Field House Residential Care Home for the Elderly

Field House Residential Care Home for the Elderly (Field House) is a residential care home. The service provides personal care and accommodation in one adapted building to up to 49 older people, some of whom live with dementia. At the time of the inspection 36 people were receiving the service.

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

Although no one had been harmed, action had not always been taken in a timely manner to keep people safe. Improvements were needed to fire safety and ensuring hot water was provided at a safe temperature. The quality assurance system had not identified these issues so that appropriate action could be taken in a timely manner. After the inspection the provider took action immediately to make the required improvements.

People living in the home and staff all spoke positively about the new manager and the changes they had implemented so far. Potential new staff to the service underwent checks to make sure they were suitable to work with people. Feedback was positive about the staffing levels in the home and people’s needs were met in a timely manner.

Staff were following current government guidance around good infection control procedures. Medicines were being administered as prescribed. Written procedures were in place to advise staff when to administer “When required” medications. Accidents and incidents were being analysed to ensure that themes and trends were identified and the necessary action taken to prevent a recurrence and the recording of this was being improved.

Staff used their training knowledge to safeguard people wherever possible and support people to keep safe from poor care and abuse. If staff had any concerns about people, they knew where to report this both internally and outside of the service. Staff spoke favourably of the management team and stated that they felt supported in their roles.

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.

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 18 May 2022).

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 that although improvements had been made in some areas they were still in breach of regulations.

Why we inspected

We carried out an unannounced inspection of this service in March and April 2022. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and quality assurance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Field House Residential Care Home for The Elderly on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to fire safety and quality assurance at this inspection.

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

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Field House Residential Care Home for the Elderly (Field House) is a residential care home. The service provides personal care and accommodation in one adapted building to up to 49 older people, some of whom live with dementia. At the time of the inspection 31 people were receiving the service.

We undertook this inspection at the same time as CQC inspected a range of urgent and emergency care services in Cambridgeshire and Peterborough. To understand the experience of social care providers and people who use social care services, we asked a range of questions in relation to accessing urgent and emergency care. The responses we received have been used to inform and support system wide feedback.

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

The provider's governance systems had failed to identify the issues we found at this inspection. For example, the provider had not always identified risks which meant staff did not always have guidance to ensure they supported people safely. Staff were not always following procedures and guidelines to ensure that risks in the home were reduced. The registered manager addressed these concerns once we brought them to her attention.

People’s care plans provided detailed guidance to staff on how to meet people’s needs and preferences. However, not all care plans contained all the relevant information or had been updated to reflect changes in people’s needs. Following our inspection site visit, the registered manager showed us these care plans had been updated.

We saw positive interactions between people and staff. However, for much of the day during our visit most people were unoccupied. Staff said more activities would enhance the day to day life of people living at the home. Some areas of the service had recently been redecorated to improve people’s environment.

Staff supported people to maintain relationships with their relatives and friends. Relatives told us the care their family members received had improved and their needs were met. A social worker told us the care received had made “a big difference” to a person’s overall health and well-being. Staff treated people with compassion and kindness and respected their privacy and dignity.

Staffing levels had improved and there were enough staff with skills and knowledge to meet people’s assessed needs. People liked the staff and said they responded promptly when they called. The provider had completed appropriate recruitment checks prior to staff working at the service. Staff received regular supervision and felt well supported by the management team. However, not all staff had undertaken training the provider considered mandatory. This put people at risk of receiving unsafe or ineffective care.

Staff supported people to have enough to eat and drink and provided help when needed. Staff supported people to access healthcare and made appropriate referrals for external advice, for example to GPs, when needed, and followed their guidance. The provider’s systems ensured people received their medicines as prescribed.

Staff knew how to report any concerns to the registered manager, and externally to other organisations, such as the local authority. Staff were confident the registered manager would take any concerns seriously. The management team had appropriately referred concerns to the local authority safeguarding team and shared information with people’s relatives where this was appropriate.

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.

The provider’s complaints procedure was available in the home. The registered manager had responded to complaints in line with the provider’s complaints procedure. The registered manager and nominated individual were approachable and responded to concerns raised. There were opportunities for people, relatives and staff to feedback on the service to help bring about improvement. The local authority told us staff worked well with them in order to improve the service provided to people who lived there.

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 inadequate (published 3 August 2021) and there were breaches of regulations. We issued the provider with a Warning Notice.

At this inspection we found the provider remained in breach of regulations and the Warning Notice actions were not met.

This service has been in Special Measures since 3 August 2021. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection and check whether the Warning Notice we previously served in relation to Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met.

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.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to fire safety, risk assessment, infection prevention and control, and governance at this inspection.

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

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Field House Residential Care Home for the Elderly (Field House) is a residential care home providing personal and nursing care to 43 people aged 65 and over at the time of the inspection. The service can support up to 49 people.

The care home accommodates 49 people in one adapted building. Each of the two floors has a number of bedrooms and shared areas such as lounges and dining rooms.

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

The service was not well-led and the provider had not had sufficient oversight of the service to ensure a high quality, safe service was provided to people. Monitoring of the service had not identified the shortfalls we found.

There were not enough staff deployed, with the necessary skills, training and knowledge to provide people with safe, high quality, compassionate care. Not all staff understood how to keep people safe from avoidable harm and abuse. The provider had not taken all reasonable steps to protect people from the spread of infection.

Staff did not always treat people with dignity and respect, support people to be independent or respect people’s privacy. Care plans were not fully person-centred and people did not have sufficient opportunities to be involved in meaningful activity.

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.

Medicines were managed well and were given to people safely. Some staff were kind and compassionate. The local authority officers were encouraged that the provider and registered manager were willing to work with them to improve the service.

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

Rating at last inspection

This service was registered with us on 25 July 2019 and this is the first ratings inspection. The last rating for the service under the previous provider was good, published on 7 July 2017.

Why we inspected

The inspection was prompted in part due to concerns received about staffing, safety, care and management of the service. A decision was made for us to inspect and examine those risks. We inspected all five key questions so that we could rate the service under the new provider.

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.

We have found evidence that a number of the concerns raised by the whistle-blowers were justified and the provider needs to make improvements. Please see the safe, effective, caring, responsive and well-led key question sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safeguarding, infection prevention and control, staffing, dignity and respect, person-centred care and governance at this inspection.

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

Follow up

We will request an action plan from 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.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

We found the following examples of good practice.

The registered manager used isolation techniques and zoning during the outbreak to reduce the spread of infection. People who were COVID-19 positive were only permitted to access their own bedrooms, and communal areas within their bubble. No person with a negative result accessed these communal areas. Staff were allocated to areas within the building to work and did not cross into other areas during the outbreak.

The service was only receiving essential visitors at the time of our inspection. Any person entering the building had their temperature taken, completed a health questionnaire and wore full personal protective equipment (PPE).

All staff, including domestic and maintenance staff had received training in PPE and infection prevention and control (IPC). Senior staff had received additional training which allowed them to train staff and provide refresher training in both the use of PPE and IPC.

The registered manager completed IPC audits of the building, which also included spot check observations of staff washing their hands. If staff were found to not be following appropriate hand washing techniques, they were signposted for additional training.

The building was clean and free from clutter. During our inspection we observed domestic staff cleaning communal areas and bathrooms and ensuring that areas regularly touched by hands were disinfected.