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Archived: Fitzwilliam Court

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Inspection report

Date of Inspection: 23 September 2013
Date of Publication: 16 October 2013
Inspection Report published 16 October 2013 PDF | 77.47 KB

The service should have quality checking systems to manage risks and assure the health, welfare and safety of people who receive care (outcome 16)

Meeting this standard

We checked that people who use this service

  • Benefit from safe quality care, treatment and support, due to effective decision making and the management of risks to their health, welfare and safety.

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 23 September 2013, talked with people who use the service and talked with staff. We talked with commissioners of services.

Our judgement

The provider had an effective system to regularly assess and monitor the quality of service that people receive. The provider had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who use the service and others.

Reasons for our judgement

The provider had appropriate and well established systems in place for gathering, recording and evaluating information about the quality and safety of care the service provided. The areas included: audits, training, complaints, incidents, risk, care plans and staffing.

We looked at a sample of the service's policies and procedures. We found the policies and procedures to be detailed, clearly written and easy to understand. Policies and procedures had been reviewed and updated in line with service requirements.

A complaints procedure was in place so that people could voice any concerns. All of the people spoken with said that they had no worries or concerns, but that they could talk to staff if they had any. Everyone spoken with said that staff would listen to them. There were no outstanding complaints about the service. The provider kept a compliments and complaints folder which we viewed.

We spoke with staff who explained that staff meetings were held every usually every two months. We reviewed the minutes from the last two meetings which were held in September 2013 and June 2013. These demonstrated that areas such as people’s care plans, medication, infection control and staffing were discussed and monitored.

We spoke with the registered manager who told us that they conducted spot checks in people's homes to observe how their staff provided care for people who used the service. These checks covered areas such as staff appearance, how staff communicated with people, how they provided care against the care plan and that completion of care records. We saw evidence of this documentation.

The manager said that they regularly sent out ‘Customer Satisfaction Surveys' to people who used the service, their relatives and health care professionals. People had been asked their opinions about such things as care, care workers, management and communication. We saw a sample of returned surveys. Overall a high level of satisfaction was experienced in all categories.