Inspection on 08/02/06 for Fletcher House

This inspection was carried out on 8th February 2006.

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 18/08/05

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 Announced Inspection 8th February 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 Fletcher House DS0000016001.V277053.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. Fletcher House DS0000016001.V277053.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Fletcher House Address Glastonbury Road Wells Somerset BA5 1TN 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) 01749 678068 01749 675927 Pauline.Leyton@somersetcare.co.uk Somerset Care Limited Mrs Pauline Doreen Ann Leyton Care Home 58 Category(ies) of Old age, not falling within any other category registration, with number (58) of places Fletcher House DS0000016001.V277053.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 18th August 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. It is situated on the outskirts of Wells, in front of playing fields. It was originally purpose built and has been upgraded recently 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 Departments quality rating accreditation. Fletcher House DS0000016001.V277053.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One inspector conducted this announced 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 inspectors would like to thank the residents and staff for their time and hospitality shown to the inspector during their visit. 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 health and safety records. A tour of the building was carried out on this visit. The building has recently had a major extension and renovation. This has increased significantly the registered numbers of beds. What the service does well: What has improved since the last inspection? Fletcher House DS0000016001.V277053.R01.S.doc Version 5.1 Page 6 The extension and refurbishment are now nearly complete. The building now offers a good range and standard of accommodation with choices of communal spaces. Décor fixtures and fittings are of a good standard. 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 DS0000016001.V277053.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 Fletcher House DS0000016001.V277053.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, 3, 4, 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” beds. EVIDENCE: The statements 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 theses 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. Discussion took place with a person who had recently moved into the home and their relatives. They confirmed that they had received information about Fletcher House DS0000016001.V277053.R01.S.doc Version 5.1 Page 9 the home prior to moving in. They confirmed that they found this information useful and it was used to reduce their anxiety. They also confirmed that they had been able to visit the home prior to moving in and that an assessment of the individuals needs had been completed. It was confirmed that people who live at the service have a copy of the terms and conditions of their stay. It is advised that Somerset Care review the terms and conditions to ensure that they comply with recent guidance issued by the Office of Fair Trading. Fletcher House DS0000016001.V277053.R01.S.doc Version 5.1 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 the following standard(s): 7, 8, 9 & 10. All people who live at the service have a plan of care. Health care needs are met in full. Medication is well managed. Privacy and dignity is respected. EVIDENCE: Five care and support plans were viewed on the day of inspection. All the plans gave clear guidance to staff of the needs of the individual. Since the last inspection some of the plans have now been reviewed with the individual to whom they relate. This work needs to continue to ensure that all people who live at the home have the opportunity to have input into this document. The plans seen had all been reviewed recently and therefore reflected the current needs of the person. Fletcher House DS0000016001.V277053.R01.S.doc Version 5.1 Page 11 All people spoken to during the inspection were aware of their key worker. The home conducts written risk assessments to protect individual abilities and needs of service users. A good range of assessment tools with regard to pressure risk, moving and handling and ‘slip, trip or fall’ and nutritional risk are used. Evidence was seen in the plans of care and the diary of regular access and visits of the GP, community nurse, dentist, chiropody and optician. Staff were observed dispensing medication on the day of the inspection. This was seen to be completed in line with good practise guidance. Training records confirmed that staff who handle medication have received adequate training. 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 1 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 DS0000016001.V277053.R01.S.doc Version 5.1 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 the following 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: Fletcher House should be commended for the activities it provides. 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. Home staff give their time to help with trips and outings. A reminiscence room has recently been developed. This is a well-used and valued resource. The room is furnished from the past. People enjoy visiting the room to discuss objects of interest and how life was in years gone by. On the day of the inspection a number of people living at the service were involved in “arm chair travel”. The theme for this activity was Scotland. A Fletcher House DS0000016001.V277053.R01.S.doc Version 5.1 Page 13 short video was shown showing the sights and places of interest in Scotland. This was intermingled with tasting including haggis, smoked salmon and whiskey. Discussion took place about visits and holidays that people had made to the area. This is a regular activity with different places of interest being chosen each time. 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. Due to the building works the garden is not up to the previous high standard. Some plants were delivered on the day of inspection and there are plans to have the garden completed ready for use in the spring and summer months. Pathways are completed and there is now a pleasant accessible walk around the building. 