Field Farm House Residential Home

Field Farm House is a residential care home providing personal care to 48 people aged 65 and over at the time of the inspection. The service can support up to 69 people.

Field Farm House accommodates 69 people across four separate wings, each of which has separate adapted facilities providing care to people living with dementia.

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

People were cared for by staff who knew how to keep them safe and understood the risks to their health and wellbeing. Risks to people’s specific needs [such as people who chose to smoke cigarettes] were discussed with them and documented in care plans, for staff to refer to.

The provider had taken action to ensure the home was clean and odour free. Staff wore personal protective equipment minimising the risk of avoidable infections.

The provider was adhering to the government guidance on visiting so people could stay in contact with their relatives and friends.

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.

The last rating for this service was requires improvement (published 18 February 2020).

Why we inspected

The inspection was prompted in part by notification of a specific incident. Following which a person using the service died.This incident is subject to investigation. As a result, this inspection did not examine the circumstances of the incident.

The information CQC received about the incident indicated concerns about the management of people living at the home who smoked. This inspection examined those risks.

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. This included checking the provider was meeting COVID-19 vaccination requirements.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe section of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Field Farm House on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our reinspection programme. If we receive any concerning information we may inspect sooner.

Field Farm House is a residential care home providing personal and nursing care to 49 people aged 65 and over at the time of the inspection. The service can support up to 69 people.

Field Farm House accommodates 69 people across four separate wings, each of which has separate adapted facilities providing care to people living with dementia.

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

The provider and the registered manager had worked together to make improvements since our last inspection. Work was continuing to drive through further improvements identified at this inspection. The registered manager understood time was needed to embed improvements and sustain these.

Although improvements since our last inspection had been made in the environment to assist people living with dementia, further work was required to ensure activities were more suited to each person living with dementia.

People were cared for by staff who were kind. Staff were considerate towards people they cared for. People and relatives felt involved and supported in decision making. People's privacy was respected, and their dignity maintained, although there were still occasions where this could be improved especially at lunchtimes.

Staff practices to manage the risks associated with infection prevention and control had been strengthened. Staff told us they had access to enough equipment to support their practices in reducing the risks of cross infections and this was used.

People were cared for by staff who knew how to keep them safe and protect them from avoidable harm. People received their medicines regularly and systems were in place for the safe management and supply of medicines.

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.

Enough, knowledgeable staff were available to meet people's needs and the registered manager understood when more people move into the home staffing arrangements will need to be reviewed.

People's needs were assessed, and care was planned and provided to meet people's needs. A new electronic care planning process had been introduced. Care was provided by staff with training and the registered manager understood this needed to be provided on a regular basis. People had a nutritious diet, and they enjoyed the food offered. Staff ensured people had enough to drink to meet their individual needs.

People felt their concerns or complaints would be listened to and action taken to improve the service as a result.

The registered manager and provider were following an action improvement plan to drive through further improvements and strengthen the effectiveness of quality monitoring systems.

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)

The last rating for this service was Inadequate [published 10 October 2019]. There were multiple breaches of regulation. 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 improvements had been made and the provider was no longer in breach of regulations. This service has been in Special Measures since October 2019. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This was a planned inspection based on the service's previous rating.

Follow up

We will continue to monitor intelligence we receive about the service until we return to visit as per our inspection programme. If any information of concern is received, we may inspect sooner.

People’s experience of using this service:

The service was not well led. The provider failed to have sufficient oversight of the home and five breaches of regulations were identified.

Leadership and governance arrangements within the service were of concern, as they were not always identifying shortfalls and making changes to address them.

People who live at Field Farm House Residential Home were not always having their needs met by enough numbers of staff on shift.

Timely action had not been taken to address concerns regarding the environment. This placed people at risk of avoidable harm.

Infection control measures were insufficient and put people at unnecessary risk.

Support was not personalised and specific to the individuals needs and people were not always treated with dignity and respect. Staff had not completed training in dignity and respect and had not recognised situations which were undignified for people.

People’s end of life wishes were not always recorded.

People’s right to dignity and confidentiality was not always respected.

People were offered a choice of food and drink. However, people ‘s fluid and food intake were not sufficiently monitored therefore putting people at unnecessary risk of dehydration.

People and their relatives were encouraged to give feedback on the service, and areas for improvement through service user meetings.

Rating at last inspection: At our last inspection which was published 5 December 2016 the provider was rated Good in all areas.

Why we inspected: We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions.

