We carried out a review of the data available to us about Fewcott House Nursing Home on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Fewcott House Nursing Home, you can give feedback on this service.
Fewcott House Nursing Home is a residential care home providing personal and nursing care to 30 older people at the time of the inspection. The service can support up to 40 people.
People's experience of using this service and what we found
People were truly respected and valued as individuals and were the heart of the service. Staff were clearly committed and compassionate, striving to provide excellent care at all times. The registered manager had developed an open, transparent and person centred culture that was driven by a motivated and committed staff team. This motivation resulted in a whole team who were totally supportive and dedicated to providing high quality, individualised care. The staff team told us they were truly valued and respected. Staff were skilled, motivated and knowledgeable. People received exceptionally personalised care and support which met their needs, reflected their preferences and promoted their self-worth. The provider upheld people's human rights.
The service worked very closely with healthcare professionals and provided excellent end of life care. People experienced a comfortable, dignified and pain-free death. Management had undertaken training on the Gold Standards Framework (GSF) programme on End of Life Care. This framework enables earlier recognition of patients with life-limiting conditions, helping them to plan ahead to live as well as possible right to the end. The service had been awarded the Gold standard. Staff had the specific skills to understand and meet the needs of people and their families in relation to emotional support and the practical assistance they needed at the end of the person’s life. Records showed staff had attended end of life care training. Staff told us they were supported by the management team with empathy and understanding.
The service was exceptionally well-led. The provider and the registered manager were clear about their expectations relating to how the service should be provided and led by example. The registered manager demonstrated how their open and listening management style and robust quality assurance systems had sustained continual development and improvement at the service. They were supported by the provider who was passionate about providing people with high quality care and supported staff fully to enable them to deliver this. The provider and registered manager had developed and maintained, through the pandemic, positive links with the community which benefited those living in the service. There was a strong commitment from the provider and management team to ensure there was equality and inclusion across the staff team. Staff were highly satisfied working in the service.
People and relatives told us staff were extremely caring. Staff did all they could to promote people’s independence and we saw examples of this. People received highly effective personalised care, tailored to their individual needs and preferences, and staff supported people and their relatives to be involved with decisions relating to their care. People's privacy and dignity was upheld through the approaches taken by staff as well as in relation to the care environment.
Staff knew how to identify and report any concerns. The provider had safe recruitment and selection processes in place which incorporated their values.
Risks to people's safety and well-being were managed through a risk management process. There were sufficient staff deployed to meet people's needs. Medicines were managed safely, and people received their medicines as prescribed.
People were supported to meet their nutritional needs and complimented the food at the home. People had a pleasant well-presented dining experience which offered a variety of appetising food choices available at times that suite people’s preferences. Staff supported people to maintain food and fluid intakes, including, through the use of snacks, and making people hot drinks to help them relax and maintain their comfort.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. Staff had a particularly good understanding of when the principles of the Mental Capacity Act should be applied. People were supported to meet their nutritional needs and complimented the food at the home.
Rating at last inspection
The last rating for this service was Outstanding. Published 5 October 2019.
Why we inspected
We undertook this inspection as part of a random selection of services rated Good and Outstanding to test the reliability of our new monitoring approach.
We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Fewcott House is a residential care home which also provides nursing care and is registered to support up to 40 people aged 18 and over with varying support needs. These included older people living with dementia; people with a physical or learning disability and people with mental health support needs. At the time of our inspection there were 40 people living in the home.
People’s experience of using this service and what we found
People were at the heart of the service and staff were clearly committed and compassionate, striving to provide excellent care at all times. The registered manager had developed an open, transparent and person-centred culture that was driven by a motivated and committed staff team. This motivation resulted in a whole team who were totally supportive and committed to providing high quality, individualised care. The staff team told us they were truly valued and respected. Staff were skilled, motivated and knowledgeable.
People received exceptionally personalised care and support which met their needs, reflected their preferences and promoted their self-worth. The provider upheld people's human rights.
