What life is like for people using this service:

• People did not receive a service that provided them with safe, effective, compassionate and high-quality care.

•The management of risk and medicines was ineffective and placed people at risk of harm.

•The environments had not been considered for people living with dementia and infection control risks had not been mitigated.

• People who remained in their rooms at all times were at risk of social isolation.

• People’s human rights were not always upheld as the principles of the Mental Capacity Act 2005 were not adhered to. People were not empowered to make choices and have control over their care and people were not provided with support that was personalised to them.

• At our last inspection in August 2016, the provider was found to be in breach of Regulation 18 registration Regulations 2009 (failure to notify). At this inspection, we found improvements had been made and all notifiable events were being reported to the Care Quality Commission (CQC).

• We found a range of institutional practice taking place at Fieldgate nursing Home. People did not consistently receive person centred care that was based on based practice guidelines.

• The service was not well led and there was a lack of quality assurance processes in place. However, people told us staff were kind and treated them with respect.

Rating at last inspection: Good, last report published 19 August 2016.

About the service: Fieldgate Nursing Home is a residential and nursing home that was providing personal and nursing care to 32 people at the time of the inspection.

Why we inspected:

This was a planned inspection based on the rating at the last inspection.

At this inspection the service has been rated ‘Inadequate’. Therefore, the service is now in ‘special measures’. Services in special measures will be kept under review and, if we have not already taken immediate action to propose to cancel the provider’s registration of the service, it will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not, enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

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.

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.

The inspection took place on the 29 and 30 June 2016 and was unannounced.

Fieldgate Nursing Home is registered to provide care for up to 39 people. The home is registered with the Care Quality Commission to provide nursing or personal care for older people. At the time of our inspection there were 33 people in receipt of care from the provider.

The home had a registered manager in place. 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.

Registered managers and providers are required to send statutory notifications to the Care Quality Commission (CQC) when a significant event occurs. For example, receiving an injury. The provider had sent very few notifications to CQC and during the inspection we found two incidents that had not been notified to CQC.

People told us they felt safe in the home and staff were aware of the procedure to take if abuse was suspected.

Staff were recruited safely and records included appropriate checks as well as proof of identity to ensure they were appropriate for the role they were employed to undertake.

Medicines were stored and secured appropriately and people received their medicines on time.

The registered manager was knowledgeable about the Mental Capacity Act 2005 (MCA) and Deprivation of Safeguards (DoLS). When people were assessed as unable to make decisions for themselves the MCA 2005 process had been followed. DoLS are put in place to protect people where their freedom of movement is restricted to prevent them from possible harm. The registered manager had taken appropriate action for people who needed their movement restricted.

People had sufficient to eat and drink and were supported to maintain a balanced diet. They had access to a range of healthcare professionals and services.

People were looked after by kind and caring staff who knew them well. They were supported to express their views and to be involved in all aspects of their care. People were treated with dignity and respect.

People and their relatives thought that the home was well-led. They all spoke positively about the registered manager and the staff group.

Complaints policies and procedures were in place and were available to people and visitors. People and their relatives told us they were confident that they could raise concerns or complaints and that these would be dealt with.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

We carried out a routine inspection on 12 August 2013 and there were 31 people living at the home. During our inspection we spoke with the matron (registered manager), three staff members, and six people who live at this home.

Care for people was provided over two floors with single or double occupancy rooms available. Many people chose to remain in their rooms throughout the day, however there were three communal lounge or dining areas available for people to use.

We saw that a wide variety of foods were on offer to people living at this home including options for people with specific dietary needs.

Staff encouraged people to participate in activities. One person was encouraged to listen to their ‘talking books’ in the lounge area. People told us they were happy with the level of organised activities at the home such as bingo, quizzes and board games.

One person told us they would like to have some different activities organised to include more physical activity.

We saw that clear care plans were in place to support people who lived in this home. The home was introducing a computerised system for managing care plans and other care records.

People had their care discussed and agreed with them although consent for care and sharing of information was not always clearly documented.

People told us they were happy living at this home and that the staff, “Couldn’t be more helpful.”

We spoke with two staff, four people who used the service, three relatives and the Registered Manager (known as the Matron).

People told us that the service was good. Care plans were in depth, but easy to navigate, and we saw evidence that people who used the service and their families were involved in care planning. Risks to people using the service were identified and reviewed at regular intervals according to specific risk and these were recorded in care plans.

One person who used the service said the home was clean and inviting, 'The staff were very kind and the food was good'. One person said this was the best home they had ever been in.

A relative told us the home looked after their parent very well, and they wouldn't want them to be anywhere else, They said they would recommend the home to anyone that asked.

Although people said they were happy in the home and their health and care needs were being met we found that improvements were needed in the areas of infection control and recruitment.

The provider did not have an effective system in place to reduce/remove the risk of infection when cleaning and laundering.

The home's recruitment process was being followed in part but some of the areas missed out could put people at risk. These were the lack of satisfactory references and a Criminal Records Bureau (CRB) certificate before the member of staff commenced employment.

During our visit we spoke with five people who live at the home, two visitors, three staff and the manager. Following the visit we received calls from eight relatives and we were able to talk with them about their thoughts and experiences of Fieldgate.

People told us that they were happy at the home; it was easy for them to move about the home if they are able and access facilities such as the bathroom and garden. They like the interaction with the staff and were very fond of some of the staff. They said they are able to give their opinion for example about the food and they feel respected and heard. They are able to have visitors at any time and even ask that their visitor has a meal with them.

Many people need a lot of support so activities usually take place in the afternoon. People said that they do like to go the lounge and meet others but they are not always able to speak with their fellow residents. People said that although they would not choose to spend their final days in a care home they are content with the care and facilities at Fieldgate.