About the service: Church Farm at Field House 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. This service supports older people. At the time of the inspection there were 39 people using the service.

People’s experience of using this service:

• The provider met the characteristics of ‘Good’ in all areas. This has improved from a rating of ‘Requires Improvement’ at the last inspection in 2017. More information about this is in the full report.

• The risks to people’s health and safety were now appropriately assessed resulting in safe care being provided. People were protected by staff who understood how to protect them from avoidable harm. People were supported by enough staff to keep them safe and to provide care in the way they wanted.

• Improvements had been made to the way people’s medicines were managed. The risks associated with medicines had now been reduced. Improvements had also been made to the safety of the building and the safe management of the risks associated with the spread of infection. The registered manager now had the systems in place to help them to learn from mistakes. This included the detailed analysis of accidents and incidents.

• The principles of the Mental Capacity Act 2005 were now appropriately applied and adhered to. This meant people were now supported to make decisions about their care and those decisions were acted on by staff.

• Staff training was up to date and they received on-going assessment of their practice. People were provided with care and support which protected them from discrimination. People received the support they needed to maintain a healthy diet. People at risk of weight loss or gain and dehydration were referred to health specialists. People had access to other health and social care agencies where needed. The environment had been adapted to support people living with dementia and/or a physical disability.

• People liked the staff and found them to be kind and caring. People were treated with dignity and respect. People felt involved with decisions and that staff respected their wishes. People’s records were stored securely to protect their privacy.

• People’s needs were assessed prior to them coming to live at them home. This helped to ensure their needs could be met by staff. People’s personal preferences were considered when care was planned. People had access to information in a format they could understand. People felt their complaints were responded appropriately. Complaints were responded to in line with the provider’s complaints policy. People did not currently receive end of life care. End of life care plans were basic and required more detailed reference to people’s personal preferences.

• Improvements had been made to the overall assessment of risk at the home. Audits were now effectively used to assist the registered manager and the provider in identifying and acting on risks in an effective and timely manner. Staff enjoyed working at the service and felt respected and valued. People could give their views about how the service could develop and improve. There was a continued focus on learning, development and improvement. The registered manager had a good understanding of the regulatory requirements of their role, however we did note they had not notified the CQC of one incident when required. Policies have been amended to ensure this does not happen again.

Rating at last inspection:

At the last inspection the service was rated as Requires Improvement (7 and 8 August 2017).

Why we inspected:

This was a planned inspection based on the previous rating.

Follow up:

We will continue to review information we receive about the service until the next scheduled inspection. If we receive any information of concern we may inspect sooner than scheduled.

This inspection took place on 7 and 8 August 2017 and the first day was unannounced.

Church Farm at Field House was last inspected in November 2014 and was rated Good.

The provider is registered to provide accommodation for up to 50 older people over two floors. There were 47 people using the service at the time of our inspection.

A registered manager was in post but was on leave at the time of our inspection 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.

Risks were not always managed so that people were protected from avoidable harm. Sufficient numbers of staff were not deployed to meet people’s needs at all times. Staff did not always follow safe medicines management and infection control practices.

People’s rights were not fully protected under the Mental Capacity Act 2005.

Systems were in place to monitor and improve the quality of the service provided, however, they were not fully effective. As a result the provider and registered manager were not fully meeting their regulatory requirements.

Staff received induction and training but supervision and appraisal levels needed improvement. People told us they received sufficient to eat and drink but the mealtime experience could be improved in one dining area. Adaptations could be made to the design of the home to better support people living with dementia.

People did not always receive personalised care that was responsive to their needs. People experienced varying levels of support to maintain interests and hobbies. Care records did not contain information to always support staff to meet people’s individual needs.

Staff understood their duty to protect people from the risk of abuse and knew how to report any concerns. Staff were recruited through safe recruitment practices.

External professionals were involved in people’s care as appropriate.

There was limited evidence that people were involved in decisions about their care. However, some relatives were involved in decisions about their family member’s care.

People did not always receive care that respected their privacy and dignity.

Staff were kind and knew people well. Staff effectively responded to people showing signs of distress. Advocacy information was made available to people. People’s independence was promoted and they could receive visitors without unnecessary restriction.

A complaints process was in place and staff knew how to respond to complaints. Complaints were generally responded to appropriately.

People and their relatives were involved or had opportunities to be involved in the development of the service. Staff told us they would be confident raising concerns with the management team and appropriate action would be taken.