There was a homely, welcoming atmosphere at the service and we observed very positive and caring relationships between people using the service and the staff who cared for them. Staff worked hard to promote people's right to make their own decisions about their care, where possible, and respected the choices they made. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.
The service was exceptionally well-led. The provider and the registered manager were clear about their expectations relating to how the service should be provided and led by example. The registered manager demonstrated how their open and listening management style and robust quality assurance systems had sustained continual development and improvement at the service. They were supported by the provider who was passionate about providing people with high quality care and supported staff fully to enable them to deliver this. The provider and registered manager had developed positive links with the community which benefited those living in the service.
People had many opportunities to participate in a variety of social and recreational activities and occasions. These included activities important to people and reflected their interests and hobbies. People received positive end of life care where they were fully supported in how they received care and support at the end of their life. Effective, personalised steps were taken to ensure people who lacked capacity to make decisions received care that was in their best interest and met their needs.
People told us they felt safe. Systems were in place to ensure that risks to their health and safety were reduced. We found that sufficient staff were deployed to safely meet people's needs. Staff had received training to ensure they had detailed knowledge to protect people from the risk of avoidable harm or abuse. People were protected from the risk of an acquired health infection, as there was appropriate infection
control and prevention policies and procedures in place.
Rating at last inspection; The last rating for this service was Good (published 15 February 2017).
Why we inspected: This was a planned inspection based on the previous rating.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Fewcott House provides nursing care for up to 40 people over the age of 65. At the time of our inspection 34 people were living at Fewcott House. Some people were living with conditions such as dementia or Huntingdon's Chorea or had a learning disability.
There was not a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The service was being managed by a manager who had applied for registration with the Care Quality Commission.
We had previously carried out an unannounced comprehensive inspection of this service on 31 May 2016 and identified a number of areas where improvements were needed. We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations 2009. This was because there had been a failure to protect people from the risks of abuse and to report when people had been put at risk. Safe recruitment procedures were not followed when recruiting staff. People had not been protected by the safe management of medicines. Staff had not completed the necessary training to ensure they had the skills to undertake their roles and responsibilities effectively. Staff had not received regular one to one meetings with their managers to ensure they were supported and were being monitored to ensure they undertook their roles correctly. People did not always have appropriate assessments in place when they lacked capacity to make decisions. Policies were not always up to date and accurate with current best practice and terminology. Records had not been kept as required to monitor aspects of people’s health. The service was rated as inadequate in the well led domain.
We undertook this inspection to check the service had made the required improvements from the inspection on 31 May 2016. We found considerable improvements had been made in all areas of the service. The provider had ensured safe recruitment procedures were followed. The service had implemented a new care planning system and electronic system of managing medicines. This had improved the systems and processes to allow an effective overview of people’s care needs and their medication. Appropriate risk assessments were in place to manage any identified risks and people in the service and relatives we spoke with felt the service was safe.
Staff had completed the necessary training to ensure they had the skills to undertake their roles and responsibilities effectively. Staff had received regular one to one meetings with their managers to ensure they were supported and were being monitored to ensure they undertook their roles correctly.
People had appropriate assessments in place when they lacked capacity to make decisions.
People in the service and their relatives described the service as caring. We saw many examples of staff providing a warm and kind approach to those they supported on the day of the inspection. People were treated with dignity and respect and appropriate privacy. People were encouraged to maintain their independence skills.
Care plans had been implemented into an electronic system where staff were able to input the care given immediately and this meant the information was accurately recorded and where concerns were noted these were flagged up so that prompt action could be taken if needed.
Staff knew the people they were supporting well and activities were being arranged and future activities considered in line with people’s interests.
There had been no complaints since the last inspection but the service had systems in place to manage these. People and their relatives were confident they could discuss any concerns without delay.
The service was well managed. The manager had made significant improvements to the service and staff spoke highly of their effectiveness and support. Policies had been updated where needed and were in line with current best practice and terminology. We saw these were circulated to staff to ensure they understood their relevance to their roles.
