Archived: Fieldside Care Limited t/a Fieldside Care Home

Fieldside Care Home provides care and accommodation for up to 34 older people, some living with dementia in one adapted building. At the time of our inspection there were 31 people receiving care and support.

People’s experience of using this service

People were not always safe. The provider had not ensured risks to people associated with infection control and environmental hazards were identified and mitigated. We discussed our concerns with the environment and infection control with the registered manager and nominated individual during the inspection and they have taken action to resolve some of the immediate issues we identified.

Despite the issues with safety we found people and their relatives were very positive about the care and support they received. Comments included, “I honestly cannot speak highly enough of the registered manager and the team, they are very kind and caring” and “The [registered] manager and staff are extremely good at what they do I am just glad we found somewhere like Fieldside.”

The provider had made improvements to the quality of care plans and risk assessments. Medicines continued to be managed safely.

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 were also positive about the support they received from the provider. Managers and staff worked in partnership with a range of health and social care professionals to plan and deliver care and support.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

At the last inspection, the service was rated as Requires Improvement (Report published 20 April 2021) and there were breaches of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations.

Why we inspected

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led. For those key questions not inspected, we used the ratings awarded at the last comprehensive inspection to calculate the overall rating. The overall rating for the service has remained ‘Requires Improvement’ based on the findings of this inspection.

We have found evidence that the provider needs to make further improvements. Please see the Safe and Well-led sections of this full report. The provider had taken some action during the inspection to mitigate risks and continued to liaise with the inspector after the inspection to advise of further improvements scheduled.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Fieldside Care Limited t/a Fieldside Care Home on our website at www.cqc.org.uk.

Enforcement:

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.

We have identified continued breaches in relation to safety and good governance processes at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up:

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. If we receive any concerning information we may return to inspect.

Fieldside Care Home provides care and accommodation for up to 34 older people, some people living with dementia. At the time of our inspection there were 30 people receiving care and support.

People’s experience of using this service

People were not always safe. The provider had not ensured risks to people were always documented and mitigated. Risk assessments and care plans contained conflicting information which could potentially lead to people being exposed to harm.

Quality assurance processes were not always effective in identifying and addressing the shortfalls in care plans and risk assessments we found. We discussed our concerns with risk management and quality assurance systems with the registered manager and nominated individual during the inspection and they have taken action to resolve some of the immediate issues we identified.

People’s medicines were managed safely by trained staff. The provider had responded to the risks associated with the Covid-19 pandemic. Infection control procedures had been increased in line with current guidelines to reduce the risk of infections being brought into the service. There were regular audits and maintenance checks to ensure safety issues were resolved and hygiene levels were maintained.

We received positive feedback from people about the care they received and the management of the service. People told us staff were kind and caring and the service was a pleasant place to live. Staff were positive about how the provider had supported them during the pandemic. The provider worked in partnership with a range of health and social care professionals.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

At the last inspection, the service was rated as requires Good (Report published 25 June 2019). The rating has deteriorated to requires improvement.

Why we inspected

We undertook this focused inspection to follow-up on specific concerns that we received about the risk management processes within the service. A decision was made to examine those risks. During the inspection we widened the scope to include the key questions of safe and well-led. No areas of concern were identified in the other key questions. We therefore did not inspect them.

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 coronavirus and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. Please see the Safe and Well-led sections of this full report. The provider had taken some action during the inspection to mitigate risks and continued to liaise with the inspector after the inspection to advise of further improvements scheduled.

Enforcement:

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.

We have identified breaches in relation to risk assessments and quality assurance processes at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up:

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. If we receive any concerning information we may return to inspect.

Fieldside Care Home provides care and accommodation for older people and people living with dementia. At the time of our inspection there were 34 people receiving care and support.

People’s experience of using this service and what we found

The provider had made improvements to the environment based on recommendations from the previous inspection. However, there were areas of the service that needed to be further improved to meet the needs of people with dementia.

Meal choices were displayed on a notice board but not in a way that most people could easily understand. This meant some people were potentially unaware that there were a range of options available. We have recommended that the service makes changes to way they display meal choices to ensure people are being supported to make informed choices.

People and their relatives told us they felt safe using the service. The provider had made improvements in how they manage risks to people and had introduced a falls champion to monitor the risk of falls. The provider supported people to take their medicines safely. There were adequate infection control processes in place to reduce the risk of harm.

The provider met people's nutritional and hydration needs and supported them to have a balanced diet. People were supported with their physical and mental health needs and care records contained good information on these. People were supported to attend all necessary healthcare appointments to ensure their healthcare needs were met.

People told us the registered manager and staff were kind and caring and knew people well. People were treated with dignity and respect.

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.

There were quality assurance systems in place to ensure care and support were kept to a good standard. The service worked with a range of healthcare and multidisciplinary professionals to achieve good outcomes for people.

Why we inspected

This was a planned inspection based on the previous rating.

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

Fieldside Care Home provides care and support for up to 34 older people and people living with dementia. The building includes a large lounge and dining area, garden with laundry facilities and a quiet lounge on the ground floor. 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.

The service had a registered manager. 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.

We carried out this inspection, in part, as there had been a high number of falls in the service. The provider was working with the local authority to improve falls management measures, but falls prevention plans lacked detail on what actions staff should take to protect people from falls. Safer moving and handling measures were not always followed, and some staff lacked training in this area. There was an extensive training programme in place for care workers, including specialist training on dementia awareness. However, records of this were not well maintained, and sometimes care workers were overdue for essential training.

