Fitzwarren House

Updated 7 December 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on the 15 and 16 October 2018 and was unannounced. The team consisted of an inspector, a specialist advisor who is a nurse with knowledge and experience of dementia and an expert by experience. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Before the inspection, the provider completed a Provider Information Return. This is a form the provider completes to give some key information about the service, what the service does well and improvements they plan to make. We checked the information we held about the service and the provider including statutory notifications. Statutory notifications include information about important events which the provider is required to send us.

We sought information about the quality of service from the local authority and other health and social care professionals. We received two responses. We spoke with 22 people and nine relatives about what it was like to live at the home. We spent time with people and saw the care and support being provided in communal areas which included how people were assisted at lunchtime. We spoke with 16 members of staff including the registered manager, regional manager, care manager, senior care assistant, housekeeping staff, kitchen staff, gardener, hospitality manager, the home chaplain, administrator and administration manager. We looked at 14 people's care records and associated documents including medicine records.

We checked whether staff were recruited safely, and trained to provide care and support appropriate to each person's needs. We looked at the results of the provider and registered manager's quality monitoring systems to see what actions were taken and planned to continually improve the quality of care and people's experiences. We observed the lunchtime experience for people, and the activities provided to people. We also observed medicines administration.

Updated 7 December 2018

Fitzwarren House is a care home with nursing and provides a service for up to 64 people, some of whom may be living with dementia. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. On the days of our inspection there were 62 people living at the service. Bedrooms are spread over two floors with ensuite bathrooms. There are also several communal areas and a private garden.

The service had a registered manager in place. 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 inspection took place on the 15 and 16 of October 2018 and was unannounced.

At the last inspection, we rated Fitzwarren House as Good overall, with the caring domain being rated as Outstanding. At this inspection we found the provider continued to be rated as Good in the safe, effective and well led domains. The service has remained Outstanding in the caring domain. We found the provider had made improvements in the responsive domain and has been rated Outstanding in this domain. The service is now rated as Outstanding overall.

Staff were highly skilled and had a natural aptitude to give reassurance and comfort to people living in the home. They treated people with the utmost dignity and respect when helping them with daily living tasks. There was an excellent understanding of seeing each person as an individual, with their own specific needs.

The provider's ethos focused around inclusion, diversity, equality and upholding people's human rights. This included encouraging people to have aspirations and goals, and supporting them to achieve these.

Staff were a highly motivated team who demonstrated their commitment to providing high quality, individualised care to meet people's preferences and needs.

The provider had gone to great lengths to ensure people had access to a wide range of meaningful activities. This included trips out to places that people said they wanted to visit. There was a very strong emphasis on the provision of activities that were meaningful to the people living in the home. This meant that people were supported to pursue interests and hobbies that were important to them, as well as being given the opportunity to develop new hobbies and interests.

People were instrumental in deciding how they wanted to be cared for, including conducting their own care plan reviews.

The registered manager was extremely passionate about delivering very high standards of care to people using the service. They had established excellent links within the local community for the benefit of people living at Fitzwarren House, and worked collaboratively with other professionals. People were very much part of their local community.

Without exception, people and their relatives gave consistent, positive feedback about the service. This included the approach of staff, the food, the range of social and leisure opportunities that were on offer to them and the accommodation.

Effective systems were in place to manage people's medicines so that they received them safely and on time. People were supported to access health care services and to maintain a healthy lifestyle. People's needs had been assessed and their support requirements and preferences were recorded in detail to provide staff with the guidance they needed to support people.

The provider's responsiveness in regard to people's care and support needs had resulted in a reduction in incidents and accidents for some people who lived at the home.

The provider had explored innovative ways of meeting people's emotional needs and wellbeing, such as employing a music therapist. This had greatly benefited people living at the home.

People told us they felt safe at the service and were well supported by staff who were caring and friendly. Staff told us they were aware of how to report any concerns and were up to date with training on how to protect vulnerable adults from abuse.

The provider had effective recruitment arrangements to ensure staff were suitable for their role before they commenced working at the home. The registered manager made sure there were enough suitably skilled, qualified and experienced staff to support people safely.

The registered manager understood their responsibilities and worked with people who used the service, relatives, staff and the provider to improve the quality and safety of care that was provided. Quality assurance procedures and a programme of audits were effective in driving continual improvements to the quality of service.

Further information is in the detailed findings below.