The service had implemented effective quality assurance systems. Information had been audited to ensure it was current and changes had been made where necessary to reflect the audit findings.
The service had been implementing a weekly action plan since the last inspection to evidence action taken to address the improvements needed. This had been received as required and we saw that the actions in the plan had been addressed during this inspection.
Relevant notifications had been made for all notifiable events to the Care Quality Commission.
The service provides nursing care for up to 40 people over the age of 65. At the time of our inspection 33 people were living at Fewcott House. Some people were living with dementia or had a learning disability.
Prior to this inspection we had received concerns that people were not always being treated with dignity and respect and were not being protected against the risk of abuse.
We had previously carried out an unannounced comprehensive inspection of this service on 1 June 2015 and identified a number of areas where improvements were needed to ensure that people were receiving care that was safe, effective, caring, responsive and well-led. We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because people had not always been treated with dignity and respect. Medicines had not been stored safely and staff had not received appropriate training or development. We also found that there were not effective systems in place to maintain records in relation to the management of the service to ensure safety and quality.
We undertook this inspection to follow up the concerns that had been raised prior to our inspection and to check the service had made the required improvements from the inspection on 1 June 2015. Not all of the improvements had been made.
This inspection was the seventh inspection of Fewcott House since February 2013. At each inspection we saw changes had been made to bring the service up to the required standard but also highlighted further areas for improvement. There has not been a stable management team at the home during this time, which meant the improvements had not all been sustained or embedded in practice. A new manager was in post because the registered manager had left in September 2015, however, they had not yet registered with the Care Quality Commission. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.
At this inspection we found there was a failure to protect people from the risks of abuse. The provider failed to recognise and report when people had been put at risk or had been subject to harmful situations. There had been unacceptable delays in the provision of information to the local authority safeguarding team and the Care Quality Commission.
The provider had not ensured safe recruitment procedures were followed when recruiting the new manager and other staff.
People had not been protected by the safe management of medicines. Procedures regarding ordering and stock control of medicines had not been followed by staff.
Appropriate risk assessments were in place to manage any identified risks. People in the service and relatives we spoke with felt the service was safe.
Staff had not completed the necessary training to ensure they had the skills to undertake their roles and responsibilities effectively. Lack of training had been identified at the last inspection but we found not all staff had completed this training at this inspection.
Staff had not received regular one to one meetings with their managers to ensure they were supported and were being monitored to ensure they undertook their roles correctly.
People did not always have appropriate assessments in place when they lacked capacity to make decisions.
People in the service and their relatives described the service as caring. We saw many examples of staff providing a warm and kind approach to those they supported on the day of the inspection. People were treated with dignity and respect and appropriate privacy. People were encouraged to maintain their independence skills.
Care plans were in place but the guidance in them was not always being followed to ensure people were receiving the correct treatment and support.
Staff knew the people they were supporting well and activities were being arranged and future activities considered in line with people’s interests.
Complaints were adequately managed by the service.
The service was not well managed. Management had failed to ensure that they followed the correct procedures when concerns had been made known to them. They had failed to notify the relevant organisations, such as the local safeguarding team and the Care Quality Commission (CQC) of serious incidents as required. When recruiting staff, management had not ensured that all the steps required by law had been followed before people started working in the service.
Policies were not always updated to reflect current best practice and terminology. Not all policies and procedures had been adhered to.
Information had not been analysed or evaluated to improve the service. Records had not been kept as required to monitor aspects of people’s health.
An action plan after the last inspection had been submitted but had not addressed the issues raised at the inspection. Some actions from this plan were still outstanding in this inspection.
Notifications had not been made for all required events to the Care Quality Commission.
We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Regulation 18 Care Quality Commission (Registration) Regulations 2009. We also made one recommendation in respect of the Mental Capacity Act 2005.
