Archived: Field House

Field House is a residential care home providing personal care to up to 28 people. The service provides support to older adults. The accommodation is provided across 2 separate floors in one adapted building. At the time of our inspection visit there were 16 people using the service.

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

Improvements had been made to all aspects of the service since the last inspection. Leadership had been consistent and the management team worked well with external agencies in order to promote positive outcomes for people.

Risks to people’s health, safety and welfare were identified and managed. Medicines were managed safely and staff followed infection prevention and control policies.

Improvements had been made to governance systems and action had been taken to address any shortfalls identified in audits. The provider continued to work through a programme of improvements to the environment.

Safe staff recruitment systems were in place. There were enough staff, who received up to date training, to provide safe care. Improvements had been made to the way in which staff were deployed.

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 13 February 2023). There were continued breaches of regulations. This service has been in Special Measures since 25 August 2022. At this inspection we found improvements had been made and the provider was no longer in breach of regulations. Therefore, this service is no longer in Special Measures.

Why we inspected

We undertook this focused inspection to check whether enforcement action we previously served in relation to conditions of registration and breaches of Regulations 12, 13 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. This report only covers our findings in relation to the Key Questions Safe, Effective 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 changed from Requires Improvement to good based on the findings at this inspection.

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 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, which will help inform when we next inspect.

Field House is a residential care home providing personal care to up to 28 people. The service provides support to older adults. At the time of our first inspection visit there were 14 people using the service and 2 people were in hospital. At the time of our second visit there were 19 people using the service. The care home accommodated people across 2 separate floors in one adapted building.

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

New admissions to the service were not managed safely. Quality assurance systems did not always identify risks and issues to improve safety for people. Known risks were not always managed. Leadership of the service was inconsistent. Relatives did not feel engaged by the provider.

Incidents of alleged abuse were not always reported to the local safeguarding authority. Infection prevention and control (IPC) was not always safe.

Medicine-related recording was not always in line with best practice. Medicines management, however, had improved since the last inspection and people received their medicines safely. Relatives gave mixed feedback on the safety of the service. Staffing levels were safe, but staff skills were not always deployed appropriately. New staff recruitment was safe.

People’s care plans sometimes included inconsistent information. People were supported to eat and drink, but some risks to people were not always highlighted effectively.

Some relatives felt the design and decoration of the building needed updating. We identified some improvements had been made to this since the last inspection. Staff understood people’s needs. People were observed to enjoy their meals.

Staff had received up-to-date training to support people safely. Some lessons were learned from incidents to improve people’s outcomes. The provider worked with other agencies to support people to achieve positive outcomes. Staff supported people in a person-centred way and relatives felt staff kept them up to date on people’s needs.

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 inadequate (published 25 August 2022). There were breaches in regulation. This service has been in Special Measures since 25 August 2022. During this inspection, the provider demonstrated that some improvements have been made and the service is no longer rated as inadequate overall. However, we found the provider was still in breach of regulations and will remain in Special Measures as one key question has remained inadequate since the last inspection.

Why we inspected

At the last inspection, we carried out an unannounced focused inspection of this service on 25 May 2022. Breaches of legal requirements were found. The provider was served with a Warning Notice with a compliance date by when to improve.

We undertook this focused inspection to check whether the Warning Notice we previously served in relation to Regulations 12, 13, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. This report only covers our findings in relation to the Key Questions Safe, Effective 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 changed from Inadequate to Requires Improvement. This is based on the findings at this inspection.

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 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.

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 people’s health and safety, protecting people from abuse and governance.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

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.

The overall rating for this service is requires improvement. However, the service will remain in Special Measures. We do this when services have been rated as 'Inadequate' in any Key Question over 2 consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services 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, 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.

Field House is a residential care home personal care to up to 28 people. The service provides support to older adults. At the time of our inspection there were 23 people using the service with a further one person in hospital. The care home accommodated people across three separate floors in one adapted building.

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

People were not protected from the risk of abuse. People ‘s medicines were not administered safely, and people were at risk of being over medicated. Risks to people were not always adequately assessed and recorded. Staff recruitment records were not always complete. People were not always adequately protected from the risk of infection. Lessons were not always learned following incidents.

