We carried out this unannounced inspection on 22 May 2018. At our last inspection in March 2017 we rated this service ‘good’. At this inspection we have rated this service ‘requires improvement’.

Fieldside Care Home provides care and support for up to 34 older people and people living with dementia. The building includes a large lounge and dining area, garden with laundry facilities and a quiet lounge on the ground floor. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service had a registered manager. 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.

We carried out this inspection, in part, as there had been a high number of falls in the service. The provider was working with the local authority to improve falls management measures, but falls prevention plans lacked detail on what actions staff should take to protect people from falls. Safer moving and handling measures were not always followed, and some staff lacked training in this area. There was an extensive training programme in place for care workers, including specialist training on dementia awareness. However, records of this were not well maintained, and sometimes care workers were overdue for essential training.

The provider worked closely with local services to deliver improvements and try out new ways of working. We found that care plans were not designed in a way people could follow and were not always clear about how to support people. The provider had recognised this and was working with the local health service to develop new plans. Plans sometimes lacked detail about people’s life stories and needs and preferences, but people received support from a stable staff team who knew them well. People told us they were treated with dignity and respect and were listened to. We observed positive interactions from caring staff.

The building was kept clean and had a pleasant environment, but aspects of its design did not meet the needs of people living with dementia or limited mobility. We have made a recommendation about this. At times confidential information could be viewed by people using the service or visitors to the service. New laundry and office facilities were being developed. The provider protected people’s rights by obtaining consent to care and assessing people’s capacity to make decisions. People received good support to eat and drink well and maintain good health.

Staffing levels were sufficient to meet people’s needs, and people told us they were satisfied with the number of staff available and the consistency of staff. We found most care workers had worked in the service for a long period of time and understood people’s needs and wishes well. There was an activities programme in place which was designed in a way to promote reminiscence and community involvement, but exercise programmes were not always effective.

Staff were working in line with safer recruitment measures. Staff understood how to safeguard people from abuse and their responsibilities to report this.

The provider worked with local health services to ensure people’s medicines were reviewed regularly and managed safely. Managers carried out regular checks to ensure that medicines procedures were followed. The provider carried out regular checks to ensure that premises were safe. People were confident about making complaints, and when these were made these were addressed and outcomes recorded. Managers held staff meetings in order to address particular concerns and promote good communication and teamwork.

We found bre

This unannounced inspection took place on 13 and 24 March 2017. Fieldside Care Limited t/a Fieldside Care Home provides care and support to up to 33 people. At the time of the inspection there were 33 people using the service.

The service 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.

We last carried out an unannounced focused inspection on 25 September 2015 and we found one breach in regulation relating to medicine management.

At this inspection we found the service demonstrated good practice in the safe management of medicines. People received their medicines as prescribed. The service maintained records, stored and administered medicines safely.

People were protected against the risk of abuse and avoidable harm. Staff received on-going training in safeguarding which enabled them to recognise and report suspected abuse. The service developed risk assessments that identified known risks and gave staff guidance on how to mitigate those risks safely.

People received support from sufficient numbers of suitably vetted and trained staff. Staffing levels reflected people’s needs and were flexible to manage people’s changing needs. Staff were supported to undergo an induction process to enable them to understand their roles and responsibilities in their job. Staff received training in core mandatory training and told us, this aided them to deliver effective care to people. Staff reflected on their working practices through regular supervisions and appraisals.

People were not deprived of their liberty unlawfully. The registered manager and staff were aware of their responsibilities of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). The service sent DoLS requests to the local authority when they it was required to restrict people’s liberty. Records showed DoLS authorisations were monitored by the service to ensure new requests were submitted prior to previous ones expiring.

People were supported to access sufficient amounts of food and drink that met their dietary requirements and nutritional needs. The service liaised with nutritionists and other health care professionals to ensure menus reflected people’s needs. People told us they like the food they received and were offered choices.

The service had care plans in place that detailed people’s history, health, medical and physical needs and preferences. Care plans were reviewed regularly to reflect people’s changing needs and shared with staff to ensure the delivery of care coincided with the changes. Where possible people were encouraged to develop their care plans. Care plans detailed how staff should support people in line with their preferences.

Staff encouraged people to make decisions about their care and had their decisions respected. People had their dignity and respect maintained by staff that were kind, caring and compassionate. People’s confidentiality was maintained by staff and records were kept securely with only those with authorisation having access to them.

People were encouraged to participate in a wide range of activities of their choice. The service provided both in-house and community based activities for all, in line with their choices and preferences. Staff were aware of the importance of monitoring people’s presentation to ensure they were not socially isolated.

People were aware of how to raise concerns or complaints to the service. People told us they felt comfortable raising issues with staff or management. The service had processes in place to respond to complaints in a timely manner. The service carried out regular audits to drive improvements. Records showed daily, weekly, monthly and a

We carried out an unannounced comprehensive inspection of this service on 27 October 2014. We found two breaches of legal requirements. After the comprehensive inspection, the provider wrote to us to say what they would do to meet the legal requirement in relation to making the required improvements.

