We inspected the service on 8 and 9 January 2019.

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 de

Fieldway Care Home provides nursing and personal care for up to 68 older people. The service has 37 designated beds for people with nursing needs and 31 beds for people who require residential care. At the time of our inspection there were 66 people residing at the home, approximately half of whom were living with dementia.

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 l