Inspection on 18/08/05 for Fletcher House

This inspection was carried out on 18th 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

Fletcher House 27/02/07

Fletcher House 08/02/06

Fletcher House 09/03/05

Fletcher House 16/07/04

Fletcher House 30/03/04

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 Fletcher House Glastonbury Road Wells Somerset BA5 1TN Lead Inspector Justine Button Unannounced 18 August 2005 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. Fletcher House D53 - D02 S16001 Fletcher House V238905 120805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Fletcher House Address Glastonbury Road Wells Somerset BA5 ITN 01749 678068 01749 675927 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) Somerset Care Limited Pauline Doreen Ann Leyton Personal Care Home Only 40 Category(ies) of Old Age (40) registration, with number of places Fletcher House D53 - D02 S16001 Fletcher House V238905 120805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: None. Date of last inspection 9th March 2005 Brief Description of the Service: Fletcher House is owned by Somerset Care Ltd and it provides residential care for up to 40 older people, including some respite and day care services. At present it is not providing ‘step down’ rehabilitation due to the building works in the home. It is situated on the outskirts of Wells, in front of playing fields. It was originally purpose built and has been upgraded over the years to comply with legal requirements and residents changing needs. Set in its own very pleasant grounds, accommodation is on two floors serviced by a passenger lift. Currently all bedrooms have single occupancy and there are a number of comfortable lounges. The home has achieved the Somerset Social Services Department’s quality rating accreditation. Fletcher House D53 - D02 S16001 Fletcher House V238905 120805 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One inspector conducted this unannounced inspection over the course of one day. The inspector was able to speak with a large number of the residents as well as staff on duty. The manager, Mrs Leyton, was available on the day of inspection. The inspector would like to thank the residents and staff for their time and hospitality shown to the inspector during their visit. This is the first inspection using the new CSCI reporting format, which focuses on outcome statements for National Minimum Standards. The inspector’s aim on this inspection visit was to seek views on the quality of the service from as many service users as possible and to speak to staff. Records examined were care plans, medication records, staff recruitment files, duty rotas, and some health and safety records. Other records will be examined at subsequent inspection visits. A tour of the building was carried out on this visit. The building is currently undertaking a major extension and renovation. This will increase significantly the registered numbers of beds. This inspection did not view the building works as this is viewed and assessed via the registration process. What the service does well: The home excels in the ethos and provision of recreational activities. There are good opportunities for activity and company. An activities programme is on going and service users spoken to enjoyed the activities provided. The staff team appear dedicated and committed to the service they provide and there was a relaxed and friendly atmosphere. People who access the service and who were able to give an opinion all gave positive comments about the service they received. A number of staff had recently completed NVQ qualifications. The home had organised an award ceremony with all staff receiving their certificates and flowers. This is not seen in other services and promotes a sense of achievement and acknowledges the hard work of the staff who had undertaken the award. Fletcher House D53 - D02 S16001 Fletcher House V238905 120805 Stage 4.doc Version 1.40 Page 6 What has improved since the last inspection? What they could do better: 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. Fletcher House D53 - D02 S16001 Fletcher House V238905 120805 Stage 4.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 Fletcher House D53 - D02 S16001 Fletcher House V238905 120805 Stage 4.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, 5, 6. The service provides an adequate amount of information in order to make an informed choice about moving into the home. The service offers intermediate care or “step down”, although this service has not been in use recently due to the building works. EVIDENCE: The Statement of Purpose and Service User Guide were viewed during the inspection. These contained the necessary information. The service offers respite and day care. A number of people access these aspects of the service prior to moving in on a full time basis and are therefore familiar with the staff and the home. For other people it was reported that they or their representatives could visit prior to moving in. As the number of beds will increase in the near future an open day has been organised for people to view the new service. There has been a good response Fletcher House D53 - D02 S16001 Fletcher House V238905 120805 Stage 4.doc Version 1.40 Page 9 to the increased number of beds and it was reported by the home manager that there is a waiting list for these beds. Fletcher House D53 - D02 S16001 Fletcher House V238905 120805 Stage 4.doc Version 1.40 Page 10 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, 10. All people who live at the service have a care plan. People who live at the service are supported to meet their health care needs. Privacy and dignity is respected. Fletcher House D53 - D02 S16001 Fletcher House V238905 120805 Stage 4.doc Version 1.40 Page 11 EVIDENCE: A sample of four service user plans was inspected. These showed an adequate range of care plan pages, which were written briefly but gave clear information for staff to follow. The plans had not been reviewed monthly. The last documented review was May 2005 for three of the people and for one a review had not taken place since 2002. Service users questioned were not all aware of their service user plans. It was not confirmed by the plans nor by discussion with service users that the plans reflect the current care needs. They had not