CQC report explained · a residential care home
What the CQC found at Fletcher House
Rated Good: inspectors found the home performing well and meeting their expectations.
What inspectors found, September 2019
Rated Good; inspectors found caring, safe and well-managed care, with some improvements needed in future end-of-life planning and a few records.
This was a planned, two-day inspection. The first day was unannounced and the second was announced. Inspectors spoke with 19 people, four relatives, nine staff and two healthcare professionals. They also reviewed care plans, medicine records, staff files and quality checks.
The home was rated Good overall and Good in all five areas: Safe, Effective, Caring, Responsive and Well-led. Inspectors found enough skilled staff, safe medicines practice, personalised care, kind treatment and effective management.
Some issues were identified and addressed during the inspection. A toilet next to the kitchen was taken out of use and arrangements were made for its removal. The manager also arranged extra training on mental capacity records and agreed to review end-of-life planning.
Kind and respectful care
People were treated with dignity and staff understood their personal needs and preferences. Feedback from relatives and healthcare professionals was positive.
“People were supported by staff that were caring and treated them with dignity and respect.” from the report
Safe medicines practice
Medicines were stored, administered and checked using suitable systems. All six medicine records reviewed were complete.
“All six MARs we reviewed had been filled out correctly with no gaps in administration.” from the report
Personalised support
Care plans included people's life histories, interests and preferences. Staff supported people to maintain relationships, hobbies and independence.
“People received care which was personalised to them because staff knew people well and respected their wishes where appropriate.” from the report
Good staff support
Staff had an induction, relevant training, supervision and appraisals. Inspectors found staff had the skills and knowledge to support people effectively.
“Staff had appropriate skills, knowledge, and experience to deliver effective care and support.” from the report
Effective management
The home used audits, feedback and reviews of accidents and incidents to monitor quality. People and relatives spoke positively about the manager.
“Quality monitoring systems included regular audits to ensure people received good care.” from the report
End-of-life planning
needs fixingNot everyone had future planning documents. This meant staff might not know people's wishes if end-of-life care became necessary.
“However, not everyone had future planning documents in place, which meant staff could not be sure what people would like to happen in the event they should need end of life care.” from the report
Mental capacity records
needs fixingSome mental capacity and best-interest assessments needed to be more specific to the decision and more personal. Extra training was arranged during the inspection.
“We discussed with the registered manager how some assessments would benefit from being more person centred.” from the report
Kitchen toilet
minorA toilet was next to the kitchen, separated from the cooking area by only one door. The provider took it out of use and arranged for its removal.
“We did find a toilet situated in the kitchen and only one door separated it from the cooking area.” from the report
Communication between professionals
minorOne healthcare professional said communication could be better, although they generally found that staff followed professional advice.
“Generally staff do implement what we ask but I think communication could be a bit better.” from the report
- 01What has changed in the home's end-of-life planning since this inspection?
- 02How are mental capacity and best-interest assessments now made specific to each decision and personalised to the individual?
- 03Has the toilet next to the kitchen been removed, as planned?
- 04How does the home make sure communication with healthcare professionals is clear and timely?
- 05How are privacy and confidentiality protected when computers are used in communal areas?
This was a planned inspection covering all five CQC questions, with the overall rating and each question rated Good. This explanation was written from the published report of 12 September 2019 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, January 2017
Rated Good overall, but inspectors found improvements were needed in mental capacity support and some food and care records.
The inspection was unannounced and took place on 20 December 2016. Inspectors spoke with people living at the home, visitors, staff and a healthcare professional. They observed care, activities, lunch and a staff handover, and checked care records, staff files and quality checks.
The home was rated Good overall. Inspectors found people felt safe, staff were kind, medicines were given safely and care was generally personalised. There were also good activities, links with the local community and an approachable management team.
The Effective rating was Requires Improvement. Staff were not always clear about supporting people who lacked mental capacity, and records did not always match the help people received with eating. Food choices and the mealtime experience were also mixed, particularly in the Avalon suite.
The previous inspection in January 2014 found no concerns. Since then, a new manager had been in post for under a year, staffing levels had increased and the new Avalon suite had opened. An action plan was in place for further improvements.
Kind and respectful staff
People said staff were caring, patient and respectful. Inspectors saw staff reassuring people who were disorientated and supporting them sensitively.
“People were supported by kind and caring staff.” from the report
Safe staffing and medicines
Inspectors found enough staff to meet people's needs. Medicines were given by trained staff whose competence was checked, supported by an electronic administration system.
“People were supported by sufficient numbers of staff to meet their needs and keep them safe.” from the report
Choice and activities
People could choose their routines and activities. The home offered clubs, hobbies, outings, faith visits and links with local schools and community groups.
“People had opportunities to take part in a variety of social activities and to pursue their hobbies and interests.” from the report
Approachable management
The manager was visible, listened to people's views and had an action plan for improvement. The provider used feedback and quality checks to make changes.
“People and staff felt the registered manager was open and approachable which enabled them to share ideas or worries with them.” from the report
Mental capacity decisions
needs fixingStaff were not confident about supporting people who lacked mental capacity. Some decisions involving equipment did not have recorded capacity assessments, which could leave people's rights insufficiently protected.
“There were no recorded assessments of people's mental capacity to make these specific decisions and staff were unclear about the process which had been followed.” from the report
Care plans did not always match care
needs fixingTwo people were being helped to eat but their care plans said they could eat independently. The manager said the records would be updated.
“However we found that care plans were not always up dated when people's needs changed.” from the report
Mealtime choices in the Avalon suite
minorPeople in the Avalon suite were served fully plated meals, so they could not choose vegetables or portion sizes at the time. Inspectors also found the mealtime atmosphere was less relaxed and sociable there.
“This meant people could not make choices about what they wanted at the time or sizes of portions.” from the report
Mixed views about food
minorPeople's opinions of the food varied. Some described it as bland and predictable, and inspectors noted limited choices of vegetables and condiments for some people.
“Comments about food varied greatly.” from the report
- 01What training have staff completed since the inspection on the Mental Capacity Act, and how do you check that they can apply it in daily care?
- 02How are capacity assessments and best-interests decisions recorded for people who cannot make particular decisions?
- 03How do you make sure care plans are updated promptly when someone's eating or other care needs change?
- 04What choices can residents in the Avalon suite make about vegetables, drinks and portion sizes at mealtimes?
- 05How have staffing levels and the new Avalon suite changed since this inspection, and what actions from the improvement plan are still outstanding?
This was an unannounced inspection covering all five key questions and the overall quality of the home; the previous inspection in January 2014 had found no concerns. This explanation was written from the published report of 17 January 2017 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Fletcher House
2 rated inspections over 3 years: the service has held its Good rating throughout.
- September 2019Goodcurrent ratingstayed GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- January 2017GoodSafe: GoodEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Good
- February 2014
Report published without a new overall rating.
- February 2013
Report published without a new overall rating.
- February 2012
Report published without a new overall rating.
- September 2011
Report published without a new overall rating.
- November 2010
Registered with the Care Quality Commission on 15 November 2010.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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