Archived: Fieldside View

Fieldside View is registered to provide accommodation and care for four people who have learning difficulties. The service is on the same site as another larger service run by the same registered provider.

At this inspection there were four people living in the service.

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

People told us they were safe at the service and well supported by staff. A person said, "The staff are my friends and help me lots." A relative said, “The staff do know the residents very well and stability is what my family member needs.”

People were safeguarded from the risk of abuse and received the care they needed. Medicines were managed safety. There were enough staff on duty. Infection was prevented and controlled. Lessons were learned when things went wrong.

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.

We expect health and social care providers to guarantee autistic people and people with a learning difficulty the choices, dignity, independence and good access to local communities most people take for granted. Right support, right care, right culture is the statutory guidance that supports CQC to make assessments and judgements about services providing support to people with a learning difficulty and/or autistic people.

Right support:

• The model of care and setting maximised people's choice, control and independence. People were empowered to make day to day choices, enabled to take control of their care and enabled to be as independent as possible. This meant people were empowered in all areas of their lives and enabled to live their life to the full.

Right care:

• Care was person-centred and promoted people's dignity, privacy and human rights. Staff had the knowledge and skills to support people in a person-centred way. Staff understood learning difficulties and autism and how to support behaviour that challenged in a positive way. People were supported in a person-centred way and interactions were respectful.

Right culture:

• Ethos, values, attitudes and behaviours of leaders and care staff ensured people using services led confident, inclusive and empowered lives. There was a positive culture in the service. This promoted people's self-esteem, confidence, human rights and quality of life.

This service was able to demonstrate how they were meeting the underpinning principles of ‘right support, right care, right culture’. People lived in a domestic-style property and received person-centred care promoting their dignity, privacy and human rights. Leaders and staff understood the importance of empowering people to develop their independence.

Quality checks had been completed to ensure people received safe care and treatment. People and their relatives had been invited to contribute to the development of the service. Regulatory requirements had been met and good team-working was promoted.

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 (published 25 June 2019).

The service remains rated Good.

Why we inspected

The inspection was prompted in part because of concerns received about people not receiving safe care due to the use of inappropriate restraint. A decision was made for us to inspect and examine this risk.

We undertook this focused inspection to gain an updated view of the care people received. This report only covers our findings in relation to the Key Questions Safe and Well-led. We found no evidence during this inspection people were at risk of harm from this concern. Please see the Safe and Well-Led sections of this full report.

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 infectious outbreaks effectively.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from the previous comprehensive inspection for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has remained as Good. This is based on the findings at this inspection. Please see the Safe and Well-led sections of the full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Fieldside View 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.

The Bungalow is a ‘care home’. 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 care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

There was a registered manager at the service who was supported by two deputy managers. 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.

At the last inspection on 3 November 2016, we asked the provider to take action to make improvements related to concerns about fire safety, staff training and induction, management of medicines and completion of records. Also quality auditing systems used by the provider had not identified the shortfalls found at our inspection and complaints had not been dealt with appropriately and this action has been completed.”

People were supported to understand how to stay safe and to recognise when they were vulnerable. Staff had received training about safeguarding and understood their responsibilities in relation to reporting any concerns. The registered manager had built a positive working relationship with the local authority safeguarding team and contracted them as required. People were involved in identifying and managing their own risks. Risk assessments gave staff the guidance they required to keep people safe. Risks to the environment were assessed and mitigated. People were now involved in regular fire drills and equipment had been put in place to alert people with hearing loss of a fire. People and staff understood how to minimise the risk of infection and used personal protective equipment when required.

People were supported by staff who had been recruited safely and staffing levels were based on people’s needs and activities. Staff had a thorough induction when they began working at the service. A comprehensive training schedule was in place to ensure staff had the skills they required to meet people’s needs. Staff told us they were supported by the registered manager and deputy managers. All staff attended regular supervision meetings and completed annual appraisals. The registered manager and staff team worked closely with other agencies to ensure they had the knowledge required to meet people’s needs and follow good practice.

People’s medicines were managed safely and in the way they preferred. People were encouraged to be involved in managing their medicines if appropriate. Some people at the service were living with long term health conditions such as diabetes or epilepsy, there was clear guidance for staff about how to support people with their health. People were supported to access health professionals when appropriate and encouraged to take a lead in their appointments. People chose their own menus and were involved in preparing their meals. Staff supported and encouraged them to have a balanced diet.

People were supported to have maximum choice and control of their lives and staff supported people in the least restrictive way possible; the policies and systems in the service supported this.

Staff used effective systems to ensure that they communicated any changes in people’s needs and to learn from incidents. People’s care plans were person centred and used pictures to support people’s understanding. People were treated with kindness and compassion by staff who had built positive relationships with them. People were supported to express their views using a range of communication tools. People were treated with dignity and respect.

People were encouraged to learn new things and develop their daily living skills. Some people went into the local town independently and had part time work. Complaints were recorded and responded to appropriately and resolved taking into account the wishes of the complainant.

The service was designed to meet the needs of the people, with enough room for people to have their own space or share communal areas. There was a large garden which people told us they enjoyed spending time in. People and staff worked together to keep the service clean and to minimise the risk of infection through the use of gloves and aprons when required.

There was a clear vision at the service which was led by the people and their goals. Care and support was designed around meeting people’s needs and preferences. Feedback about the service was sought and acted upon when appropriate. People and staff are involved in developing the service and trying new ways of working. The registered manager and staff team continually seek to improve the service taking into account the needs and opinions of the people they support. Audits had been used effectively to drive improvement and identify any shortfalls.