Staff had not received up to date training. People did not always have their full needs assessed, but relatives told us people were offered choice. Some people were deprived of their liberty without authorisation from the local authority. Nutritional and hydration needs were not always adequately assessed and documented. Relatives told us there was a good standard of food choice.

There was a lack of oversight at the service from the registered manager and the provider. The service did not have a person-centred culture and the registered manager was not always accessible to relatives. People, relatives and staff were not engaged in the running of the service. The provider did not work well with partner agencies and this impacted on the care people received. People told us they felt safe at the service.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; systems in the service did not support 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 good (published 27 September 2018).

Why we inspected

The inspection was prompted in part due to concerns received about the service’s response to deterioration in people’s health and concerns raised by the local authority safeguarding team around care planning and incident reporting.

As a result, a decision was made for us to inspect and examine those risks. We undertook a focused inspection to review the key questions of safe and well-led. However, following concerns found around Deprivation of Liberty Safeguards (DoLS), the inspection was also opened to the key question of effective.

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 the provider needs to make improvements. Please see the safe, effective and well-led sections of the full report.

You can see what action we have asked the provider to take at the end of this full report. The provider has taken some actions to mitigate these risks, but this was not always effective.

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 changed from good to inadequate based on the findings of this inspection.

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.

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 safety, staff training, management and leadership at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

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.

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 home was clean and hygienic and enhanced cleaning had been introduced during the recent COVID-19 outbreak.

The registered manager checked the vaccination status of new staff.

People were supported to see their relatives in a safe environment.

We inspected the service on 10 and 17 July 2018. The first day of our inspection was unannounced. On the first day of our inspection there were 24 people living in the home.

There was a registered manager in post at the time of our inspection. A registered manager is a person who has registered with CQC to manage the service. Like registered providers (the ‘provider’) 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.

At our last inspection we found continuing shortfalls in the provision of communal activities and other forms of stimulation. As a result, the provider was in breach of Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and the overall rating of the home was Requires Improvement.

On this inspection we were pleased to find the breach of regulations had been addressed and people were provided with physical and mental stimulation appropriate to their needs. Two administrative errors aside, service quality in all other areas had been maintained and the overall rating is now Good.

Staff worked well together in a mutually supportive way and communicated effectively, internally and externally. Training and supervision systems were in place to provide staff with the knowledge and skills they required to meet people’s needs effectively. There were sufficient staff to meet people’s care and support needs without rushing. Staff provided end of life care in a sensitive and person-centred way.

Staff were kind and attentive in their approach. People were provided with food and drink of good quality that met their individual needs and preferences. The physical environment and facilities in the home reflected people’s requirements.

People’s medicines were managed safely and staff worked closely with local healthcare services to ensure people had access to any specialist support they required. Systems were in place to ensure effective infection prevention and control.

The registered manager had the trust and confidence of her team. Throughout our inspection she demonstrated a commendably open and reflective approach. A range of audits was in place to monitor the quality and safety of service provision. People’s individual risk assessments were reviewed and updated to take account of changes in their needs. Staff knew how to recognise and report any concerns to keep people safe from harm. There was evidence of some organisational learning from significant incidents and events. Formal complaints were rare and any informal concerns were handled effectively. Action was required to ensure CQC was always notified of any significant incidents or events.

CQC is required by law to monitor the operation of the Mental Capacity Act, 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves. At the time of our inspection the provider had been granted a DoLS authorisation for one person living in the home and was waiting for a further two applications to be assessed by the local authority. Staff understood the principles of the MCA and demonstrated their awareness of the need to obtain consent before providing care or support to people. Senior staff documented decisions that had been made as being in people’s best interests.

We inspected the home on 9 May 2017. The inspection was unannounced. There were 24 people living in the home on the day of our inspection.

The home had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers (the ‘provider’) 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.

During our inspection we found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the provider was still failing to ensure an effective, person-centred response to people’s need for physical and mental stimulation. You can see what action we told the provider to take on this issue at the back of the full version of this report.

Reflecting the provider’s failure to respond fully to the findings of our last inspection, we found improvement was required in the systems and processes used to assess, monitor and improve service quality.

In other areas, the provider was meeting people’s needs effectively.

