Field House Rest Home

Field House Rest Home is a residential care home providing personal care to 39 people aged 65 and over at the time of the inspection. The service can support up to 54 people. The home is split into three separate areas “Main house, Coach and Cottage.”

People’s experience of using this service and what we found

The provider's quality checking arrangements were not effective in ensuring there was safe administration and management of people’s medicines.

There were discrepancies between the quantity of medicines found and the administration records. These discrepancies showed the provider was unable to demonstrate people had received some of their medicines as prescribed.

People did not always receive their medicines as intended, written guidance available was not always sufficiently detailed on the use of 'when required' medicines. The site recording of the administration of people’s skin patches was not always sufficient to prevent unnecessary side effects.

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.

People were supported by staff who had received training and knew how to report witnessed incidents of potential abuse. The provider had robust recruitment procedures, so they could assure themselves potential new staff were suitable to support people who lived at the home.

People and relatives described the staff as kind and caring.

The home environment was clean and tidy, and staff worked to reduce the risk of infection. When accidents or incidents occurred, learning was identified to reduce the risk of them happening again.

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

Rating at last inspection and update.

The last rating for this service was good (published 18 February 2021).

Why we inspected

We received concerns in relation to the management of medicines and staffing levels. We undertook a focused inspection to review the key questions of safe and well-led only.

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 service has changed from good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

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.

Enforcement and Recommendations

We have identified breaches in relation to potential risks to people’s medicine management and monitoring and oversight of the service.

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

Please see the action we have told the provider to take at the end of this 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 request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Field House Rest Home is a residential care home providing personal care to 46 people aged 65 and over at the time of the inspection. The service can support up to 54 people.

People’s experience of using this service and what we found

The provider had now implemented effective governance systems to identify shortfalls in the quality and safety of the service. Systems were in place to ensure improvements were completed and sustained. Actions identified were addressed allowing continuous learning and improving the quality of care provided.

The provider had made the necessary improvements since our last inspection to ensure people were safe and had their assessed needs met. Risks to people were now managed safely and systems to ensure people were protected from the risk of infection were now effective.

These improvements meant the provider was no longer in breach of Regulation 17 HSCA RA Regulations 2014 Good governance.

There were sufficient staff to meet the needs of the people living at the home.

People received their medicines from staff who had received training to administer medicines safely. Staff followed good infection control practices to reduce the risk of infection.

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.

People were supported by staff who knew their needs and attended regular reviews.

People and staff felt the home was well-led by a supportive registered manager.

Rating at last inspection (and update)

The last rating for this service was Requires Improvement [published 03 December 2019].

Why we inspected

The inspection was prompted in part because concerns were received in relation to people’s safe care and treatment. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

At our last unannounced comprehensive inspection of this service on 21 October 2019 a breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve Regulation 17 HSCA RA Regulations 2014 Good governance.

At this focused inspection we checked the provider had followed their action plan and to confirm they now met legal requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from Requires Improvement to Good. This is based on the findings at 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 coronavirus and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Field House Rest Home [published 03 December 2019] on our website at www.cqc.org.uk.

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.

Field House Rest Home is a residential care home providing personal to 35 people aged 65 and over at the time of the inspection. The service can support up to 54 people.

People’s experience of using this service and what we found

The provider had not always ensured people were safe and had their needs met. Risks to people were not always managed safely and systems to ensure people were protected from the risk of infection were not always effective. Improvements were not always actioned and completed to ensure people’s safety was improved. People’s medicines were managed in a safe way. People were protected from abuse by knowledgeable staff.

The provider did not always show compassion for people by ensuring there were sufficient staff, and equipment to support people’s dignity and people’s choices about where they received their support. People were not always supported to enjoy their meal time experience. Staff were not always effectively deployed, and people did not always have the equipment they needed to enjoy the meal time experience. People and their relatives said they were supported by kind and caring staff. Staff were kind to people. People’s privacy was not always upheld because staff did not always follow best practice.

People had their needs assessed, and the provider was in the process of adapting the environment to meet people’s needs. People had a nutritious diet, and they enjoyed the food offered. People were supported to access the health care they needed. People were supported to have some 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.

People were supported by staff who knew their needs and attended regular reviews. The management team were reviewing staff deployment to ensure people’s needs were met. People had access to interesting things to do. People’s end of life plans were being reviewed to ensure they were up to date. Complaints were investigated, and outcomes actioned.

The provider did not always have effective governance systems in place to identify shortfalls in the quality and safety of the service. Systems to ensure improvements were completed and sustained were not always effective. Actions identified were not consistently addressed, therefore there was a lack of continuous learning and improving the quality of care provided.

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 9 July 2018).