been reviewed regularly and changes had not been made to the plans as a result of involvement with the service users. The home conducts written risk assessments to protect individual abilities and needs of service users. As the home provides personal care only the community nurses visit the service regularly to complete any nursing tasks. One of the community nurses visited the service on the day of inspection. The nurse stated that he was extremely happy with the care provided at the home. He stated, “Staff were very conscientious and were knowledgeable about the needs of the people who lived at the home. People at the home were always clean, tidy and well cared for”. The service user plans confirmed that health professionals visited the home on a regular basis including GP, podiatry and optical care. It could not be confirmed if people had access to a dentist. A good range of assessment tools with regard to pressure risk, moving and handling, ‘slip, trip or fall’ and nutritional risk are used. People spoken to stated that staff were very kind and that they always “knocked on your door before coming in”. During the inspection the inspector observed staff interacting with service users in a professional, kindly and respectful manner. Staff are friendly but professional in their approach. Some service users have telephones in their bedrooms. There is also a public telephone on the ground floor that offers a private space. The home has one double room, which is presently being used as a single room. The home has dedicated space for hairdressing in its own salon. Service users can book appointments with the home’s hairdresser or their personal hairdresser may use the home’s facilities. Fletcher House D53 - D02 S16001 Fletcher House V238905 120805 Stage 4.doc Version 1.40 Page 12 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, 14, 15. There are a wide range of social and leisure activities available. Family and friends are able to visit at any time. People who live at the service are able to maintain control of their lives and choices are offered. The food provided is of a good quality. EVIDENCE: People who live at the service commented that there was always lots going on and that they enjoyed the activities on offer. The numerous notices about the home advertising forthcoming events confirmed this. In addition to this there were photographs and displays from recent social occasions. These included Chinese Day (where the manager did a presentation of her trip to China including souvenirs and photo’s of her trip), a trip to the fish and chip shop (at the request of one of the ladies who had stated that she used to love eating fish and chips out of the paper) and visits to local sites. Home staff give their time to help with trips and outings. Fletcher House D53 - D02 S16001 Fletcher House V238905 120805 Stage 4.doc Version 1.40 Page 13 There is a dedicated activities organiser who arranges trips and in house entertainment. The activities organiser also spends time for one-to-one and small group sessions. A group of volunteers support the organiser and they manage a shop and licensed bar. Access to the garden has been diminished this summer due to the building works. The manager explained the plans to landscape the gardens at the end of the building work. The garden should therefore be fully available again next summer. Links with the community are strong. Visitors are made very welcome and can visit at any time to suit the service user. They can share a meal with the service user and they are invited to leave a donation for the amenity fund. A notice to this effect is displayed in the main foyer. A number of family members and visitors were present at the staff presentation. There are links with the local community via a Bridge Club, local schools and local churches. Holy Communion is celebrated monthly and other ministers and preachers visit regularly. The home has links with Age Concern advocacy service. Service users can bring into the home personal possessions under management agreement. Service users confirmed that they could spend their time as they wish and are consulted about this. Lunch was observed on the day of inspection. Fruit juice was initially served followed by chicken curry or cold ham with a selection of vegetables and rice or potatoes. The food was nicely served with individual dishes of vegetables served at each table. A number of people had purchased a glass of wine from the bar. A selection of hot and cold puddings and desserts was then served from a sweet trolley. The tables were nicely laid with linen tablecloths and napkins. The kitchen is in need of refurbishment. This is planned as part of the renovation programme. The storage for food had been moved as part of the current building work so this was not inspected in detail. The health and safety checks including fridge and freezer temperatures had been maintained. There was evidence of fresh fruit and vegetables. There was a selection of homemade cakes prepared for afternoon tea. The menus showed that a balanced and nutritious diet was available. People spoken with stated that the food was always of a good standard. Fletcher House D53 - D02 S16001 Fletcher House V238905 120805 Stage 4.doc Version 1.40 Page 14 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) These standards were not assessed on this occasion but were satisfactory at the last inspection. EVIDENCE: Fletcher House D53 - D02 S16001 Fletcher House V238905 120805 Stage 4.doc Version 1.40 Page 15 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) 19, 20, 21, 22, 23, 24, 25, 26. The building was not inspected in detail due to the current building work. The home was clean and tidy on the day of inspection. The service meets the needs of the people who live there. EVIDENCE: As building works are underway the building was not inspected in detail. Given the amount of work that is being undertaken the staff and contractors have worked hard to reduce the disruption to the people who live at the service to a minimum. Given the amount of dust and dirt that is generated with any building works the home remained clean and tidy. The domestic staff should be commended for this. Some of the communal space has been commandeered in the short term as storage and a staff room. There is still however enough communal