Archived: FieldHouse Care Home Limited

We found the following examples of good practice.

There were effective measures in place to minimise the risks around Covid-19. Temperatures were being taken and visitors were requested to spray their shoes before entering the home.

The environment was clean, well maintained and hygienic. Cleaning schedules and audits were in place. High touch points within the home were cleaned every two hours. This helped to help minimise the spread of infection.

We observed clear signage and procedures regarding isolation where people had Covid-19. Personal protective equipment (PPE) was used effectively to safeguard staff and people using the service and current government guidance was being implemented.

People and staff were tested regularly for COVID-19, in line with government guidance. All staff employed at the home had been vaccinated, to help keep people safe from the risk of infection.

The registered manager had regular contact with the local authority and infection control teams. The service had risk assessments and policies and procedures in place to manage the risks of COVID-19. There was a dedicated visiting room with an intercom system for visitors. At the time of the inspection, only essential care givers and people at end of life were visiting the home.

The home supported people to maintain contact with relatives. People were also supported to access the community and risk assessments were in place to ensure this was done in a safe manner.

We found the following examples of good practice.

The provider had created a safe and dedicated visiting room to allow residents to see and speak to their friends and relatives. The room had an airtight divider screen, intercom system and external door. The room was well-ventilated and cleaned between visitors.

The provider was following best practice guidance in terms of ensuring visitors to the home did not spread COVID-19. Staff were adhering to personal protective equipment (PPE) guidance and practices, and there was a dedicated room for staff to change before and after their shift. The home has had no positive COVID-19 cases and all staff and residents had received their first COVID-19 vaccination.

Social distancing systems were in place in communal areas and clear plans were in place for those who were required to self-isolate. For those residents who struggled with social distancing additional support was provided.

At the last inspection of August 2016, the service was found to be in breach of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulation 7 HSCA RA Regulations 2014. The service did not have a person registered as manager with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC 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. A person registered with the CQC on the 24 October 2016. The service is no longer in breach of the regulation.

The service used the local authority safeguarding procedures to report any safeguarding concerns. Staff had been trained in safeguarding topics and were aware of their responsibilities to report any possible abuse.

Recruitment procedures were robust and ensured new staff were safe to work with vulnerable adults.

The administration of medicines was safe. Staff had been trained in the administration of medicines and had up to date policies and procedures to follow.

The home was clean, tidy and homely in character. The environment was maintained at a good level.

Electrical and gas appliances were serviced regularly. Each person had a personal emergency evacuation plan (PEEP) and there was a business contingency plan for any unforeseen emergencies.

There were systems in place to prevent the spread of infection. Staff were trained in infection control and provided with the necessary equipment and hand washing facilities. This helped to protect the health and welfare of staff and people who used the service.

People were given choices in the food they ate and told us it was good. People were encouraged to eat and drink to ensure they were hydrated and well fed.

Staff had been trained in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). The registered manager was aware of their responsibilities of how to apply for any best interest decisions under the Mental Capacity Act (2005) and followed the correct procedures using independent professionals.

New staff received induction training to provide them with the skills to care for people. Staff files and the training matrix showed staff had undertaken sufficient training to meet the needs of people and they were supervised regularly to check their competence. Supervision sessions also gave staff the opportunity to discuss their work and ask for any training they felt necessary.

We observed there were good interactions between staff and people who used the service. People told us staff were kind and caring.

We saw from our observations of staff and records that people who used the service were given choices in many aspects of their lives and helped to remain independent where possible.

We saw that the quality of care plans gave staff sufficient information to look after people accommodated at the care home and the plans and care regularly reviewed.

People were treated with respect and dignity.

People were treated in accordance to their age, gender, sexuality and religion.

Plans of care were individual, person centred and reviewed regularly to help meet their health and social care needs.

We saw that people could attend activities of their choice and families and friends were able to visit when they wanted.

Audits, surveys and meetings helped the service maintain and improve their standards of support.

People thought the registered manager was approachable and supportive.

Fieldhouse Care Home is a purpose built home in Rochdale. It provides accommodation to people over the age of 65 who require assistance with personal care. The service is registered to accommodate 41 people. There were 37 people using the service on the day of our inspection. There is a garden area at the rear of the building.