At our previous inspection of this service in December 2015 we found the service was not meeting the required standards in respect of providing an effective system for the monitoring of service quality. We took enforcement action to require the provider to address this shortfall quickly, there were also additional breaches in a number of regulations and we asked the provider to tell us how they were going to address these. This inspection was to assess whether the improvements they had told us about had been embedded and were now everyday practice.

There was a registered manager in post. A registered manager is a person who is 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. The registered manager has oversight of two services at this location but spent the majority of her time in the larger service. A deputy manager has been appointed and they were located at the bungalow and had helped with the progress made to date.

People said they liked living at the service, they were supported to develop independence skills and some would now like to move on to more independent living. Relatives told us that they were satisfied with the delivery of care to their relatives and felt they were kept informed as and when needed. We contacted health and social professionals and feedback showed that some had reservations about service quality but felt the registered manager was working hard to raise standards and the arrival of the deputy manager and her presence on a regular basis at the bungalow had helped to bring about gradual improvement. Staff also spoke positively about the presence of the deputy manager on influencing change in the service.

Our inspection highlighted that the provider had taken action to address a number of the previous breaches of regulation and also some of the good practice recommendations we had made; the number of continued breaches however was disappointing where some breaches had not been fully addressed and improvement embedded into everyday practice so quality monitoring procedures although improving were still not fully effective.

Some of the people we met showed a much improved personal appearance and also their willingness to engage with staff and others. There was good evidence that people were supported to access healthcare when they needed to and received appropriate support for all their health needs, however some important records on pain management, frequencies of seizures and risks related to nutrition were not well completed consequently they were unable to provide a complete understanding of people’s needs in these areas.

There was good progress in regard to: the content of staff recruitment files - to evidence that all necessary checks on the suitability of new staff were being made, the management of medicines, and improvements to fire arrangements and staffing levels. Some minor shortfalls were still evident in these areas for example, one recruitment file had one gap in the employment history that had not been accounted for and we have asked the registered manager to complete this with the person concerned. The communication book showed us that staff had been left to undertake medicines ordering without having received the appropriate training to do so, this could lead to mistakes and errors being made. We were concerned that not all staff had received fire drill training particularly those undertaking night duties and this could place people at risk in the event of a fire. People were provided with opportunities to share their views but there was evidence that complaints were not being recorded or acted upon by staff. Although there was evident progress towards meeting previous shortfalls there were some continued breaches.

Good progress had been made in respect of providing a range of easy read information for people. The provision of improved activities and stimulation had meant people had access to the onsite day centre if they chose and the improved staffing levels Monday to Friday had ensured people had more opportunity to go out from the service. The premises had been refurbished in bathrooms and the communal lounge and some bedrooms, these improvements provided a more homely and clean environment to people. There was however, a need to ensure through effective quality monitoring repairs and improvements undertaken in the premises were to a good standard and that cleanliness and good infection control practices were sustained.

The atmosphere in the home was welcoming, staff were open and easy to talk with and felt that things had improved for both the people in the service and for them as staff. Staff showed that they understood peoples needs and wishes and were guided by detailed support plans. The provision of activities and stimulation for people when at home had improved for some but this was an area for further improvement. Staff said they said they now felt better supported. People and their relatives were consulted about people’s everyday care and end of life wishes and were provided with opportunities to comment about the service. People were supported to maintain links with the important people in their lives.

We have made two recommendations:

We recommend that a competent person assesses the suitability for people with sensory hearing loss in the service to use specialised equipment to alert them to potential fire alerts.

We recommend the provider using a nationally recognised staffing tool reviews weekend staffing levels in the light of increasing dependency for some people and the need to ensure staff availability to meet the needs of other people living in the house.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of the report.

We observed a major refurbishment updating and re-fitting kitchen and bathrooms, moving the laundry room to an outside facility. Staff and service users were watching and advising.

On the day of the inspection there were only four people living in the home. The home manager said they were looking for a fifth person and were redecorating one of the rooms. We saw the single rooms were individual, minimalist to an Arsenal supporter's room. One person was in their room, they complained to the manager that a carer had made the bed and put 'stuff on upside down'. The manager said he would speak with the carer.

People were clearly encouraged to be independent, making day to day decisions about their care and participating in social activities. Staff were attentive to individual needs with a robust interaction between people and carers. We saw pictorial menus on the wall. People liked to shop and help with chores, nobody liked to cook but all could make toast or sandwiches. One person had requested that staff purchase surprise Christmas gifts from a provided list.

We saw that the environment was adequately maintained and that there were systems in place to monitor service delivery as well as the health and safety of the service.

We saw that people were involved in making day to day decisions about all areas of their lives and care. People were encouraged to be independent and participate in social activities they enjoyed. People had their needs met and they were supported to reach their own goals. We noted that a person had a visible injury which the staff had not noticed for a week. Therefore treatment had not been considered and the incident had not been documented. However, the manager took this very seriously and took appropriate action. The staff were supported and had their training needs met. Staff told us they would ask staff and managers for advice and support. Staff told us that the service was 'well run', 'people seem happy'.

We saw that the environment was adequately maintained and there were plans for redecoration. There was mould in a bathroom and a toilet seat had become unhygienic. There were systems in place to monitor service delivery and the health and safety of the service.