Archived: Field View Care Home

Field View is a residential care home providing personal care to up to 40 people. Some of the people using the service were living with dementia. At the time of our inspection there were 33 people using the service.

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

The home was predominately clean, and the registered manager and staff understood how to minimise the risk and spread of infection. The provider had systems in place to safeguard people from the risk of abuse. Since our last inspection, improvements had been made to risk assessments. Risks associated with people's care were identified and risk assessments reflected people's current needs and how to keep them safe.

There was a suitable recruitment system in place to ensure suitable staff were selected to work at the home. Some people commented there were not always sufficient staff available. However, on the day of inspection we found staff were available and responded to people in a timely way. People received their medicines as prescribed by staff who were trained and competent to do so safely. Accidents and incidents were analysed, and trends and patterns identified. Action was taken to mitigate future risks to people.

People's needs were assessed and reviewed regularly to ensure care was delivered in line with people's current needs. People received a healthy and balanced diet which met their needs and considered their preferences. Staff received appropriate training and support and felt this assisted them to carry out their role.

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.

A range of audits took place to ensure the service was monitored and the quality maintained. Some areas of the home were tired and worn and required maintenance and decoration. The registered manager was addressing these areas with the provider. We have made a recommendation the provider identifies areas of the home requiring maintenance and takes action to improve the environment.

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 20 December 2019).

The provider completed an action plan after the last inspection to show what they would do and by when to improve the governance of the service.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Field View Care Home is a private residential care home providing accommodation and personal for up to 40 people. There were 31 people living at Field View when we carried out the inspection.

People’s experience of using this service:

The provider was taking steps to make necessary improvements following the last inspection and these were beginning to take effect but were not yet fully embedded and some work was still in progress. Audits and quality assurance systems were in place and well organised, although these were not yet sufficiently embedded to identify shortfalls found on inspection.

People felt safe living at Field View. Individual risk assessments were in place although these lacked detail with which to guide staff.

Staff were confident in how to support each person with their medicines. However, recording was not always clear enough to fully demonstrate how people were supported safely.

Recruitment processes were robust and appropriate checks carried out to help ensure staff were suitable to support people using the service. The registered manager had systems in place to recruit staff with the right values and attitudes for their role. There were enough staff to care for people safely and consistently.

Accidents and incidents were recorded and monitored to identify where improvements could be made. Any areas for learning were identified and shared with staff.

A refurbishment plan was in place, although this was not completed at the time of the inspection and the environment was in need of a thorough clean in places. People’s own rooms were not always clean or free from odours. There was a clear emergency plan, although the fire risk assessment and some individual emergency evacuation plans needed to be updated.

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. Systems were in place to support people’s rights. Staff understood the legislation where people had Deprivation of Liberty Safeguards (DoLS) in place although recording needed to improve around mental capacity and where decisions were made in people’s best interests.

People using the service and their relatives spoke highly about Field View Care Home. They told us they enjoyed the food and there were plenty of varied snacks. People’s nutritional needs were not always robustly monitored to minimise the risk of malnutrition and dehydration.

Staff treated people with dignity and respect and promoted their independence and confidence. Where people needed additional services to support their health, referrals were made.

Staff were kind and treated people with patience and care; they knew people well and developed positive relationships with them. Activities were planned and organised, with many ideas for new activities based upon people’s expressed choices. Care records were not always detailed, particularly for those people on short stays in the home.

Complaints and compliments were managed and responded to well. People knew who to speak with if they were not happy with any aspect of their care or service delivery.

Staff told us there was an improving culture in the home and said the registered manager was approachable and fair. Staff had clear direction in their work and there was good communication to enable them to be sure of their responsibilities.

There was clear, enthusiastic and confident leadership of the service which promoted team working and supported a person-centred culture.

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 (report published 28 September 2018) and there were two breaches, regulation 14, meeting nutritional and hydration needs and regulation 17, good governance. 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 some improvements had been made and the provider was no longer in breach of regulation 14, meeting nutritional and hydration needs. There was work being done to ensure the service was continuously improving. However, improvements in regulation 17 had not yet been sufficiently embedded to ensure there was no breach in good governance, or to make a change to the ratings.

