Fitzwarren House

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question good. At this assessment the rating has remained good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

This service scored 67 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not always ensure people's care and treatment was effective through the assessment and review of their health, care, wellbeing and communication needs.

Care plans contained information about people's needs and support requirements. However, goals and desired outcomes were not always clearly identified or consistently recorded. In some records, there was guidance about what people wished to achieve from their care and support, or how progress towards these outcomes would be measured and reviewed. This meant the provider could not always demonstrate that care planning was focused on achieving outcomes that were important to people or that the effectiveness of care and support was consistently evaluated.

Assessments of people's needs were completed prior to admission. These assessments involved people and, where appropriate, their relatives, to ensure their needs, preferences and desired outcomes were understood. Information gathered through the assessment process was used to develop care plans and provide staff with information about people's needs.

People we spoke with did not raise any concerns about the effectiveness of their care and support. Healthcare professionals also spoke positively about the care people received. One professional told us, "The staff competence on the nursing floor is excellent in meeting people's needs safely and in terms of monitoring them medically.

The provider made sure people's experiences relating to food safety were fully reflected in the food provided.

People's dietary requirements, and allergies were clearly documented. Records identified where people required specific diets, including gluten-free and modified diets. International Dysphagia Diet Standardisation Initiative (IDDSI) levels were clearly recorded, and monthly IDDSI checks were completed.

Kitchen staff had access to information about people's dietary needs, including any associated dietary considerations. For example, records detailed how certain health conditions could be affected by specific foods, helping staff to support people in line with their assessed needs.

The provider worked effectively across teams and services to support people. Systems were in place to share information when people moved between services, helping to ensure people did not need to repeat their history and that assessments of need were available to support continuity of care.

Healthcare professionals spoke positively about their working relationships with the provider and the outcomes achieved for people. One professional told us, "The service proactively seeks my advice at times, and any action suggested is reviewed and implemented." They also described the provider as approachable and easy to contact.

People did not raise any concerns about how staff worked with other professionals or services to support their care.

Staff told us they had effective working relationships with healthcare professionals and felt able to seek advice and guidance when required. However, some staff felt information sharing could be improved to ensure relevant information was communicated more quickly.

The provider supported people to manage their health and wellbeing in a way that maximised their independence, choice and control.

The provider made referrals to external healthcare professionals, including dentists and chiropodists, when people required specialist support. Records demonstrated that people had access to healthcare services to help meet their identified needs.

Staff were able to describe how they supported people living with diabetesand demonstrated an understanding of the importance of appropriate dietary management. They provided examples of how meals and desserts were adapted to reduce sugar content, such as offering diabetic-friendly cakes and alternative options.

People did not raise any concerns about the support they received to manage their health and wellbeing.

The provider monitored people’s care and treatment to support continuous improvement and help ensure outcomes met both clinical expectations and people's individual needs.

Healthcare professionals spoke positively about the nursing team and told us nurses demonstrated a good understanding of complex health conditions, emergency medicines, and when concerns required escalation. Professionals described their working relationships with nursing staff as positive and collaborative, with staff sharing information and seeking guidance when appropriate.

People told us they were involved in reviews of their care and support. They said their care plans were reviewed and updated when changes occurred and that they were asked to sign them to confirm their agreement.

The provider did not always ensure people were informed about their rights in relation to consent, nor did they consistently respect these rights when delivering care and treatment.

The provider did not always work in line with the principles of the Mental Capacity Act (MCA) 2005. Where people's capacity to make specific decisions was reduced, mental capacity assessments and best interest decision records were not always in place.

For example, records for 1 person stated they were not free to leave the service; however, there was no documented mental capacity assessment or best interest decision to support this restriction.

For another person, a "Capacity and Communication Assessment" stated they were unable to understand information and unable to make minor day-to-day decisions independently, requiring staff support with daily decision-making. However, conflicting information elsewhere within care records, stated the person was able to make choices about meals using visual prompts and plated meal options. This meant there was a risk that people's rights were not consistently protected and the provider could not be assured the least restrictive measures were considered and implemented.

Staff told us they had received training in the MCA and were able to describe the importance of supporting people to make decisions where possible.