We carried out a review of the data available to us about Field House on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Field House, you can give feedback on this service.
Field House is a care home, which provides personal and nursing care for up to 55 people. At the time of the inspection, 42 people were living at the home.
People's experience of using this service and what we found
People were safeguarded from the risk of abuse. Risks to people's health and wellbeing were assessed thoroughly and clear instructions meant staff were working in safe ways. People were protected from avoidable infections as the home was clean and staff had good hygiene practices.
Medicines were being managed safely. At the last inspection we found evidence that some medicines had been pre potted for people to take later. This practice had stopped, and medicines were safe. An electronic medicine system had been introduced since the last inspection. Accidents and incidents were recorded and used to identify lessons learned, these were shared with the staff team. There were enough staff available to assist people to meet their needs in a prompt way. The provider had a safe recruitment process, which assisted them in recruiting suitable staff.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.
Governance systems were robust, and the home had a stable management team. Continual monitoring and improvement through audits took place to ensure the home operated effectively and people were safe. The registered manager and the clinical lead were working with staff to ensure people’s records were kept up to date. Staff were proud to work at the home. They spoke positively about the management team. Surveys were sent out to gather feedback, improvements were implemented. Partnerships with other agencies and health professionals enabled effective outcomes for people.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
The last rating for this service was good (published 24 April 2018). The rating at this inspection remains good.
Why we inspected
We undertook this inspection as the service had not been inspected for some time. We inspected two key questions, Safe and Well led. Prior to this inspection we received some information of concern about the care people that people received and in relation to night staff working at the home. We used the information as part of are planning. We found no evidence of concern.
For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the home remains good based on the findings of this inspection.
We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.
Follow up
We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Field House on our website at www.cqc.org.uk
At the last inspection on 15 and 16 February 2017 the service was rated Requires Improvement. We found breaches in two regulations relating to safe care and treatment and record keeping. Following this inspection, the provider sent us an action plan telling us how they would make the required improvements.
We carried out a comprehensive inspection on 13 and 14 March 2018. At this inspection, we found improvements had been made and the legal requirements had been met. We found further improvements were needed to the quality assurance systems to ensure the service provided to people is consistently well-led.
The service has improved to Good.
There was a registered manager in post. 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.
Sufficient numbers of staff were deployed at the time of our visit. Staff performance was monitored. Staff received supervision and training to ensure they could meet people’s needs.
Medicines management shortfalls were promptly acted upon and actions taken to make improvements.
Staff demonstrated a good understanding of safeguarding and knew how to report concerns.
Risk assessments and risk management plans were in place. Incidents and accidents were recorded and the records showed that actions were taken to minimise future occurrences.
People’s dietary requirements and preferences were recorded and people were provided with choices at mealtimes.
Staff were kind and caring. We found people were being treated with dignity and respect and people’s privacy was maintained.
A range of activities were offered and provided people with entertainment both in and out of the home.
Systems were in place for monitoring quality and safety. Improvements were needed to make sure required areas for improvement were identified.
Field house provides accommodation for up to 55 older people who require nursing or personal care. At the time of our inspection 48 people were living in the home.
A registered manager was not in post. 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 found that medicines were not always managed safely. We also found risk assessments and risk management plans were not fully completed for some people with bed rails. Accidents and incidents were not always fully reported and recorded.
Staff demonstrated an understanding of the principles of the Mental Capacity Act. However, where people were unable to consent to care and best interest decisions were made on their behalf, they were not always fully recorded.
People’s care records were not always personalised and monitoring records were not always up to date to reflect the care people had received. Audits were in place that had identified shortfalls although actions had not been fully completed to make the necessary improvements.
People lived in a clean and well maintained environment and checks were undertaken to make sure this remained the case. Equipment used to support peoples’ care, for example, wheelchairs, hoists and pressure relieving mattresses were provided and readily available to meet peoples’ healthcare needs. Equipment was serviced in line with national recommendations. We saw there were appropriate and adequate stocks of personal protective equipment such as gloves and aprons.
Safe recruitment procedures were followed before new staff were appointed. Appropriate checks were undertaken to ensure staff were of good character and were suitable for their role. The staff induction programme was comprehensive. Staff views were mixed about the support and supervision they received.
People were cared for in a kind and respectful way. People were supported to maintain their health and were referred to other external health professional when needed. Activities provided were varied and responsive to individual needs and abilities. People were positive about the range of activities, events and outings provided for them.
We found three breaches 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 the report.
The inspection took place on 19 January 2016 and was unannounced. Field House was last inspected on 8 September 2014 and was meeting the legal requirements.
Field House is a care home that is registered to provide personal and nursing care for up to 54 people. There were 51 people at the home on the day of our visit.
The home was without a registered manager at the time of this inspection. 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. A manager was in post and this person said they were planning to apply to be registered with the Commission.
There were enough staff to meet people’s needs. People felt safe and supported by the staff.
People were cared for in a safe, clean and well maintained environment.
Staff received training to meet the needs of their role. However, we have made a recommendation that the provider reviews the arrangements for staff supervision.
People told us they liked the food served at Field House and people were given choices at each meal time.