Enforcement: At this inspection, we identified breaches of regulation 10, 12, 15, 17 and 18. Full information about CQC's regulatory response to any breaches of regulation found during inspections is added to reports after any representations and appeals by the provider have been concluded.

Follow up: Following the inspection we referred our concerns to the local authority. In addition, we requested an action plan from the provider, and evidence of improvements made in the service. This was requested to help us decide what regulatory action we should take to ensure the safety of the service improves.

The overall rating for this registered provider is 'Inadequate' and the service is therefore in 'special measures'. This means we will keep the service under review and, if we do not propose to cancel the provider's registration, we will re-inspect within 6 months to check for significant improvements.

If not, enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

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.

Field Farm House provides accommodation and personal care for up to 65 people. At the time of our inspection there were 60 people living at the home.

There was 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 and associated regulations about how the service is run.

People were kept safe by staff that knew how to recognise and report any concerns about people's safety. Staff understood people's needs and about risks and how to keep people safe. There were enough staff on duty to make sure that people got the right support at the right time. The provider completed checks to ensure staff were suitable and safe to work at the home.

People were positive about the support and care that they received. People were treated with dignity and respect and staff were kind and caring in their approach with people. People's care and support was centred on their individual needs.

People had their health needs responded to effectively. People were supported to access doctors and other health professionals when required. People were supported to have their medicines when needed. Medicines were stored and administered appropriately.

People were asked and gave staff permission before any care or support was given. Time was taken to make sure that people could make choices and decisions about the care and support they received.

People were supported by staff that had the skills and knowledge to understand and meet their health needs. Staff had access to on-going training and support to meet people's specific health and wellbeing needs. Staff felt that they were able to contact the registered manager at any time if they needed support or guidance.

People and their relatives found the staff and management approachable and willing to listen to their views and opinions. People knew how to complain and who to complain to.

Audits and checks were completed regularly to ensure that good standards were maintained. There were established links with organisations relevant to the care and support provided.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well-led?

This is a summary of what we found.

Is the service safe?

Both the people who lived in the home and their relatives were pleased with the care provided and felt that their views were respected and listened to. The staff worked in a safe and hygienic way and used appropriate protective clothing. There were enough staff to meet the needs of the people living in the home and a member of the management team was available on call in case of emergencies.

Staff personnel records contained all of the information required by the Health and Social Care Act. This meant the provider demonstrated that staff employed to work at the home were suitable and had the skills and experience needed to support the people who lived in the home.One person said: "They (staff) do anything for you."

The registered manager and the staff we spoke with understood the importance of safeguarding vulnerable adults, could identify potential abuse and knew how to report any incidents of abuse. One relative said: "It is safe. They are brilliant.They all know her."

Is the service effective?

People told us that they were happy with the care that had been delivered and their care records were up to date and signed by them or their relative. One relative said: 'They are brilliant. They all know her.'

Care records confirmed people's preferences, interests, needs had been recorded and care and support had been provided in accordance with people's wishes. One relative said: 'I am completely satisfied.'

We heard that information was shared effectively between staff. A variety of ways were used to share information including handovers, daily records, and monthly reviews of care plans.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. One person said: 'I couldn't fault them.' Another person said: 'There's good interaction with staff.'

Is the service responsive?

People's needs had been assessed before they were admitted to the home. People's needs were carefully described so that care workers knew exactly what tasks to undertake to support them. Any change in people's care needs was reported to the registered manager or the deputy manager and they briefed senior care staff. One relative said 'They have got a lovely way of doing things.'

Suggestions made by people living in the home who attended meetings with the deputy manager were regularly taken up and trips arranged to the places suggested.

Is the service well-led?

Staff had a good understanding of the culture of the home and quality assurance processes were in place. People told us they had received customer satisfaction surveys and we saw they contained many positive comments. For example: 'The day to day care is excellent and staff are very attentive and friendly.' The deputy manager met with people who lived in the home to seek suggestions for any improvements required. Staff told us they were clear about their roles and responsibilities and said they were well supported both professionally and personally.

The home had a friendly and welcoming atmosphere, and people told us that the staff were approachable and helpful. Relatives said that they were made to feel welcome at any time.

There was a varied range of activities for people to get involved in, if they chose to do so. There was a strong emphasis on the importance of people being supported to make their own decisions. Staff knew people's individual likes and dislikes.

People told us that they would feel comfortable about raising any concerns with senior staff. They were confident that they would be listened to and that action would be taken.