You are here

Fewcott House Nursing Home Outstanding

All reports

Inspection report

Date of Inspection: 14 August 2013
Date of Publication: 18 September 2013
Inspection Report published 18 September 2013 PDF

People should get safe and appropriate care that meets their needs and supports their rights (outcome 4)

Not met this standard

We checked that people who use this service

  • Experience effective, safe and appropriate care, treatment and support that meets their needs and protects their rights.

How this check was done

We looked at the personal care or treatment records of people who use the service, carried out a visit on 14 August 2013, observed how people were being cared for and checked how people were cared for at each stage of their treatment and care. We talked with people who use the service, talked with carers and / or family members, talked with staff and reviewed information given to us by the provider. We reviewed information sent to us by commissioners of services and talked with other authorities.

Our judgement

Care and treatment was not planned and delivered in a way that was intended to ensure people's safety and welfare.

Reasons for our judgement

We spoke with eight people who used the service. We looked at 11 people’s care plans and spoke with staff about people’s needs. We found that people’s needs were not consistently assessed and care and treatment was not always planned and delivered in line with their individual care plan. For example, we looked at one care plan where a ‘behaviour assessment’ had identified that no special assistance was required. However, within the daily notes, it was apparent the person commonly expressed abusive language and intimidating behaviour. We looked at the care plan and could not find documented strategies for staff to follow to manage this behaviour. We spoke with one care worker about how they managed this person’s behaviour. The care worker told us they “just walk away”. We spoke with some people who said there were “peculiar residents” who “wandered around and shouted”.

Care and treatment was not always planned and delivered in a way that ensured peoples’ welfare. We looked at risk assessments. Some had been undertaken using the ‘Waterlow score’ to identify the risk of people developing pressure damage. Six of the eight risk assessments we saw had identified a very high risk of pressure damage. It was not always clear in the care plans what preventative actions staff were taking.

For example, we spoke to one person, assessed as high risk of developing pressure damage. This person was in bed and said “my heels are aching terribly. Being in bed all the time the heels are on the bed and that’s why they’re painful” and “I feel I’d like to lift my feet up because they’re so painful”. The person told us they had spoken to staff; “they don’t know what to do. They don’t want to know”. We looked at the person’s care plan. The tissue viability plan, written by nurses working at the home, did not clearly identify how staff should prevent pressure damage. The Waterlow guidance and royal college of nursing guidelines recommend people assessed as being at ‘high risk’ should have an alternating pressure relieving mattress. This person did not have one. The ‘pain’ care plan stated “staff to elevate legs whilst in bed”. We looked at the daily notes for the previous week and saw only one entry to indicate that the person’s legs had been elevated whilst in bed. We looked at other plans relating to people at high risk and found that some detailed regular repositioning, but they did not contain details on what pressure relieving equipment was being used.

Care and treatment was not always planned to ensure people's safety. For example, one file contained three care plans for immobility. Each plan had a different date and different instructions to staff. There was a risk the person would not be supported appropriately because instructions to staff were not clear. This person’s file also contained a hoist and sling risk assessment, which had not been reviewed for 15 months. This placed the person at risk of being supported inappropriately with their moving and handling needs.

We looked at the care plans of five people who had been assessed as being at risk of becoming malnourished or dehydrated. Records of eating and drinking were being maintained for all five people. We saw that two people’s care plans indicated that they should drink at least 1500mls of fluid in a 24 hours period. We looked at the records for these two people which frequently indicated that they were not drinking the recommended amount. We saw that the daily fluid records had not been regularly added up. Therefore staff could not easily identify if people were drinking enough fluid. We could not find records of action being taken when people were drinking insufficient fluids.

Care was not being planned to meet people’s social needs. One person said “I get a bit bored, it's ok but not like home”. We saw that one person was able to mobilise in a wheelchair. The person’s ‘communication’ and ‘social interests’ care plans indicated that staff should encourage the person to get