There was no registered manager in place in the service. 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. The previous registered manager had de-registered with the commission on the 17 May 2016. The service had employed a new manager who had applied to register with the commission on the 24 July 2016. The registration process was ongoing at the time of our inspection. The CQC place a limiter on this domain which cannot be assessed as anything other than requires improvement if there is no registered manager.

Prior to our inspection we reviewed our records and saw that Deprivation of Liberty Safeguards (DoLS) applications, which CQC should be made aware of, had been notified to us in a timely manner. We saw information to show that authorisations to deprive people of their liberty had been made to the relevant supervisory body (local authority). DoLS were in place or an application had been submitted for those people who were being restricted in some way.

We spoke with the manager and three staff who were aware of the mental capacity act and what would constitute a deprivation of a person’s liberty.

We saw that a mental capacity assessment had been made prior to admission. However, this was completed by the manager and there was no subsequent best interest meeting to decide if a person could consent to care and treatment. We saw that this had minimal impact on people because the service subsequently applied for a DoLS using the correct procedures. We have made a recommendation that the manager looks at professional guidance for best interest/capacity assessments prior to completing an application for a DoLS.

All other files we looked at showed people had capacity and had consented to care and treatment. We did observe staff members verbally asking for people’s consent prior to undertaking personal care.

People who used the service told us they felt safe. We saw safeguarding policies and procedures were in place to support staff should they have any concerns. Staff had also received training in safeguarding and knew their responsibilities. There was also a whistle-blowing policy in place to protect staff who reported poor practice.

Care records we looked at contained risk assessments for people who had been identified as at risk of poor nutrition or pressure ulcers. We saw these were reviewed regularly to ensure they remained relevant.

Recruitment systems and processes that were in place were robust. We saw references and identity checks were carried out as well as Disclosure and Barring Service checks.

We checked the management of medicines within the service. We found these were managed safely, policies and procedures were in place, only staff who were trained administered medicines and regular audits were undertaken.

Wheelchairs, hoists and moving and handling equipment had been serviced to ensure it was safe to use. Records showed that staff members had received training in moving and handling procedures.

All the people we spoke with told us the food was good. We checked the kitchen and found adequate supplies of fresh, fresh, tinned and dried food was available. The service had a 5* rating from environmental health.

Numerous training courses had been completed by staff members including fire safety, moving and handling, health and safety, infection control and dementia care. National Vocational Qualifications (NVQ’s) were also being undertaken or had been undertaken by a number of staff members.

All the people we spoke with told us the food was good at Fieldhouse Care Home. We observed people had a choice of two main meals at lunchtime. For those people living with dementia, food was served on red plates to aid nutritional intake as best practice suggests this is effective.

We observed the lounge was lively throughout the day. People were chatting with each other or with staff members and laughter was regularly heard. Staff members took the time to sit and chat with people who used the service. Visitors were in and out of the service throughout the day.

Care records contained detailed information to guide staff on the care and support to be provided. There was good information about the person’s social and personal care needs, like and dislikes and routines. However, these had not been signed by the person or their representative. Whilst this did not particularly show a person-centred approach to providing care the detailed information contained in them evidenced that there had been involvement from the person or their family members at some point.

People who used the service were encouraged to remain as independent as possible, with staff support available as and when required.

The service undertook regular quality audits to highlight any improvements needed. We saw policies and procedures were in place to guide and direct staff in their roles.

Staff members we spoke with told us they would be happy for one of their relatives to use the service. They told us there was a good culture and the manager was very supportive of them.

We saw the manager sent out surveys to people who used the service and their relatives in order to gain feedback on how the service was doing and if any improvements could be made.

Below is a summary of what we found but if you want to see the evidence supporting our summary please read our full report

Is the service safe ?

There are safeguarding and whistle blowing policies and procedures in place which staff understood and were acted upon if necessary. Staff all felt the home was safe and knew who they would inform if they were concerned, they were also confident that appropriate action would be taken. The visiting relatives and social worker also felt the home was a safe place. One relative said it was as safe as 'anywhere could be' for their relative who we saw had complex needs.

