Inspection on 13/03/06 for Fitzwarren House

This inspection was carried out on 13th March 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Fitzwarren House 16/12/08

Fitzwarren House 11/01/07

Fitzwarren House 10/08/05

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 Inspection 13th March 2006 09:30 X10015.doc Version 1.40 Page 1 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 Fitzwarren House DS0000064069.V286196.R01.S.doc Version 5.1 Page 2 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 DS0000064069.V286196.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Fitzwarren House Address Kingsdown Road Stratton St Margaret Swindon Wiltshire SN3 4TD 01793 836920 01793 836921 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) home.fxg@mha.org.uk Methodist Homes for the Aged Mrs Wendy Champion Care Home 60 Category(ies) of Dementia - over 65 years of age (30), Old age, registration, with number not falling within any other category (30) of places Fitzwarren House DS0000064069.V286196.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. The maximum number of service users aged 65 years and over with dementia who may be accommodated at any one time and in receipt of personal care is 30. These persons may only be accommodated on the ground floor. 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. The staffing levels set out in the Notice of Decision dated 14 June 2005 must be met at all times. 10th August 2005 2. 3. Date of last 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 DS0000064069.V286196.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Two inspectors undertook this unannounced inspection between 9.15am and 3.45 p.m. The findings are based on a tour of the premises, speaking to residents, relatives, staff, 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 Champion, the homes manager, at the end of the inspection. What the service does well: What has improved since the last inspection? What they could do better: Although the standard of care planning was generally satisfactory, some need to be more comprehensive and information regarding care to be given when someone is nearing the end of their life needs to be clearer. The monitoring of residents who have lost weight could also be improved. Staff who complete assessment documents and medication charts should make sure that they sign them. The supervision of residents who may be a risk to others needs to improve, as does the recording of complaints. There also needs to be a commitment to provide more social and recreational activity for residents, particularly on the nursing unit. Fitzwarren House DS0000064069.V286196.R01.S.doc Version 5.1 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 DS0000064069.V286196.R01.S.doc Version 5.1 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 Outcomes Statutory Requirements Identified During the Inspection Fitzwarren House DS0000064069.V286196.R01.S.doc Version 5.1 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 the following standard(s): 1,2 and 3. Potential residents and their relatives have the information to make an informed choice about the home, contracts are issued and residents’ needs are assessed before admission. EVIDENCE: A comprehensive statement of purpose has been produced and there is a service users guide, which is well produced and easy to read. The homes last CSCI report was available. Residential care agreements (terms and conditions of residency) are issued to all new residents or their next of kin if appropriate. Care plans indicated that, where possible, the manager or her deputy had carried out pre admission assessments. These were fully completed, dated and signed, which was an improvement on the previous inspection. Other pre admission documents, such as social services care manager reviews were also available. Fitzwarren House DS0000064069.V286196.R01.S.doc Version 5.1 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 the following standard(s): 7,8 and 9. A good standard of personal and health care is delivered but care plans do not always fully reflect residents’ assessed needs. 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: Frail residents on the nursing unit received appropriate care and were clean and comfortable. Appropriate equipment was in place for those at risk of pressure sores. Records in care plans indicated that health needs were being addressed promptly and residents were referred to their GP’s or specialists as required. Two residents confirmed this. Other residents indicated that they were happy with the care and support they received, one stating, “They’re really good to me” and another “Nothing is too much trouble”. Residents on the dementia unit appeared to have their personal hygiene needs addressed, were alert and active and medication charts showed minimal use of sedation. A selection of residents care plans was reviewed on each of the homes units. They were mainly a good reflection of residents’ health and care needs, however care needs to be taken to ensure all documents are signed and dated by the person completing them. Night plans seen were particularly Fitzwarren House DS0000064069.V286196.R01.S.doc Version 5.1 Page 10 individualised and detailed residents’ personal preferences. Nutritional assessments are undertaken but there was no recorded evidence in two cases that action had been taken following a period of weight loss, and no plan to direct care. Care plans were not always in place for those who receive night sedation, in order to review necessity and monitor any positive or adverse effects. Clearer information needed to be recorded with regard to consent to ‘end of life’ decisions to ensure that the care given is in line with the wishes of the resident, their family and professional guidance. The arrangements for storage and administration of medicines were satisfactory. As noted at the previous inspection, there were some gaps in medication administration