The Fieldings

We found the following examples of good practice.

The Fieldings ensured current government guidelines in relation to COVID-19 were being followed by staff and visitors to reduce the risk of infection to people living at the home. This included comprehensive checks for visitors on arrival.

The registered manager had a methodical and organised approach to recording individuals COVID-19 vaccination status, isolation periods and COVID-19 test results. Detailed and up-to-date policies and procedures were in place.

The Fieldings managed risk in relation to infection well, where people were unable to social distance regular observation checks were recorded and increased touchpoint cleaning was undertaken.

In the case of an outbreak contingency plans were prepared and the home was already set up in zones to reduce the risk of cross contamination.

The Fieldings is a residential care home providing accommodation for those who require nursing or personal care. The home is registered for 47 people and there were 29 living at the service at the time of our inspection.

The home spans over two floors with a dining room on each floor and various lounge areas. Bedrooms have their own en-suite facilities.

Medicines were not always managed safely. We found a number of discrepancies regarding the management and monitoring of medicines.

Staff didn't always respect people’s dignity and privacy but they were working on ways to ensure that people were as independent as possible.

End of life care planning was not followed through with people’s wishes. One person had asked to have a will written and this had not been supported.

Staff referred to people in a respectful manner. Some people felt that the staff supported them well, other people thought that some staff did not support them as well.

The provider had acknowledged improvements that were required and had put measures in place to make the required improvements. This was being implemented at the time of our inspection and we saw that new processes had been implemented to bring about positive change.

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.

The environment was safe, clean and suitable for people’s needs. We observed cleaners working in both the communal areas and cleaning individual rooms.

People’s right to make their own decisions was respected. People were supported to access healthcare services if needed. Staff had appropriate skills and knowledge to deliver care and support in a person-centred way. People were supported to have enough to eat and drink.

The service had a manager who was registered with the Care Quality Commission. However we were told by the area manager that there was to be a new registered manager in post and the current one would be deregistering from the service. There was an acting deputy manager who had applied to be the registered manager and they had a clear vision about the quality of care they wanted to provide. Staff were aware of their roles and responsibilities. A range of quality assurance checks were carried out to monitor and improve the standards.

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

Why we inspected

This was a full comprehensive inspection as a follow up to a previous responsive inspection which was carried out on 3 May 2019. At the previous inspection the service was rated as inadequate in all domains and there were several breaches of regulation. We carried out this inspection to identify if the provider had carried out the required improvements as per our last inspection findings.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

People’s experience of using this service: The service was not safe. People were exposed to the risk of abuse and violence. People were placed at serious risk of harm as risks associated with their care and support and the environment were not managed safely. Opportunities to learn from incidents had been missed which meant people had been exposed to the risk of avoidable harm. The home was in a very unhygienic state and people were not protected from the risk of infection. Staff were not deployed effectively to ensure people’s safety. Safe recruitment practices were followed.

People were supported by staff who did not have the required skills or competency to provide safe and effective support. People’s physical and mental health needs were not always met. Care and support was not properly planned and coordinated when people moved between services. Care was not always delivered in line with current legislation and standards. People were not supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible; the policies and systems in the service did not support this practice. The environment was not well maintained and this posed a risk to people’s safety.

People were not treated with dignity and their right to privacy was not upheld. People told us that staff were kind and caring. However, care plans lacked information about people which meant staff did not always have enough information to provide person centred care. There was an inconsistent approach to involving people in decisions about their care and support.

People did not consistently receive personalised care that met their needs. People were not consistently provided with opportunity for meaningful activity. No value or acknowledgement was given to complaints made by people living at the home, as opposed to complaints made by members of the public and relatives.

The provider did not have effective oversight of the home and the manager did not have sufficient time or support. Consequently, there had been a failure to identify and address serious issues with the safety and quality of the service. Systems to monitor and improve the quality of the service were not effective. Where audits had identified areas for improvement, action had not been taken to address issues. The provider had not implemented learning from serious incidents. Failings in leadership and governance placed people at risk of harm.

The service met the characteristics of Inadequate in all areas; more information is in the full report.

Rating at last inspection: Good (report published 14 July 2017).

Why we inspected: We brought this inspection brought forward due to information of concern and a serious incident which occurred at the home.