On the day we visited the home was clean and well maintained, there were sufficient skilled and experienced staff to see that people were attended to safely and promptly. Staff were dressed appropriately to undertake their work and to comply with Health and Safety and Infection Control regulations. We saw that senior staff that were responsible for administering medication were wearing red tabards to indicate that they should not be distracted or unduly disturbed during the procedure.

Is the service effective?

There was a key worker system in place and people who used the service had their health and care needs assessed and planned with them and or their relatives and we saw that they were reviewed regularly. People who use the service had their nutritional status assessed and their weights were measured and recorded. The staff and their relatives said the food was "very good'. We observed the service users enjoying their choice of meals and being offered snacks and drinks regularly during the day. Those people who required help to eat and drink were supported by carers in an unhurried and dignified manner.

There is evidence of multidisciplinary working and good communication between the home and other professionals and the professionals we spoke to on our visit told us the home was one of 'the better homes'. The visiting relatives told us that communications between themselves and staff was very good and they were informed about changes to their relatives' condition or when they required some new clothing or personal effects.

Is the service caring ?

On the day we visited there were thirty nine people who lived at the home, the majority of whom had complex physical and communication difficulties. Staff encouraged people to be as independent as possible and told us that they could understand the signs and signals some people used to communicate with them. We observed this throughout the day as staff interacted with the people who were confused or had limited communication due to their deteriorating health.

Most people who lived at the home were in various parts of the two lounges. There were a few friendship groups that had been formed by people who lived at the home and one such group told us about the musical entertainment that the home had recently provided, and laughing with glee recalled how one event in particular had provided them with much amusement. Staff also told us about improvements in peoples wellbeing when they formed friendships with other people who lived at the home.

Some relatives visit every day and one told us the staff were 'part of my family now' and that they 'took comfort' in the fact that their relative was looked after the way they would have done. One person who was highly dependent on staff for all their needs, told us with some difficulty that 'staff looked after them very well' and we saw that they had a warm and affectionate relationship with their main carer who clearly understood what was being said and what the person needed. Staff were observed making visitors feel welcome and that refreshments and snacks were being offered and served to them. The home had been awarded the Dignity in Care award and staff were seen to be polite friendly and respectful of people when carrying out their work.

Is the service responsive?

We saw from the care plans and were told that people who lived at the home or their relatives had given their consent to being in the home. They were involved in their care plans and had given their consent to being photographed, to their medical treatment and involvement in social activities. Ends of life plans were also recorded. We saw a complaints policy and the three records kept of complaints since our last visit. They were notated, dealt with appropriately and signed.

We saw evidence of a range of activities during the week and on the day we visited we observed group bingo, music playing and one to one pampering. The social worker also confirmed that every time they visited the home was always busy with activities going on. We were told that there is also a visiting hairdresser and podiatrist. In addition, the relatives and staff told us that the different faith communities visited the home and that their relatives could maintain their faith observances.

Is the service well led?

The manger is a Registered Nurse who had worked at the home for a number of years and was respected by everyone we spoke to on the day of our visit. Staff told us they were supported by training and regular supervision and that the manager were 'firm but fair'. They also felt the manager was approachable on any matter and if there was a problem related to the home they were confident that it will be dealt with appropriately.

There is an effective system of quality assurance in place which allows the manager to audit and monitor the service against Essential Standards and clear lines of accountability and reporting for staff that was understood by them and the visiting relatives. The manager undertakes spot checks and has expectations of good standards of behaviour from all the staff. There was a plan for supervision and training in place. We saw that complaints were monitored and acted upon. The manager also monitored accidents and incidents which were mainly related to falls

We saw the annual quality assurance questionnaire used by the manager which is distributed widely to relatives and people who live at the home. The manager collates this information which is on the overall running of the home, the food, care and daily living as well as staff and management and the responses we saw were highly positive.

We spoke to four members of staff and observed and heard staff interacting with people and assisting them. One staff member commented, 'We are here to look after people but not to take away their choices'.

The registered manager told us that she believed people should be 'happy whilst they are here. For some people, it may be the last place they live and it is important we do what we can so that their lives are happy'.