We carried out a review of the data available to us about Fitzwarren House on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Fitzwarren House, you can give feedback on this service.
The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.
The inspection took place on the 15 and 16 of October 2018 and was unannounced.
At the last inspection, we rated Fitzwarren House as Good overall, with the caring domain being rated as Outstanding. At this inspection we found the provider continued to be rated as Good in the safe, effective and well led domains. The service has remained Outstanding in the caring domain. We found the provider had made improvements in the responsive domain and has been rated Outstanding in this domain. The service is now rated as Outstanding overall.
Staff were highly skilled and had a natural aptitude to give reassurance and comfort to people living in the home. They treated people with the utmost dignity and respect when helping them with daily living tasks. There was an excellent understanding of seeing each person as an individual, with their own specific needs.
The provider's ethos focused around inclusion, diversity, equality and upholding people's human rights. This included encouraging people to have aspirations and goals, and supporting them to achieve these.
Staff were a highly motivated team who demonstrated their commitment to providing high quality, individualised care to meet people's preferences and needs.
The provider had gone to great lengths to ensure people had access to a wide range of meaningful activities. This included trips out to places that people said they wanted to visit. There was a very strong emphasis on the provision of activities that were meaningful to the people living in the home. This meant that people were supported to pursue interests and hobbies that were important to them, as well as being given the opportunity to develop new hobbies and interests.
People were instrumental in deciding how they wanted to be cared for, including conducting their own care plan reviews.
The registered manager was extremely passionate about delivering very high standards of care to people using the service. They had established excellent links within the local community for the benefit of people living at Fitzwarren House, and worked collaboratively with other professionals. People were very much part of their local community.
Without exception, people and their relatives gave consistent, positive feedback about the service. This included the approach of staff, the food, the range of social and leisure opportunities that were on offer to them and the accommodation.
Effective systems were in place to manage people's medicines so that they received them safely and on time. People were supported to access health care services and to maintain a healthy lifestyle. People's needs had been assessed and their support requirements and preferences were recorded in detail to provide staff with the guidance they needed to support people.
The provider's responsiveness in regard to people's care and support needs had resulted in a reduction in incidents and accidents for some people who lived at the home.
The provider had explored innovative ways of meeting people's emotional needs and wellbeing, such as employing a music therapist. This had greatly benefited people living at the home.
People told us they felt safe at the service and were well supported by staff who were caring and friendly. Staff told us they were aware of how to report any concerns and were up to date with training on how to protect vulnerable adults from abuse.
The provider had effective recruitment arrangements to ensure staff were suitable for their role before they commenced working at the home. The registered manager made sure there were enough suitably skilled, qualified and experienced staff to support people safely.
The registered manager understood their responsibilities and worked with people who used the service, relatives, staff and the provider to improve the quality and safety of care that was provided. Quality assurance procedures and a programme of audits were effective in driving continual improvements to the quality of service.
Further information is in the detailed findings below.
A registered manager was employed by the service. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The registered manager was available throughout the inspection.
People’s medicines were managed in a safe and competent manner. People received timely support to meet their health care needs and the nursing and care staff were focused on how the person wished their care and support to be given. Care records reflected people’s wishes about their support needs and gave staff appropriate guidance to be able to deliver personal care in the way the person wished. People’s care and support was regularly reviewed with them and their families. The nursing staff demonstrated an excellent understanding and implementation of wound care.
People said they felt safe living at the home. Staff were aware of their responsibilities towards safeguarding people and showed a positive attitude to this. There was a complaints procedure in place; the service investigated complaints and responded in a timely way.
Staff were deployed in a way which meant people were appropriately supported in a timely way. People told us their care was not rushed and we observed staff took time when they were supporting people. Staff also spent time chatting with people and their families. People enjoyed the food and were supported to eat and drink in a sensitive manner.
People and families praised the staff for the caring nature of staff, their compassion and humanity. Families felt the end of life care people received was outstanding. Staff had developed positive relationships with people and sought to improve each person’s quality of life. People were treated as individuals and equally by staff.
Staff received training which was relevant to their role and staff demonstrated a high skill base. Staff were offered supervisions and the registered manager was in the process of arranging further clinical supervision for nursing staff and the annual appraisals.
Health care provision was available to people through regular GP visits and other health professionals visited the home to offer care and treatment, such as speech and language therapy. People had access to dental and optical care.
There was a range of activities which people could take part in and the activities co-ordinator sought to make activities meaningful for people. A music therapist supported people through the use of music to help express themselves.
The registered manager and management team were keen to expand their knowledge of best practice and other methods to improve outcomes for people.
The home is registered for up to 64 people. On the day of our inspection we were told there were 63 people in the home.
We spoke with eight people who received care at Fitzwarren House and four family members who were visiting. We talked with seven staff and the manager. We examined records, minutes of meetings and surveys.
The quality of care planning required greater detailing, there are a number people having dementia we noted that their level of capacity and the need for assessment with the Deprivation of Liberty Safeguards required more comprehensive recording. Also a person who had a detailed care plan on leisure and recreational activities reported to us that they were not participating in those same activities.
One relative told us that the recent departure of the registered manager had 'certainly unsettled people' but felt very able to express any concerns that they had.
The provider had effective systems in place to ensure the CQC were notified of safeguarding incidents. Safeguarding and complaints information was displayed in the office areas for the staff.
We found that the home had a well organised care planning system in place that ensured needs were assessed and plans updated when required. We saw that plans were person centred.
We found that the home was kept clean and hygienic and that standards were maintained by well trained domestic staff.
The home had safe systems in place for the storing and administering of medicines and staff received appropriate training in this area.
The home had safe and effective systems in place for recruiting staff.
Care staff received regular supervision from the senior staff and were trained in the tasks they are required to complete.
Relatives told us they were always made to feel welcome in the home and were involved in the planning and reviewing of care when appropriate.
People were provided with person centred care plans which were reviewed regularly and updated when required.
People said they felt safe living in the home and were able to discuss concerns or issues with the staff if they wished to. We were told that the service provided enjoyable and varied activities for people.
There were comprehensive auditing and reviewing procedures in place to identify any areas where improvements could be made.