Why we inspected

The inspection was prompted in part due to concerns received about infection control and staffing levels. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We have identified a breach at this inspection, in relation to the governance of the home.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Field House Rest Home is a ‘care home’. 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. A maximum of 54 people can live at the home. There were 34 people living at home on the day of the inspection and a number of people lived with dementia.

In August 2017 we inspected and rated the service as Inadequate and we placed them into Special Measures. This was because the provider had failed to ensure systems and processes were place to assess, monitor and mitigate risk to people living in the home. The provider had a condition placed on their registration to provide a monthly review to demonstrate how they were working towards making the required improvements. This was to ensure people living at the home remained safe while improvements were made. The previous manager had left and there was no registered manager in post. The provider had appointed a new manager with the intention of them becoming the registered manager.

We completed a focused follow up inspection in October 2017 to check that the provider and manager had made immediate improvements in the key questions Safe and Well-Led. At this inspection the provider and manager had made improvements and were no longer in breach of the regulations. However, we did not change the rating to the service at that time and the service remained in Special Measures. This was because the characteristics of ratings for ‘Good’ describe a level of consistency in achieving high standards which could not been demonstrated at that inspection. The provider and manage sent an action plan to show what they would do, and by when, to improve the key questions Safe, Effective, Caring, Responsive and Well Led.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

At the time of this inspection 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.

People living in the home told us that staff assisted them to maintain their safety and made the home safe. People minimised the risk to their safety with support from staff offering guidance or care that reduced those risks. Staff were clear in their responsibilities in recognising and reporting any suspected risk of abuse. People’s care needs were met in a timely manner as staff were always available. People’s medicines were managed and administered for them by staff in safe way to support their health needs.

Staff were supported with training to remain knowledgeable about people’s support needs. Staff told us the training they received and guidance from managers maintained and improved their skills and knowledge. People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People were pleased with the meal choices and enjoyed the food on offer. Where people needed support to eat and drink enough to keep them healthy, staff provided one to one assistance. People had access to other healthcare professionals and ongoing review which provided treatment, advice and guidance to support their health needs.

People were seen chatting and spending time with staff. Relatives we spoke with told us staff were kind and friendly. Staff told us they took time to get to know people and their families. People’s privacy and dignity was supported by staff when they needed personal care or assistance. People’s daily preferences were known by staff and those choices and decisions were respected. Staff promoted people’s independence and encouraged people to be involved in their care and support.

People’s care needs had been planned, with their relative’s involvement where agreed, which had been recorded in care plans and had been reviewed and updated regularly. People also told us they enjoyed the social aspect of the home and the activities offered which had improved since our last inspection.

People and relatives knew how to make a complaint if needed. People also told us they would talk with staff if they had a question or concern. The provider had policies and processes in place to ensure that any complaints received were investigated and responded to, and where needed changes made to improve people’s experiences.

Since the last inspection the manager had continued developed the existing quality assurance systems and people had the opportunity to state their views and opinions with surveys and meetings. Audits had been fully implemented to identify and record the required ongoing improvements.

We undertook this focused inspection to check the provider had rectified these urgent concerns and to confirm they now met the legal requirements. 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 Field House Rest Home on our website at www.cqc.org.uk.

The provider is registered to provide accommodation and personal care for up to 54 people at Field House Rest Home. At the time of this inspection there were 40 people living at the home.

There was not a registered manager in post. The interim manager was completing our registration process. 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 had their risks assessed and their environment improved to ensure they remained safe. People who needed additional support to mobilise safely had their needs assessed and their risks mitigated. The management team took action to ensure accidents and incidents were reported, investigated and steps taken to ensure people remained safe.

Where people had potential restrictions in place and did not have the mental capacity to agree to these the interim manager had now made Deprivation of Liberty applications to the supervisory body for authorisation. By doing this, the interim manager had followed the correct process to take on the legal responsibility to make sure people were not unlawfully restricted of their freedom or liberty unnecessarily.

The management team had reviewed their governance systems and taken action to improve how they monitored people’s safety and well-being. They were in the process of recruiting new staff to ensure there were sufficient staff to meet people’s needs. Updates for staff training had been started and staff said they were more confident. Staff we spoke with told us they had confidence in the management team.

We will review our rating for this service at our next comprehensive inspection to make sure the improvements made continue to be implemented and embedded into practice.

We undertook a comprehensive inspection of this service on 2 May 2017. At that inspection the service was rated as good overall, and requires improvement in the caring section. We found the service was not consistently caring and required improvement. People were supported by staff in a task focussed way and the specialist needs for people living with dementia needed improvement. We found on this inspection that improvement had not been made.

