Archived: Fenwick House

During this inspection, we used a number of different methods to help us understand the experiences of people using the service, because some people living in the home had complex needs which meant they were not able to talk to us about their experiences. We looked at care records for two people and spoke with or observed the care and support being provided to five people living in the home on the day of the inspection; to corroborate our findings and ensure the care being provided was appropriate for them. We also spoke with two relatives, five members of staff including the registered manager, a representative for the provider, a community pharmacist and a senior member of Bedford Borough Council's care standards and review team.

During this inspection, we gathered evidence against the outcomes we inspected to help answer our five key questions: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with staff and looking at records.

If you want to see the evidence supporting our summary please read our full report.

Is the service safe?

We looked at care records for two of the 12 people living in the home at the time of this inspection. We were unable to find evidence that either person's needs had been assessed prior to them moving into Fenwick House. This meant that the home could not have been clear about how to meet their needs when they moved in.

Care plans that we looked at contained some very basic information. This meant that people were at risk of receiving inconsistent care because their needs and preferences were not sufficiently detailed.

We noted that one person who administered their own medication had been prescribed a controlled drug (CD). It is a legal requirement that a separate medication record (a CD register) is maintained for certain controlled drugs. We checked the home's CD register to see how the home was adhering to this requirement. We found deficiencies because entries did not accurately show when the person had been given their medication from the stock held, to self-administer. This placed people at risk because arrangements for managing medicines within the home were not adequate.

At our last inspection on 2 April 2014, we identified concerns with the home's staffing arrangements. The provider told us after the inspection that they recognised there were staff vacancies within the home and had instructed the manager to recruit to these positions. We learnt during this inspection that the home still had staff vacancies and as such the manager did not have time to complete her managerial tasks as she was continually providing care and support to people living in the home.

Is the service effective?

Through the course of the day we observed food and drink being regularly provided to people living in the home. However, people's social needs were not being met. The television was on but people were not engaged with this. One person told us they would like to watch a musical and another person wanted access to the internet, but neither were available. Staff explained that more structured activities took place in the afternoons, although one person living in the home told us these were 'non-existent.' During the afternoon we observed one member of staff asking people if they wanted their finger nails painted or cut. When asked, staff did not have plans to provide any other activities that day.

We observed people being given a hot drink and biscuits in the morning. It was clear from our observations that staff knew the people they were providing care and support to. However, although people were asked how many sugars they would like in their drinks, they were not given the chance to choose their drink and biscuit. It is really important that people, particularly those with dementia, are enabled to maximise their skills and independence as far as they possibly can, and making simple choices is a key part of this.

We were told that people could not go into the kitchen to make themselves drinks and snacks. We looked at care records for one person who had the ability to make themself a hot drink or snack. There was no risk assessment in place to support the fact that they had restricted access to the kitchen. We were concerned that people were at risk of becoming deskilled and losing their independence if they were prevented from opportunities to undertake tasks like this.

It was clear from our observations and from speaking with staff, that the team did not work well together, and we were concerned about the impact of this on people living in the home.

Is the service caring?

We observed some positive interactions between staff and people living in the home, and it was clear that staff knew people well.

Is the service responsive?

We observed people's requests being met in a timely way. For example, one person asked for a drink and this was provided.

Is the service well-led?

A registered manager was in place.

However, this inspection highlighted that there were inadequate arrangements in place to identify, assess and manage risks relating to the health, welfare and safety of people living, working or visiting the home.

For example, we found concerns with the way that controlled drugs were being managed. There was no indication that this had been picked up or addressed by the service.

We observed that parts of the kitchen were not clean, which placed people living in the home at risk. There was no evidence that this had been identified within the service prior to our inspection. We were concerned about the potential risks to people living in the home so we reported our findings to Bedford Borough Council's environmental health team. They carried out their own inspection of the kitchen the following day.

A fire safety inspecting officer from Bedfordshire Fire and Rescue Service had visited the home on 30 April 2014 and found deficiencies in a number of areas. There was no evidence that action had been taken to address these by the time of our inspection on 3 July 2014. This placed people at risk because the home did not meet required fire safety standards. The provider took action to address this once it was brought to their attention, but it was a concern that this had not been acted on sooner.

