We carried out an unannounced comprehensive inspection of this service on 17 May 2018.

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

We completed an unannounced comprehensive inspection of this service on 30 and 31 August 2017. We found there were breaches in the legal requirements and regulation associated with the Health and Social Care Act 2014. There was a breach in Regulation 13 The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider had failed to protect people from abuse. A breach in Regulation 12 (1) The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider had not ensured people were supported in a safe way. A further breach in Regulation 17 (1) of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider did not have effective arrangements in place to monitor and improve the quality and safety and welfare of people using the service. We asked the provider to take immediate action to rectify these concerns.

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.

The Field House Rest Home provides accommodation and personal care for up to 54 people. On the day of our inspection there were 44 people living at the home.

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 a

We carried out an unannounced comprehensive inspection of this service on 3 May 2017.

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.