The Ferns

The inspection was undertaken due to the length of time since we lasted visited the service. The site has large grounds with access to rural walks and a farm which forms part of the day service.

We assessed the service against ‘Right support, right care, right culture’ guidance to make judgements about whether the provider guaranteed people with a learning disability or autistic people respect, equality, dignity, choices, independence and good access to local communities that most people take for granted. The provider did not always work in line with these principles.

We found 2 breaches of the legal regulation relating to consent and good governance.

The service demonstrated several areas requiring improvement, particularly around consent, safety, and oversight. Although systems for recording incidents existed, they were not effectively monitored or followed up, creating the risk of issues recurring. Safeguarding practices and oversight were inconsistent. Risk assessments and care plans were in place, but some did not reflect changes in people’s needs. While the environment was generally clean and people reported feeling safe, there were shortfalls in medicines management, staff training, and risk management, and improvements were required in relation to infection prevention and control (IPC).

People and those who knew them were involved in assessments of their needs. Assessments and reviews of people’s needs were inconsistent, with care plans often lacking important information about people’s communication and health needs. People had enough to eat and drink to stay healthy. Staff worked with all agencies involved in people’s care for the best outcomes and smooth transitions when moving services. While we saw some positive examples of person-centred care and family involvement, safeguarding systems lacked robust oversight, and restrictive practices were not consistently reviewed in line with the Mental Capacity Act 2005 (MCA).

People were treated with kindness and compassion. Staff protected their privacy and dignity. They treated them as individuals and supported their preferences. People were encouraged to maintain relationships with family and friends. Staff responded to people in a timely way. The provider supported staff wellbeing.

While medicines were generally managed safely, improvements were needed in areas of quality monitoring such as audits. Staff did not always follow safe practices for medicine administration, and the provider needed greater oversight in the use of ‘as required’ (PRN) medications, to ensure all appropriate action had been taken prior to the administration of such medicines. Once highlighted, the management team took steps to address this.

Although some people experienced positive outcomes, this was not consistent across the service. Opportunities for independence and meaningful engagement were limited, and care plans and goals were not reviewed regularly. While people had access to activities, the community, and information in accessible formats, planning for future needs was inconsistent, and some individuals lacked support around life changes or long-term goals.

Leaders were visible and supportive but demonstrated gaps in knowledge. Governance systems were ineffective, with audits failing to identify or address key issues. Some staff lacked essential training for specific conditions. However, staff felt able to give feedback, were treated equally, and reported an absence of bullying or harassment. They understood their roles and responsibilities, and relatives felt confident raising concerns and believed these would be taken seriously.

People’s relatives felt comfortable to give feedback and were confident the service would take it seriously and act on it.

The model of care meant people lacked opportunities to gain employment, learn new skills and become more independent.

We have asked the provider for an action plan in response to the concerns found at this assessment.