We undertook this focused inspection on 25 September 2015 to check that they had followed their plan and to check that they now met the legal requirement inspected. This report covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Fieldside Care Home on our website at www.cqc.org.uk.

At our previous inspection we found that medicines were not administered and managed safely. Recruitment processes were not safe as criminal record checks were not always carried before applicants started working at the service. The systems for assessing and monitoring the quality of the service provided were not always effective.

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

Medicines were still not administered and managed safely. There were several gaps on the medicine administration record (MAR), medicines were not handled safely as we saw liquid medicine in pot in the office with no indication whom it belonged to and how long it has been poured out.

The provider had ensured that all new staff had a criminal record check and reference in place before they started work. Effective systems had been put in place to monitor and assess the quality of service provided.

Fieldside Care Home provides accommodation and personal care to older people, some of whom were living with dementia. The service is registered to accommodate up to 33 people. At the time of our inspection there were 29 people using the service.

This unannounced inspection took place on 27 October 2014. At the previous inspection of the service on 10 December 2013, the service met the regulations we inspected.

There was a registered manager at the home. 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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Medicines were not always managed and administered safely. There were unexplained gaps on the medicine administration record (MAR). Medicines were not always administered in line with people’s prescription. This meant there was a breach of the regulations and you can see what action we told the provider to take at the back of the full version of the report.

Recruitment process was not always safe and robust to ensure people employed at the service were suitable to work at the service. Appropriate criminal record check was not obtained before a person employed by the service started work. This meant there was a breach of the regulations and you can see what action we told the provider to take at the back of the full version of the report.

Staff were knowledgeable in recognising signs of potential abuse and followed the required reporting procedures. Staffing levels was planned considering the needs and dependency levels of people using the service. The service was covered 24 hours by staff and there were procedures in place for staff to follow in the event of unforeseeable emergencies.

Staff were supported by their manager through trainings, regular supervisions and appraisals. Team meetings took place with staff and the manager to discuss concerns regarding the people they supported. Staff had qualifications in health and social care.

People’s needs were assessed and care plans were developed detailing how needs identified would be met. Staff liaised with other healthcare professionals to ensure people received the care and support they required. Staff were patient and kind in the way they supported people with their needs. People’s dignity and privacy were respected.

There were a range of activities that took place at the service to stimulate and occupy people as they wished. People and their relatives were involved in decision making about their care and support.

The manager was approachable and operated an ‘open door’ policy so people had access to her anytime when they wished. There were no effective processes and systems for auditing and checking the quality of service provided.

We have made a recommendation about assessing and monitoring the quality of the service.

People who used the service said they liked living at the home. One of them told us “I can always ask if I need anything”. We observed that care staff knew everyone well and understood their needs and preferences. Care records were regularly updated to reflect current needs and to provide instructions for care staff on how these needs should be met. The home obtained relevant professional advice and worked in collaboration with other services to manage the risks relating to the health and welfare of people using the service.

People’s choices were respected and they were involved in discussions about their care. When people using the service did not have capacity the provider took appropriate steps to make decisions in their best interest.

There were processes in place for the safe management of medicines.

Staff had access to the training they needed and the manager made regular checks of their competence. The staff we spoke with said there was good communication among the staff team and that management were available if they had any concerns.

The provider took steps to maintain the quality of the service. People using the service and their relatives were asked for their views about the service.

We carried out an inspection of Fieldside Care Limited t/a Fieldside Care Home on 3 November 2011 where we issued one compliance action requiring the provider to ensure the home met the essential standards of quality and safety. Following that inspection we received an action plan from the registered manager which told us how the home would become compliant. On 16 March 2012 we carried out an inspection of Fieldside Care Limited t/a Fieldside Care Home to check it was meeting the essential standards. During our visit we found that our previous compliance action had been met, however we identified other areas of non compliance in people’s care records. We met with the registered manager on 23 March 2012 to discuss our findings.

People who used the service and their relatives that we spoke to during our visit on 3 November 2011 told us that people were comfortable and well cared for and that they were kept safe. They said that staff were kind and easy to get on with and that they did their work well. They also said that staff were approachable and were always very welcoming to visitors. One person told us that the meals were good.

During our inspection we spoke with six people using the service and with six staff and looked at a range of care and other records.

People who used the service told us that they valued the quality of their care, the food, the premises and cleanliness at the home. They told us that that Fieldside was their home. One person we spoke with said, “staff are good to you and treat you like a person, an individual”.

There were enough qualified, skilled and experienced staff to meet people’s needs. People told us: “The people who run this place are kind, gentle, lovely“; another person told us, “staff have done things I really appreciated that they didn’t have to”.

We found that, overall, people experienced care, treatment and support that met their needs and protected their rights. However, although there were arrangements in place to deal with some foreseeable emergencies, there was no clear written process for staff to follow in relation to accessing medical care for short respite placements, which meant that staff were not always supported to provide timely and appropriate care in every emergency.

We also found that although, overall, care records were fit for purpose, but some record keeping practice was not in line with the provider’s policies, which meant there was a risk that information could not be located promptly when needed.