Fletcher House

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

People spoken with said they felt safe at Fletcher House and with the staff who supported them in a kind and caring manner. Staff knew how to recognise and report abuse and told us they had received safeguarding training. Improvements were needed to ensure care plans and risk assessments had sufficient information and guidance for staff. The provider had identified this and were working to improve care records. Staff were working with people and relatives to be more involved in developing and reviewing their care plans. Staff had a person centred approach to medicines. There were policies and procedures in place covering all aspects of medicines optimisation. Care plans did not always contain adequate detail to enable staff to manage people’s medicines associated risks, however when we spoke to staff they were aware of these risks. We received mixed feedback about staffing levels, although people felt this was improving. On the day of our visit, we observed there were enough staff available to respond to people’s needs. There was a safe recruitment process in place. Agency staff had a range of checks in place to ensure they had the right skills to undertake their role. Staff had not always received the training required. The provider had identified this as an area for improvement and had an action plan in place to address the shortfall. Staff said they felt supported and gave positive feedback regarding management. People and relatives told us the home was clean and staff wore personal protective equipment (PPE). All areas of the home looked clean and smelt fresh. Staff told us they had received infection control training. Mental capacity assessments, best interest decisions and deprivation of liberty safeguards were not always in place where needed. The provider had identified this and were in the process of completing these. There were processes in place to learn from accidents, incidents, or safeguarding concerns.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Evidence of learning was provided to ensure peoples experience was improved. We observed staff discussing with a person who had fallen, actions that could be taken to minimise the risk of re-occurrence.

There were processes in place to learn from any accidents, incidents, or safeguarding concerns. These were reviewed, with learning shared at flash meetings, handovers and through messages on the provider's electronic care system. A process was also in place to share learning across the organisation. During the assessment, we shared concerns raised by people with the manager. These were acted upon during the assessment.

The Nominated Individual told us the home had been reviewed, with areas of improvements identified. An action plan had been developed and reviewed weekly to ensure improvements. The area manager told us the home manager and quality support manager reviewed events, accidents, incidents, and safeguarding concerns to identify any learning.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

People were observed to be supported by kind and caring staff.

There was a process in place to report and record safeguarding concerns within the service. This showed the provider had a system to record, report and learn to prevent concerns from happening again.

All people spoken with said they felt safe at Fletcher House and with the staff who supported them. One person said their routines helped them to feel safe. One person said they felt safe at the home but felt that on one occasion staff were ‘a bit clumsy’. The manager advised this would be investigated. People and relatives told us the manager was approachable and would deal with any concerns raised. Comments included, “There was an issue, we noticed and told staff, the manager was brilliant. They are brilliant here”, “I would speak to the manager if I have any concerns, she is very approachable, she’s a very nice person, the best thing is that I feel safe” and “The manager will do anything, cook meals, cleaning (even in the evening when she should have gone home), she’s brilliant, just the ticket, she’s lovely.”

Staff knew how to recognise and report abuse. They said if they reported any concerns, they were confident that action would be taken. All staff, including ancillary staff, said they had received safeguarding training. One member of staff said, “We all do safeguarding training. Would go to [management team]. They would definitely do something about it.” Another staff member, who had worked at the home for a number of years told us they had never seen or heard anything they were not comfortable with. They said they could always go to someone at the home to report and knew how to contact head office if they still had concerns. The deputy manager understood their responsibilities under the Mental Capacity Act 2005 (MCA). They gave an example of an MCA they had completed. The deputy manager told us that the relevant mental capacity assessments, best interest decisions and deprivation of liberty safeguards were not always in place where needed. The provider had identified this as an area for improvement and had an action plan in place to address.

Staff knew about identified risks to people. One member of staff told us information about risk was always passed on at handover, and in messages received within the system.

Care plans were in place, and where people were at risk of harm assessments were carried out. Some of the care plans and risk assessments required additional information to ensure they provided sufficient information and guidance for staff. The provider had identified this as an area for improvement and had an action plan in place to address this shortfall.

