Care Home: Fitzwarren House

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What the care home does well Fitzwarren House is a modern purpose-built home and as such the facilities are able to meet the needs of residents. All residents have their own single room, with its own ensuite. Currently these are all being improved to provide showers in every en-suite. There is a choice of sitting areas for residents. These are homely and comfortable in style. The view from the back of the building is over woodland, with wildlife visible for residents to watch. The first floor of the home has its own rabbit, which staff reported residents enjoyed watching and handling. The home has a full activities programme. One resident told us that they were going to listen to music, which they enjoyed, which was taking place during the morning. A quiz was observed, it was well attended. A resident told us that there were many activities offered and they could get involved or not as they wished. They also reported on how they appreciated the church service every Friday. When residents did not wish to join in activities, we observed that staff were available to support them, going in and out of their rooms or sitting with them in the sitting rooms. People commented on the meals. One person reported that the food was "very good", another that it was "all right", another that they had fish and chips every Friday and that they liked that. We observed a resident come to tell staff that they had "made a different arrangement" and had decided to eat their meal in their room; this was respected by staff. A member of staff told us that if a resident did not like the choices on the menu, they could always tell the kitchen, who would provide an alternative. We observed that afrail resident had fallen asleep just before lunch. A carer very gently work them up and made sure they understood what was going on, before starting to support them in eating. We observed a resident was not able to open their mouth fully, be assisted to eat. A carer gently supported them, using a teaspoon and not hurrying the person, checking that they had swallowed safely before offering the person another teaspoonful. We talked with residents about how they could raise issues of concern. One resident told us about how the home held monthly meetings where staff, clients and others were able to say "their piece in public" and that what they said was "acted upon". They told us that they also had a book to comment on meals and showed it to us. We could see that entries had been made by people about what they thought about the meals. For example, one person had written a comment about a cold meal on one day. A resident told us "I`m satisfied with what I get in every respect". A carer said to us that "of course" senior staff listened to them. Another member of staff reported that the deputy manager was fully open to suggestions to improve practice. What the care home could do better: When we discussed residents` needs with staff, we found that while staff were able to inform us of residents` individual needs in detail, not all of this was written down. For example we observed a resident who was assessed as being at high risk of falls, was wearing a pair of slippers which did not appear to fit properly. The registered nurse knew why this was but this was not documented. Another resident used an appliance to support their continence needs. The use of this appliance was documented, but in order to support provision of care, the wording of the care plan relating to this appliance would benefit from being completed in more detail, to fully direct staff on all actions to take. Another person`s care plan documented that staff were to use "skin care products", when the person had more than one such product in their room. The care plan should have stated which topical application was to be used and where on the person`s body. Where people were assessed at being at risk of pressure ulceration, care plans should state precisely how often the person needed their position moving, taking into account current research-based evidence from bodies such as the National Institute for health and Clinical Excellence (NICE). Random inspection report Care homes for older people Name: Address: Fitzwarren House Kingsdown Road Stratton St Margaret Swindon Wiltshire SN3 4TD two star good service 16/12/2008 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Susie Stratton Date: 1 5 0 4 2 0 1 0 Information about the care home Name of care home: Address: Fitzwarren House Kingsdown Road Stratton St Margaret Swindon Wiltshire SN3 4TD 01793836920 01793836921 home.swn@mha.org.uk www.mha.org.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Wendy Champion Type of registration: Number of places registered: Conditions of registration: Category(ies) : Methodist Homes for the Aged care home 60 Number of places (if applicable): Under 65 Over 65 30 30 dementia old age, not falling within any other category Conditions of registration: 0 0 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. Date of last inspection Care Homes for Older People 1 6 1 2 2 0 0 8 Page 2 of 10 Brief description of the care home Fitzwarren House is a purpose built care home which 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 (MHA) 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 are also provided. Care Homes for Older People Page 3 of 10 What we found: We performed this random inspection following concerns raised about a range of matters from a person or persons external to the home. The random inspection took place on Thursday 15th April 2010, between 10:35am and 3:15pm. It was unannounced. One inspector performed this inspection. This person is referred to as we throughout this report, as the inspection was performed on behalf of the Care Quality Commission (CQC). During the inspection, we met with the registered manager, a senior nurse in charge of one of the floors of the home, two other registered nurses and five carers, one of whom was recently employed. We met with eight different