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Fieldway Care Home Requires improvement

The provider of this service changed - see old profile

Inspection Summary


Overall summary & rating

Requires improvement

Updated 20 February 2019

We inspected the service on 8 and 9 January 2019.

Fieldway is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. The service can accommodate up to 68 people. At the time of our inspection 63 people were living in the care home. People living in the care home from now on will be referred to as ‘people’ throughout this report.

The service continues to have the same registered manager in post who has been in day-to-day charge of the care home since February 2017. A registered manager is a person who has registered with the CQC. Registered managers like registered providers 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.

This was the service’s first inspection since we re-registered them in December 2017 under the new provider HC-One Oval Limited. During this inspection, we identified several areas of concern which lead us to issue five breaches of the regulations. We have therefore rated the service Requires Improvement overall, inadequate for the key question, ‘Is the service safe?’ and requires improvement for the key questions, ‘Is the service caring, responsive and well-led?’

The service was rated inadequate in safe because medicines were not always safely managed in the care home. People were supported to take their medicines as they were prescribed, but were not always securely stored. This failure to always follow the relevant National Institute of Clinical Excellence (NICE) guidelines around the safe storage of medicines had put people at unnecessary risk of harm.

Furthermore, the service does not always have enough staff with the right experience to meet people’s needs. Although the care home was adequately staffed on both days of our inspection, we received mixed comments from people living in the care home, their relatives, external health care professionals and staff concerned about the lack of experienced staff working who were familiar with the needs, wishes and daily routines of people We also observed several instances of staff not being available in a timely manner when people requested assistance.

People’s privacy and dignity were not always respected by staff. Throughout our inspection we observed most staff interacted with people in a kind and compassionate way. However, we saw several instances of staff not respectfully engaging with people they were assisting to eat or entering a person’s bedroom without knocking or asking permission to do so.

People did not always receive the right level of personal and health care and support they required to ensure their individual needs and wishes were met. The mixed feedback we received from people, their relatives and external health care professionals, as well as our own observations, indicated staff sometimes failed to meet people’s basic health and personal care needs by not following their care plan and risk management plan.

The provider had established some good governance systems to assess and monitor the quality and safety of the care and support people received, but we found these were not always implemented. We identified numerous issues the providers governance systems had failed to pick up during our inspection, which included poor management of medicines and staff not always respecting people’s privacy and dignity or meeting their needs and wishes. Records the service was required to keep in respect of the people living in the care home were not always appropriately maintained by staff.

You can see what action we told the provider to take in response to all the breaches of the regulations outlined above at the back of the full version of the report.

We discussed all the issues de

Inspection areas

Safe

Inadequate

Updated 20 February 2019

The service was not safe.

People were supported to take their medicines as they were prescribed, but contrary to recognised best practice, medicines were not always stored safely in the care home.

The care home was adequately staffed on both days of our inspection, but remains over reliant on agency nurses and care workers to cover large numbers of staff vacancies. We found there were not always enough experienced staff to safely meet people's needs.

The provider had robust procedures in place to safeguard people from harm and abuse. Staff were familiar with how to recognise and report abuse.

Appropriate staff recruitment checks took place before staff were permitted to commence working at the care home.

The environment was kept hygienically clean and staff demonstrated good awareness of their role and responsibilities in relation to infection control and food hygiene.

Effective

Requires improvement

Updated 20 February 2019

Some aspects of the service were not effective.

People did not always receive the right level of health care they required to ensure their individual needs and wishes were met.

Staff had the right mix of knowledge and skills to meet the needs and wishes of people they supported, through effective training, supervision and work performance appraisals.

The care home was a comfortable place to live and accessible. As recommended at the service’s last inspection we saw signage designed by people living in the home was now used help people living with dementia identify rooms that were important to them.

People were supported with their nutritional needs. Staff identified when people required further support with eating and drinking and took appropriate action.

People accessed health care services when required.

The principles of the Mental Capacity Act (MCA) were followed.

Caring

Requires improvement

Updated 20 February 2019

Some aspects of the service were not caring.

This was because some people’s dignity and privacy were not always respected by everyone who worked at the care home.

People were supported to maintain relationships with their relatives and friends.

Staff understood and responded to people's diverse cultural and spiritual needs and wishes.

People were supported to do as much as they could and wanted to do for themselves to retain control and independence over their lives.

When people were nearing the end of their life, they received compassionate and supportive care.

Responsive

Requires improvement

Updated 20 February 2019

Some aspects of the service were not responsive.

People did not always receive the right level of personal care and support they required to ensure their individual needs and wishes were met.

People had opportunities to participate in some meaningful social activities, but the quality and choice could be improved to make them more suitable for people living with dementia.

People had an up to date and personalised care plan, which set out how their care and support needs should be met by staff.

The provider had arrangements in place to deal with people's concerns and complaints in an appropriate way.

When people were nearing the end of their life, they received compassionate and supportive care.

Well-led

Requires improvement

Updated 20 February 2019

Some aspects of the service were not well-managed.

Although the provider had governance systems in place, these were not always operated effectively.

People living or working in the care home also felt the staff team lacked cohesion and their morale was low.

The service continued to have a registered manager in post and they understood their responsibilities in relating to sending us notifications about incidents that affected people living in the care home.

People were asked to share their feedback about the service.