About the service: The Field View Residential Home provides accommodation and personal care for up to 20 people. It provides care to older and younger people living with dementia, people with mental health issues and people with sensory impairments. During out visit 19 people lived at the home.

People’s experience of using this service:

• Risk’s associated with people’s planned care and within the building were not always identified or managed safely.

• Staff were not always recruited safely.

• Medicines were not always safely managed.

• Referrals to other healthcare professionals were not always made in a timely way.

• Advice from healthcare professionals was not always followed.

• Systems and processes were not effective. Where areas of concern had been identified, action had not always been taken to make improvements.

• Most people felt safe and spoke positively about their care. People told us staff were caring and kind.

• People’s individual needs were assessed to ensure they could be met by the service.

• People made decisions about their care and were supported by staff who understood the principles of the Mental Capacity Act 2005.

• People’s told us their privacy and dignity was respected.

• People’s nutritional needs were met.

• People’s care plans lacked detail. Further information was required to help staff provide personalised care.

• Systems were in place to manage and respond to any complaints or concerns raised.

• The registered manager and the director were open and transparent and took some immediate actions to resolve concerns found at our visit.

This is the second consecutive time the home has been rated as Requires Improvement.

The registered provider was in breach of Regulations 12 and 17 of the Health and Social Care Act 2008(Regulated Activities) Regulations 2014 and Regulation 18 of the Care Quality Commission (Registration) Regulations 2009.

Rating at last inspection: At the last inspection the service was rated as requires improvement. (The last report was published on 5 April 2018).

Why we inspected: This was a planned inspection based on the rating at the last inspection. The service continues to be rated as ‘Requires Improvement’ overall.

Enforcement: Action we told provider to take (refer to end of full report)

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our inspection programme. If any concerning information is received we may inspect sooner.

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

The inspection took place on 6 March 2018 and was unannounced.

The Field View Residential Home is a home which provides care to older people including some people who are living with dementia. The home is two storeys with bedrooms on the ground and first floor. There is lift access to the first floor. 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 Field View Residential Home is registered to provide care for up to 20 people. At the time of our inspection there were 16 people living at the home.

The provider had taken over the home as a ‘going concern’ in July 2017. This was their first ratings inspection since taking ownership of the home.

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. The previous registered manager had recently left the home. The provider had appointed a new manager who had been in post for eight weeks at the time of our inspection visit. The new manager had submitted their application for registration.

People felt safe living at The Field View Residential Home because there were enough suitably qualified and experienced staff to keep them safe. The provider had a programme of training to ensure staff refreshed their knowledge and kept their skills up to date.

Care plans included risk assessments related to people's individual needs and abilities. However, there were no risk management plans to advise staff how to support people who could demonstrate behaviours if they became anxious or frustrated because of their medical condition. Some environmental risks had not been identified. Improvements were needed to ensure the checks and audits that kept people safe and protected were always implemented effectively.

People’s needs were assessed before they moved to the home and they were supported to obtain advice from their GP or healthcare professional when their health needs changed. People received their medicines as prescribed to manage their medical conditions, but guidelines to support good medicines management were not always in place.

The provider was keen to promote a caring environment and led by example. People told us the staff were kind, caring and approachable and took time to understand them as individuals. Care staff recognised and respected people's diverse needs and promoted their independence.

Staff worked within the principles of the Mental Capacity Act 2005. They explained how they used their knowledge of the legislation to support people in line with their choices or known preferences. Staff used different methods of communication to ensure people consented to the care they received. Where restrictions on people's liberty had been identified, the appropriate applications had been submitted to the authorising authority.

Each person had a care plan which contained the basic information staff needed to meet people’s needs safely. However, some care plans needed additional information to help staff respond to people’s emotional and communication needs and provide consistent care and support. Care plans included information about people’s dietary needs and staff supported people to eat and drink enough to maintain their health.

The provider understood the importance of ensuring people had stimulation and engagement to maintain the social aspect of their lives. Improvements were being made to the activities provided, but when staff were busy they had limited opportunities to keep people occupied and interested.

The home was clean and staff understood their roles and responsibilities in relation to infection control a