We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

This inspection took place on 6 November 2014 and was unannounced.

At the last inspection on 22 and 23 January 2014, we asked the provider to take action to make improvements to the areas of consent, care and welfare of people who use services, assessing and monitoring the quality of service provision, notifications and records. We received a letter dated 3 October 2014 in which the provider told us the actions they had taken to meet the relevant legal requirements. At this inspection we found that improvements had been made in all the areas.

Accommodation for up to 50 people is provided in the home over two floors. The service is designed to meet the needs of older people.

There is a registered manager and he was available throughout the 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.

People were kept safe in the home and were not restricted. Systems were in place for staff to identify and manage risks and the premises and equipment were safely maintained. Sufficient staff were on duty to meet people’s needs and were recruited through safe recruitment practices. Effective infection control and medicines management procedures were followed.

Staff received appropriate induction, supervision, appraisal and training. People’s rights were protected under the Mental Capacity Act 2005 and people were happy with the food provided at the home. The home involved outside professionals in people’s care as appropriate.

We observed interactions between staff and people living in the home and staff were kind and respectful to people when they supported them and people were involved in their care where appropriate.

Information was available to support staff to meet people’s needs and people who used the service told us they knew who to complain to if they needed to and we saw that complaints had been handled appropriately by the home.

People told us that there were meetings held where they could raise issues and we saw that the registered manager responded appropriately to them. Staff told us they would be confident raising any concerns with the management and that the registered manager would take action. There were systems in place to monitor and improve the quality of the service provided.

People told us they were treated with dignity and respect. They also told us their privacy was respected. One person told us there were a lot of activities offered. They said, ‘You can join in if you want to or stay in your room if you want to.”

Two of three people could not remember receiving a questionnaire asking for their views of the service. People were not sure how to make a formal complaint although all people told us they would tell staff if they had any concerns.

People told us they felt very well cared for. A person said, “Everyone is wonderful.” Another person said that they received ‘good care’. People told us staff asked permission before providing care and call buzzers were generally answered quickly.

People told us they were happy with the quality of the food, received their medication when they needed it and saw the GP when they needed to. Three of four people who use services told us the amount of activities offered was good.

People told us they felt safe. A person told us they were happy with their room. People told us staff were well trained and there were enough staff on duty. A person said, “Staff are very kind. No improvements.”

Residents told us that their needs were generally met although several spoke of having to wait for staff to answer the call bell. They were positive about the activities provided. Residents said they were treated with respect although their preferences were not always being considered.

Some residents we spoke with were pleased with the quality, variety and choice of food offered. One person told us, "The staff made me a curry a couple of weeks ago, at my request, which was lovely". However, others were more critical and spoke of some meals being "cold" and one person said "I’m bored of carrots."

All those residents we spoke with felt safe living at Field House Nursing Home. They also thought that staff understood their individual needs.

Residents made consistent comments to us about poor staffing levels. They told us of regular and significant delays in staff responding to their calls on the call bell system. Comments from one person included, "I get annoyed at the times I'm kept waiting". Another person said, "I've complained about waiting…they tell me how busy they are".

We spoke with four people using the service. One person said, “Staff ask me if it’s ok before they do anything.” People were generally positive about the quality of care that they received. One person said, “Staff are polite and maintain my privacy.” Another person said, “Staff are very careful with me. They are very good to you, whatever you want it’s no bother.” Another person said, “Staff really really care.”

However, two people were unhappy with the speed of response to buzzers. One person said, “Waiting times are far too long.” Another person said, “Sometimes you could do with a few more staff. I only see them during the day at mealtimes.”

People felt that the home was clean and they were comfortable raising any issues of concern. One person said, “I would raise any concerns directly with the nurse.” Another person said, “Staff respond to complaints. They get it sorted.”

We found that where people did not have the capacity to consent, the provider could not provide sufficient evidence to demonstrate that they acted in accordance with legal requirements at all times. We also found that people did not always experience care, treatment and support that met their needs.

We found that people were cared for in a clean, hygienic environment and were protected from unsafe or unsuitable equipment. We also found that there were effective recruitment procedures in place and that the provider responded to complaints appropriately.

However, we found that the provider did not have an effective system to regularly assess and monitor the quality of service that people receive and was not notifying the CQC of all incidents that it was required to do so by law. We also found that records were not accurate or fit for purpose.