The provider worked closely with local services to deliver improvements and try out new ways of working. We found that care plans were not designed in a way people could follow and were not always clear about how to support people. The provider had recognised this and was working with the local health service to develop new plans. Plans sometimes lacked detail about people’s life stories and needs and preferences, but people received support from a stable staff team who knew them well. People told us they were treated with dignity and respect and were listened to. We observed positive interactions from caring staff.

The building was kept clean and had a pleasant environment, but aspects of its design did not meet the needs of people living with dementia or limited mobility. We have made a recommendation about this. At times confidential information could be viewed by people using the service or visitors to the service. New laundry and office facilities were being developed. The provider protected people’s rights by obtaining consent to care and assessing people’s capacity to make decisions. People received good support to eat and drink well and maintain good health.

Staffing levels were sufficient to meet people’s needs, and people told us they were satisfied with the number of staff available and the consistency of staff. We found most care workers had worked in the service for a long period of time and understood people’s needs and wishes well. There was an activities programme in place which was designed in a way to promote reminiscence and community involvement, but exercise programmes were not always effective.

Staff were working in line with safer recruitment measures. Staff understood how to safeguard people from abuse and their responsibilities to report this.

The provider worked with local health services to ensure people’s medicines were reviewed regularly and managed safely. Managers carried out regular checks to ensure that medicines procedures were followed. The provider carried out regular checks to ensure that premises were safe. People were confident about making complaints, and when these were made these were addressed and outcomes recorded. Managers held staff meetings in order to address particular concerns and promote good communication and teamwork.

We found breaches of regulations relating to safe care and staff training. You can see what action we told the provider to take at the back of the full version of this report.

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.

We last carried out an unannounced focused inspection on 25 September 2015 and we found one breach in regulation relating to medicine management.

At this inspection we found the service demonstrated good practice in the safe management of medicines. People received their medicines as prescribed. The service maintained records, stored and administered medicines safely.

People were protected against the risk of abuse and avoidable harm. Staff received on-going training in safeguarding which enabled them to recognise and report suspected abuse. The service developed risk assessments that identified known risks and gave staff guidance on how to mitigate those risks safely.

People received support from sufficient numbers of suitably vetted and trained staff. Staffing levels reflected people’s needs and were flexible to manage people’s changing needs. Staff were supported to undergo an induction process to enable them to understand their roles and responsibilities in their job. Staff received training in core mandatory training and told us, this aided them to deliver effective care to people. Staff reflected on their working practices through regular supervisions and appraisals.

People were not deprived of their liberty unlawfully. The registered manager and staff were aware of their responsibilities of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). The service sent DoLS requests to the local authority when they it was required to restrict people’s liberty. Records showed DoLS authorisations were monitored by the service to ensure new requests were submitted prior to previous ones expiring.

People were supported to access sufficient amounts of food and drink that met their dietary requirements and nutritional needs. The service liaised with nutritionists and other health care professionals to ensure menus reflected people’s needs. People told us they like the food they received and were offered choices.

The service had care plans in place that detailed people’s history, health, medical and physical needs and preferences. Care plans were reviewed regularly to reflect people’s changing needs and shared with staff to ensure the delivery of care coincided with the changes. Where possible people were encouraged to develop their care plans. Care plans detailed how staff should support people in line with their preferences.

Staff encouraged people to make decisions about their care and had their decisions respected. People had their dignity and respect maintained by staff that were kind, caring and compassionate. People’s confidentiality was maintained by staff and records were kept securely with only those with authorisation having access to them.

People were encouraged to participate in a wide range of activities of their choice. The service provided both in-house and community based activities for all, in line with their choices and preferences. Staff were aware of the importance of monitoring people’s presentation to ensure they were not socially isolated.

People were aware of how to raise concerns or complaints to the service. People told us they felt comfortable raising issues with staff or management. The service had processes in place to respond to complaints in a timely manner. The service carried out regular audits to drive improvements. Records showed daily, weekly, monthly and annual audits were undertaken and where issues were identified, action was taken in a timely manner. Quality assurance questionnaires were sent to people, their relatives and staff to question the service provision.

People, their relatives and staff spoke highly of the registered manager. The registered manager operated an open door policy whereby people were able to speak with them at a time of their choosing. People told us the registered manager was open and transparent and encouraged partnership working.

People's choices were respected and they were involved in discussions about their care. When people using the service did not have capacity the provider took appropriate steps to make decisions in their best interest.

There were processes in place for the safe management of medicines.

Staff had access to the training they needed and the manager made regular checks of their competence. The staff we spoke with said there was good communication among the staff team and that management were available if they had any concerns.

The provider took steps to maintain the quality of the service. People using the service and their relatives were asked for their views about the service.

People who used the service told us that they valued the quality of their care, the food, the premises and cleanliness at the home. They told us that that Fieldside was their home. One person we spoke with said, 'staff are good to you and treat you like a person, an individual'.

There were enough qualified, skilled and experienced staff to meet people's needs. People told us: 'The people who run this place are kind, gentle, lovely'; another person told us, 'staff have done things I really appreciated that they didn't have to'.

We found that, overall, people experienced care, treatment and support that met their needs and protected their rights. However, although there were arrangements in place to deal with some foreseeable emergencies, there was no clear written process for staff to follow in relation to accessing medical care for short respite placements, which meant that staff were not always supported to provide timely and appropriate care in every emergency.

We also found that although, overall, care records were fit for purpose, but some record keeping practice was not in line with the provider's policies, which meant there was a risk that information could not be located promptly when needed.