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. Field House provides accommodation with nursing and personal care for up to 55 people. At the time of our inspection 44 people were living in the home.

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.

The inspection took place on 15 and 16 January 2017 and was unannounced. When the care home was last inspected in January 2016, there was one breach of the legal requirements identified. We found people’s hydration needs were not fully met. The provider wrote to us with an action plan to tell us how they would meet the requirements of this regulation. During this inspection, we found actions had been taken to meet the specific requirements of this regulation. However, we identified three regulatory breaches with regard to the provision of safe care and treatment and record keeping.

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

During our inspection we spoke with ten of the 54 people who lived at Field House. We also spoke with the registered manager, eight members of staff, three visiting professionals and six relatives of people who lived at the home.

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.

When we visited the service in June 2013, we found that care wasn't always planned and delivered in a way that fully protected people and met their needs. We also found that the systems in place for monitoring the quality of the service provided were limited and provided little opportunity for people using the service to provide feedback. There was a lack of overall planning in relation to staff development and supervision.

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.

This inspection took place in order to check the progress that the service had made in response to a warning notice issued in June 2013. The warning notice was in relation to record keeping; we had found that staff were not making accurate recordings of people's food and fluid intake where required. There were also a number of gaps in records relating to repositioning of people at risk of developing pressure areas to the skin. Records were not being kept securely because they were unlocked and in an area of the home that was potentially accessible to visitors to the home.

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 spoke with four people receiving care and three relatives during our visit. Much of the feedback they provided was positive, for example one person told us that "the majority of staff are very caring". Another person said that it is "very good here". People's feedback about the food at the home was very good; we heard that choices were provided and there was always enough to eat with drinks and cake rounds being provided between meals.

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 people living at Field House and received a range of comments, some of them positive and others reflecting the fact that staff weren't always able to come and help them as quickly as they would like. One person said that their only complaint was "that it takes a while" for staff to respond to call bells. This person also commented that there were "a lot of things going on", in terms of activities for them to take part in over Christmas. Other people told us that they were well cared for and that it depended how busy it was as to how quickly staff came.

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.

We spoke with five people who were staying at Field House. One person was due to leave to go to a different home and told us that they were “exceptionally sad to leave” and that they were very happy there. A relative of a person at the home told us that "staff seem very good".

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.