sheets. Staff should sign for any medication administered or enter the code, which shows the reason for any nonadministration. Fitzwarren House DS0000064069.V286196.R01.S.doc Version 5.1 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 the following standard(s): 12, 13, 14, 15. More attention is required to ensure residents’ social and recreation needs are fully met. The home is supporting residents’ to maintain contact with people who are important to them and ensures a healthy, nutritious and balanced diet is provided. EVIDENCE: Discussion with the dementia unit manager confirmed senior staff are responsible to ensure residents’ have opportunity to take part in activities at the home. This is an interim measure until a full time activities coordinator is appointed. A list of activities is in display on each unit, however discussion with residents, staff and visitors indicated that they felt activities are not occurring as regular as they should. Records of activities for two units are sporadic and show some months where no activities are taking place. This is more evident on the nursing unit where relatives and a resident reported little or no activities going on. On the ground floor dementia unit there is more emphasis on residents’ participation in leisure activities. Some residents report that they have been able to go out and staff confirmed transport is available for these trips. There are weekly religious services and regular visits from a hairdresser. As noted at the previous inspection, not all residents care plans had the social care assessment completed or plans developed to address their social and recreational needs. Fitzwarren House DS0000064069.V286196.R01.S.doc Version 5.1 Page 12 Discussion with three relatives confirmed they could visit their relative at any time and were made to feel welcomed by the staff. Residents can meet with their visitors in the privacy of their room or in one of the communal areas. Relatives confirmed they are able to stay overnight when concerned about their relative’s health. There is evidence that residents’ personal choice is respected. Routines are relaxed and staff were observed supporting residents rather than directing them. Choices are offered at each meal. One resident commented that the food is “excellent”, another that “the food is very nice”. The home operates a four-week rotating menu and every effort is made to ensure residents are consulted about the meals they want. The chef confirmed he speaks to residents each day to obtain feedback on the day’s menu. Residents’ likes and dislikes are recorded and special diets are catered for. Part of the lunchtime meal was observed. The mealtime was relaxed and unhurried and where residents required assistance with their meal, this was provided in a discrete and sensitive manner. Fitzwarren House DS0000064069.V286196.R01.S.doc Version 5.1 Page 13 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 the following standard(s): 16 and 18. Systems are in place to ensure that complaints are taken seriously but complaints recording needs to improve and residents need to be made more aware of the complaint procedure. The supervision of residents with challenging behaviour towards others needs to be more robust to fully protect residents from potential abuse. EVIDENCE: The complaints procedure was on display and is also incorporated in the service users guide. Some comment cards received from residents indicated that they were unaware of the complaints procedure. A complaint arising from a vulnerable adults protection case in the home has been investigated by a representative of the registered providers (Methodist Homes Group) using their complaints procedure and an action plan had been produced indicating areas requiring improvement with regard to communication with relatives, systems for reporting incidents and escorting residents to hospital. The manager reported that she did not record all complaints and the need for this was discussed. The vulnerable adults case indicated that staff required more training with regard to protection procedures. This has subsequently been arranged with the Swindon Vulnerable Adults Unit. Incidents that had occurred indicated that more robust supervision of residents’ with challenging behaviour towards others was required on the dementia unit, in order to protect other service users. This was discussed with Mrs Champion and Mrs Cole the unit manager for immediate action. Fitzwarren House DS0000064069.V286196.R01.S.doc Version 5.1 Page 14 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 the following standard(s): 19, 20, 21, 22, 23,24, 25 and 26 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 recently opened purpose built home, which is furnished and equipped to a high standard. Entry to the home is controlled and access to each unit is by keypad. CCTV monitors the external grounds. Residents’ rooms have full en suite facilities and there are other assisted bathrooms and toilets close to communal areas. Residents were very complimentary about the standard of accommodation at the home. One said, “I have everything I need”. The relative of another said the accommodation was “great”. A number of residents’ rooms had been personalised with photographs, pictures and personal items they had brought with them. The laundry room is situated away from food preparation areas and residents reported their washing is promptly returned. There are two designated laundry Fitzwarren House DS0000064069.V286196.R01.S.doc Version 5.1 Page 15 staff who provide a 7-day service. The home has three large commercial washers with sluice and disinfectant cycles and two commercial dryers. Staff reported these are sufficient for the needs of the home. Fitzwarren House DS0000064069.V286196.R01.S.doc Version 5.1 Page 16 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 consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 and 29 There are enough staff to