residents, observed some care provision, a mealtime and an activities session. We looked at records, including records relating to four residents. As issues had been raised mainly about the first floor nursing unit, we concentrated on this area, although we did briefly visit the ground floor dementia care unit. When we arrived at the home in the mid-morning, all breakfasts had finished some time ago. Some residents were receiving care, some were up and sitting in either of the sitting rooms, or their own room and other people were still in bed. Discussions with staff and residents indicated that residents were able to get up when they wished and could go to the sitting room of their choice or remain in their room or their bed, as they preferred. A resident reported to us that they liked to get up at 7:30am every morning, so that they could have breakfast at 8:00am. During the inspection, we observed a resident asking a carer do you think you could make me a Horlics? The carer answered fine Ill do that and went on to discuss with the resident how they would prefer to have their Horlics prepared. Another resident who described themselves as poorly, reported that they were remaining in bed in their room because that was where they wanted to be. A resident described to us that they needed help with all of their personal care, due to a disability, and we observed two members of staff being supportive to this person, fully taking into account their disability. We asked residents how they summoned assistance if they needed it. Many of the residents showed us the call bell they had attached to a pendant round their neck. One person reported to us that as well as the pendant round their neck, they also had one by their bed and in their en-suite. They reported that they had recently fallen to the floor and that within ten minutes, they had been picked up by two members of staff and been given a full check-up. Another person reported to us they they always made sure that their call bell was within reach as they were worried about falling. A further resident reported to us that they would use the bell round my neck, to summon assistance and that hopefully, staff come running. We observed that residents in sitting rooms always had a member of staff available to support them and sometimes more, depending on the time of day. Lunch-times appeared well organised. One member of staff in each sitting/dining room served the meals from the hot trolley. Residents at dining tables were then served table-by-table. After this, staff took meals to people who preferred to eat in their own room or who were unable to leave their rooms. Where residents needed support to eat their meal, a member of staff sat with them and assisted the person to eat their meal. There were also sufficient staff available to observe and support residents who became inattentive during their meal. Care Homes for Older People Page 4 of 10 Residents told us that the home were supportive if they were unwell. One resident told us that they had had a bad night the previous night and that they had told staff about this, who had supported them. Another person reported to us that if they were unwell, the home got the doctor in - and how. Another resident reported that they were always having falls but that they had had no serious falls. They hoped that they would not have to go to hospital following a fall, reporting that if they did fall, they rang their bell and two carers would come and put them on their chair or their bed. Records and discussions with staff showed that a frail person who was at dietary risk had been referred to the dietitian and that the home were following the dietitians advice on how the person should be supported in gaining weight. We discussed another resident with a registered nurse who reported that the person was reluctant to eat, they reported that this varied, so the ways they supported the person also needed to vary. They reported on their liaison with the residents GP and family and that all this was documented in the persons records. We observed a resident who had visible bruising on them. The person was not able to inform us of why this was. Staff we discussed this persons bruising with reported that the person had been admitted to the home with this bruising. A registered nurse was aware of the medical reasons for this persons bruising. When we looked at the persons records. They reflected what staff had told us about this persons condition on admission, their underlying medical condition to cause their bruising and their subsequent nursing and care in the home to support the person. We observed care practice, particularly how staff supported residents who were not able to move themselves. We observed that staff performed manual handling safely, using appropriate equipment to do this. Staff consistently explained to residents what they were going to do to support them while they were helping them to move. None of the residents had pressure ulceration. Equipment to prevent pressure ulceration was readily available and being used correctly for residents. A person who had been admitted with pressure ulcers in the past had been referred to the tissue viability nurse. Their pressure ulcer was now healed. We discussed residents needs with a range of staff. All staff we spoke with showed a good knowledge of how residents different nursing and care needs were to be met. One new member of staff told us that they learnt about residents needs from reading care plans and working with staff. They reported that if they had any concerns, they could always talk to the registered nurse and knew they would be listened to. Another carer agreed with this and reported on the report handover about residents which they always had every morning. Another carer reported to us on how important it was to listen to relatives and what they had to say. They reported on how supportive senior managers were to them. We looked at records in detail relating to four residents. We observed that all residents had assessments of need carried out prior to