Field View

About the service

Field View is a residential care home that provides personal care and support for up to 8 people with a learning disability and/or autism. At the time of the inspection 7 people lived at the service and one person received a supported living service in their own home.

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

Right Support: Risks associated to people's health and welfare were not always effectively managed. Overall 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; but there were inconsistencies in the policies and systems in the service to support this practice. The outcomes for people were not always appropriate and the management team and staff were not always aware of what might constitute restrictive practice. Staff understood how to protect people from poor care and abuse. The service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it. There were enough staff to meet people's needs. Medicines were managed safely.

Right Care: People did not always receive care that was person-centred. There were gaps in staffs training to support people with specific needs and communication. People had enough to eat and drink, and individual dietary needs were met.

Right Culture: The provider's governance arrangements did not provide assurance the service was well-led. Systems and processes to oversee the safety and quality of the service were not used effectively and had not identified the shortfalls we found during our inspection. Regulatory requirements continued not to be met. Staff knew and understood people well and supported them to live a quality life of their choosing.

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 3 December 2021).

At our last inspection we recommended the provider seek advice from a reputable source on their rota systems and recruitment and review their procedures to ensure medicines were managed in line with best

practice guidance. At this inspection we found the provider had made improvements.

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.

We initially looked at the safe and well-led domains but opened the inspection up to include the effective domain due to concerns about staff training and the application of the Mental Capacity Act, and the potential impact this might have on people using the service.

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 remains requires improvement. This is based on the findings at this inspection. We have found evidence the provider needs to make improvements. Please see the safe, effective, and well led sections of this full report.

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

You can read the report from our last inspection, by selecting the 'all reports' link for Field View on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches of regulations in relation to safe care and treatment and good governance.

We have made recommendations in the effective domain in relation to staff training and the Mental Capacity Act. Please see this section for further details.

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

Field View is a care home providing accommodation and personal care for up to eight younger adults in a residential setting who have a learning disability and/or autism. The service consists of a main building and two individual bungalows. At the time of our inspection eight people lived at the service and one person received a supported living service in their own home.

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

Quality assurance processes were not effective. Audits had not identified some of the areas we found at this inspection. When audits had identified areas, action had not always been taken to rectify the issues.

The service did not employ sufficient staff to give people a consistent staff team, there was a high reliance on agency use which at times impacted people’s daily lives. The provider was trying to recruit staff. We have made a recommendation regarding recruitment and rota systems.

Medication records were not always accurate or fully completed. We have made a recommendation regarding medicines.

Some areas of the service were not clean, and some people’s bedrooms required attention. Accident and incidents were reviewed by the registered manager but not always fully explored to learn lessons.

Safe recruitment practices were followed, and we received positive feedback regarding the caring nature of staff. Staff felt well supported by the registered manager.

People were supported to have maximum choice and control of their lives and staff supported /did them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

Based on our review of safe and well-led key questions. The service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. Relatives were happy with the care their relatives received and shared the positive outcomes the service had on people’s lives. People told us they chose what they wanted to do and how they wanted to spend their time.

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 (published 12 March 2020)

Why we inspected

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 received concerns in relation to risk management and oversight of the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

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 improvement. Please see the safe and well-led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

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

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 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 for 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 service has been developed and designed in line with the principles and values that underpin ‘Registering the Right Support’ and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

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

People, their relatives and the staff who supported them provided positive feedback about the benefits the service had on supporting people to have positive outcomes. Care and support was tailored to each person's needs and preferences. Individuals who knew people well were fully involved in developing and updating their planned care.

The provider had systems in place to safeguard people from abuse and staff demonstrated an awareness of safety and how to manage any identified risks.

People were supported to gain work experience and engaged in activities and events

that were of interest to them. Staff responded to people’s personal preferences and individual beliefs to ensure they received care and support in a way they liked. Evaluations of people’s needs ensured planned goals remained relevant and achievable.

People received information in a way they could understand. Staff demonstrated effective skills in

communication. Sufficient, regular and skilled staff worked at the service. People were able to choose their support worker and recruitment checks ensured all staff were suitable to work at the service. Staff received training and support to enable them to carry out their roles following best practice guidance.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice.