After this inspection we received concerns in relation to how people were safely cared for and how their care was managed. As a result we undertook an unannounced comprehensive inspection to look into those concerns on the 30 and 31August 2017. The inspection was carried out by two inspectors.

At the time of our inspection there was no registered manager in place. The previous registered manager had de registered with us in March 2017. There had been another manager who had since left and at the time of the inspection there was an interim manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered providers and registered managers 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 people living at the home were not consistently protected from abuse by other people living at the home. Staff we spoke with were aware of how to recognise signs of abuse, and systems were in place to guide them in reporting these, however these were not always actioned and investigated to ensure people were protected. Staff were not always confident to support people who became upset. We saw there was not always sufficient staff effectively deployed to ensure people remained safe. People had not always had their risks identified, and their identified risks assessed and mitigated. Staff were not always aware of the safe way to support people. People were not always supported to live in a safe environment and protected against the risk of infection. The management team had started to take action with some of the areas that needed improving. People told us they had their medicines as prescribed.

People were not always assessed when needed to ensure they were able to consent to their care. People may have been deprived of their liberty without a best interests assessment being completed. Staff told us they did not always have up to date knowledge and training to support people. Staff respected people's rights to make their own decisions and choices about their support. People had food and drink they enjoyed to maintain a healthy diet. People said they had access to health professionals when they needed to. Relatives were confident their family member was supported to maintain their well-being.

People said they were supported by kind staff. Relatives told us they were happy with the care their family member received. However we saw staff were not always able to spend the time they needed to meet people’s needs. People were not always provided with choice in their day to day lives, such as if they wanted more food or choice of condiments or sauces People living with dementia were not always provided with the specialist help, and adaptations to their environment to improve their well-being. People living at the home were able to see their friends and relatives as they wanted. We saw staff treated people with dignity. They knew people well, and worked with people to maintain their independence.

People were not always supported in a way that took into account their personal choices and wishes. They were not always able to get up and eat their breakfast, or have baths when they wanted to. They knew how to raise complaints and were confident to raise them. There was had a complaints process in place to ensure people were listened to and action could be taken if required, however we found not all complaints were recorded for transparency.

People told us they did not always have interesting things to do, and relatives told us there could be more access to pastimes their relative enjoyed. The management team had identified people needed more interesting things to do. They were looking at recruiting additional staff to provide more support in this area. People and their relatives had not attended regular meetings recently and were not aware of what was happening at the home.

The provider had not taken actions to ensure people were supported safely and in an environment where they were not placed at risk. There was a culture of complacency where known risks were not reduced or monitored. Staff didn’t feel supported and were not confident to discuss concerns with the provider. The provider had systems in place to monitor the quality of care and treatment people living at the home received. These were not always effective at identifying improvements such as ensuring the environment was safe. Where improvements had been identified there was a plan in place however actions were not completed or sustained.

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.

The overall rating for this service is ‘Inadequate’ and the service is therefore 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. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

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.

The home is registered to provide accommodation and personal care for adults who require care and who may have a dementia related illness. A maximum of 56 people can live at the home. There were 43 people living at home on the day of the inspection. There was a manager in post however they were not currently registered with us. 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's access to activities and support varied across the homes three lounges and we have made a recommendation for the provider in relation to the specialist needs of people living with dementia. People told us and we saw that their privacy and dignity were respected and staff were kind to them. People received supported to have their choices and decisions respected and staff were considerate of promoting their privacy and dignity. Staff developed positive, respectful relationships with people and were kind and caring.

People felt safe in the home and were supported with staff assistance in a safe way. Staff told us about keeping people safe from the risk of potential abuse. People told us the staff supported them when they needed or wanted help or assistance. People told us they received their medicines as prescribed and at the correct time. They also felt that if they needed extra pain relief or other medicines these were provided.

People told us staff knew how to look after them and staff told us training reflected the needs of people who lived at the home. People had been involved in any decision making and where appropriate support from relatives and other professionals had been sought. Where people had not been able to consent to certain aspects or decisions about their care, records of decisions had been completed.

People told us they enjoyed the food which was well prepared and presented. Where needed people were given assistance from staff to eat their meal. People had access to other healthcare professionals that provided treatment, advice and guidance to support their health needs.

People were involved in their care and support plans and staff knew the care needs of people. The manager had recognised that people’s written care plans required review and updating to provide a more personal plan of care. People and relatives we spoke with told us they happily raised any concerns or complaints with the management team and felt listened to.

People and relatives felt the home provided the care they needed and they liked the home. The provider had made a number of improvements to the décor and maintenance of the home and planned to further improve the facilities offered. The manager regularly checked that people and their family members were happy with their home and care. The management team were approachable and visible within the home which people and relatives liked.