The Fieldings

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Medicines were not always managed safely. The environment medicines were kept in, was not always safe. The medicines room was observed to be cluttered and there was overstock of some medicines. Staff had failed to record that they had administered medicine to a person, meaning the information recorded manually was incorrect. People and those important to them were supported to understand safeguarding and how to raise concerns when they didn’t feel safe. Staff understood their duty to protect people from abuse and knew how and when to report any concerns they had to managers. When concerns had been raised, managers reported these promptly to the relevant agencies and worked proactively with them, to make sure timely action was taken to safeguard people from further risk. Safety risks to people were generally managed well. Managers assessed and reviewed safety risks to people and made sure people, and those important to them, were involved in making decisions about how they wished to be supported to stay safe. Some care plans and risk assessments were unclear or lacked information, however the registered manager took action to improve these while we were at the service. There were enough staff to support people with their needs. Managers reviewed staffing levels regularly to make sure there were always enough suitably skilled and experienced staff on duty. Staff received relevant training to meet the range of people’s needs at the service. Staff received support through supervision and appraisal to support their continuous learning and improve their working practice. Managers made sure recruitment checks were undertaken on all staff to ensure only those individuals that were deemed suitable and fit, would be employed to support people at the service.

This service scored 59 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

People felt staff would keep them safe from harm. One person said, ”The staff make me feel very safe and are doing a very good job. I have never felt unsafe staying here.” Another person described that when others become agitated and distressed, staff respond to ensure those around them are not impacted by this agitation. People and staff were seen to have positive relationships.

Staff understood their responsibilities to keep people safe from abuse. Staff had good knowledge of how to report safeguarding concerns. They were confident that concerns would be acted on appropriately, but also knew how to escalate concerns that they felt were not acted on.

The service had respected people’s human rights. Some people at the service could find it difficult to make decisions. Where this was the case, they completed mental capacity assessments and if needed, decided what action would be in the person’s best interest. The provider also effectively applied for deprivation safeguards. This application ensures people who cannot consent to their care arrangements in a care home or hospital, are protected if those arrangements deprive them of their liberty.

Processes were in place to ensure allegations of abuse were responded to. Staff had received training on how to report any safeguarding concerns. Documentation showed us that any concerns were quickly investigated and referred to local safeguarding teams as required.

People told us that they felt able to communicate their needs, to receive the right type of support. One person said, “I feel I get the right level of support from staff when needed.”

The service had created an indoor smoking room for people to use. This reduced the risk of people smoking unsafely in their bedrooms. However, we found associated risk assessments for this smoking room were not good quality. We reported this to the management team and improved documentation was created during our assessment process.

People’s needs were not always clearly documented in their care plans. Some care plans were lengthy. This meant it can be difficult for staff to understand a person’s needs in a timely way. One person’s care plan did not describe what symptoms they would show if their health condition deteriorated. This meant there was a risk of staff not recognising a person was unwell.

Whilst care plan and risk assessment documentation were not always good quality; staff knew people’s needs and how to support any risks safely. There was a clear approach to supporting people’s risks in a person centred and least restrictive way.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

On the day of the assessment, we saw there were enough staff to provide safe support to people.

Staff told us that there were not always enough staff in place. However, we saw arrangements were in place to cover last minute staff shortages (for example sickness cover). We also saw that the provider had used a calculation tool to assess how many staff were needed for people’s needs. The rota’s showed these staffing levels had then been arranged according to this calculation.

There were robust recruitment practices to make sure that all staff were of suitable character to complete their role. For example, references had been gathered from previous employers. Recruitment, disciplinary and capability processes were fair and to ensure there were no disadvantage based on any specific protected equality characteristic. Staff had received suitable training to complete their role. They also received regular supervisions from the management team. This gave them an opportunity to feedback about their experiences working at the service. Staff told us they could request additional supervisions if needed.

Most people told us there were enough staff to support them. One person said, “There are enough staff but, in the past they were short of staff.”

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

People felt appropriately involved in decisions about their medicines. A person told us, “I feel the staff manage my medication well and give me this at the correct times”.

Staff told us that they had received training to safely provide support to people with medicines. Staff were able to describe safe systems for medicine management. However, due to the concerns seen, we remain concerned that staff did not have appropriate skills to manage medicines safely.

The medicine room was not organised safely. The medicines room was cluttered and there was too much stock of some medicines. A tablet was observed as being loose on the side, with no packaging. This type of environment can risk staff confusion and mismanagement of medicines. We saw medicines pots were being washed in a hand washing basin. This is designed to be an area for hand washing only and can contribute to pots being washed in an unclean area. An electronic device for recording medicines administration, had been placed on top of a needle or ‘sharps’ disposal container. There is a risk of contamination from the needles to the hand-held device. The manager had put in place a new process to oversee the amount of medicine stock, however this process was ineffective. For example, staff had failed to record that they had administered medicine to a person. This meant the information recorded manually was incorrect. Internal checks had not identified that this had not been recorded. The registered manager was already aware and was reviewing new ways to oversee medicine stock levels. Some people used flammable creams and also smoked cigarettes; this can present a risk of serious burns. Staff did not have clear guidance on how to support this risk. The management team responded to the concerns by creating improved care planning documents. Controlled drugs were stored in a safe place. However, staff were not completing regular stock check audits of these medicines. Controlled drugs are subject to government restrictions due to the risk of harm and/or addiction. Not completing regular stock checks of these medicines, risks unsafe management of these high-risk medicines.