Enforcement: You can see what action we told the provider to take at the back of the full version of the report. 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.

Follow up: We will continue to monitor intelligence we receive about the service until we complete our next planned inspection. If any concerning information is received we may inspect sooner.

The overall rating for this service is ‘Inadequate’ and the service therefore remains in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, 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.

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

The service had a registered manager at the time of our visit. 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.

People were supported by staff who were aware of the risk of abuse and knew what action to take in response to concerns about possible abuse. Risks to people’s health and safety were assessed and if required measures identified and used to help keep people safe. People were supported by sufficient numbers of staff who had been recruited safely. People were supported to take their medicines as prescribed and these were managed and stored safely.

People were supported by staff who had received or were in the process of completing an induction and training specific to their role. People were asked for their consent before care was provided however improvements were required to ensure that people were being supported in their best interests if they lacked capacity to make a decision themselves. People were supported to maintain their healthcare needs and to eat and drink enough.

People were supported by staff who were kind and compassionate. People were involved in planning their own care and encouraged to maintain their independence. Staff were knowledgeable about the likes and dislikes of the people they supported, respected their privacy and upheld their dignity.

People received support in line with their preferences. People’s needs were assessed before they moved to the service and people had care plans which informed staff about their needs. People were supported to maintain their interests and could be assured that any complaints would be responded to appropriately.

People were supported in a friendly and open environment. People and staff felt able to discuss any concerns or issues with the management team. People, relatives and staff were complimentary of the registered manager who understood their responsibilities and sought people’s feedback regarding the running of the service. Quality monitoring systems were in place and effective in maintaining oversight of the service.

We carried out an unannounced comprehensive inspection of this service on 24 and 25 May 2016. Breaches of legal requirements were found. We issued a warning notice in relation to one of these breaches.

We undertook this focused inspection to confirm that the provider had met the requirements of the warning notice. This report only 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 The Fieldings on our website at www.cqc.org.uk.

The service had a registered manager in place at the time of our 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 and associated Regulations about how the service is run.

At our last inspection on 24 and 25 May 2016, we asked the provider to take action to ensure that people were provided with safe care and treatment through the proper and safe management of medicines.

During this inspection, we found that the required action had been taken by the provider to ensure that medicines were managed safely.

We could not improve the rating for effective from requires improvement because to do so requires consistent good practice over time. We will check this during or next planned comprehensive inspection.

Prior to our inspection the registered manager had left the service. A new manager had been appointed in March 2016 and had applied to become registered at the service. 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.

People did not always receive their medicines as prescribed and the management of medicines was not safe. People were not supported in an environment that was always clean and hygienic and were not always protected from risks associated with infection. People were at risk of measures identified to reduce the risk of harm to them not being followed and not being involved in discussions about the risks they took.

People felt safe in the service however not all staff had received training in safeguarding adults to help them identify potential abuse.Records showed that when incidents of suspected abuse were identified these were reported to the relevant authorities. Staffing levels were sufficient to support people’s needs.

People were not always supported by staff who had sufficient support, knowledge and skills. People were supported to make their own decisions and in the event a person lacked capacity, a capacity assessment had been completed. Applications had been made to ensure people were not deprived of their liberty without the required authorisation, however improvments were required to ensure conditions were being complied with.

People were supported to maintain their nutritional and hydration needs and to attend healthcare appointments. However the suggestions and recommendations of healthcare professionals were not always followed.

People did not always have their privacy respected and were not always treated in a dignified way. We observed that people were treated with kindness by staff but were not always supported to be involved in planning their care.

Staff did not always read people’s care plans which meant there was a risk that staff would not follow guidance contained within plans. Improvements had been made to people’s new care plans about people’s preferences and how they wished to be supported. People expressed mixed views regarding the activities on offer at the service and records did not always reflect whether people were supported to maintain their interests or achieve their goals.

People felt comfortable approaching the manager with any concerns and complaints. However, there was little oversight of concerns raised to identify any trends. People could not be assured that the quality monitoring of the service was robust and effective.

People’s views on the running of the service were sought and people, their relatives and staff felt that the new manager had implemented positive changes at the service.

You can see what action we told the provider to take at the back of the full report. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.