admission and regularly after admission. Care plans were developed from assessments, to direct staff on how residents individual needs were to be met. Records of residents daily lives were maintained, recording their responses to nursing and care. Where peoples conditions changed, including accidents, clear records were made. The home also maintained detailed records of conversations with residents relatives. People had been concerned about issues relating to heating of the home. It was reported that the home had had problems with one of their boilers during the winter. The heating Care Homes for Older People Page 5 of 10 engineers were under contract, with a four hour response time. When one boiler had not been functional, industrial heaters had been brought in, to ensure residents did not become cold. Engineers were visiting the home on the day of the inspection to flush out the system and ensure that heating systems were fully functional. There was full documentation relating to this. A resident reported to us oh yeah, this room is warm. Concerns had also been made about fire safety systems, particularly in relation to evacuation in case of fire. The home have recently been inspected by the Fire and Rescue Authority, who did not raise any issues in relation to evacuation of the premises or lack of availability of staff or required equipment. We had also been advised that the home had a high turnover in staff and problems in relation to recruitment of staff. Staff reported to us that there was a low turnover in comparison with other homes they had worked in. They reported that some staff had continued their employment in the home from when it opened. One member of staff reported that they could not drive, but there was a bus stop close to the home and that buses ran at different times of day, so they could get home after shift and get to the home in time to start an early shift, including at weekends. The manager reported that the home was fully up to the providers staffing establishment and that they did not have any difficulties in recruitment. At the time of the inspection, they had a waiting list of people who would like to work in the home, but they did not have any vacancies. A senior member of staff reported that as the home did not have vacancies, when a vacancy arose, they could chose who came to work in the home. They reported on the induction programme and how they could take the time needed to induct new members of staff. They reported that all new members of staff were allocated a buddy to support them through their induction period. What the care home does well: Fitzwarren House is a modern purpose-built home and as such the facilities are able to meet the needs of residents. All residents have their own single room, with its own ensuite. Currently these are all being improved to provide showers in every en-suite. There is a choice of sitting areas for residents. These are homely and comfortable in style. The view from the back of the building is over woodland, with wildlife visible for residents to watch. The first floor of the home has its own rabbit, which staff reported residents enjoyed watching and handling. The home has a full activities programme. One resident told us that they were going to listen to music, which they enjoyed, which was taking place during the morning. A quiz was observed, it was well attended. A resident told us that there were many activities offered and they could get involved or not as they wished. They also reported on how they appreciated the church service every Friday. When residents did not wish to join in activities, we observed that staff were available to support them, going in and out of their rooms or sitting with them in the sitting rooms. People commented on the meals. One person reported that the food was very good, another that it was all right, another that they had fish and chips every Friday and that they liked that. We observed a resident come to tell staff that they had made a different arrangement and had decided to eat their meal in their room; this was respected by staff. A member of staff told us that if a resident did not like the choices on the menu, they could always tell the kitchen, who would provide an alternative. We observed that a Care Homes for Older People Page 6 of 10 frail resident had fallen asleep just before lunch. A carer very gently work them up and made sure they understood what was going on, before starting to support them in eating. We observed a resident was not able to open their mouth fully, be assisted to eat. A carer gently supported them, using a teaspoon and not hurrying the person, checking that they had swallowed safely before offering the person another teaspoonful. We talked with residents about how they could raise issues of concern. One resident told us about how the home held monthly meetings where staff, clients and others were able to say their piece in public and that what they said was acted upon. They told us that they also had a book to comment on meals and showed it to us. We could see that entries had been made by people about what they thought about the meals. For example, one person had written a comment about a cold meal on one day. A resident told us Im satisfied with what I get in every respect. A carer said to us that of course senior staff listened to them. Another member of staff reported that the deputy manager was fully open to suggestions to improve practice. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 7 of 10 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 8 of 10 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 6 Care plans should be clear and use measurable language to fully direct staff on actions to take to meet peoples needs. Care plans should use research-based evidence when directing care. All information known about peoples individual nursing and care needs should be documented in their records. 2 7 Care Homes for Older People Page 9 of 10 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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