Inspection on 10/08/05 for Fitzwarren House

This inspection was carried out on 10th August 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Fitzwarren House 16/12/08

Fitzwarren House 11/01/07

Fitzwarren House 13/03/06

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Fitzwarren House Kingsdown Road Stratton St Margaret Swindon Wiltshire SN3 4TD Lead Inspector Steve Cousins Unannounced 10 August 2005 th The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Fitzwarren House D51 D01 s64069 FitzwarrenHouse v239982 100805 Stage4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Fitzwarren House Address Kingsdown Road Stratton St Margaret Swindon Wiltshire SN3 4TD 01582 414210 01582 412498 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Methodist Homes for the Aged Mrs Wendy Champion Care Home 50 Category(ies) of DE(E) Dementia - over 65 (20) registration, with number OP Old Age (30) of places Fitzwarren House D51 D01 s64069 FitzwarrenHouse v239982 100805 Stage4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1. The maximum number of service users aged 65 years and over with dementia who may be acommodated at any one time is 20. These persons may only be accommodated on the ground floor. 17 June 2005 2. The maximum number of service users in receipt of nursing care who may be accommodated in the category OP at any one time is 30. These persons may only be accommodated on the first floor. 17 June 2005 3. The staffing levels set out in the Notice of Decision dated 14 June 2005 must be met at all times. 17 June 2005 Date of last inspection This is the first inspection. Brief Description of the Service: Fitzwarren House is purpose built care home that was first registered with the Commission on the 14th June 2005. It is situated in a semi rural area on the outskirts of north Swindon and is well designed and equipped. The home is owned and managed by the Methodist Homes for the Aged group. The home is divided into two distinct areas. Personal care for elderly people with dementia is provided in a specially designed unit on the ground floor. Elderly people who require nursing care are accommodated on the first floor. Mrs Wendy Champion is the registered manager and there are individual managers for both of the homes units. The nursing unit has a registered nurse on duty at all times, supported by care assistants. The dementia unit has a senior carer in charge of each shift, supported by other care assistants. Domestic, laundry, catering, administration and maintenance services and staff are also provided. Fitzwarren House D51 D01 s64069 FitzwarrenHouse v239982 100805 Stage4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place between 9.15am and 3.45pm. There were 20 residents in the home, 13 on the dementia unit and 7 on the nursing unit. The findings from this inspection are based on a tour of the premises, speaking to residents, relatives, staff, and the regional manager Mrs Lynn Mitchell; and visiting frail residents. A number of records were inspected including care plans and staff files. Service users are known as residents in this home and will be referred to as such throughout this report. The findings were discussed with Mrs Mitchell at the end of the inspection. The Commissions pharmacy inspector, Mary Collier, visited the home on the 17th August 2005 to check medication procedures and her findings are contained in this report. What the service does well: What has improved since the last inspection? What they could do better: Some residents and their relatives felt that there could be more social activity in the home, although this may improve as more residents are admitted. There were also occasions when the staffing levels fell below that agreed between the owners and CSCI, which is a breach of the homes Conditions of Registration. Not all assessment documentation had been completed and staff were not always signing and dating documents, including medication records. Care also needs to be taken to make sure that staff do not start work before all the required recruitment checks have been undertaken, and all staff documentation needs to be in place. Fitzwarren House D51 D01 s64069 FitzwarrenHouse v239982 100805 Stage4.doc Version 1.40 Page 6 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Fitzwarren House D51 D01 s64069 FitzwarrenHouse v239982 100805 Stage4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Fitzwarren House D51 D01 s64069 FitzwarrenHouse v239982 100805 Stage4.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2,3,4 and 5. Standard 6 does not apply to this home Residents have the information and opportunity to make an informed choice about the home, their needs are assessed before admission, although not always thoroughly, and the home has the capability to meet their needs. EVIDENCE: A comprehensive statement of purpose has been produced and there is a service users guide, which is well produced and easy to read. Residential care agreements (terms and conditions of residency) are issued to all new residents or their next of kin if appropriate. Residents and some relatives confirmed that they had visited the home prior to moving in, in order to assess its suitability. Pre admission assessments had been carried out but not all were fully completed, dated and signed. Other pre admission documents, such as social services care reviews were also available. The home aims to provide nursing