Why we inspected:

This was a planned inspection based on the previous rating.

Enforcement

We have identified a continued breach in relation to the good governance of the service.

Please see the action we have told the provider to take at the end of this report.

Since the last inspection we recognised that the provider had failed to ensure a registered manager was in post. This was a breach of regulation and we issued a fixed penalty notice, which the provider accepted and paid in full.

Follow up:

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Field View 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.

Field View is a private care home. It is a large detached building. Field View is registered to provide care and support for up to 40 older people. At the time of our inspection there were 29 people living at the home.

A registered manager was not in place. However, a new manager had been appointed and was in the process of submitting an application to become registered with the Commission. 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.

People told us they felt safe and staff knew how to recognise and report any concerns about people's safety and welfare.

Overall, there were enough staff deployed. Required checks were done before new staff started work to help to protect people. Staff were trained to meet people's needs.

Medicines were managed safely. However, more work was required around documentation.

Individual risks to people's health and welfare were identified and managed. Some care plans were detailed to ensure people receive appropriate care which met their needs. Other care plans required updating. However, there was a plan in place to manage this.

The home was clean and well maintained. Plans were in place for refurbishment to make the home more dementia friendly.

We found people's capacity to consent to their care and treatment was assessed. The correct processes were followed to ensure those making decisions on their behalf had the legal powers to do so.

Most people told us they liked the food. People were offered a variety of food and drink, which took account of their likes and their medical, cultural and religious needs. However, people’s nutritional needs were not always met.

People were supported to meet their healthcare needs and had access to a range of healthcare professionals. People's needs were assessed. Care plans were in place and this ensured people would receive appropriate care, which met their needs.

People were treated with respect and kindness and were supported to maintain their independence. People were given the opportunity to take part in a variety of social activities.

Information about complaints was displayed in the home. Most people told us the manager and provider was approachable and listened to them. People were supported to share their views about the service.

We found the providers quality-monitoring systems were not always working as well as they should be. We were assured of the provider's commitment to making the required improvements.

We found two breaches of regulations in relation to meeting nutritional and hydration needs and good governance. We are considering the appropriate regulatory response to our findings.

During this inspection, we identified the service was breaching regulations related with safe care and treatment, staffing, care and welfare and good governance. This is the second time the service has been rated Requires Improvement.

CQC regulates both the premises and the care provided at Field View Care Home, and both were looked at during this inspection. The home accommodates a maximum of 40 people; on the day of our inspection 31 people were living at the home.

The service had a manager in place although they had commenced their application to register with the Care Quality Commission (CQC), at the time of the inspection this process was not completed. 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. In the month following the inspection the registered provider told us the manager had subsequently resigned from their post, they assured us they were taking action to fill the vacancy.

Although most people told us they felt safe, we found aspects of the service were not safe. Risk assessments did not always contain sufficient detail and in four of the five files we reviewed the risk assessments had not been updated for the previous two months. Personal emergency evacuation plans lacked relevant information to support staff to evacuate people safely and we could not evidence all staff had recently attended a fire drill.

Records relating to medicines needed to be improved to ensure they provided an accurate record of the medicines and creams people had been administered. There were no protocols in place to provide clear and consistent guidance for staff when administering medicines prescribed to be taken ‘as required’.

We saw equipment was not always clean or stored hygienically.

The manager was in the process of recruiting to a number of positions at the home; we saw processes were in place to reduce the risk of employing unsuitable staff.

Not all staff were up to date with their training requirements and staff had not been receiving regular management supervision, although action was being taken to address these shortfalls.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. We have made a recommendation in regard to evidencing compliance with the Mental Capacity Act 2005. People had access to external health care professionals.

Prior to the inspection we received information that peoples meals were not always hot. On the day of the inspection we did not find this to be the case. We were concerned the nutrition and hydration needs of one person had not been met.

