The inspection took place on 10 May 2017 and was unannounced.

The service provides residential care for up to 17 older people. At the time of our inspection 16 people were using the service.

A registered manager was 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 had previously carried out an inspection on 9 February 2016 during which we identified four breaches of regulation. These related to the poor management and recording of risk, insufficient numbers of staff and failure to assess people’s capacity to give consent. We also identified a breach relating to the overall governance of the service. We issued four requirement notices and the service supplied an action plan detailing how they would make the required improvements. At this inspection we found improvements in all areas that had previously concerned us.

People received safe care which met their individual needs.

Staff were trained in safeguarding people from abuse and the manager understood their responsibility to refer incidents appropriately to the local authority safeguarding team for investigation and to inform the Care Quality Commission.

Risks were assessed and documented in care plans and environmental risks were well managed.

There were enough staff to keep people safe and to enable them to live their lives in the way they chose.

Medicines were managed safely and people received their prescribed medicines when they needed them.

Infection control measures were in place and staff had an understanding of how to reduce the risk and spread of infection.

Staff received an induction and relevant training to help them carry out their roles. Staff were supported with regular meetings, supervision and appraisal of their performance.

Staff had received training in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). The MCA ensures that people’s capacity to consent to care and treatment is assessed. If people do not have the capacity to consent for themselves the appropriate professionals, relatives or legal representatives should be involved to ensure that decisions are taken in people’s best interests according to a structured process. DoLS ensure that people are not unlawfully deprived of their liberty and where restrictions are required to protect people and keep them safe, this is done in line with legislation. Practice related to MCA and DoLS was in line with legal requirements.

People who used the service were happy with the food and were supported to eat a varied diet.

People were supported to access the healthcare support they needed promptly. There was evidence of good partnership working with the district nursing team.

Staff were caring and treated people respectfully, ensuring their dignity was maintained. Good, caring relationships were evident between the staff and those they were supporting and caring for.

People who used the service, and their relatives, were involved in planning and reviewing their care and had opportunities to feedback about the service.

People were supported to follow their own hobbies and interests.

A complaints procedure was in place and formal complaints were dealt with appropriately and in a timely way. Informal issues were well managed and resolved quickly to people’s satisfaction.

Audits were in place to monitor the safety and quality of the service and the manager took overall responsibility for ensuring that any identified actions were put in place. There was a commitment to continuous improvement of the service.

The inspection visit took place on 9 February 2016 and was unannounced.

The home is registered to provide accommodation with personal care for up to 17 older people. There are 13 single bedrooms and two shared bedrooms. On the day of our visit there were 16 people living at the home.

The provider was also the registered manager. However, they were not permanently based at the home and visited only once a week. They had delegated management responsibilities to the care manager who was on site all week. 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 felt safe at the home and staff were knowledgeable about safeguarding adults and the different types of abuse to look out for. They knew what action to take if concerned about possible abuse.

The safety of people living at the home was compromised on a number of occasions in terms of day to day care. There were not enough staff on duty to always meet people’s needs. People were not always able to get up or go to bed when they wanted too, and there were not always enough staff to spend time with people.

Care records and risk assessments were not up to date and did not reflect changes in need for people living at the home. Risk was not always assessed and appropriate steps were not always put in place to keep the person safe.

Medicines were managed safely and people received their medicines on time.

People were supported to eat and drink, however nutritional assessments and other records were not adequately maintained or kept up to date to ensure people had enough to eat. Food was cooked freshly every day and people were offered alternatives were available.

Staff and the registered manager’s knowledge around the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguarding (DoLS) was poor and the process was not clearly followed to a level appropriate to people needs.

People’s rooms were decorated with their personal belongings so that they were comfortable and the area was made into their own space as much as possible. People thought staff were very nice and they felt cared for. However on occasions staff did not stop to consider people’s feelings.

The care records kept by the home were not always responsive to the needs of the people living in the home.

People knew how to raise concerns and previous complaints had been dealt with.

The registered manager had failed to keep up with changes to legislation and their responsibilities as a registered person. Policies and procedures to support staff were out of date and some were incorrect. Audits for quality had been recorded as carried out however they had failed to identify issues or actions to resolve these.

You can see what action we told the registered manager to take at the back of the full version of the report.

People were offered the care and support that would meet their needs. Care plans were in place showing people had an assessment of their needs. These were used to develop care plans and risks associated with their care needs had been assessed. We were told by people spoken with, “I can get up and go to bed when I wish. Sometimes I like to stay up late if I am reading a good book or a good programme is on the television. The staff are so kind. They help whenever you need it.” Another person said, “I have just had my toe nails cut, my glasses have just been replaced, my clothes always come back from the laundry clean and fresh; what more could I want for? Everyone is so kind and caring.”

We found the home clean and fresh. Staff were aware of good infection control procedures and there was a plentiful supply of disposable protective clothing.

The medication procedures were followed but the provider may find it useful to note that the application of certain creams was not always recorded.

Staffing levels at this home were found to be suitable. Staff were knowledgeable, worked as a team and were quick to respond when care and support was required.

The home had not received any complaints. The information on how to make a complaint or what to do if the person was unhappy with the response to a complaint was available. It could be easily seen in the entrance to the home by visitors or potential customers to the home. The home had a record of all the compliments received.

One person told us that, “The staff are keen to involve me in the activities that go on in the home”. Someone else confirmed that, “Staff are kind and I feel respected in the home”. This showed us that people’s privacy, dignity and independence were respected. People spoken with told us that they were well looked after and that their independence was promoted wherever possible. This demonstrated to us that people experienced care, treatment and support that met their needs and protected their rights.

Those care records seen identified that clear assessment of risks and care plans were in place that outlined how staff would manage and minimise risks to the people who were using this service. This showed us that people who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. Staff reported that they received additional training to assist them in meeting the needs of the people who were using this service. This demonstrated to us that people were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. Records were seen that confirmed the ongoing monitoring and assessment of quality of the services provided had been carried out. This showed us that the provider had an effective system to regularly assess and monitor the quality of service that people received.

Throughout our visit to Field View we heard a lot of positive comments about the home. One person told us, "It was like moving from home to home," and another person said, "I've never known time to go so quickly as when I have been here, I've never regretted coming in."

People told us that they made choices and decisions about their daily lives. One person said, "I haven't found any rules; I have the same routines as I did at home." Another person told us that people living in the home had opportunities to express their views and make suggestions if they thought things could be improved.

Everyone with whom we spoke said they liked the staff. One person told us, "Staff encourage me to be independent but they are there to help if I get in a muddle and they always help very willingly." Another commented, "Staff are very friendly and kind." We were told that staff treated everyone with dignity.

People told us that they were satisfied with the care they received and that it met their needs. One person commented, "I am ever so happy here; I am looked after very well and have everything I need." There were regular social and recreational activities and we were told, "They have lots of different activities and games, I join in everything and it's really brought me out of myself."

We received a number of positive comments about the meals. People told us that there was a good variety and they were satisfied with the portion sizes.