Field House Care Home

Field House Care Home is a residential care home providing personal and nursing care to up to 35 people. The service predominantly provides support to older people, some of whom may be living with dementia but could also support younger people with medical conditions. At the time of our inspection there were 27 people using the service.

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

Staff did not always provide respectful, dignified care. We have issued a breach related to this.

People’s end of life care plans were not personalised. We have made a recommendation related to this. We observed a lack of meaningful activity during both our visits. Discussion with staff, people and relatives suggested people were either happy with what was available or chose not to participate. However, we were concerned the limited options meant people lacked motivation to become involved.

The provider had not ensured there were enough staff for people to receive good quality care. People were supported by trained staff to take their medicines. However, there were issues with stock level recording.

Risks to people's safety were assessed and monitored and there were systems to safeguard people from the risk of abuse. The service’s infection prevention control measures were effective.

The provider had made some changes to the environment and further improvements were in progress. However, the home lacked atmosphere with few homely features throughout.

People were supported by trained, competent staff and supported to access other healthcare services when needed. People gave positive feedback about the food.

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.

Managers had not identified the issues we found in the quality of care provided. The provider had not ensured there were sufficient staffing levels and meaningful activities available. People, relatives and staff felt comfortable raising any concerns and giving feedback. Staff felt supported by their managers and colleagues. The provider had systems to monitor the quality and safety of the service and staff worked effectively with other health professionals to support people's health and wellbeing.

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 22 October 2019).

At our last inspection, we recommended staffing levels were adapted when needed based upon people's changing needs. Although some changes had been made, we found there were not enough staff to meet people’s needs.

We recommended the provider ensured the environment was suitable for people living with a sensory or cognitive impairment and that individual preferences, cultural and support needs were reflected in how premises are adapted or decorated. Some improvements had been made; LED lighting and signage had been added.

In addition, we recommended the provider review the activity provision to ensure they were person-centred and encouraged people to maintain hobbies and interests. We found this had not improved.

The last rating for this service was requires improvement (published 22 October 2019). The service remains rated requires improvement. This service has been rated requires improvement for 2 consecutive inspections.

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.

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

Enforcement and Recommendations

We have identified a breach in relation to staff not always treating people with dignity and respect.

We have made a recommendation for the provider to ensure people’s end of life care plans are personalised.

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

Field House is a residential care home providing personal and nursing care to 28 people aged 65 and over at the time of the inspection. The service can support up to 35 people living with dementia or sensory impairment. Field House accommodates people in one adapted building. There are spacious gardens people can access, alongside separate activity and communal areas. The service is fully accessible, however not all rooms have en-suite facilities.

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

People’s needs were not responded to promptly or when people required assistance by staff. This was due to poor deployment of staff.

People who required assistance with choosing or eating their meals, did not receive appropriate support. The building was not sufficiently adapted to meet the needs of people living there. We have made a recommendation about this.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. However, staff did not always refer to these when considering best interest decisions. We have made a recommendation about this.

People’s social needs and personal interests were not met through a stimulating or engaging program of activity. Decision relating to people end of life wishes around resuscitation were not reviewed as required. We have made a recommendation about this.

People told us they thought the service was well led. The registered provider had a system of governance in place to monitor and improve the quality and safety of the service. However, we could not see how once issues had been identified, how they were managed in a timely manner. Quality audits were in place but were not effective in identifying the improvements required at this inspection.

People said they felt safe living at Field House. People’s medicines were managed and administered safely, and people lived in a clean, hygienic environment.

Staff told us the training was good and relevant to their roles and felt supported by the manager. Staff received regular supervision where they could discuss their ongoing development

People who used the service and their relatives told us staff were kind and caring. People's likes, preferences and dislikes were assessed, and care met people's desired expectations.

There was a complaints procedure and people knew how to complain.

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. (Report published 01 November 2016).

Why we inspected

This was a planned inspection based on the previous rating.

The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvements. Please see the Safe, Effective, Responsive and Well Led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Field House 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 home provides accommodation, nursing and personal care for up to 32 older people, with a range of health and support needs. At the time of this inspection there were 28 people living at the home.