care for elderly people and residential dementia care. The building is designed to accommodate both groups of clients and there is ample equipment available. Staff receive appropriate training to enable them to meet the residents needs. Fitzwarren House D51 D01 s64069 FitzwarrenHouse v239982 100805 Stage4.doc Version 1.40 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,and 9 The standard of personal and health care delivered was good and met the assessed needs of residents. The systems for the handling of medication ensure that the residents are protected but some records need to be clearer in order to evidence this. EVIDENCE: Care plans on the nursing unit appeared to be a good reflection of assessed needs. Risk assessments had been carried out with regard to pressure damage, nutrition and mobility. Not all assessments had been signed and dated. The residents or relatives agreement to care plans had been obtained in some cases, but not all. Care planning on the dementia unit was being changed to a more personal care focused system. There were records of visits by GP’s and staff appeared to respond promptly to any change residents health. There were positive comments from residents and relatives about the support given by staff including, ‘they are all very helpful’ and I’m well looked after’, ‘staff are wonderful’. Residents’ hygiene needs were being met and there was good attention to their appearance. All medicines were stored appropriately and records maintained. The carers on the residential unit receive training in medication and are assessed before Fitzwarren House D51 D01 s64069 FitzwarrenHouse v239982 100805 Stage4.doc Version 1.40 Page 10 handling medicines independently. Information about medicines is available on each unit. Daily notes contain details of doctors’ visits and medication changes. Care plans are in place for the management of anxiety in some residents, but the criteria for the use of any medication must be added. Administration records are completed, but codes must be used when medicines are omitted and written additions should be signed and checked. Fitzwarren House D51 D01 s64069 FitzwarrenHouse v239982 100805 Stage4.doc Version 1.40 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13 and 14. The residents’ social and recreational needs are not always fully met but they are supported in maintaining their own lifestyle as far as possible, and to have contact with friends and relatives. EVIDENCE: Social assessments had been carried out and some residents ‘life story’ obtained but plans were yet to be developed to address social and recreational needs. Some residents and a relative said there was a lack of social activity; this was evident mainly on the nursing unit and was evidenced by observation and individual activity records. There are weekly religious services and a hairdresser visits the home. Residents personal choice was respected, one service user was left to sleep until she wanted to get up and another stated that he was able to ‘pick and choose’ what he wanted to do. A relative commented on ‘the very nice atmosphere’ on the dementia unit and staff were observed assisting residents calmly with out directing them against their will. There were no restrictions on visiting unless at the request of the resident and visitors were in the home throughout the inspection. Residents were receiving visitors in private or in one of the communal rooms. Fitzwarren House D51 D01 s64069 FitzwarrenHouse v239982 100805 Stage4.doc Version 1.40 Page 12 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and18 There are systems to ensure that complaints are taken seriously and investigated appropriately. Staff have an awareness of abuse issues but staff recruitment procedures do not always ensure residents are protected. EVIDENCE: The complaints procedure was on display and was also incorporated in the service users guide. Residents and relatives spoken to were aware of whom to complain to. No complaints had been received either by the home or CSCI. Review of staff recruitment documentation indicated that not all required documents, as listed in Schedule 2 of the Care Homes Regulations 2001 were in place. Two staff members only had one reference on file and one staff member had commenced work before receipt of a POVA check, however CRB and POVA checks had been obtained in all other cases. Staff spoken to indicated an awareness of issues regarding the reporting of suspected abuse and information about this was available around the home. A supporting policy and procedure is available which staff are made aware of during induction. Fitzwarren House D51 D01 s64069 FitzwarrenHouse v239982 100805 Stage4.doc Version 1.40 Page 13 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) All standards were assessed. The home meets, and in some areas, exceeds the standards, providing a clean, comfortable, well-equipped and safe environment for residents, which meets their needs. EVIDENCE: Fitzwarren House is a new, purpose built home which is furnished and equipped to a high standard. Entry to the home is controlled and access between the units is by keypad. CCTV monitors the external areas. There are ample communal areas and good access to the surrounding grounds. There is an enclosed garden, with walkways. All rooms have full en suite facilities and there are also assisted bathrooms and other toilets close to communal