Field House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The home is registered to provide accommodation for up to 28 people, including older people and people living with dementia.

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.

Field House is registered to provide accommodation and personal care for up to 28 older people, including people living with dementia. At our last inspection in February 2016 we rated the home as Requires Improvement.

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.

Field House is registered to provide accommodation for up to 28 older people requiring nursing or personal care, including people living with dementia.

We inspected the home on 10 February 2016. The inspection was unannounced. There were 27 people living in the home on the day of our inspection.

Although the home had a registered manager in place, this person no longer worked at Field House and was in the process of cancelling their registration. A new manager had been appointed by the registered provider and started work in January 2016. At the time of our inspection this person was preparing their application to register with the Care Quality Commission (CQC). 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. The references to ‘the manager’ throughout this report relate to the new manager and not the registered manager.

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 submitted DoLS applications for two people living in the home and was waiting for these to be assessed by the local authority.

Staff knew how to recognise signs of potential abuse and how to report any concerns. Staff also had a good understanding of the MCA and demonstrated their awareness of the need to obtain consent before providing care or support to people.

However, care plans were not reviewed effectively by the provider and people and their relatives were not involved in reviews of their individual plan.

Some people’s individual risk assessments were not reviewed and updated on a regular basis to take account of changes in their needs. The preventive measures put in place to address some risks were not consistently implemented by staff.

Staff worked together in a friendly and supportive way. However, staffing levels on the morning shift did not appear adequate to meet people’s needs and required urgent review by the provider.

Staff worked closely with local healthcare services to ensure people had access to any specialist support required. The management of people’s medicines was in line with good practice and national guidance.

There was a warm and welcoming atmosphere in the home. Staff knew people as individuals and provided kind, person-centred care. The provider ensured staff completed their core training requirements and encouraged them to study for advanced qualifications.

People were provided with food and drink of good quality that met their nutritional needs.

There was a lack of a structured approach to the provision of activities which meant some people did not have enough stimulation and occupation, particularly people living with dementia.

The manager encouraged people to come directly to her or other senior staff with any concerns. Formal complaints were managed effectively.

The manager demonstrated a very open and democratic management style and had begun to win the respect of people and staff.

The provider sought a range of views on the quality of the service and was committed to identifying any action required in response to the feedback received.

The systems used by the provider to monitor service quality were not consistently effective.

Below is a summary of what we found when we inspected Field House on 02 July 2014. The summary is based on our observations during the inspection, speaking with people who used the service, their relatives and the staff supporting them. We also looked at four people’s care records and other documentation.

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.

One person told us, “As far as here goes, I could thoroughly recommend it. I’m very happy.” We saw carer workers treated people with dignity and respect. They spoke quietly to people and knew their preferred name.

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.

As part of our inspection we spoke with a number of people who used the service. They spoke positively about the care and support they received. They told us they liked living in the home and confirmed they were supported to make choices and decisions about the care they received. One person told us, “I like it here, people are nice and friendly.”

We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk to us. We saw care workers were kind and considerate to the people living at the home. Care workers spoke with in a way that enabled them to make decisions about the care they received.

We could see there was an ongoing maintenance schedule of the home and people told us they were happy with their newly decorated bedrooms.

Staff were aware of infection control issues and knew how to reduce the risk of infection. However we did not see an appropriate cleaning schedule.

Care plans did not always contain appropriate risk assessments and did not fully describe people’s care. Although there was a policy available for document management this was not being followed and the provider was retaining documents and people’s information longer than necessary.

People told us they received the care and support they wanted. They were complimentary about the staff one person said to us “I love it here, it’s nice and friendly, the staff are nice.” Another person told us that they were helped to live as they would do if they were in their own home. They said “I can assure you that I am looked after properly.” While a relative said “Its nice and homey, they look after them well.”

People we spoke with told us they were activities in the home, these included weekly bingo and hairdressing. People told us that they had done some painting and some had their artwork on their bedroom walls. There had been a recent trip to a local garden centre, there was a clothes sale organised and they day before we visited people had enjoyed the Christmas party.

People told us they knew how to raise a complaint if there was something they were not happy with. One person said “If I’m not happy I talk to the manager, any complaints they will sort them out.”