Following this inspection the provider was asked to submit weekly action plans to show what they were doing to address the findings from the inspection. Since that time, we have received these weekly updates as requested.
We visited Fewcott House Nursing home on 1 June 2015 It was an unannounced inspection. We previously inspected the service on 7 June 2014. The service was meeting the requirements of the regulations at that time.
The service provides nursing care for up to 40 people over the age of 65. At the time of our inspection 33 people were living there. Some people were living with dementia or had a learning disability.
There was a registered manager at the service. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.
People and their relatives were complimentary about the registered manager and provider. The registered manager demonstrated a personalised approach and a commitment to providing good quality care. Since being in post they had made many changes and improvements for people living at the service. However, they required support and development to make further changes to bring the service up to the required standard. Systems were not always effective in monitoring the quality of the service and ensuring people were protected from harm. Some documents relating to the management of the service needed reviewing and updating. People felt able to raise any concerns with the management team and were confident they would be addressed promptly.
Medicines were not always stored in a safe way. Action was not taken to ensure medicines were always stored at the correct temperature and one medicine that could present a risk to people if not taken in the right way was stored within reach of people. People received their medicines as prescribed.
People felt safe and their relatives told us they did not have concerns about people’s safety. People were protected from abuse. There were enough care staff to meet people’s needs although a shortage of housekeeping staff meant communal lounge areas were not as clean as people would like them to be.
People told us they liked living at the home and were complimentary about staff. People felt they were treated in a caring, patient and friendly way. Whilst we observed many positive and caring interactions we also observed some interactions that meant people were not always supported in a way that was respectful. Staff did not always engage with people unless they were providing a care task. A lack of activity meant some people were bored and lacked stimulation. We have made a recommendation about the provision of activities at the service.
People were offered choice and their preferences were respected. People liked the food and were supported to maintain a healthy diet. People were referred for specialist advice as required.
Staff felt supported. However, gaps in training for both new and existing staff meant they were not always supported to improve the quality of care they delivered through training.
Although risks to people’s health were identified and plans were in place to minimise the risks, there was no systems to identify whether pressure relieving mattresses were set correctly. We identified one person with a mattress that was set too high for their weight which may mean they were not protected from developing a pressure ulcer. One person had behaviour that could be described as challenging. Although staff knew the person and understood their needs this information was not recorded in their care record.
The provider, registered manager and staff understood their responsibilities under the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS); these provide legal safeguards for people who may be unable to make their own decisions or who may be deprived of their liberty for their own safety.
We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see the action we took and what action we told the provider to take at the back of the full version of the report.
Fewcott House is a residential and nursing home providing nursing care and accommodation for up to 40 people. At the time of our inspection there were 29 people living at the home. The home cares for older people, some of whom are living with dementia or may have learning disabilities.
The home did not have a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service and shares the legal responsibility for meeting the requirements of the law with the provider. Prior to the inspection the manager had not been working in a supernumerary capacity, and worked mainly as a nurse. The management had taken appropriate action following concerns raised at previous inspections regarding monitoring the quality of the home.
People told us they felt safe at the service and they were protected from abuse. Staff had knowledge of safeguarding and knew what to do if concerns were raised. We found the service was meeting the requirements of the Deprivation of Liberty Safeguards.
People felt that they were protected from risks associated with their care because staff followed appropriate procedures to protect them. People’s medicines were administered safely and the service had appropriate systems in place to ensure that medicines were stored securely.
People told us they were involved in decisions about the care and support they received and people were encouraged to express their views about their care. People received support and treatment that enabled them to stay as independent as possible.
People’s care plans reflected their needs, choices and preferences and people benefitted from effective care and treatment as staff had the skills and knowledge to meet people’s assessed needs and choices.
People were assessed to identify any risks associated with food and drinks and were involved in discussions about their nutritional needs. People also saw dietary and nutritional specialists when needed.