space for the needs of the people who live at the service. Once the building work has been completed it is envisaged that a high standard of accommodation will be Fletcher House D53 - D02 S16001 Fletcher House V238905 120805 Stage 4.doc Version 1.40 Page 16 available. People spoken to during the inspection stated that they found the developments exciting and had been involved and informed of what was going on. A regular newsletter was issued to help this process. All the new rooms are for single occupancy with en-suite facilities. Two of the existing rooms are also being developed to provide en-suite facilities. The existing rooms are being decorated on a rolling programme or as they become available. People are able to personalise their rooms and this was seen. All the bedrooms were clean and tidy. The service provides an adequate number of toilets and bathrooms that are of a satisfactory standard. Fletcher House D53 - D02 S16001 Fletcher House V238905 120805 Stage 4.doc Version 1.40 Page 17 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, 28, 29, 30. The service provides staff who are suitably trained and in adequate numbers. The recruitment practises protect the people who live at the service. EVIDENCE: The staffing rotas were viewed on the day of inspection. The occupancy within the home is currently reduced due to the building work. The rotas demonstrated that there are adequate staff on duty. People spoken to during the inspection stated that there were enough staff on duty and that they did not have to wait if they required assistance. Staff training records were viewed. These showed that the majority of staff had received all mandatory training. The exceptions to this were three staff who had not received fire training and four staff who had not received recent health & safety training. As previously stated a number of staff had recently completed an NVQ qualification. These included two staff who had achieved NVQ2, four staff with NVQ 3 and the administrator who had achieved an NVQ 4. These are in addition to the staff that had already achieved this award. Staff spoken with during the inspection stated that they felt adequately trained in order to fulfil their role. Two new staff, who had recently commenced employment, stated that they felt well supported and that they had received induction. Fletcher House D53 - D02 S16001 Fletcher House V238905 120805 Stage 4.doc Version 1.40 Page 18 The recruitment files of the two most recent staff members were inspected. These demonstrated that the homes recruitment procedures were in line with good practise guidelines and included CRB and POVA checks. Fletcher House D53 - D02 S16001 Fletcher House V238905 120805 Stage 4.doc Version 1.40 Page 19 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, 32, 33, 34 35, 37, 38. This home generally has good occupancy rates. Service users speak well of the care and service they receive. Records are well managed and are stored securely. The home is well managed. Fletcher House D53 - D02 S16001 Fletcher House V238905 120805 Stage 4.doc Version 1.40 Page 20 EVIDENCE: The registered manager has been in post for 20 years. She is therefore well experienced and professionally competent to run the home. She has kept her professional development updated. She holds a Certificate in Social Services and also has successfully completed the IOSH Managing Safely course, which covers legislation and risk assessment in health and safety. All feedback from service users, staff and a visiting professional said that there is an open management approach in the home. All those who were asked said that they could approach either the manager or the deputy with any concerns. The manager and her deputy were observed to demonstrate a clear sense of leadership by their interactions with staff. There are regular staff meetings and further impromptu meetings when necessary to discuss issues of concern. There is a calm and professional approach to management in the home helping to give a sense of security and comfort for service users and staff. Small amounts of money are kept for safekeeping for those service users who request this. A communal ‘Amenity Fund’ is kept in a bank account and this is used as a banking facility for individuals a well as for the group. The funds are used for social and recreational activities. Receipts are kept for all purchases and receipts are given when money is paid into the account. There are two signatures for all transactions. It is recommended that this account be audited by an external auditor, since money was seen to be loaned to service users occasionally. The fire safety log, accident book, wheelchair, lift and hoist servicing records were viewed. These were in line with good practise. Fletcher House D53 - D02 S16001 Fletcher House V238905 120805 Stage 4.doc Version 1.40 Page 21 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 x x x 3 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 3 15 3 COMPLAINTS AND PROTECTION 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x 3 4 3 3 2 x 3 3 Fletcher House D53 - D02 S16001 Fletcher House V238905 120805 Stage 4.doc Version 1.40 Page 22 Are there any outstanding requirements from the last inspection? No. 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 Regulation Requirement Timescale for action 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. Refer to Standard OP7 Good Practice Recommendations It is recommended that the service user plans are reviewed to ensure that they all adequately reflect the current needs of the people who live at the service. The plans should be developed and reviewed regularly with the indivdual or representative. It is recommended that monies are not lent from one fund to another. It is good practise for two signitures to confirm all transactions. It is recommended that the all monies are audited regularly. 2. OP35 Fletcher House D53 - D02 S16001 Fletcher House V238905 120805 Stage 4.doc Version 1.40 Page 23 Commission for Social Care Inspection Riverside Chambers Castle Street Tangier Taunton TA1 4AL 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 Fletcher House D53 - D02 S16001 Fletcher House V238905 120805 Stage 4.doc Version 1.40 Page 24 - 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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