Fieldway Care Home

Fieldway Care Home is a residential care home providing personal care and support for up to 68 people living with nursing and dementia care needs. At the time of the inspection, there were 61 people using the service. The Care Quality Commission (CQC) only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.

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

People told us they liked living at Fieldway Care Home and that staff were kind and treated them with respect.

The provider had acted on our recommendations from the previous inspection in relation to activities provision within the home. However, we found record keeping especially in relation to end of life care planning needed to be improved.

People told us they enjoyed the range of activities in the home and were complimentary about the wellbeing team who were responsible for running these. Members of the wellbeing team had received training in how to support people living with dementia and offered both group and individual activities for those people who were bed-bound.

People received care and support from staff according to their individual assessed needs and preferences. Care plans were person-centred and contained information about how they preferred staff to meet their individual care needs and wishes.

People said they were aware of the provider’s complaints policy and how to raise any concerns or complaints they might have.

The provider had made arrangements for adequate management cover whilst they were recruiting a new, permanent registered manager. The interim manager had identified a number of areas of improvement for the service which were being actioned. There was an open culture within the service and staff said they felt well supported. The provider engaged with people and relatives asking for their feedback about how the service was run. Governance systems were used to monitor the quality of care provided.

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 10 October 2019). There were recommendations in place regarding activities provision. At this inspection enough improvement had been made in relation to this area.

Why we inspected

This inspection was carried out to look at improvements against the recommendations found at the previous inspection. As a result, we undertook a focused inspection to review the key questions of responsive and well-led only.

We did not inspect the key questions of safe, effective and caring. 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 to good based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Fieldway Care Home, 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.

We found the following examples of good practice.

People had two designated visitors as per national guidance. Visitors were required to wear a face covering when visiting. Facilities were in place to wash hands and visitors had use of hand sanitiser on entering and leaving the home. All visitors were screened for symptoms of COVID-19 before being allowed to enter the home.

People using the service were supported to maintain safe social contact with family, friends and relatives; for example, by telephone/mobile or video calls, visiting in the communal garden or in a specially adapted room. Where possible remote solutions were also considered by other visitors such as professionals and clinical consultations.

Staff had access to and wore appropriate Personal Protective Equipment (PPE) such as masks, gloves and aprons when providing personal care. Staff had attended training from an Infection Prevention and Control (IPC) specialist at the local authority, provider inhouse sessions and received regular updates from public bodies such as Public Health England, Department of Health and Clinical Commissioning Group. There were prominent displays of signage on donning/doffing (putting on and taking off) PPE and handwashing in all required areas, including for visitors.

The provider ensured people were tested for COVID-19 by the hospital and from the community before agreeing to admit them. People using the service were monitored for COVID-19 symptoms. Symptomatic residents were isolated in single occupancy rooms. Residents in isolation did not attend communal areas and alternative facilities were provided.

People using the service were tested regularly for Covid-19 while all staff undertook twice a week testing. The provider had and knew how to apply for coronavirus testing kits via the online care home portal.

The service was clean and hygienic. Domestic staff had cleaning schedules, which they were required to complete and that included frequency of cleaning of high touch areas, e.g. light switches and door handles. Staff followed guidance in managing laundry to prevent the spread of infection.

Changes had been made to the layout of the service to help with social distancing of people and staff. Dining tables were set apart and two people dined together on one table. There was a visitor’s room which was subject to enhanced cleaning in between each visit.

The majority of the relatives we spoke with told us communication between them and the home during the Covid-19 pandemic had enabled them to maintain contact with people using the service in a safe manner.

The registered manager told us the service did not use agency staff. The registered manager undertook spot checks, regular meetings and communicated with staff to increase compliance in the use of personal protective equipment.

Relatives told us staff wore PPE correctly. A relative said, “When we have video calls or visit you can see the staff wearing PPE”. We observed staff using PPE in accordance with current guidance.

Fieldway Care Home is a residential home providing nursing and/or personal care to older people. The service can accommodate and support up to 68 people in a single building compromising of two floors, each with their own separate adapted facilities. Most people using the service have nursing needs and are living with dementia. At the time of the inspection, there were 53 people using the service.

People’s experience of using this service

At our last inspection we found the provider had failed to ensure people had enough opportunities to participate in meaningful activities that reflected their social interests and needs. At this inspection we found not enough improvement had been made in relation to activities. We have therefore repeated the recommendation we made at the providers last inspection that they find out about training for activities coordinators, based on current best practice, in relation to meeting the specialist social care needs of people living with dementia.

At our last inspection we also found multiple breaches of regulation. This was because the provider had failed to ensure medicines were always safely stored; people received continuity of care and support from competent staff ; people were treated with dignity and respect, records were appropriately maintained and governance systems were operated effectively.

