some further improvements were needed to ensure that effective systems were in place to consistently maintain care records that were accurate and up to date. When care records are not accurate and up to date, people are placed at risk of receiving inconsistent or unsuitable care.

We found some monitoring systems that had been implemented were effective. However, some further improvements were needed to ensure that care plan audits were effective in identifying and rectifying concerns.

People felt safe when they were supported. Staff understood how to recognise possible signs of abuse and the actions they needed to take if they had any concerns.

People’s risks were assessed and managed to keep people safe from harm.

There were enough suitably qualified staff available to keep people safe and the provider had a safe recruitment procedure in place.

People were supported by staff who had received training, which gave staff the knowledge and skills to provide appropriate care that met people’s needs.

People consented to their care where able and the provider followed the requirements of the Mental Capacity Act 2005 (MCA) where people lacked the capacity to make certain decisions about their care. Staff understood their responsibilities and followed the requirements of the MCA when they provided support.

People told us that they enjoyed the food. People’s nutritional needs were assessed and plans were in place to ensure risks when people were eating and drinking were lowered.

People were supported to access other health professionals in a timely manner to maintain their health and wellbeing.

People were supported in a caring and compassionate way by staff who knew people well. People’s privacy and dignity was protected when staff provided support and staff promoted and listened to people’s choices in care.

People were involved in their care. People received care that met their preferences because staff knew people well and knew how they liked their care to be provided.

People were encouraged to be involved in meaningful hobbies and interests within the service to promote their emotional wellbeing.

The provider had a complaints policy available and people knew how to complain a

We completed an unannounced inspection at Fernlea on 21 November 2016. At the last inspection on 23 December 2015, we found that the service was meeting the regulations, but some improvements were still required.

Fernlea are registered to provide accommodation with personal care for up to 13 people. People who use the service may have physical disabilities and/or learning disabilities. At the time of the inspection the service supported 13 people.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

There was a registered manager 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.

At this inspection we identified breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

Risks to people’s health and wellbeing were not consistently identified, managed or followed by staff to keep people safe from the risk of harm.

People were not always protected from the risks of abuse because appropriate and timely action was not taken by the registered manager when concerns were raised and the appropriate authorities were not always informed of potential safeguarding concerns.

We found that medicines were not administered and stored in a consistent and safe manner and they were not always administered as prescribed.

The provider did not have effective systems in place to consistently assess, monitor and improve the quality of care. This meant that poor care was not identified and rectified by the registered manager and provider.

People’s care records did not contain an up to date and accurate record of people’s individual needs. This meant that people were at risk of receiving inconsistent care.

Systems in place to monitor accidents and incidents were not being followed or managed to reduce the risk of further occurrences.

Staff told us they received training. However, we found that some of the training they had received was not effective. There were no systems in place to ensure that staff understood and were competent to support people safe

We carried out an unannounced comprehensive inspection of this service on 18 May 2015, and breaches of legal requirements were found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the amount of staff available to meet people’s needs, to ensure that staff were responsive to people’s preferences in care and that improvements were made to ensure that the service was well led.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Fernlea on our website at www.cqc.org.uk

At this inspection we found that the provider had made the required improvements to meet the legal requirements.

We saw there were enough suitably qualified staff available to meet people’s needs and the provider had systems in place to assess and monitor their staffing levels.

People were protected from harm because staff knew how to keep them safe and understood how to report allegations of alleged abuse.

People’s risks were assessed and staff understood how to support people with their risks whilst maintaining their independence.

People were supported to access hobbies and interests that met their needs and preferences.

People told us and we saw that staff were available to support people and were responsive to their individual needs.

Staff were motivated and enthusiastic about their role and they felt supported by the management.

Feedback was sought from people, their relatives, staff and other professionals and issues raised were acted on to bring around improvements.

There were systems in place to monitor the quality of the service and these had been maintained by the registered manager.

We inspected Fernlea on 18 May 2015 and it was unannounced.

Fernlea is registered to provide accommodation for up to 13 people who primarily have a physical disability or learning disability. At the time of our inspection there were 11 people who used the service.

The service had 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 the time of the inspection the registered manager had been managing another service that the provider owned and had not been involved in the management of Fernlea for a period of 12 months. This had been raised with the registered manager and we were told that they had applied to de-register but we had no record of this on our system.

Risks to people’s health and wellbeing had been assessed but plans to keep people safe were not always followed, which meant that they were at risk of unsafe care and treatment.