The home had a registered manager. 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.

There were risk assessments in place that gave guidance to staff on how risks to people could be minimised and how to safeguard people from the risk of possible harm.

The provider had robust recruitment processes in place. There were sufficient staff to support people safely. Staff understood their roles and responsibilities. Staff received supervision and support, and had been trained to meet people’s individual needs.

People were supported by caring and respectful staff who knew them well, and showed them respect and dignity at all times. Staff were given the opportunity to get to know the people they supported.

People had been involved in determining their care needs and the way in which their care was to be delivered. Their consent was gained before any care was provided and the requirements of the Mental Capacity Act 2005 and associated Deprivation of Liberty Safeguards were met.

Staff supported people to maintain their health and well-being and supported them to eat a healthy and well balanced diet.

Feedback was encouraged from people and the manager acted on the comments received to continually improve the quality of the service. The provider had effective quality monitoring processes in place to ensure that they were meeting the required standards of care. There was a formal process for handling complaints and concerns which were investigated and resolved in a timely manner.

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people who used the service and the staff that supported them. We also spent time looking at records. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

We found that care was planned and delivered in a way that was intended to ensure people's safety and welfare.

We found that there were shortfalls in relation to safeguarding people from the risk of abuse in relation to unlawful restraint and the service is required to make improvements.

We found that there was an effective recruitment and selection policy and procedure in place which ensured the right people were employed to work with vulnerable people.

Is the service effective?

People told us that they were happy with the care that they received. Care plans were written in a way which reflected people's needs and preferences.

We saw that risk assessments and support plans had been reviewed monthly. We looked at the care notes for people whose plans we had viewed and saw that care was recorded as being delivered in accordance with the plans.

People who used the service and their relatives told us that the activity provision was not sufficiently stimulating and engaging to meet people's needs.

We found that there were systems in place that protected people from the risks of inadequate nutrition and dehydration.

Is the service caring?

People we spoke with told us that staff members were kind and caring.

An external health professional with whom we spoke said they found that staff members were courteous and kind towards the people who used the service.

We talked with three relatives who all said that they were kept well informed about their relatives' care and treatment and were involved in their regular care plan reviews. They told us that the staff members were helpful and kind.

Is the service responsive?

People told us that issues they brought up with the home management had been dealt with in a timely manner.

Relatives of people who used the service told us that they would be confident to raise any concerns with the home management and equally confident that any concerns would be managed appropriately.

Is the service well led?

We noted that the manager for the service was new in post at the time of our inspection and was in the process of implementing new systems. They were being supported by a deputy manager who was also new in post. The staff told us that the management team was making changes within the home.

We talked to people who used the service as well as staff who worked at the home. People told us that the home was pleasant and that staff were lovely and that the food was of a good standard. However, all of the people we spoke to told us that sometimes they had to wait for a long time for their buzzer to be answered, and that this was particularly difficult if they were waiting to be assisted to go to the toilet. People also told us that the activities were not very appealing. Some of the people also told us that they were often not assisted to get up for the day until between 11am and 12pm and that they would like to get up much earlier. People were otherwise satisfied with the care they received and liked the staff who worked at the home.

The staff we spoke to supported these views, they told us that some people were not helped to get up until late morning and that sometimes people did have to wait a long time for buzzers to be answered. Staff told us that they had sufficient staff working at the home and offered different explanations for delays in answering buzzers.

We found that medication was well managed and people received their medication in accordance with their prescription. Staffing arrangements were adequate and most staff had attended all of the required mandatory training.

Care plans were detailed and included good information in parts, however, some sections lacked detail or had not been completed.

During our observations, we saw that staff were respectful and cared about the people in the home as individuals. For example, when supporting people to use the toilet, staff were careful to close the door to maintain privacy. We heard staff talk to people in calm and supportive tones and when undertaking an activity, they did not rush them, allowing them to take it at their own pace.

We saw that the support provided for people respected individual needs and pace. For example, some people were brought into the activity room in wheelchairs and we observed one person being supported to walk using a walking frame. People were offered choices and their decisions were respected.