CQC report explained · a nursing home
What the CQC found at The Fleet
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- Inspectors found that risks were assessed and managed, medicines were given as prescribed, staffing was sufficient and recruitment checks were completed. Infection prevention arrangements were also found to be effective.
- Effective?
- Good
- This question was not inspected during this focused visit. Its previous rating was used when calculating the overall rating.
- Caring?
- Good
- This question was not inspected during this focused visit. Its previous rating was used when calculating the overall rating.
- Responsive?
- Good
- Care records reflected people's individual needs, choices and preferences. People were supported with communication, activities, complaints and relationships with family and friends.
- Well-led?
- Good
- Inspectors found a clear management structure, regular audits and good communication. People, relatives and staff expressed confidence in the management team.
What inspectors found, April 2022
Rated Good; inspectors found safe, personalised care and clear improvement since the previous inspection, but there was no registered manager in post.
This was an unannounced focused inspection on 24 and 25 March 2022. One inspector reviewed care records, medicines, staff files, training, incidents, complaints and quality checks. They also spoke with people living in the home, relatives and staff.
The home was rated Good overall. Safe, Responsive and Well-led were rated Good. Inspectors found that risks were managed, medicines were given as prescribed, staffing was sufficient and infection control arrangements were in place. Care records were personalised, and people were supported to keep in touch with family and take part in activities.
The previous rating was Requires Improvement, with breaches of regulation. Inspectors found that the provider had made improvements and was no longer in breach. This inspection did not assess Effective or Caring, so those ratings were carried forward from the previous inspection.
Risk management
People's risks were assessed and care records explained the actions staff should take to reduce harm. Inspectors gave the example of detailed support for someone at risk of choking.
“Risks to people's safety and well-being were assessed and managed.” from the report
Medicines
Medicines were stored, administered and checked safely. Staff received training and regular competency checks.
“Medicine Administration Records (MAR) showed people received their medicines regularly.” from the report
Personalised care
Care records reflected how people wanted to be supported. A regular review process was used to keep care tailored to individual needs.
“Care records were personalised and reflected an individual's needs about how they would like to be supported.” from the report
Family relationships
People were supported to maintain relationships with family and friends, and to take part in activities in the home or wider community.
“People told us, and records demonstrated that people were supported to maintain relationships with their family and friends.” from the report
Quality monitoring
The manager and staff carried out daily checks and audits. These were used to monitor quality and make improvements.
“The manager and their team carried out daily walk rounds, audits and checks to monitor the quality of the service and to drive forward improvements.” from the report
Manager registration
minorThere was no registered manager in post when inspectors visited. A manager was in place and was completing an application to register with the CQC.
“At the time of our inspection there was not a registered manager in post.” from the report
- 01Has the manager since become registered with the CQC, and who is legally responsible for the home now?
- 02How are the improvements to medicines records and medicines checks being monitored today?
- 03How often are care records reviewed, and how are residents and families involved in those reviews?
- 04What current audits are used to check safety, staffing, incidents and the quality of care?
- 05What rating was given to Effective and Caring at the previous inspection, which was carried forward in this report?
This was a focused inspection of Safe, Responsive and Well-led, including infection prevention and control; Effective and Caring were not inspected and their previous ratings were carried forward. This explanation was written from the published report of 28 April 2022 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, September 2021
Rated Requires Improvement; inspectors found kind care, but weaknesses in records, medicines oversight and governance created risks.
This was the first full inspection since the home registered. It was unannounced and took place over two days. Inspectors spoke with people living there, relatives, staff and a health professional. They reviewed care records, medicines records, staff files and management records.
People and relatives described staff as kind, caring and responsive. Inspectors found good practice in consent, staff training, access to healthcare, food and drink, dignity and relationships. Staffing levels were found to be sufficient, and medicines were being given safely overall.
However, records did not always clearly show people's risks, needs, preferences or how care had been provided. There were also gaps in medicines records, best-interest records, infection-control auditing and the recording of complaints and activities. The provider's monitoring systems had not identified these problems reliably.
The overall rating was Requires Improvement. Safe, responsive and well-led were rated Requires Improvement, while effective and caring were rated Good. The report found no evidence that people had been harmed, but said weak systems placed people at risk and identified a breach of Regulation 17.
Kind and respectful staff
People and relatives spoke highly of staff. Inspectors observed kindness, compassion, dignity and respect during the visit.
“We observed staff interacting with people on both days of our visit. Staff showed kindness and compassion throughout; all showed respect towards people.” from the report
Sufficient staffing
Inspectors found staff had been recruited safely and were deployed in sufficient numbers. People and relatives were happy with staffing levels.
“We found, staff were recruited safely and deployed in sufficient numbers to ensure people were safe.” from the report
Good support with food and drink
People could choose alternatives, were offered drinks regularly and received support from health professionals where nutritional risks were identified.
“People were supported to remain hydrated with regular encouragement and opportunities to drink what they chose.” from the report
Access to healthcare
People said they could see their GP when needed. Records showed that health and social care professionals were involved when required.
“People's records detailed staff had involved other health and social care professionals when needed.” from the report
Incomplete care records
seriousRecords did not always explain people's risks, health conditions, preferences or the care they needed. This meant staff did not always have enough written information to identify concerns and provide safe, personalised care.
“People's risks, needs and health conditions were known to staff however, the supporting evidence was not always recorded, inconsistent or was not available to review.” from the report
Medicines records and checks
seriousRecords did not clearly support some covert medicines decisions or show that pharmacist advice had been obtained. The medicines policy did not reflect current practice, and stronger audits were needed.
“There was no record advice had been sought from a pharmacist to ensure their medicines could be given safely in this way.” from the report
Weak quality monitoring
seriousRegular, robust audits had not been completed and care records had not been audited. The provider's systems failed to identify several problems found during inspection.
“Robust audits had not been completed on a regular basis to enable continual monitoring of the service.” from the report
Infection-control audits
needs fixingThe home was not carrying out infection-control auditing regularly at the time of inspection. The manager said an audit was planned, and later confirmed it had been completed.
“The infection control auditing had not been completed for some time.” from the report
- 01How have you improved care records so they clearly describe each person's risks, preferences, health conditions and daily care?
- 02How do you record best-interest decisions and pharmacist advice when medicines are given covertly?
- 03What audits are now completed, how often are they reviewed, and how do you check that actions have been completed?
- 04How are short-stay residents' rehabilitation goals and progress recorded and shared with them and their families?
- 05How do you record people's communication needs, interests and end-of-life wishes?
This was the first full inspection of all five key questions; a separate infection-prevention and control check in March 2021 found no concerns. This explanation was written from the published report of 7 September 2021 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 The Fleet
2 rated inspections over a year: the service has improved, from Requires improvement to Good.
- April 2022Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- September 2021Requires improvementSafe: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- April 2021Inspected but not ratedSafe: Inspected but not rated
- April 2020
Registered with the Care Quality Commission on 17 April 2020.
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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17 live-in carers within about an hour of Devon
These are self-employed carers on PrimeCarers, the introductory agency that runs this directory. Each has a profile with their own rates and reviews from families, and you choose who to talk to.
Most charge £1,020 to £1,270 a week. 15 can care for a couple. 13 years' experience on average.
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Every carer has had an enhanced DBS check in the last 18 months, ID and right-to-work checks and an online interview. Their skills and training are for you to check with them. Carers set their own rates, and who is free changes week to week.