met the needs of the residents and residents are generally supported and protected by the recruitment procedure, however there is a need to ensure references are obtained from recent employers. EVIDENCE: There were 21 residents on the dementia unit who were supported by the unit manager and four care assistants. There were 14 residents on the nursing unit, with one registered nurse and three care assistants. Review of recent staffing rotas for both units indicated that the home is complying with the levels agreed with CSCI, with regard to staff numbers and skill mix. The number of domestic staff appeared appropriate, as the home was clean and tidy and the laundry dealt with promptly. Comments from residents indicated that they felt there were enough staff to help them when needed. Comments from some relatives indicated that they sometimes did not see staff when they first enter the home and that this gave the impression that there were not many about. This was discussed with Mrs Champion. A selection of staff recruitment records were reviewed and found to contain the required documentation. POVA checks and two references were obtained prior to staff commencing work and CRB checks were also undertaken. In one case the references available did not contain one from the persons previous employer, which was another care home. Therefore there was no record of why they had left that employment. Fitzwarren House DS0000064069.V286196.R01.S.doc Version 5.1 Page 17 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 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31 and 38 The registered manager is qualified, competent and experienced and the home is making every effort to ensure residents are able to live in a safe environment. EVIDENCE: The registered manager, Mrs Wendy Champion, has eight 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. 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. The home has a full time maintenance person who is responsible for completing health and safety checks at the home. Fire safety records Fitzwarren House DS0000064069.V286196.R01.S.doc Version 5.1 Page 18 demonstrate fire safety checks are being completed on the fire alarm system and emergency lighting. However fire safety drills are only being completed every six months. It is a requirement that these are completed every three months. Being a new building, gas and electrical safety checks are up to date. To ensure residents safety, radiators are guarded and hot water temperatures are regulated close to 43c. The home has a comprehensive health and safety manual and staff confirmed they have received training in safe working practices such as infection control, first aid, manual handling and food hygiene. Health and safety risk assessments are in place. Fitzwarren House DS0000064069.V286196.R01.S.doc Version 5.1 Page 19 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 4 4 3 3 3 3 3 4 STAFFING Standard No Score 27 3 28 X 29 2 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X X X X 2 Fitzwarren House DS0000064069.V286196.R01.S.doc Version 5.1 Page 20 Are there any outstanding requirements from the last inspection? Yes 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 OP7 Regulation 12 (1,a,b) 15 (1) Requirement The registered person is required to ensure that action is taken and care plans are in place to direct care, for any resident with sustained weight loss. The registered manager is required to ensure that information is recorded with regard to consent to ‘end of life’ decisions, to ensure that the care given is in line with the wishes of the resident, their family and professional guidance. The registered person is required to ensure that medication administration records clearly show the reason for any nonadministration. Unmet requirement from previous inspection held 10/08/05 The registered person is required to ensure that residents are consulted about social and recreational activities provided at the home. The registered person is required to ensure that plans are DS0000064069.V286196.R01.S.doc Timescale for action 13/03/06 2 OP7 12 (2,3) 13/04/06 3 OP9 13 (2) 13/03/06 4 OP12 16 (2 m,n) 13/04/06 5 OP12 16 (2 m,n) 13/06/06 Fitzwarren House Version 5.1 Page 21 6 OP16 17 (2) ch 4 (11) 7 OP18 12 (1,a) 13 (6) 8 OP29 19(1,a,b,c )Sch2(3,4 ) 9 OP38 23(4)(e) developed to address residents’ social and recreational needs. Unmet requirement from previous inspection held 10/08/05 The registered manager is required to ensure that a record is kept of all complaints made that includes details of any investigation and action taken. The registered person is required to ensure that residents who exhibit challenging behaviour towards others are supervised at all times. The registered person is required to ensure that where a person has previously worked in a position involving contact with vulnerable adults, then a reference is obtained along with written verification of why they ceased to work in that position, unless it is not reasonably practical to do so. The registered person is required to ensure fire safety drills are completed a minimum of four times a year. 13/03/06 13/03/06 13/03/06 13/03/06 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 OP12 OP16 Good Practice Recommendations In order to evidence good practice it is recommended that all assessments and entries in care plans are signed and dated by the person completing them. The registered person should ensure a record is kept of residents’ participation social and leisure activities. It is recommended that thought be given to raising residents’ awareness of the complaint procedure. DS0000064069.V286196.R01.S.doc Version 5.1 Page 22 Fitzwarren House Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham 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 DS0000064069.V286196.R01.S.doc Version 5.1 Page 23 - 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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