People received their medicines safely and on time. The service worked closely with a range of health professionals which benefitted people’s wellbeing. Dietary requirements were monitored, and healthy eating promoted.

Relatives and staff told us the registered manager was approachable and accountable. The registered manager was supported in their role by the provider. Oversight and checks helped to maintain a high standard of service and highlighted any areas for improvement.

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

Rating at last inspection

The last rating for this service was good (published 6 July 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our reinspection programme. If we receive any concerning information we may inspect sooner.

At the last inspection in March 2015, the service was rated good, although the well-led domain was rated as requiring improvement. We identified a breach in regulation for failing to establish and operate systems or processes to effectively assess, monitor and improve the quality and safety of the service. This included a lack of staff supervisions, staff and relatives meetings and reviewing of quality auditing. The registered provider sent us an action plan in response to the breach we identified stating what measures they were going to take in order to address the issues. At this inspection we found the registered provider had taken the action required of them to meet the regulation.

This comprehensive inspection took place on 1 June 2017 and was announced. At this inspection we rated all the domains as good and therefore the service remained ‘Good’.

The service had a manager who was registered with the Care Quality Commission (CQC) in March 2016. 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.

We found improvements to the quality assurance systems at the service. The registered manager had implemented an effective quality assurance system which ensured the service was continually improving and a range of audits and checks were completed regularly to ensure that good standards were maintained. Staff were receiving regular supervision and team meetings were held frequently. People’s relatives were receiving regular updates in the form of a ‘letter home’ from the service.

People were relaxed with staff. Staff had a good understanding of how to safeguard adults from abuse and who to contact if they suspected any abuse. Risks assessments were individual to people's needs and minimised risk whilst promoting people's independence.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People's permission was sought before any care or support was given.

Staff demonstrated good communication with people and supported them to express their views. They had clear strategies and aids in place where people had difficulties with communication. The staff were familiar with the needs of people living with autism and learning disabilities.

Staff supported people in a positive way and were able to recognise when people may require additional support. They had received bespoke training to intervene when people were at risk from behaviour that may challenge others.

Staff were well supported and had access to additional training specific to people's individual needs. The training was monitored and refresher courses made available. We found some gaps in the training records at the service. We discussed this with the registered manager who addressed this immediately after the inspection and provided us with updated records and an action plan to ensure this remained relevant.

There were enough staff to provide a good level of interaction. Staff felt that they were able to contact the registered manager at any time if they needed support or guidance. People were supported by staff that had the knowledge and skills to understand and meet their health needs.

Effective recruitment and selection processes were in place and medicines were managed in a safe way for people.

People had good relationships with the staff. There was a relaxed atmosphere at the service with staff spending quality time with people. People were treated with dignity, respect and kindness. People received care and support to meet their diverse needs including people who had complex health needs.

People's nutritional needs were met. We saw that they enjoyed a good choice of food and drink during both mealtimes and were also provided with snacks and refreshments throughout the day.

People had their health and social care needs assessed and plans of care were developed to guide staff in how to support people. People who lived at Field View received additional care and treatment from health professionals based in the community.

We looked at the ways nutrition was managed and found people were able to choose what they ate and where necessary weight and dietary intake was monitored effectively. The service was clean and hygienic and infection control procedures were followed well by staff.

We found that staff were well supported to carry out their roles and were able to access a wide variety of training. Staff supervision and appraisals were regular and thorough. One staff member told us 'My progress and performance is discussed at each supervision meeting, which is really useful'. There was a robust system in place for monitoring the effectiveness of the service and people who used the service and families were involved in the development and improvement of the service.

People were supported through a care planning process to have their needs met and care plans included a large amount of information about the individual and how they were to be supported.

We saw that there was a staff recruitment process in place and that all staff had completed this to help ensure that people were only supported by staff suitable for the role.

We saw that staffing levels ensured support to maintain peoples one to one hours and that any shortfalls were covered by regular staff in the home.

There was a quality assurance system in the home that included the views of relatives and was being developed to include the views of people who lived in the home.