Archived: Field View

Field View is a residential home which provides care to older people including some people who are living with dementia. Field View is registered to provide care for up to 20 people. At the time of our inspection there were 14 people living at the home, however one person was in hospital.

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 2008 and associated Regulations about how the service is run.

At our previous inspection in May 2015, we rated the home as requires improvement. At this inspection we looked to see if the provider had responded to make the required improvements. Whilst we found some areas of improvement had been made, we found additional areas of concern that had potential to place people at risk of harm.

There was a lack of management oversight by the provider to check delegated duties had been carried out effectively. The quality monitoring systems included reviews of people’s care plans, health and safety checks and checks on medicines management. These checks and systems were not regularly reviewed and completed so it was difficult for the provider to be confident people received a quality of service they deserved. Accidents, incidents and falls were not regularly analysed to prevent further incidents from happening. Improvements were required in assessing risks to people and how staffing levels were determined to ensure safe levels of care were maintained to a standard that supported people’s health and welfare.

We checked the registration status of the provider and found the partnership was no longer active as a partnership because there was only one partner remaining. This suggested the remaining partner was carrying on without the appropriate registration. Where we refer to the 'provider' in the report we do so within this context.

Health and safety checks were not always completed to ensure risks to people’s safety were minimised. We identified some health and safety issues to the registered manager and the provider on the day of our inspection where we had immediate concerns to people’s safety.

Risks to people’s health and welfare were identified but not effectively managed and where people were at risk of harm, actions had not been taken to keep people safe. Care plans provided information for staff that identified people’s support needs and associated risks. However, some care plans and risk assessments required information to be updated to ensure staff provided consistent support that met people’s changing needs.

There were not enough staff on duty to respond to people’s health needs and to keep people safe and protected from risk. The registered manager completed a dependency tool to establish safe staffing levels but there was no effective formula that calculated what those safe staffing levels should be. The registered manager and deputy manager regularly supported staff on shift which meant some quality checks and improvement actions were not always identified and resolved. This affected the quality of service people received.

At the last inspection we found people were not supported in line with the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). At this inspection there were some improvements in how people’s capacity was determined, but further improvements were still required. Mental capacity assessments were completed but these were not always decision specific and records of those involved were not always completed. Five people had a DoLS in place at the time of our inspection. The registered manager acknowledged people’s care plans around mental capacity required improving.

Staff knew how to keep people safe from the risk of abuse. People told us they felt safe living at Field View and a relative agreed their family members felt safe and protected from abuse or poor practice.

People felt cared for by staff who had the skills and experience to care for them. Staff understood people’s needs and abilities and received updated information at shift handovers. Staff training was completed, but not all staff had received training to update their skills in line with the provider’s expectations. There was no effective system to identify which staff required training updates.

People were offered meals that were suitable for their individual dietary needs and preferences. People were supported to eat and drink according to their needs, which minimised risks of malnutrition but there was limited interaction and conversation with those staff who supported them. Staff ensured people obtained advice and support from other health professionals to maintain and improve their health.

People said staff provided the care they needed. Care plans were reviewed although some information required updating to ensure staff had the necessary information to support people as their needs changed. Some people felt their physical and mental stimulation was limited because they were not proactively supported to pursue their own hobbies and interests.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also found the provider’s registration status was no longer valid and asked the provider to take immediate action to ensure this service was registered in accordance with the Regulations. You can see what action we told the provider to take at the back of the full version of the report.

Is the service safe?

People told us they felt safe. One person told us, "I feel very safe here, everyone is so kind." Safeguarding procedures were in place and staff understood their role in safeguarding the people they supported. Staff were aware of the provider's whistleblowing policy.

Staff respected people's choices and preferences in the way they received support. One person told us, "They (the staff) always ask us what we need and want. We choose what we do." This ensured that people's rights were protected.

Staff knew about people's risk management plans and we saw they were supported in line with those plans. This meant people were cared for in a way that protected them from harm.

People were protected against the risks associated with the administration of medicines.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications had needed to be submitted, proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made and how to submit one.

Systems were in place to make sure the manager and staff learned from events such as accidents and incidents, complaints and checks made on the service. This reduced the risk to people.

Is the service effective?

People told us their care needs were assessed with them. We saw evidence that people were involved in their care planning and reviews. We saw care plans were regularly reviewed and updated. One person told us, "The staff always ask what I need."

People had their medicines at the dose, time and frequency they were prescribed to ensure medicines were effective. Staff monitored the effect of medicines and reported these to people's health care professionals.

Is the service caring?

People were supported by kind and caring staff. We saw staff were patient and encouraged people to be independent. One person told us, "You couldn't ask for better staff."

People's preferences, interests and diverse needs had been recorded and care and support was provided in accordance with people's wishes.

Is the service responsive?

People had the opportunity to plan and engage in a range of different activities each day.

People were asked their views about the service and the provider acted on comments that people made.

Where care staff had noticed people's changing needs, their care plans were updated to reflect this. We found staff discussed people's care needs with them on a regular basis.

Is the service well led?

The provider had risk management systems in place. We found the provider checked that risks were managed effectively. We found the provider used the information they gathered from their checks to develop a service improvement plan.

The provider sought the views of people who used the service and staff. Records seen by us indicated that people were asked about all aspects of the service and their views were acted on.

Staff told us they were clear about their roles and responsibilities. Staff told us the service was well organised and they felt supported by their manager.

We looked at care plans for four of the people who lived at the home. They covered a range of needs and had been reviewed regularly to ensure that staff had up to date information. There were also detailed assessments about the person's health so that staff could support people to keep healthy and well. All the staff we spoke with had knowledge of the needs of the people who lived there.

People who lived at the home were supported to make choices around the care they received. A person who lived there told us: 'They (staff) are very good really. They listen and don't make you do anything you don't want to do'.

We saw that staff helped and supported people. We saw that people received care that met their individual needs.

People lived in a clean environment and the provider had reduced the risk of the spread of infection.

Staff had knowledge of keeping people safeguarded from abuse.

The two relatives of people who used the service gave us positive feedback about the standards of care and support that the staff provided. One person said that they were, "Confident in the level of knowledge and skill of all staff'. Another said that, 'They care about people as people, not just residents".

Staff employed at the service had access to further training and told us that they felt supported by their peers and the registered manager. One staff member said they had, "Good access to further training". Another said they felt, "Confident with the support offered".

There were regular audits of areas of care, and regular feedback was obtained from the people using the service and their relatives.