Fernways

Updated 20 January 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

Inspection team

The inspection was carried out by one inspector and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

This service provides care and support to people living in specialist ‘extra care’ housing. Extra care housing is purpose-built or adapted single household accommodation in a shared site or building. The accommodation is bought or rented and is the occupant’s own home. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for extra care housing; this inspection looked at people’s personal care and support service.

Registered manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post. However, they had been absent from the service for longer than three months. The provider had made alternative arrangements to ensure the registered manager position was covered.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed the information we already held about this service. This included details of its registration, previous inspection reports and any notifications of significant incidents the provider had sent us. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with one relative of someone who used the service about their experience of care. We spoke with 7 members of staff, including a manager, 1 administrator, 1 site warden and 4 care staff. We also spoke with a visiting health care professional.

We reviewed a range of records. This included 4 people’s care plans and multiple medicines records. We looked at 6 staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.

Following the inspection visit we spoke over the phone with 1 person who used the service and a further 7 relatives about their experience of care. We continued to seek clarification from the provider to validate evidence found. We looked at training data, information about activities and recruitment.

Updated 20 January 2023

About the service

Fernways is registered to provide personal care and support to people living in specialist ‘extra care’ housing in London Borough of Redbridge. Not everyone who lived in the housing received personal care from the service. CQC does not regulate premises used for extra care housing; this inspection looked at people’s personal care and support service. People using the service lived in their own flats within a gated community where there were 52 properties. The service was providing personal care to 17 people at the time of the inspection.

People’s experience of using this service and what we found

The provider had missed calls to people using the service, this related to staff absence and system failure. Medicines management required improvement; there were no protocols for medicines which were administered as and when required (often referred to as PRN medicines) and there were often gaps found in medicine administration records and no record of follow up with prescribing health professionals or GPs as to what to do if medicines were missed. Lessons were not always learned when things went wrong, incidents and accidents were not regularly discussed with staff.

Improvements were required in respect of governance systems at the service. We found a lack of systematic follow up or record of response to issues noted in staff communications. Similarly, records of communications with health professionals were not always recorded. There was no record of what occurred in staff handovers, and staff meetings did not contain rolling agenda items such as safeguarding or incidents and accidents.

We have made recommendation about recording people’s end of life wishes.

There were systems in place to safeguard people from abuse. Risks to people were assessed and monitored. Infection prevention measures were in place.

Staff were supported through induction, training and supervision. The service worked alongside other agencies to provide effective care. People were supported with their health needs. People’s needs were assessed so the service knew whether they could meet them or not. People were supported with their dietary needs. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People’s equality and needs were recorded so staff could support people in culturally sensitive way. The service had received compliments about the care they provided. People and relatives were supported to express their views on the service. People were supported respectfully and their independence promoted.

People received personalised care; their care needs were recorded in their care plans. People’s communication needs were met. People were supported with activities. The provider was responsive to complaints and concerns raised.

The provider had some quality assurance measures in place. While some aspects of their quality assurance systems did not work well, such as medicines audit follow up and incident and accident reporting, other aspects helped to improve the service, such as spot checks.

. People and relatives, we spoke with were generally positive about the service and staff working there. Staff knew their roles.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The previous rating for this service was good (published 08 December 2017).

Why we inspected

The inspection was prompted in part due to concerns received about people’s care calls being missed. A decision was made for us to inspect and examine those risks.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement and recommendations

We have identified breaches in relation to safe care and treatment good governance at this inspection. We have also made a recommendation about recording people’s end of life wishes.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.