Fernica (Residential Care Home)

Fernica (Residential Care Home), known as Fernica, is a residential care home providing care and support for to up to 13 people. The service provides support to people diagnosed with mental health conditions. At the time of our inspection there were 10 people using the service.

Each person has their own bedroom with shared communal areas, such as bathrooms, lounges and a dining area. People have access to an outside space with a smoking area.

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

Staffing arrangements had improved. Whilst long-term appointments had not always been successful there was more consistency in the staffing arrangements, as the deputy manager had forged links with local recruitment agencies.

Risks posed to people were included within wider care plans but weren’t always clearly identified. We made a recommendation with regards to the documentation of risk assessments separately, using a risk assessment tool. The deputy manager took appropriate action.

Care plans identified people's support needs and were reviewed. People continued to receive their medicines as prescribed. Systems were in place to protect people from abuse and people told us they felt safe living at the home. Any safeguarding concerns were reported to the appropriate agencies. Premises checks and all maintenance records were up to date. Required test and safety certificates were in place.

After the last inspection the deputy manager told us they intended to submit an application to become registered manager. The role would be shared with the current registered manager. There had been some delays with this but at the time of this inspection an application had been made. Management and oversight of the home had improved but these improvements needed to be fully embedded and sustained.

People we spoke with told us they liked living at Fernica, and that they were well-supported both day and night. There were regular residents' meetings to gain feedback from people and a recent survey had been completed.

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.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 18 January 2023) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We carried out an unannounced inspection of this service on 22 November 2022. Two breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve staffing and recruitment and good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions of Safe and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed to Good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Fernica (Residential Care Home) on our website at www.cqc.org.uk.

Follow up

We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Fernica (Residential Care Home), known as Fernica, is a small family-run residential care home for up to 14 people living with mental health difficulties. At the time of our inspection there were 10 people living at the home. Each person had their own bedroom and shared bathrooms, lounges and dining room.

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

Staffing arrangements remained inadequate. The registered manager still worked an excessive number of hours and sleep-in duties. The registered manager's oversight of the home remained inadequate. The registered manager continued to focus mainly on care tasks, with the deputy manager completing most of the managerial functions at the home. These were ongoing issues identified in inspections since 2017.

Some improvements had been made. Staff were safely recruited, infection control procedures followed current government guidance, notifications to the CQC had been made. People were able to go out when they wanted to, and visitors could visit people. The home had made links with the local authority, the infection control team and had joined a provider forum.

People continued to receive their medicines as prescribed. Risk assessments and care plans identified people’s support needs and were regularly reviewed. Staff had completed the training for their role and felt supported by the registered manager and provider. Incidents were recorded and reviewed by the deputy manager.

People said they liked living at Fernica. There were regular residents’ meetings to gain feedback from people.

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.

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

Rating at last inspection and update

The last rating for this service was inadequate (published 21 April 2022) and there were 5 breaches of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. We also met with the provider to monitor progress on the identified actions.

At this inspection we found the service remained in breach of some regulations. Improvements had been made in other areas.

At our last inspection we recommended that the provider supported people to avoid social isolation and access the community based on their personal preferences and needs. At this inspection we found improvements had been made.

Why we inspected

We carried out an announced comprehensive inspection of this service on 8 February 2022. 5 breaches of legal requirements were found.

We undertook this focused inspection to check whether the Warning Notices we previously served in relation to Regulations 12 (safe care and treatment) and 17 (good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. We also checked the provider had followed their action plan for the 3 other breaches we had found and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions safe, responsive and well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from inadequate to requires improvement. This is based on the findings at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Fernica (Residential Care Home) on our website at www.cqc.org.uk.

Enforcement

We have identified continued breaches in relation to safe staffing arrangements and the registered manager’s lack of oversight of the service to ensure good governance at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is ‘Requires improvement’. However, the service remains in 'special measures'. We do this when services have been rated as 'Inadequate' in any Key Question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services in special measures. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

Fernica is a small family-run residential care home for up to 14 people living with mental health difficulties. At the time of our inspection there were six men and four women living at the home.

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

The provider and registered manager did not always understand or meet all the relevant legal requirements and obligations associated with registration. The provider did not keep abreast of changes in practice, guidance and legislation.

The home had not complied with national guidance on COVID-19 infection prevention and control measures for care homes. The provider did not always recruit staff safely. The home did not have sufficient or robust staffing arrangements to prevent staff working excessive hours and to meet people’s needs to access the community. The provider did not meet the recommendation from our last inspection to implement a business improvement plan to record ongoing and sustained improvement. The provider had failed to submit statutory notifications for two incidents.

The COVID-19 pandemic had imposed restrictions on people’s ability to achieve maximum choice and control of their lives. The home had started to ‘open up’ as COVID-19 restrictions eased; some people accessed community activities but others who needed help had limited access due to staffing levels.

Staff administered medicines safely. Staff completed risk assessments and developed care plans to support people with their individual care needs. Staff recognised people’s changing needs due to their health conditions, old age or frailty and took steps to address them.