areas. Residents spoken to were happy with their accommodation; bedrooms were spacious, well decorated and fittings were of a good standard. Some rooms were personalised and some had a photo of the resident outside in order to help their orientation. Beds are height adjustable, profiling and have pressure relief mattresses and there are comfortable chairs for residents. The home was very clean and odour free and infection control procedures were in place. Fitzwarren House D51 D01 s64069 FitzwarrenHouse v239982 100805 Stage4.doc Version 1.40 Page 14 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,29 and 30 The skill mix of staff met the residents’ needs and staff are trained and competent; however the number of staff available does not always meet the homes minimum staffing notice and staff recruitment procedures do not always ensure residents are protected. EVIDENCE: There was one nurse and two care assistants on duty for seven residents on the nursing unit and one senior care assistant and two care assistants for thirteen on the dementia unit. Staff indicated that they were able to meet the residents’ needs with the level of staff available. Review of staff rotas indicated periods were the homes agreed staffing levels were not being implemented and this was discussed with Mrs Mitchell, the regional manager, for immediate action. As reported in the Complaints and Protection section of this report, not all the required staff recruitment documentation was in place. Conversations with staff and review of training records indicated that staff had received induction and mandatory training. Other training available included dementia care. Staff training needs are assessed and individual training records are kept. There are many staff who have had previous experience working with elderly people in care homes. Fitzwarren House D51 D01 s64069 FitzwarrenHouse v239982 100805 Stage4.doc Version 1.40 Page 15 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31 The registered manager is qualified, competent and experienced to run the home, and receives appropriate support. EVIDENCE: The homes registered manager, Mrs Wendy Champion, was not present during this inspection. Mrs Champion has seven years experience as a registered manager having previously worked in two nursing homes for elderly people in Oxfordshire. She is a registered nurse who obtained the Registered Managers Award in 2004 and has previous experience caring for people with dementia. Mrs Champion undertook the ‘fit person’ procedure with the CSCI in June 2005 and demonstrated excellent understanding of her role and was recommended for registration. The home is owned and managed by Methodist Homes for the Aged, who currently have 55 homes throughout the UK. Mrs Champion is line managed by the regional manager, and is supported in her role by two deputies. Fitzwarren House D51 D01 s64069 FitzwarrenHouse v239982 100805 Stage4.doc Version 1.40 Page 16 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 2 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 x COMPLAINTS AND PROTECTION 4 4 3 3 3 3 3 4 STAFFING Standard No Score 27 2 28 x 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 3 x x x x x x x Fitzwarren House D51 D01 s64069 FitzwarrenHouse v239982 100805 Stage4.doc Version 1.40 Page 17 N/A Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP3 Regulation 14 (1,a) Requirement The registered manager is required to ensure that pre admission assessments are fully completed, signed and dated. The criteria for the use of ‘as required’ medication and nonprescribed remedies must be clearly documented in the care plans. The medication administration record must clearly show the reason for any nonadministration. The registered manager is required to ensure that plans are developed to address residents social and recreational needs. The registered manager is required to ensure that POVA checks are obtained before staff commence working in the home. The registered manager is required to ensure that all the documents required by Schedule 2 are obtained for all staff The registered manager is required to ensure that the homes agreed minimum staffing notices, dated 14th June 2005, are met at all times. Timescale for action 10/8/05 2. OP9 13(2) 10/8/05 3. OP9 13(2) 10/8/05 4. OP12 16(2,m,n) 10/8/05 5. OP18 OP29 6. OP18 OP29 7. OP27 Schedule 2 Reg 7,9,19 Schedule 2 Reg 7,9,19 18(1,a) 10/8/05 10/8/05 10/8/05 Fitzwarren House D51 D01 s64069 FitzwarrenHouse v239982 100805 Stage4.doc Version 1.40 Page 18 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard OP7 OP7 OP9 Good Practice Recommendations In order to evidence practice, it is recommended that assessments in care plans be signed and dated. It is recommended that care plans be agreed and signed by the resident or their representative. It is recommended that written additions to the medication administration record should be signed, dated and checked by two members of staff. Fitzwarren House D51 D01 s64069 FitzwarrenHouse v239982 100805 Stage4.doc Version 1.40 Page 19 Commission for Social Care Inspection Suite C, Avonbridge House Bath Road Chippenham Wiltshire SN15 2BB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Fitzwarren House D51 D01 s64069 FitzwarrenHouse v239982 100805 Stage4.doc Version 1.40 Page 20 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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