Archived: Fitzwilliam Care Centre

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs. This is the first assessment for this service. This key question has been rated Requires improvement: This meant people’s needs were not always met.

The service was in breach of legal regulation in relation to person-centred care.

This service scored 57 (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 make sure people were at the centre of their care and treatment choices and they did not always work in partnership with people. Staff did understand what person-centred approaches meant but care plans lacked consistent and accurate information about people’s support needs and abilities. Managers and staff were not aware of mandatory guidance, such as CQC’s policy around RSRCRC, which is important as it ensures people rights to respect, equality, dignity, choices, independence and good access to local communities are upheld. They did not therefore ensure these principles were being implemented in people’s care. People’s care plans did not reflect their personal details, needs, abilities or wishes. This meant staff did not always have the correct information to support people in-line with their wishes. People told us they were not always asked about their preferences such as the gender of staff supporting them and times of support. Where these had been agreed, people told us the agreed choice was not adhered to. For example, one person told us, “Originally, I had a choice, but it seems to have stopped. I had female [staff] but am ok with the occasional male now” Another person said, “Timing seems to go to pot with things. Today I was offered a coffee at 11.50am when usually the trolley comes round about 10.30am.”

People told us they had things to do, such as groups activities, visitors or chats with each other but almost everyone we spoke with said there was a lack of opportunity to do anything outside of the home/grounds. One person told us they felt claustrophobic due to not being able to go out. Another person said, “I’d love to see a visiting dog or have someone spend a bit of time with me, but it’s never been offered.” The provider was in the process of purchasing a mini-bus and implementing additional staff on shift to enable people to access their community, but this was not yet in place.

There were some shortfalls in how the provider understood the diverse health and care needs of people and their local communities, so care was not always joined-up, flexible or supportive of choice and continuity. While most people’s care needs were met and the staff team did work with local health professionals such as doctors and dentists, not all health needs were identified and recorded. A professional told us that people who had more complex health needs had gaps in their records of past medical history and a lack of information was handed over when transferring or sharing care. They went on to say, “Many of the [people] have a dual diagnosis and require the ongoing input of specialist services. A detailed history is therefore essential to be able to provide safe and appropriate care.

The provider did not always supply appropriate, accurate and up-to-date information in formats that were tailored to individual needs. Staff and the manager were not aware of the Accessible Information Standard, which requires staff to ensure information is in formats that people can understand. For example, there was no evidence of trying to teach one person who required hearing aids in both ears other forms of communication that would aid their choices. Another person’s care plan said they required picture cards to aid their communication. However, none of the staff we spoke with were aware of the cards and all confirmed they were not used. Language used in care plans presented a lack of respectful tone and equity. Terms such as ‘challenging behaviour’, ‘toileting’, ‘resistance to care’ and ‘exiting seeking’ were unhelpful and did not support staff to recognise what a person might be trying to communicate.

Relatives told us communication from managers to themselves and their family members was poor. One relative said, “My main concern is the lack of communication to us. My [family member] has had 2 falls. We were not told about [another injury]. I’ve questioned the manager who should notice these things.” Another relative told us, “Communication is the biggest bugbear. I’ve had to chase them a lot. We need decent notice for family meetings.” Some relatives told us the tone used by some staff was disrespectful when they had not realised people could hear, which caused them distress and worry.

The provider did not always make it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. While most people and relatives felt happy to complain, some people told us they felt scared to raise concerns due to a fear of repercussions. A person told us, “I don’t want to upset things by complaining about someone, as it’ll have repercussions for me.” Not all people felt they would be heard. A complaints and compliments process was in place and comments had been received that were both positive and negative. However, not all complaints to the manager had been recorded formally or acted upon. This showed a lack of transparency by the manager.

The provider made sure that people could access the care, support and treatment they needed when they needed it. People had access to external health services such as doctors, dentists and district nurses. A relative said, “[Staff] are very good at getting a doctor if needed.” We observed staff supporting a person to understand a dentist referral letter and they supported them to make contact and chase up the appointment.

We could not be assured staff and leaders always actively listened to information about people who are most likely to experience inequality in experience or outcomes. There was no evidence of seeking feedback from people or reviewing lessons learnt about access in order to improve how people accessed health services. For example, there were no reasonable adjustment care plans in place for people most at risk of inequity in health care. This meant people’s care was not always tailored in response to this.

People were supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life. Care plans contained information about people’s preferences in the event of ill health where they were happy to discuss it. This meant staff had guidance to follow to ensure people’s rights and wishes were upheld in emergencies or the event of a chronic illness.