People told us staff were caring. Throughout the inspection we observed staff to be kind and attentive; there was a warm, friendly atmosphere in the home. People’s care was delivered in a manner which respected their right to privacy and maintained their dignity.

There was a range of activities provided at the home which people were enabled to participate in as they wished. People’s care plans were person centred, but the information within them was not always consistent throughout their care plans.

There was a system in place to manage complaints. We saw there were a number of active complaints the manager was investigating at the time of our inspection.

Feedback regarding the new manager was positive. The manager told us they had identified a number of areas where improvements were needed, audits were being undertaken and an action plan was in place to monitor progress. The manager told us the registered provider was supportive of the changes they were making. The manager had held a recent meeting with staff and with people who lived at the home. They had also sent surveys to people to ask for feedback in regard to the quality of the care they received. However, the concerns we identified demonstrated the systems of governance have not been effective.

You can see what action we told the provider to take at the back of the full version of the report.

Field View is a care home providing accommodation for up to 40 people. It mainly supports older people, some of whom are living with dementia. The home does not provide nursing care. The home has provision for people to stay on a permanent and short stay basis. The premise is purpose built on two floors; the first floor is accessible using a lift. Car parking is available on site.

The service had a registered manager in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

At the time of the inspection 32 people were living at the home. The home had a friendly atmosphere which people described as welcoming. Throughout our inspection we saw staff supporting people in an inclusive, caring, responsive and friendly manner. They encouraged them to be as independent as possible, while taking into consideration their abilities and any risks associated with their care. The people we spoke with made positive comments about how staff delivered care and said they were happy with the way the home was managed.

People told us they felt the home was a safe place to live and work. We saw there were systems in place to protect people from the risk of harm. Staff we spoke with were knowledgeable about safeguarding people and were able to explain the procedures to follow should an allegation of abuse be made.

A structured recruitment process helped make sure staff were suitable to work with vulnerable people. People we spoke with told us there were enough staff available to meet their, or their family member’s needs.

The service had a medication policy outlining the safe storage and handling of medicines, but this had not always been consistently followed. However, identified shortfalls had or were being addressed.

People we spoke with told us they thought staff had the appropriate skills and knowledge to support people. Training records confirmed staff had completed essential training, as well as specific training to meet people’s needs.

We found the service to be meeting the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). The staff we spoke with had a satisfactory understanding and knowledge of this subject and where appropriate DoLS applications had been made.

People were provided with a choice of healthy food and drink ensuring their nutritional needs were met. The majority of the people we spoke with said they were happy with the meals provided and we saw people had been involved in making changes to the menus.

People were supported to maintain good health, have access to healthcare services and received on-going healthcare support.

People had been involved in need assessments prior to moving into the home, as well as in planning care. We found most people had a clear care plan that outlined their needs, risks associated with their care and their preferences. However, on the first day of our inspection we found one person’s care plan was very basic and did not provide staff with comprehensive information. When we returned on the second day a more detailed care plan had been formulated.

The home employed specific staff to facilitate social activities. People told us they had enjoyed the activities they had taken part in.

We saw the complaints policy was available to people who used and visited the service. The people we spoke with told us they would feel comfortable speaking to any of the staff if they had any concerns. Complaints received had been recorded and investigated appropriately.

There were systems in place to enable people to share their opinion of the service provided. This included meetings, surveys and reviews.

On the first day of our inspection we found areas of the home that needed some attention. For example, paintwork in corridors and communal areas was chipped and worn. The wash hand basins in the rooms of two people living at the home were cracked and a bedroom carpet needed replacing. These had been identified in the registered manager’s audit, but they had not been addressed. When we returned to the home we saw the provider had taken action to address some of the areas highlighted and plans were in place to address others.

There was a quality assurance system in place so the provider could monitor how the home was operating, as well as staffs’ performance. Systems identified the majority of the shortfalls we found during our visit, but actions plans did not always identify the planned completion date. The management team demonstrated how they were working to improve this.

The provider had not always submitted notifications to the commission in a timely manner.