There was a warm, relaxed atmosphere and staff supported people in a kind, friendly way. Staff treated people with dignity and respect and encouraged them to exercise choice and control over their lives. People were provided with food and drink of good quality that met their individual needs and preferences. People knew how to raise concerns or complaints and were confident that the provider would respond effectively.

People’s medicines were managed safely and staff worked alongside local healthcare services to ensure people had access to any specialist support they required. People’s individual risk assessments were reviewed and updated to take account of changes in their needs. Care plans were well-organised and kept under close review by the registered manager. Staff knew how to recognise and report any concerns to keep people safe from harm.

There were sufficient staff to meet people’s care needs and staff worked together in a friendly and mutually supportive way. The provider organised a varied programme of training and encouraged staff to study for advanced qualifications. Staff were provided with effective supervision and support from the registered manager and other senior staff. The registered manager provided strong, visible leadership and had won the respect and loyalty of her team.

CQC is required by law to monitor the operation of the Mental Capacity Act, 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves. At the time of our inspection the provider had been granted a DoLS authorisation for three people living in the home. Staff understood the provisions of the MCA and demonstrated their awareness of the need to obtain consent before providing care or support to people.

If you want to see the evidence supporting our summary please read the full report.

During our inspection we focused on our five key questions:

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

Is the service safe?

Systems were in place to make sure the manager and staff learnt from events such as complaints, concerns and investigations. This reduced the risks to people and helped the service to continually improve.

The home had policies and procedures in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS) although no DoLS authorisations had been made.

The Mental Capacity Act 2005 and Deprivation of Liberty Safeguards is a law which protects people who are unable to make decisions for themselves.

People were treated with respect and dignity by the staff. People we spoke with told us that they felt safe. Safeguarding procedures were in place and staff we spoke with and records we looked at confirmed that staff were trained and understood how to safeguard the people they supported.

Is the service effective?

People's health and care needs were assessed. People, and where appropriate, their relatives, were involved in reviewing their care plans. Specialist dietary requirements, mobility and equipment needs had been identified in care plans where required.

We looked at people's care records which showed that care plans set out people's individual care needs. They were current and the records showed that they had been reviewed on a monthly basis and amendments had been made when a person's care needs changed.

During our inspection we observed that members of staff knew people's individual health and wellbeing needs. We saw that people responded well to the support they received from staff members.

We saw that information about advocacy services were available for people and their relatives should they require it. This meant that when required people could access additional support from other agencies.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when they supported people. One person we spoke with told us: 'It's a lovely place to live and staff are always willing to help and support me.'

People who used the service, their relatives and friends completed a satisfaction survey on an annual basis. Where concerns or comments were raised these had been addressed by the manager. For example, one person had noted that there was not a clock in one of the communal areas and we observed on our inspection there was now one in place.

People's preferences, interests and diverse needs had been recorded in their care plans and people we spoke with told us that their care and support had been provided in accordance with their wishes.

Records showed people had access to a range of healthcare professionals some of whom visited people at the home. These included GPs, district nurses, speech and language therapists and a chiropodist.

Is the service responsive?

People completed a range of activities in and outside the home on a regular basis. The home had access to a minibus, which helped people to have to trips to the seaside etc. There were links with the local primary school and students were also involved in undertaking work experience placements at the home.

The provider had a complaints policy in place and information on how to make a complaint was displayed in the home. There was written information on how to make a complaint in people's bedrooms within the service user guide, should people or their relative wish to raise a concern.

Is the service well led?

The service worked well with members of the multi-disciplinary team which included GP's, district nurses and the local authority to make sure people received their care in a joined up way.

The service had a quality assurance system in place and we found records showed that shortfalls were addressed. As a result the quality of the service was improving.

People were offered a choice of meals. One person told us, 'If they have got it you can have it.' Where people required special diets they were available to them.

We looked around the home and saw all area were clean and tidy. We asked one person if staff kept the home clean. They replied, 'Yes they do.' Staff told us how they reduced the risk of infection by wearing gloves and aprons and changing them at appropriate times.

Recruitment processes ensured staff were appropriate to work with vulnerable adults.

Care records accurately recorded people's care needs and the associated risks. Records were kept for the appropriate length of time and then destroyed securely.