The inspection took place on 22 September 2016 and was unannounced. Field House provides accommodation and personal care for up to six people, with complex care needs which may include mental health and physical disabilities. There were six people living at the home at the time of our inspection. People had the use of a number of communal areas including a lounge and conservatory dining area and a garden, and their own rooms.

We spoke with five people about the care and support they received. The examples we have given are therefore brief because we respect people’s right to confidentiality.

Two registered managers were in post at the time of our 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’s views on how risks to their safety and well-being could be reduced were taken into account in the way staff supported them. People’s safety and care needs were understood by staff and staff took action so people’s safety and well-being needs would be promoted. There were enough staff to care for people and staff had opportunities to chat to people so they did not feel isolated and to prevent them from becoming anxious. Staff were confident action would be taken if they raised any concerns for people's safety or well-being. People were involved in decisions about how they supported to take their medicines so they would remain well.

People benefited from receiving care from staff who had the training they needed to develop their skills and meet people’s care needs. Staff cared for people in ways which recognised people’s rights to make their own decisions. Where people required some support from staff in order to choose from a range of options this was provided by staff. Staff supported people in ways which protected their freedoms and recognised their independence. People enjoyed the meals and drinks provided and had enough to eat to remain well. People received help from staff to see health professionals and staff advocated on people’s behalf so they would enjoy the best health possible.

People were supported by staff who knew them well. People had built caring relationships with staff and enjoyed spending time with them. People were encouraged to make their own decisions about how they spent their time, and were confident staff would support them to decide how they wanted to live their lives. People's rights to dignity and privacy was understood and acted upon by staff.

People’s views on what care they wanted, and how they wanted to receive this was used to develop plans which addressed people’s individual needs. Plans for people’s care took into account their preferences, health and life histories. Staff supported people in ways which recognised where they were independent and helped to ensure people had opportunities to do things they enjoyed doing and express themselves. People were confident action would be taken if they made any complaints about the care they received.

People were encouraged to let staff know what they thought of the care they received, and their views were used to inform further development of the services offered at the home. Staff were given clear guidance in understanding their roles and were supported by senior staff to provide the care people wanted. Checks were made on the quality of the care by registered manager and provider and staff took action to further improve people’s experience of living at the home.

We carried out an inspection to help us answer five questions;

Is the service caring?

Is the service responsive?

Is the service safe?

Is the service effective?

Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with four of the people using the service ,three care staff supporting them and looking at two people's care records. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

People who used the service told us that they felt safe. One person told us, "There are no worries about safety here". Safeguarding procedures were in place and staff understood their role in safeguarding the people they supported. Staff were aware of the provider's whistleblowing policy.

People's independence, rights and choices were protected because the provider had procedures in place to gain people's consent to the care and support they received. Where people were not able to give consent the provider had acted in people's best interests and met legal requirements.

Staff knew about risk management plans and we saw that they supported people in line with those plans. Medicines that people needed were ordered, stored and administered in a safe way. This meant that people were supported with their care needs in a way that was intended to ensure their safety and well being.

The manager ensured that staff rotas were planned in advance to maintain the staffing numbers required to provide care in a safe way.

Systems were in place to make sure that the manager and staff learned from events such as accidents and incidents, complaints and checks made on the service. This reduced the risk to people and helped the service to continually improve.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place. Relevant staff have been trained to understand when an application should be made and how to submit one.

Is the service effective?

People’s care needs were assessed with them. All of the people we spoke with told us they were involved in their care planning and reviews of care. We saw that care plans were regularly updated.

Where people had complex needs that required the input of specialist health care services, assessments had been made by the appropriate professionals. Their recommendations were carried out by the staff. This meant the provider worked well with other services to ensure people's health care needs were met.

Is the service caring?

People were supported by care staff that were kind and caring. We saw that care staff gave people encouragement and respected their privacy and dignity. One person told us, "The manager and the staff are very kind to us".

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 had the opportunity to plan and engage in a range of different activities each day. People told us about opportunities they had to try new activities.

People were asked their views about the service and the provider acted on comments and suggestions that people made.

Where care staff had noticed people's changing needs, their care plans were updated to reflect this. This was because staff discussed people's care needs with them on a regular basis. People told us staff would always do their best to make sure they were happy.

Is the service well led?

The provider had quality assurance and risk management systems in place. We found the registered manager checked that risks were managed effectively.

The provider sought the views of people who used the service. Records seen by us indicated that shortfalls in the service were addressed. People expressed concerns about the length of time it took to get work completed on the environment and the replacement of worn furniture and carpets.

Staff told us they were clear about their roles and responsibilities and understood the quality assurance and risk management systems. This helped to ensure that people received a good quality of care. Staff told us the home was well organised and they felt supported by their manager.

We were able to speak with two people who lived at the home, two care workers, the registered manager and the director of care. We found people were able to express their views and had been involved in making decisions about their care and treatment.

People were complimentary about the care and support they received. One person told us: “I am very happy here, they look after me really well”. Another person said: “I absolutely love it here”.

People received care and support as planned according to their needs. Care workers understood people’s needs and how to give the support they needed.

We found that people who lived in the home were protected from the risk of abuse.

People were cared for in a safe and clean environment. The premises were suitable for people who required wheelchair access and people were able to access all parts of the home and garden.

The provider had a system in place that made sure care workers who had been recruited, had the required documents and checks in place to protect people.

People knew how to make a complaint and felt supported in that process.

We saw that the environment was clean and that the living space at the service was well maintained. On the day we inspected the service it suffered a temporary loss of hot water. We found that the provider had contingency plans in place and they were able to restore the hot water within a short period of time.

We spoke with two people who used the service on the day we inspected. One person told us that it was "the best [service] by a long way". Another person said it's the "best place I've been in".

We spoke with a relative who was visiting someone who lived at the service on the day we inspected. They told us that the service was "marvellous" and that they "couldn't fault it one bit". They explained to us how their relative had been the most settled they had been in years and that the service had "fetched him on leaps and bounds".

We found that people at the service were involved in decisions about their care. The provider was able to work with people to establish agreements on what was in the best interests of people's health and welfare, even when that involved giving people difficult messages.

One person who used the service told us that they enjoyed the environment they lived in.

You can see our judgements on the front page of this report.