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Field House Care Home Requires improvement

Reports


Inspection carried out on 31 July 2019

During a routine inspection

About the service

Field House is a residential care home providing personal and nursing care to 28 people aged 65 and over at the time of the inspection. The service can support up to 35 people living with dementia or sensory impairment. Field House accommodates people in one adapted building. There are spacious gardens people can access, alongside separate activity and communal areas. The service is fully accessible, however not all rooms have en-suite facilities.

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

People’s needs were not responded to promptly or when people required assistance by staff. This was due to poor deployment of staff.

People who required assistance with choosing or eating their meals, did not receive appropriate support. The building was not sufficiently adapted to meet the needs of people living there. We have made a recommendation about this.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. However, staff did not always refer to these when considering best interest decisions. We have made a recommendation about this.

People’s social needs and personal interests were not met through a stimulating or engaging program of activity. Decision relating to people end of life wishes around resuscitation were not reviewed as required. We have made a recommendation about this.

People told us they thought the service was well led. The registered provider had a system of governance in place to monitor and improve the quality and safety of the service. However, we could not see how once issues had been identified, how they were managed in a timely manner. Quality audits were in place but were not effective in identifying the improvements required at this inspection.

People said they felt safe living at Field House. People’s medicines were managed and administered safely, and people lived in a clean, hygienic environment.

Staff told us the training was good and relevant to their roles and felt supported by the manager. Staff received regular supervision where they could discuss their ongoing development

People who used the service and their relatives told us staff were kind and caring. People's likes, preferences and dislikes were assessed, and care met people's desired expectations.

There was a complaints procedure and people knew how to complain.

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

Rating at last inspection

The last rating for this service was Good. (Report published 01 November 2016).

Why we inspected

This was a planned inspection based on the previous rating.

The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvements. Please see the Safe, Effective, Responsive and Well Led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Field 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 re-inspection programme. If we receive any concerning information we may inspect sooner.

Inspection carried out on 5 October 2016

During a routine inspection

This inspection took place on 05 October 2016 and was unannounced. When the service was last inspected in May 2015 we found that the provider was not meeting the required standards in relation to the health and social care act 2008. The overall standard of care was rated as 'requires improvement.' At this inspection we found that the service had taken action to address the issues highlighted in our previous report and now met the requirements for a 'good' rating.

The home provides accommodation, nursing and personal care for up to 32 older people, with a range of health and support needs. At the time of this inspection there were 28 people living at the home.

The home 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.

There were risk assessments in place that gave guidance to staff on how risks to people could be minimised and how to safeguard people from the risk of possible harm.

The provider had robust recruitment processes in place. There were sufficient staff to support people safely. Staff understood their roles and responsibilities. Staff received supervision and support, and had been trained to meet people’s individual needs.

People were supported by caring and respectful staff who knew them well, and showed them respect and dignity at all times. Staff were given the opportunity to get to know the people they supported.

People had been involved in determining their care needs and the way in which their care was to be delivered. Their consent was gained before any care was provided and the requirements of the Mental Capacity Act 2005 and associated Deprivation of Liberty Safeguards were met.

Staff supported people to maintain their health and well-being and supported them to eat a healthy and well balanced diet.

Feedback was encouraged from people and the manager acted on the comments received to continually improve the quality of the service. The provider had effective quality monitoring processes in place to ensure that they were meeting the required standards of care. There was a formal process for handling complaints and concerns which were investigated and resolved in a timely manner.

Inspection carried out on 14 May 2015

During a routine inspection

This inspection took place on 14 May 2015 and was unannounced. When the service was last inspected in June 2014 we found that the provider was not meeting the required standards in relation to the use of restrictive practices, specifically the inappropriate use of wheelchair lap belts. At this inspection we found that the service had taken action to address the issue and now met the required standards.

The home provides accommodation, nursing and personal care for up to 32 older people, with a range of health and support needs. At the time of this inspection there were 28 people living at the home.

The home 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.

Staff were aware of the safeguarding process. Personalised risk assessments were in place to reduce the risk of harm to people, as were risk assessments connected to the running of the home and these were reviewed regularly. Accidents and incidents were recorded and the causes of these analysed so that preventative action could be taken to reduce the number of occurrences. There were effective processes in place to manage people’s medicines.

The necessary recruitment and selection processes were in place and the provider had taken steps to ensure that staff were suitable to work with people who lived at the home. There were enough staff on duty at the home.

