Fieldhouse Care Home

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

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question requires improvement due to a breach of regulations in respect of the safe management of medicines. At this assessment we found improvements had been made and the service was no longer in breach of regulations. The rating has changed to good. This meant people were safe and protected from avoidable harm. However, some improvements are needed to the environment, notably in the bathrooms. The provider has a plan in place for these to be carried out. Improvements are also needed in the oversight of people’s fluid intake and how this is monitored and documented in people’s care records.

This service scored 66 (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 proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice. Accidents, incidents and complaints were documented and actions taken, including who had been informed and any learning outcomes recorded. Where necessary, root cause analysis had been completed to identify any possible causes and to support the lessons learned process. The registered manager had apologised if any issues with care had been identified following investigation, in line with duty of candour. Staff described an open culture and told us they felt able to raise concerns and make suggestions and these were listened to and acted on.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services. Before people came to live at the service the registered manager did a full assessment of their needs to ensure these could be met at the service. When people were transferred to hospital from the home, the registered manager ensured all relevant information about the person’s care needs and any medicines they used was shared with the hospital.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately. Everyone we spoke with told us they liked living at the home and felt safe and happy. One person said, “This is the best place I have lived in.” A family member told us, “I sleep at night knowing my relative is safe and well cared for.” Staff had completed safeguarding training and had an understanding of their responsibilities and how they should report concerns.

The provider worked with people to understand and manage risks. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them. Potential risks to people were assessed and plans put in place to reduce the chances of harm occurring. For example, people who were at risk of falls had support plans and guidance for staff on how they could be helped to mobilise safely and equipment such as sensor mats and sensor beams were used to minimise the risk.

However, records maintained by staff regarding people’s fluid and diet intake were not always accurate and needed improving. Some fluid charts indicated very low amounts of fluid offered and taken, although we did see plenty of drinks served during our assessment. We discussed this with the registered manager who made changes to the care planning system to ensure more accurate recording. She also discussed the issue with staff.

The provider did not always detect and control potential risks in the care environment. Some bathrooms and toilets were in a poor condition. However, the provider had a

refurbishment plan which showed these would be redecorated in the near future. On the first day of our assessment, we found some fire doors propped open. We asked for them to be closed correctly. Regular checks and audits were carried out to ensure the home and equipment used for people’s care was safe. Certificates were in place which confirmed utilities and equipment were safe to use.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs. The provider used a system for determining staffing numbers, which was based on people’s needs. Staff rotas were compiled in line with this information, with gaps due to sickness or leave filled by staff working overtime or by agency staff. Overall, people reported no concerns with staffing levels. One family member told us that they visited daily and “You wouldn’t know if it was Monday or Sunday, there are always lots of staff around.” However, two people commented they felt more staff were needed at weekends. Staff completed regular training to ensure they had the knowledge and skills needed for their roles and received supervision from senior staff. The registered manager was in the process of compiling a comprehensive induction programme for new staff.

Staff were recruited safely. Checks were undertaken on new staff before they started work. This included checking their identity, their eligibility to work in the UK, obtaining two references and Disclosure and Barring Service (DBS) checks. The DBS checks help employers make safer recruitment decisions and prevent unsuitable people from working with vulnerable people.

Improvements were needed to some areas of the home environment. There were exposed porous surfaces, rusty pipework and flaking paintwork in several bathrooms and toilets. This made thorough cleaning of these areas difficult. However, the provider had an action plan to improve these areas. Staff had completed training in infection prevention and control, as well as food hygiene and health and safety. Personal Protective Equipment (PPE) was readily available, and we saw staff using it correctly.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. They involved people in planning, including when changes happened. Systems were in place to ensure regular medicines were given as prescribed and recorded accurately. Medicines were stored safely and stock levels recorded correctly. This included controlled drugs. There was a process for people with swallowing difficulties who had thickening powder added to drinks, to ensure that they were given, stored and recorded safely. Medicated patches were applied and recorded correctly. The site of application was rotated in accordance with manufacturer’s guidance. People’s allergies were not always recorded accurately on medicines administration records. However, they were recorded in people’s care plans. Information to support staff to safely give ‘when required’ medicines was in place. However, the outcomes following these medicines being given was not always recorded to ensure they were effective. The management team were aware of this and were actively working to improve these records.

Medicines audits were completed at regular intervals to identify issues and drive improvement. Managers told us that staff had completed medicines training and had been assessed to ensure that they gave medicines safely. We were shown evidence of training records to confirm this. Following the assessment, we received a detailed action plan addressing shortfalls we had identified.