The Fields Care Home

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture. At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant the management and leadership was inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care.

The provider was in breach of legal regulation relating to good governance.

This service scored 57 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities.

People told us they felt comfortable living at the service and described it as warm, welcoming and homely. Staff provided care and support that reflected the provider's aim of delivering personalised care within a friendly environment. Staff demonstrated an understanding of the importance of treating people with dignity, respecting their choices, and promoting their independence wherever possible. Throughout the inspection, interactions between staff and people were positive and respectful, and the atmosphere within the service was calm and welcoming. People appeared relaxed in the presence of staff, indicating they felt comfortable and supported in their surroundings.
 

Not all leaders demonstrated a clear understanding of the context in which care was delivered. The provider and manager had not ensured consistent oversight of the running of the service, which led to breaches of legal regulations in some areas. Governance systems were not always effective, and audits had failed to identify issues with care records and aspects of the premises in relation to window safety.

However, the manager was dedicated to the staff team and the people using the service. They were receptive to our feedback and committed to making improvements. People and staff spoke positively about the manager, describing them as approachable and supportive. A staff member told us, “I talk to the manager most days and can talk about any problems I have.” A person told us, “I'm definitely safe. The staff are great.” If I have any concerns, I talk to [managers name]. She told me that her door is always open and it is. I go downstairs and sit in the office with her and she listens.”

There was an evident culture of kindness and compassion within the service, despite the governance challenges.
 

People were not always given the opportunity to speak up and have their voice heard.

The systems and processes in place were not sufficiently robust to support the wellbeing of staff or promote a culture in which people felt confident to raise concerns and provide feedback. Whilst the service had a whistleblowing policy in place, arrangements for staff oversight and engagement were not always effective. Staff supervisions had not been undertaken consistently, and team meetings were infrequent and poorly attended, which reduced opportunities for staff to discuss concerns, receive updates, and contribute to service development.
 

The provider valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who worked for them.

All staff completed equality and diversity training and understood the importance of treating colleagues and people with respect.

There were no reports of bullying or discrimination, staff said they felt valued and supported.
 

The provider did not have clear responsibilities, roles, systems of accountability and good governance. They did not act on the best information about risk, performance and outcomes, or share this securely with others when appropriate.

The provider and manager had not maintained effective oversight of the service, which had contributed to breaches of legal regulations. Governance systems and quality assurance processes were not sufficiently robust to identify and address concerns in a timely manner. Audits had failed to identify a number of significant issues, including environmental risks, inaccuracies and omissions within care records, overdue care plan reviews, and gaps in staff training.

The quality and completeness of care records were inconsistent. Some care plans had not been reviewed for several months, increasing the risk that staff did not have access to accurate and up-to-date information to support people safely. In addition, arrangements for supporting and monitoring staff performance were not consistently implemented, with supervisions and appraisals not taking place regularly. Systems for seeking and acting on feedback were also limited, and people were not routinely provided with formal opportunities to express their views.

The manager had been in post for approximately three years but had not completed the registration process with the Care Quality Commission (CQC). We discussed this during the inspection, and the manager told us they believed registration was not required due to the arrangements that were in place when the service was originally established as a partnership. This understanding was incorrect. Following our discussion, the manager took immediate action to submit an application through the appropriate channels.

Despite these concerns, the manager demonstrated a commitment to improving outcomes for people using the service. They were open and receptive to feedback throughout the inspection and responded promptly when issues were identified. Action had already commenced to review and update care documentation, strengthen oversight arrangements, and address the concerns highlighted during the inspection.
 

The provider understood their duty to collaborate and work in partnership, so services worked seamlessly for people. They shared information and learning with partners and collaborated for improvement.

Staff worked in partnership with community agencies and made appropriate referrals to ensure people received any specialist support they needed. Community healthcare professionals who visited the service told us people were happy and well cared for. They told us management and staff were friendly and approachable, and the quality of care provided was good.
 

The provider did not always focus on continuous learning, innovation and improvement across the organisation and local system. They did not always encourage creative ways of delivering equality of experience, outcome and quality of life for people. They did not always actively contribute to safe, effective practice and research.

Whilst systems were in place to record and monitor accidents, incidents, audits and feedback, these were not sufficiently robust to demonstrate appropriate action had been taken in response to identified issues or that learning had been effectively embedded to reduce the risk of recurrence. Records did not always clearly evidence how concerns had been reviewed, what actions had been implemented, or how improvements had been sustained.

We discussed this with the manager during the inspection. They were receptive to feedback and responded positively to the concerns raised, taking prompt action to strengthen systems and processes where shortfalls were identified. The manager demonstrated a commitment to learning from the inspection findings and a willingness to drive continuous improvement to enhance the quality and safety of the service.