People had been involved in determining their care needs and the way in which their care was to be delivered. Their consent was gained before any care was provided and the requirements of the Mental Capacity Act 2005 and associated Deprivation of Liberty Safeguards were met.

Several people did not enjoy the food and some people did not get as much to drink as they would like.

Staff were polite and courteous to people but interaction beyond offering care was minimal. Most staff treated people with respect but some staff talked about people in front of them in a manner which was not respectful.

Information was available to people about the services provided at the home and how they could make a complaint should they need to. People were assisted to access other healthcare professionals to maintain their health and well-being.

The manager had a clear presence and promoted a person centred culture within the service.

There was an effective quality assurance system in place.

Inspection carried out on 28 May 2014

During a routine inspection

During our inspection on 28 May 2014 we set out to answer five questions. These were whether the service is caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people who used the service and the staff that supported them. We also spent time looking at records. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

We found that care was planned and delivered in a way that was intended to ensure people�s safety and welfare.

We found that there were shortfalls in relation to safeguarding people from the risk of abuse in relation to unlawful restraint and the service is required to make improvements.

We found that there was an effective recruitment and selection policy and procedure in place which ensured the right people were employed to work with vulnerable people.

Is the service effective?

People told us that they were happy with the care that they received. Care plans were written in a way which reflected people�s needs and preferences.

We saw that risk assessments and support plans had been reviewed monthly. We looked at the care notes for people whose plans we had viewed and saw that care was recorded as being delivered in accordance with the plans.

People who used the service and their relatives told us that the activity provision was not sufficiently stimulating and engaging to meet people�s needs.

We found that there were systems in place that protected people from the risks of inadequate nutrition and dehydration.

Is the service caring?

People we spoke with told us that staff members were kind and caring.

An external health professional with whom we spoke said they found that staff members were courteous and kind towards the people who used the service.

We talked with three relatives who all said that they were kept well informed about their relatives� care and treatment and were involved in their regular care plan reviews. They told us that the staff members were helpful and kind.

Is the service responsive?

People told us that issues they brought up with the home management had been dealt with in a timely manner.

Relatives of people who used the service told us that they would be confident to raise any concerns with the home management and equally confident that any concerns would be managed appropriately.

Is the service well led?

We noted that the manager for the service was new in post at the time of our inspection and was in the process of implementing new systems. They were being supported by a deputy manager who was also new in post. The staff told us that the management team was making changes within the home.

Inspection carried out on 27 November 2013

During a routine inspection

Overall we found the home was visibly clean on the day of our inspection and people appeared to have had their personal care needs met.

We talked to people who used the service as well as staff who worked at the home. People told us that the home was pleasant and that staff were lovely and that the food was of a good standard. However, all of the people we spoke to told us that sometimes they had to wait for a long time for their buzzer to be answered, and that this was particularly difficult if they were waiting to be assisted to go to the toilet. People also told us that the activities were not very appealing. Some of the people also told us that they were often not assisted to get up for the day until between 11am and 12pm and that they would like to get up much earlier. People were otherwise satisfied with the care they received and liked the staff who worked at the home.

The staff we spoke to supported these views, they told us that some people were not helped to get up until late morning and that sometimes people did have to wait a long time for buzzers to be answered. Staff told us that they had sufficient staff working at the home and offered different explanations for delays in answering buzzers.

We found that medication was well managed and people received their medication in accordance with their prescription. Staffing arrangements were adequate and most staff had attended all of the required mandatory training.

Care plans were detailed and included good information in parts, however, some sections lacked detail or had not been completed.

Inspection carried out on 15 November 2012

During a routine inspection

People told us what it was like to live at this home and described how they were treated by staff. They also detailed their involvement in making choices about their care. We received positive comments from people about the quality and choice of food available.

During our observations, we saw that staff were respectful and cared about the people in the home as individuals. For example, when supporting people to use the toilet, staff were careful to close the door to maintain privacy. We heard staff talk to people in calm and supportive tones and when undertaking an activity, they did not rush them, allowing them to take it at their own pace.

We saw that the support provided for people respected individual needs and pace. For example, some people were brought into the activity room in wheelchairs and we observed one person being supported to walk using a walking frame. People were offered choices and their decisions were respected.

Reports under our old system of regulation (including those from before CQC was created)