After this inspection we made contact with the provider because we had found a number of things that required improving at Fenwick House. Prior to the inspection we learnt that Bedford Borough Council, who have a commissioning and quality monitoring role in respect of this service, also had concerns, and had already imposed a suspension on new admissions. The provider acknowledged all the concerns and responded by providing us with a clear action plan setting out how they intended to address them.

We acknowledge the timely and positive response from the provider following this inspection, and their commitment to making things better for people living at Fenwick House. However, this inspection has highlighted that a number of improvements are still required to ensure people consistently receive safe, quality care and support.

Is the service safe?

People had been cared for in an environment that was safe, clean and hygienic. People's needs had been assessed, and risk assessments described how any identified risks to people were minimised. The staff were knowledgeable about people's care and support needs, and people received medication from staff who had been trained to administer it safely. However, we found there were not enough staff on duty to meet the needs of the people living in the home. This put people at risk of receiving unsafe care. We have asked the provider to tell us how they will make improvements and meet the requirements of the law in relation to staffing.

Is the service Effective?

People were happy with the care that had been delivered and their needs had been met. Staff had received training to support people with various care needs including dementia and mental illness. However for one person, the service did not have robust systems to ensure that a person who administered their own medication was able to do so in a way that ensured an effective medication treatment regime. It was therefore not possible to confirm that all people's needs were being met. We have asked the provider to tell us how they will make improvements and meet the requirements of the law in relation to the management of medicines.

Is the service caring?

People were supported by kind and attentive staff. It was clear from our observations and from speaking with staff that they had a good understanding of the needs of the people living in the home and that they knew them well. One person told us, "The staff are caring and they look after me very well.'

Is the service responsive to people's needs?

We observed that staff responded promptly to people's needs. We saw that care plans had been updated when people's needs had changed, and that referrals had been made to health and social care professionals when needed.

Is the service well-led?

In this report the name of a registered manager appears who was not in post and not managing the regulated activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time. However, the home had employed a manager, who is undergoing assessment for their registration. We saw that the manager had made progress in developing systems to assess and monitor the quality of the service they provided. They regularly sought the views of people using the service, and took account of these to improve the service.

We observed the morning medication round. We saw that people using the service were given their medication on time, told about the medication they were taking, and were observed to ensure the medication had been swallowed. This was done in an unhurried way and people's individual needs were met. For example one person had their medication from a spoon and another from a pot into their hand.

We saw that clear records were kept relating to the ordering, administration, storage and disposal of the medications.

As part of this inspection we looked at the medication administration record (MAR) sheets for the nine people living at Fenwick House. The provider had told us they had improved their systems to monitor the safe administration of medication. However, we found there was continued evidence of failure to comply with this regulation. We returned on 25 June 2013 and found the service to be compliant with Regulation 13.

People told us they were aware they had care plans and some people confirmed that they, or their families, had been involved in the developing them. We saw that where appropriate care plans had been signed to confirm agreement.

Medications were administered by trained staff. However we saw some poor recording that had the potential to make the medication procedures unsafe. We have asked the provider to tell us how this will be improved.

People told us they felt safe living at Fenwick House. We found staff had a good understanding of their responsibility to keep people safe by responding appropriately to any signs of potential abuse. Staff involved professionals, including health professionals, correctly and sought advice appropriately.

People told us that the staff always spent time with them and we saw that the staff had good relationships with people and tried to encourage them to maintain their independence wherever possible.

People told us that they felt safe living at Fenwick House. However when we spoke with staff about safeguarding processes, their responses were inconsistent. Some were unsure of how to report matters of concern, and one said there could be a 'backlash'. This meant there was a risk that safeguarding concerns may not always be appropriately reported and people could be at an unnecessary risk of harm or abuse.

There was a relaxed atmosphere in the home, and the staff were courteous and polite in their approach to people. One person told us, "Without exception they are all kind and friendly". People were involved in making choices about their care, and said the quality and choice of food was good. We observed the midday meal service and noted that people enjoyed the food and the social aspect of the mealtime.

We observed that people were offered support at a level which encouraged independence, however some of the moving and handling practices we witnessed put people at risk. We also found that care plans did not always reflect peoples current needs. This meant there was a risk that people may not always receive the care they required.