People were not protected from potential abuse as the provider had not recognised areas of unsafe practice.

There were insufficient numbers of staff to keep people safe and provide the right care at the right time. People’s individual care needs and preferences were not always met. When staff had the time they supported people with care, compassion and respect. However, we saw that the staff did not always have the time to consistently support people in this manner, which had an effective on people’s dignity.

We found that records relating to people’s care, including their medicines were not always accurate and up to date and medicines were not always managed safely. This meant accurate records were not maintained.

Activities were provided but these did not meet people’s preferences. We found that people’s personal care needs and preferences were not always met.

The provider did not have effective systems in place to assess and monitor the quality of the service provided. Areas of concern that had been identified by the local authority had not been acted on in a timely way.

The provider did not always inform us of incidents that occurred at the service. This meant we were not always aware of reportable incidents and the provider was not promoting an open and transparent culture.

People told us that the quality of the food was good and they were given meal choices. We saw that assessments were in place to ensure that risks of malnutrition were reduced, but improvements were needed to ensure that people’s nutrition needs were monitored consistently.

Some people who used the service were unable to make certain decisions about their care. We found that mental capacity assessments had been carried out in accordance with the Mental Capacity Act 2005. We saw that decisions were made in people’s best interests when they are unable to do this for themselves.

People were supported to access other health care professionals, such as doctors and dentists, which meant people’s health needs were met effectively.

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

Fernlea provided accommodation for 13 people with a learning disability. Some of the people who used the service also had a physical disability. We spoke with six people who used the service about their experiences of living at the home. We spoke with two members of the care staff and the registered manager.

Records showed that people had consented to the care and support they received. A person who used the service said, "They always ask. They are always nice”.

The service cooperated with the wider health community. A member of staff said, "We have a really good relationship with the doctor and district nurses".

Systems were in place to prevent and control the spread of infection.

The provider had a recruitment system which ensured that only staff that were of good character and with appropriate skills qualifications and ability were employed.

The provider monitored and assessed the quality of the service provided.

We inspected this service in September 2012, and we found the service was not compliant with how records were managed to ensure people were safeguarded from financial abuse. We carried out this inspection to check improvements in this area. The inspection was unannounced, which meant the provider and the staff did not know we were coming. We spoke with one person using the service, and two staff members on duty about the financial arrangements.

The financial arrangements had been reviewed and systems were in place to record how people using the service spent their money. People we spoke with confirmed they had access to their money and were satisfied with the arrangements.

We inspected this service in June 2012, and we found the service was not compliant with how medicines were managed. We carried out this inspection to check the improvements in this area. The inspection was unannounced, which meant the provider and the staff did not know we were coming. We spoke with three people using the service and three staff about how the service was delivered.

We saw financial records were not completed accurately and money held for people living in the home did not correspond to the home’s financial records. Receipts were not always available to demonstrate how people spent their money. This meant the service could not demonstrate systems were in place to protect people from financial abuse.

Systems were in place to ensure people using the service received their prescribed medicines. A new medication system had been introduced into the service and tablets had been dispensed into a blister pack by the pharmacy. Staff told us, "This means there's less room for error, as the pharmacist has already put the all the tablets into one blister. We then have all the tablets ready to give people." People we spoke with, were confident they were receiving the right medicines at the correct time.

We carried out this visit to check on the care and welfare of people using this service. The visit was unannounced which meant the provider and the staff did not know we were coming. We carried out this visit as part of our schedule of planned inspections.

People we spoke with told us that staff were helpful and kind. During our visit we saw examples of staff interacting well with people living in the home. People were provided with choices about how they lived their lives. They told us they chose how they spent their day and had choices over what they ate and drank.

We spoke with people using the service, who told us they were happy with the support they received. The people we spoke with said they did not have any reason to complain about the service or staff. People said, “I love it here, and I hope that I am here for good.” And “This is the best place, I get the best care and staff help me to do the things I want.”

Family and friends could visit the home whenever they wanted to, and family members were able to continue to provide care for a relative and spend time in the home. People told us that they went to their families’ homes, went out for meals and continued to enjoy family events. They confirmed relatives could accompany them on medical appointments if they chose to.

We saw that people were dressed in individual styles that reflected their age, gender and the activities they were doing. People told us they went shopping with staff and chose their own clothes.

People using the service confirmed they could speak with the staff if they had a concern or a complaint and were confident that staff would address them. This meant people felt able to voice their concerns and were listened to.