We found a breach of regulation in relation to the provision of suitably thickened fluids for people. Thickened fluids were not always given in accordance with people’s assessed needs.
The management team understood their responsibilities with regard to the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards (DoLS).
People were cared for in a compassionate and respectful way. People were supported to maintain their health and were referred to other external health professional when needed. People were provided with person centred care which encouraged choice and independence.
Risks to people’s health were identified and equipment was provided to meet their assessed level of need.
Activities provided were varied and responsive to individual needs and abilities. People were positive about the range of activities, events and outings provided for them.
People and staff were positive about the new manager. People felt confident they could raise concerns which would be listened to and addressed by the manager. Staff felt confident the recent changes meant they would receive the support and guidance they needed to effectively fulfil their roles.
You can see what action we told the provider to take at the back of the full version of this report
We used this inspection to answer our five key questions; is the service safe, effective, caring, responsive and well led?
Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people who used the service, their relatives, visiting professionals and the staff told us.
Is the service safe?
People were treated with respect and dignity by the staff, People told us they felt safe. Safeguarding procedures were robust and staff understood how to safeguard the people they supported. Policies and procedures were in place to help make sure unsafe practice could be identified and people were protected.
We saw systems were in place to help ensure the manager and staff learnt from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.
The home had policies and procedures in place in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. Staff had been trained to understand when an application should be made and how to submit one. This meant people were safeguarded as required.
People living at the home were supported by a staff team who had systems in place which enabled them to carry out their duties safely and effectively.
Is the service effective?
Advocacy services were available if people needed them. This meant people could access independent support when they required it.
People's health and care needs were assessed with them and they were involved in the development of their plans of care. Specialist dietary, mobility and equipment needs had been identified in care plans where required. Care plans reflected the current needs and wishes of people living at the home.
Is the service caring?
People were supported by kind and attentive staff. We saw staff were patient and gave encouragement when they supported people. One person said; "The staff here are marvellous and so kind to me".
People's preferences, interests and diverse needs had been recorded and care and support was provided in accordance with people's wishes.
Is the service responsive?
People knew how to make a complaint if they were unhappy. The complaints procedure was easily accessible and details were displayed on the wall in the hallway and in people's service user guides. People we spoke with told us they had no complaints to make. We saw a comments book was available for people to make comments in and a suggestion box was clearly visible on the wall in reception. The registered manager told us the suggestion box was emptied once a week and the comments book was checked weekly.
Is the service well led?
People who used the service, their relatives, friends and others involved with the service completed an annual satisfaction survey. Comments and ideas were listened to and acted upon in a timely manner.
The service worked well with other agencies and services to help make sure people received their care in a consistent and appropriate manner.
The service had a quality assurance system and records showed notes for action were addressed promptly. As a result, the quality of the service continued to improve.
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Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and quality assurance processes which were in place. This helped ensure people received a good quality service at all times.
We returned to the service in November 2013 and found that improvements had been made. We spoke with four people who used the service and viewed feedback questionnaires. We also spoke with two care assistants, viewed records relating to supervision and viewed a staff feedback survey. The feedback we received from people using the service was positive and this was reflected in the results of the questionnaires we viewed. We saw that the risks in relation to people's care were assessed and care plans put in place where necessary to address these risks.
Staff had received formal supervision and had opportunity to discuss their development and training needs. The overall plan for supervising staff was much clearer. A number of audits had been introduced to monitor how well the service was performing and to ensure that any risks to people were identified and acted upon. The manager was had plans to develop the quality monitoring systems further.
When we returned to the service in August 2013, we found that improvements had been made and records relating to people's daily care were being completed more accurately. The new manager in the home had introduced a new system of recording which had been discussed and agreed with staff. The cupboards containing people's records were locked which meant the risk of them being accessed by an unauthorised person had been minimised.
We did hear about some concerns from relatives and made observations on the day of our visit that demonstrated that people did not always receive the standard of care that they needed. One person we met with had been left in a bed sheet overnight that was not in an acceptable state. Records relating to people's health and care were not sufficient to protect people from the risks of inappropriate care or treatment.
Staff told us that they felt supported by senior staff and had received training to support them in their role. Some checks were taking place to monitor basic staff competencies. However there was a lack of overall planning and monitoring of staff development and performance. We saw little evidence of formal supervision taking place and the manager told us there was no supervision policy.
Systems in place for monitoring the service were insufficient and took little account of the views of people using the service and their representatives.
We spoke with staff who told us that they read care plans to keep up to date with people's needs and that this information would also be discussed at staff handover times. Staff confirmed that they had received training in safeguarding, although it was difficult to gain a clear picture of the level of staff training because we were told that this information was in need of updating.
We found that there were a number of gaps in record keeping that meant there was a risk that people's care needs would not be met. There were also gaps in the signing of care plans, by the person concerned or their relative. This meant that it was difficult to assess how far they had been involved in the process.
Other comments indicated that staff weren't always able to attend to people as quickly as they would like. For example we were told that when one person pressed their call bell 'it takes a while sometimes'. Another person told us that "it takes a few minutes but they come eventually".
We noted that there was a file stored at the home with a number of thank you messages and cards from relatives of people who had stayed at Field House.