People looked well. They received the healthcare they needed from other professionals such as GPs and psychiatric nurses. The service prompted people to attend to their personal care needs and supported them when required.

Staff showed a strong commitment to keeping people safe and well. They received the appropriate training and supervision to help them support people effectively. People and their friends and relatives gave mostly positive feedback about the service. They described staff as caring and attentive.

We observed good interactions between staff and people. Staff knew people well and responded to their individual needs, preferences and choices. The service met the cultural needs of people. For example, staff supported people to practice their faith, access culturally appropriate activities and eat appropriate food.

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

Rating at last inspection

The last rating for this service was Good (published 14 November 2018).

At our last inspection we recommended that findings from the audits and feedback received continued to be reflected in the home’s business improvement plan along with any action taken to help demonstrate ongoing and sustained improvements. At this inspection, we found that the recommendation had not been met.

Why we inspected

We undertook a targeted inspection to look at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively. This included checking the provider was meeting COVID-19 vaccination requirements.

At the inspection, we found concerns with infection control practices and governance. We widened the scope of the inspection to a full inspection looking at all five key domains. During this inspection we identified further concerns, some of which the provider attended to immediately. For example, they arranged for a service to be carried out on a person’s bath chair; they updated the signatures for the medicines administration system, and they submitted two outstanding statutory notifications.

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

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to safe care and treatment, staffing, good governance, notification of incidents, and fit and proper persons employed at this inspection. We have recommended the provider support people to avoid social isolation and access the community based on their personal preferences and needs.

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

Follow up

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within six months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of Inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions of the 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.

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 were carried out to ensure the suitability of staff working at the home. Staff continue to receive ongoing training and support in carrying out their role and said they were fully supported by the registered manager. People said the staff team worked well together and supported them in a way they wanted.

Systems were in place to protect people from abuse. Policies and procedures were being updated in line with local procedures and staff continued to receive annual updates in training. Staff spoken with knew what action should be taken so that people were protected.

The service continues to maintain a safe system for the management and administration of people’s medicines.

Suitable arrangements were in place to ensure people were protected against the risks of cross or spread of infection.

People were actively involved and consulted with about their care and support. Person centred plans were available to guide staff reflecting the individual needs, wishes and preferences of people. Where risks to people’s health and well-being had been identified these were assessed and planned for.

Suitable arrangements were in place with regards to the mealtime arrangements. People told us they were supported to access relevant health care professionals so that their health and well-being was maintained.

People told us they liked living at Fernica and had choice and control over their daily routines following activities of their own choosing. Staff were said to have a good understanding of their individual needs and wishes and treated them with dignity and respect.

Systems were in place for the reporting and responding to any complaints brought to the registered managers attention.

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 the deputy manager was arranging for alternative restrictors to be fitted in line with the guidance.

Pre-admission assessments had not been completed for those people who had recently moved into the home. Without such information people needs, wishes and preferences may not be considered and planned for.

Care plans had been improved providing more person centred information about the current needs, wishes and preferences of people. Risk assessment had also been updated to provide clearer information about identified areas of risk and how these were to be managed so that staff could quickly respond to people’s changing needs.

Relevant authorisations were in place where people were being deprived of their liberty.

People told us they liked living at the home and felt safe. Staff had a good knowledge and understanding of the individual needs of people. On-going training and support had been provided to help staff do their job safely.

The staff team was very stable with no new staff having been employed for a number of years. Previous inspections of recruitment records have been satisfactory.

Staff were aware of their responsibilities in protecting people from abuse and had completed annual updates in training to ensure they understood the procedures in place.

Systems were in place for the safe management and administration of people’s medicines.

Suitable arrangements were in place to ensure people were protected against the risks of cross or spread of infection.

People were offered adequate food and drink throughout the day. We saw people had access to health care professionals, so that their current and changing health needs were met.

Systems were in place for the reporting and responding to any complaints brought to their attention. People said the registered manager was approachable and they could talk with them.

You can see what action we told the provider to take at the back of the full version of the report. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

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.

We are currently considering our options in relation to enforcement action regarding some of the breaches of regulations identified. We will update the section at the back of the inspection report once any enforcement work has concluded.

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 of cross infection.

The management and administration of people’s medicines was safe and demonstrated people received their medicines as prescribed.

People were offered adequate food and drinks throughout the day ensuring their nutritional needs were met. Where people’s health and well-being were at risk, relevant health care advice had been sought so that people received the treatment and support they needed.

Staff encouraged people to maintain their independence and offered support and encouragement when needed. Interactions between staff and people were polite and friendly and people were treated with respect.

People had lived at the home for some time and said they were happy and settled. We saw people followed their own routines taking part in activities of their own choosing. Consideration was given to people’s cultural and religious needs.

The provider had a system in place for the reporting and responding to any complaints brought to their attention. People told us they could raise any issues if they needed to.

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.

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.

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.