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 can spend their time as they wish and are consulted about this. Lunch was observed on the day of inspection. The food was of a good standard and was nicely served with individual dishes of vegetables served at each table. The menu is on display through out the home and a choice is available at all meals. All people spoken to stated that the food was always of a good standard. 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 has recently been refurbished. After initial teething problems the kitchen is now in good working order. The kitchen was clean and tidy on the Fletcher House DS0000016001.V277053.R01.S.doc Version 5.1 Page 14 day of the inspection. 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. One person stated that the butter was often too hard at teatime. This issue was raised with the manager who agreed to look into this matter. Fletcher House DS0000016001.V277053.R01.S.doc Version 5.1 Page 15 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 & 18. There is a complaints procedure but this is not readily advertised. The recruitment and training procedures carried out ensure that people are protected from the risk of harm or abuse. EVIDENCE: Comment cards were received from a number of people living at the home and relatives. The comment cards ask two questions • Have you ever made a complaint • Are you aware of the home’s complaints procedure All people stated that they have not had the need to make a complaint however seven people stated that they were not aware of the complaints procedure. The complaints procedure was not readily advertised in the home although a copy of the procedure is in the service user guide. It is recommended therefore the complaints procedure is displayed in a prominent area of the home. One person who lives at the home complained to the inspector on the day of the inspection that the security system on the front door, which is activated in the evening, was very loud and often disturbed her. This has been discussed previously with the manager. The manager agreed to look again at this issue Fletcher House DS0000016001.V277053.R01.S.doc Version 5.1 Page 16 although a balance has to be maintained between safety and disturbing a minority of service users. Staff records examined confirmed that POVA and CRB checks are obtained prior to an employee starting work. Abuse awareness is included in induction. Staff spoken to were clear about who they should speak to should they suspect poor practice. Fletcher House DS0000016001.V277053.R01.S.doc Version 5.1 Page 17 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 & 26. The building provides a good range of both individual and communal facilities. The majority of areas have been redecorated and refurbished. All bedrooms are for single occupancy. EVIDENCE: A tour of the building was conducted during the inspection. The extension has now been complete and provides single bedrooms with en-suite facilities. There are a number of communal spaces in this area. The older parts of the building have undergone a refurbishment in part. The communal spaces including lounge and dining areas have been redecorated and refurbished. As previously stated the kitchen has been relocated and refitted, as has the laundry. The home provides a number of accessible communal bathrooms in addition to the en-suites in the majority of the bedrooms. Those in the new extension are Fletcher House DS0000016001.V277053.R01.S.doc Version 5.1 Page 18 of a good standard with specialist baths. Some of bathrooms and toilets in the older part of the building were undergoing refurbishment on the day of the inspection. All of the rooms were clean and tidy on the day of the inspection. All rooms have access to a nurse call bell. The service is now non smoking. The fixtures and fittings in the newer rooms are of a good quality. In the older bedrooms the fixtures are in good order although aging. People are able to bring in personal possessions and to individualise their rooms if they wish. This was seen in the majority of the bedrooms. A ramp was being fitted to the old entrance door during the inspection. This will improve accessibility to this area. Parking at the service is limited. Fletcher House DS0000016001.V277053.R01.S.doc Version 5.1 Page 19 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, 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 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 staff had received all mandatory training. In addition training in creative activities for people with dementia, catheter care, flexercise and care planning has been provided. A number of staff had recently completed an NVQ qualification. Staff spoken to during the inspection stated that they felt adequately trained in order to fulfil their role. The recruitment files of the 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 DS0000016001.V277053.R01.S.doc Version 5.1 Page 20 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, 32, 33, 34, 36, 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. EVIDENCE: Fletcher House DS0000016001.V277053.R01.S.doc Version 5.1 Page 21 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 was 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. The fire safety log, accident book, wheelchair, lift and hoist servicing records were viewed. These were in line with good practise. Fletcher House DS0000016001.V277053.R01.S.doc Version 5.1 Page 22 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 3 3 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 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 3 3 3 X 3 3 3 3 Fletcher House DS0000016001.V277053.R01.S.doc Version 5.1 Page 23 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. 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. 2. Refer to Standard OP7 OP16 Good Practice Recommendations It is recommended that the service user plans be developed and reviewed regularly with the individual or representative. It is recommended that the complaints procedure be on display in a prominent position with in the home. Fletcher House DS0000016001.V277053.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street 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 DS0000016001.V277053.R01.S.doc Version 5.1 Page 25 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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