Some people told us they were not aware of their care plans. We asked the manager about this. They told us they have recently brought in a system called ‘resident of the day’, where staff sit with the resident and go through their care plan. The manager advised that they were new in post and they had also asked residents and family if they would like a care plan review with them. These were booked in the coming weeks. People were supported to move freely around the home and there did not seem to be any unnecessary restrictions on people. People’s relatives confirmed risks were discussed with them and relevant information was shared. One relative told us when their loved one fell over they “Had done all what they had to do” and when their loved one was unwell they “Had done all the right things.” People were encouraged to take positive risks. One person told us, “The staff are friendly and helpful, they give me the opportunity to do what I want to do, if I mention anything, someone might be able to organise it, as far as I am concerned I don’t think anything needs to be improved.”

Our observations of staff supporting people were positive, for example, when supporting people in line with their eating and drinking risk assessment.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

We observed there were enough staff available to respond to people’s needs.

Most staff spoken with felt staffing levels had improved, were happy within their roles and felt supported. Comments included, “At one time we were so short, it’s now a level we can manage, sometimes it’s not easy, but better than what it was” and “Generally I believe there are enough.” Some people raised concerns regarding the length of time staff took to answer call bells, particularly in the evening. We asked the manager about this, who advised the call bells were audited monthly and this would pick up any trends. This information was shared with the staff team in staff meetings, shared learning and flash meetings. The audit also looked at whether staff were able to answer call bells in a timely manner and if not, what needed to be put in place to support both the person and staff.

Staff had not always received the training required. The provider had identified this as an area for improvement and had an action plan in place to address. Staff rotas were based on a dependency tool. The management team advised these were currently being updated. There was a safe recruitment process in place. Staff files viewed evidenced safe recruitment checks had been completed. Agency staff were being used within the service. There were a range of checks in place to ensure agency staff had the right skills to undertake their role. There was a process in place to share essential information and ensure they were kept up to date with people’s needs.

Some people told us they felt there were enough staff, although other people raised concerns regarding the length of time staff took to answer call bells, particularly in the evening. Comments included, “We have the same staff, not many changes”, “I have not noticed any shortage of staff, usually there are the same people around, not a lot of agency”, “There is usually someone there when you want them, staffing is not too bad in the daytime, nighttime and evenings you can wait up to half an hour, the staff know you, they are friendly”, “I feel safe, there is always someone to come eventually, but they don’t always take notice of the bell”, and “I feel safe, there is enough staff.” The manager was working with people to ensure they had their preferred gender of staff to support them with personal care. They told us people were asked, and their preference added to their care plan with staff then allocated accordingly.

All areas of the home looked clean and smelt fresh. Pedal bins were observed to be in place, including bins for clinical waste. PPE was visible within bathrooms, as well as posters to encourage hand washing. Staff were observed washing their hands between tasks.

Staff told us PPE and all cleaning materials needed were available. They confirmed they had received infection control training.

There was a process in place to ensure effective cleaning of the home. Cleaning schedules were viewed that covered numerous areas of the home.

People and relatives told us the home was clean and staff wore personal protective equipment (PPE). Comments included, “The place is clean, the food is not bad either, there is not a lot that I can complain about”, “They always wear gloves, and change them every time”, “They wear gloves for personal care and other times”. A relative told us, “It is beautiful, nice clean and tidy, [relative] is well looked after.”

Staff used an electronic medicines system [e-MAR] to record administration of people's medicines. Staff knew people well and were able to identify those people with specific health conditions such as diabetes and Parkinsons. Staff ensured people’s individual needs and preferences were accounted for.

Staff worked closely with the local GP practices, pharmacy and district nurses to ensure medicine issues, were resolved in a timely manner. Staff received annual medicine training and an annual medicine competency assessment to ensure people received their medicines safely. Staff knew people living in the home well and knew which people were on high risk medicines and how to manage those risks. For example they were aware that anticoagulants caused and increased risk of bleeding.

The provider had clear policies and procedures covering all aspects of medicines optimisation including controlled drugs. We saw staff were following the procedures. Medicines risk assessments in care plans did not contain adequate detail to support staff to manage people’s health conditions. For example there was no detail about bleeding risk in care plans for people taking anticoagulant medicines. However when we spoke to staff they were aware of these risks. Detailed guidance specific to each person on how to administer medicines to be taken as and when required (PRN) was available to staff. Staff carried out monthly medicines audits and an action plan was in place to address identified issues.