At this inspection we found the provider had made enough improvements to ensure they were no longer in breach of regulations. This was because we found medicines were now managed safely; sufficient nursing and care staff were employed to meet people’s ; staff treated people with respect and dignity; governance systems were operated effectively and records were appropriately maintained by staff.

Similarly, people told us the service had significantly improved in the last six months under the leadership of the new manager. Feedback from people, relatives and professionals about the standard of care and support at the home was positive. In addition, most people also said the new manager had done a “great job” ensuring the service was now fully staffed with permanent nurses and care workers who were familiar with people’s needs and wishes.

However, the provider will need to demonstrate that all the improvements described above are sustainable over a longer period of time before we can consider rating the service good overall.

People were cared for and supported by staff who knew how to manage risk and keep people safe. We saw the premises remained clean and staff followed relevant national guidelines regarding the prevention and control of infection. People continued to live in a suitably adapted and reasonably well decorated care home that met their needs.

The training and support staff received remained relevant to their roles and responsibilities. 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. People were supported to maintain a nutritionally well-balanced diet. People were supported to stay healthy and well and have access to the relevant community health care professionals.

People were treated equally and had their human rights respected, including their spiritual and cultural needs and wishes. People were encouraged and supported to develop their independent living skills. Assessments of people’s support needs continued to be carried out before they started using the service.

Care plans were personalised and up to date. Managers and staff understood the Accessible Information Standard and ensured people were given information in a way they could easily understand. People were encouraged to make decisions about the care and support they received and had their choices respected. People were satisfied with the way the provider dealt with their concerns and complaints. People’s end of life care wishes was recorded in their care plans.

The manager recognised the importance of learning lessons when things went wrong. The provider worked in close partnership with other health and social care professionals and agencies to plan and deliver people’s packages of care and support. The provider promoted an open and inclusive culture which sought the views of people using the service, their relatives and staff.

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

Rating at the last inspection

The last rating for this service was requires improvement overall and inadequate for the key question, ‘Is the service safe?’ (report published 20 February 2019).

Why we inspected

This was a planned inspection based on the previous rating.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Fieldway Care Home 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.

Fieldway is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. The service can accommodate up to 68 people. At the time of our inspection 63 people were living in the care home. People living in the care home from now on will be referred to as ‘people’ throughout this report.

The service continues to have the same registered manager in post who has been in day-to-day charge of the care home since February 2017. A registered manager is a person who has registered with the CQC. Registered managers like registered providers 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.

This was the service’s first inspection since we re-registered them in December 2017 under the new provider HC-One Oval Limited. During this inspection, we identified several areas of concern which lead us to issue five breaches of the regulations. We have therefore rated the service Requires Improvement overall, inadequate for the key question, ‘Is the service safe?’ and requires improvement for the key questions, ‘Is the service caring, responsive and well-led?’

The service was rated inadequate in safe because medicines were not always safely managed in the care home. People were supported to take their medicines as they were prescribed, but were not always securely stored. This failure to always follow the relevant National Institute of Clinical Excellence (NICE) guidelines around the safe storage of medicines had put people at unnecessary risk of harm.

Furthermore, the service does not always have enough staff with the right experience to meet people’s needs. Although the care home was adequately staffed on both days of our inspection, we received mixed comments from people living in the care home, their relatives, external health care professionals and staff concerned about the lack of experienced staff working who were familiar with the needs, wishes and daily routines of people We also observed several instances of staff not being available in a timely manner when people requested assistance.

People’s privacy and dignity were not always respected by staff. Throughout our inspection we observed most staff interacted with people in a kind and compassionate way. However, we saw several instances of staff not respectfully engaging with people they were assisting to eat or entering a person’s bedroom without knocking or asking permission to do so.

People did not always receive the right level of personal and health care and support they required to ensure their individual needs and wishes were met. The mixed feedback we received from people, their relatives and external health care professionals, as well as our own observations, indicated staff sometimes failed to meet people’s basic health and personal care needs by not following their care plan and risk management plan.

The provider had established some good governance systems to assess and monitor the quality and safety of the care and support people received, but we found these were not always implemented. We identified numerous issues the providers governance systems had failed to pick up during our inspection, which included poor management of medicines and staff not always respecting people’s privacy and dignity or meeting their needs and wishes. Records the service was required to keep in respect of the people living in the care home were not always appropriately maintained by staff.

You can see what action we told the provider to take in response to all the breaches of the regulations outlined above at the back of the full version of the report.

We discussed all the issues described above with the registered manager and a regional quality assurance director who both confirmed the service was now subject to an internal review being conducted by the provider to look more closely at the problems the service is experiencing, identify the root causes and develop an improvement plan to try and address them. .

Measures to reduce risks posed to people's safety by the environment were in place, but these were not always followed and some equipment had not been kept in a good state of repair. On the first day of our inspection we found several damaged window restrictors on the first floor and chemicals and in an unlocked cupboard. These failures had placed people at unnecessary risk of harm. We discussed these safety issues with the registered manager who agreed to remind all staff about their responsibilities to keep people safe. On the second day of our inspection we saw all the damaged window restrictors had been repaired and doors to rooms where people should not access were kept safely locked when they were not in use.