The service was caring because staff treated people with kindness and compassion and respected their dignity. Staff used people’s preferred names throughout our visit and people were comfortable with this. People’s preferred names and titles were recorded in their care assessments. However staff did not always take the time to talk with people. We observed that staff often moved around the home but did not always acknowledge people and we saw people were often withdrawn or sleeping and one person became agitated when staff members did not acknowledge them.
Not all of the people who used the service had access to activities that appealed to them. However, people who spent time in their own rooms were protected from the risk of social isolation as staff and people told us they spent time talking to them.
People and their representatives were encouraged to make their views known about their care, treatment and support. People had their needs assessed and support was sought where necessary. The manager and provider planned to develop good practice of care within the home. Staff told us they contributed to improving the practice of staff. Staff felt motivated, well supported and trained.
During this inspection we saw the provider had implemented processes that had led to improvements in the service. We found that people's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. Staff we spoke with told us they felt supported and had received training and supervision. One told us 'I feel supported, it's good since [the manager] came. Everything is more organised'. One person told us 'it's my home and I'm happy here'.
During our inspection we looked at the provider's quality assurance and risk management systems. At our last inspection we identified that the provider did not have an effective system to regularly assess and monitor the quality of the service that people received. We also found that the provider did not have an effective system to identify, assess and manage risks relating to the health, safety and welfare of people who used the service. At this inspection we found that the provider had introduced some systems to evaluate the quality of the service and to identify, assess and manage risks. However, we found that some of these systems were not being effectively operated. We also found that the provider did not have comprehensive oversight of the risks affecting all aspects of the service and therefore the approach to managing risks was not coordinated and structured.
Records relevant to the management of the service were not always accurate and fit for purpose. For example, records relating to the supervision of staff. Records were not always kept securely and could not always be located promptly or easily.
We found that people's needs had been assessed, but that care and treatment had not always been planned and delivered on the basis of the assessments. For example, where people had been assessed as having a very high risk of developing pressure areas it was not always clear what actions staff should take and were taking to reduce and manage the risk.
We found that there were enough suitably qualified and experienced staff on duty to meet the needs of the people. However, we found that staff were not always appropriately supported to carry out their role. For example, nursing staff had not received regular supervision and appraisal.
The provider did not have suitable systems in place to assess and monitor the quality of the service that people received. People were sometimes exposed to care that was not always safe due to a lack of quality monitoring.
We found that notifications to CQC of deaths of people who used the service had not always been made.
We found that care plans and assessments contained detailed information about people's preferences and choices. One person told us "I can choose when I go to bed and when I want to get up, I choose what to wear".
We found that people were treated with care and respect and received care in a way they preferred. One relative told us 'the staff here are wonderful, they cannot do enough for you'. A person using the service told us 'the staff are very caring'.
Staff were supported and trained to enable them to deliver good care One care worker told us " I have supervision every two months, I find it really helpful with my role.'
We found the service had quality assurance methods in place, which involved people, to make sure they maintained and enhanced the quality of the service they were providing.
People we spoke to were happy with the service they received and knew how to complain if they had a concern. One person we spoke with told us 'I could complain if I needed to but there is nothing to complain about here".
People's healthcare needs had been assessed and regularly reviewed. People using the service had access to other professionals to ensure that their healthcare needs could be met.
Whilst the majority of staff were observed to have kind and respectful manner, there was one occasion when a person's needs were not met in a person-centred way. The manager subsequently confirmed that action had been taken to prevent any reoccurrence.
Safeguarding was taken very seriously and staff were aware of their responsibilities. Management took appropriate action to ensure the wellbeing of people using the service.
Improvements had been made to the environment and the programme of refurbishment was continuing. One relative commented that 'standards are improving constantly'.
Dependency measures were used to identify the number of staff needed on duty. Additional staff were being recruited. Staff groups had clearly defined duties to ensure that care was not compromised.
The manager and CEO monitored the care and service being provided. A relative said that their opinions were sought and valued. Plans to provide appropriate formats to obtain the views of people using the service would make the formal quality assurance process more inclusive.