Staff received most of the training and support they required to meet the needs of the people they supported. However, staff had not received any training in how to prevent or appropriately manage behaviours that could challenge the service. We fed this back to the registered manager who agreed to ensure all staff received suitable training to help them prevent or appropriately manage behaviours considered challenging. We will review at our next inspection whether the action taken by the provider to address this shortfall in staff training has led to improved outcomes for people.

People had opportunities to participate in some meaningful social activities at the home and in the wider community. However, feedback we received from people and their relatives about the quality and choice of the social activities on offer was mixed. We discussed these comments with the registered manager who told us they were actively trying to recruit more activities coordinators to improve the opportunities for people to engage in fulfilling social activities. We will review at our next inspection whether the action taken by the provider has been achieved. We also recommend that the service finds out about the specialist social needs of people living with dementia to develop a more suitable activities programme and dementia awareness training for activities coordinators.

Most people living, visiting or working in the care home, felt the current staff team lacked cohesion and their morale was low.

We found the provider had robust procedures in place to safeguard people from harm and abuse. Staff were familiar with how to recognise and report abuse. Appropriate staff recruitment checks took place. The environment was kept clean and staff demonstrated good awareness of their role and responsibilities in relation to infection control and food hygiene.

As recommended at the service’s last inspection we saw easy to read and understand signage was now used to help people living with dementia identify rooms that were important to them. People were supported with their nutritional needs. Staff identified when people required further support with eating and drinking and took appropriate action. The principles of the Mental Capacity Act (MCA) were followed.

People were supported to maintain relationships with their relatives and friends. Staff understood and responded to people's diverse cultural and spiritual needs and wishes. People were supported to do as much as they could and wanted to do for themselves to retain control and independence over their lives. When people were nearing the end of their life, they received compassionate and supportive care.

People’s needs were assessed and planned for with the involvement of the person and/or their relative where required. Each person had an up to date and personalised care plan, which set out how their care and support needs should be met by staff. There was a complaints procedure and action had been taken to learn and improve where this was possible.

People were asked to share their feedback about the service. The registered manager understood their responsibilities and sent us the information they were required to, such as notifications of changes or incidents that affected people they supported.

At the last Care Quality Commission (CQC) inspection in May 2015, the overall rating for this service was ‘Good’. Since that inspection Fieldway Care Home has been reregistered by the CQC in February 2017 to another Bupa sub-company. Consequently, this inspection represents the service’s inaugural inspection and rating under the new provider, although most staff, processes and systems and people using the service continued to be the same. We found this newly registered service met the regulations and fundamental standards and we have rated them ‘Good’ overall.

The service 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, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

We have made a recommendation about the home’s environment and design not being as dementia ‘friendly’ as it could be. Although we saw there were some signs up in the home to help people identify toilets and bathrooms, most bedroom doors lacked any visual clues in order to make the room more recognisable to people. We also saw communal areas such as hallways and bedroom doors, which had recently been redecorated, had been painted in similar colours. This lack of attention to the environment where people with dementia were cared for could lead to people becoming disorientated to place.

People and their relatives told us they were happy with the care the service provided. We saw staff looked after people in a way which was kind and caring. Staff had built caring and friendly relationships with people and their relatives. Our discussions with people living in the home, their relatives and community health care professionals supported this.

There were robust procedures in place to safeguard people from harm and abuse. Staff were familiar with how to recognise and report abuse. The provider assessed and managed risks to people’s safety in a way that considered their individual needs. Recruitment procedures were designed to prevent people from being cared for by unsuitable staff. There were enough staff to keep people safe. The premises and equipment were safe for people to use because managers and staff routinely carried out health and safety checks. Medicines were managed safely and people received them as prescribed.

Staff received appropriate training and support to ensure they had the knowledge and skills needed to perform their roles effectively. People were supported to eat and drink enough to meet their dietary needs and preferences. They also received the support they needed to stay healthy and to access healthcare services.

Staff were caring and treated people with dignity and respect and ensured people’s privacy was maintained particularly when being supported with their personal care needs. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

People received personalised support that was responsive to their individual needs. Each person had an up to date and personalised care plan, which set out how their care and support needs should be met by staff. This meant people were supported by staff who knew them well and understood their needs, preferences and interests. Staff encouraged people to actively participate in meaningful leisure activities that reflected their social interests and to maintain relationships with people that mattered to them.

The managers provided good leadership and led by example. People felt comfortable raising any issues they might have about the home with managers and staff. The service had arrangements in place to deal with people’s concerns and complaints appropriately. The provider also routinely gathered feedback from people living in the home, their relatives and staff. This feedback alongside the provider’s own audits and quality checks was used to continually assess, monitor and improve the quality of the service they provided.