About the service:

Fieldhead Court provides accommodation, care and support for up to 45 people over 65 years old including people living with dementia, people receiving end of life care and people on respite care. At the time of our inspection, there were 36 people living at the service.

People's experience of using this service:

¿ People and relatives told us they felt safe with the care provided. One person said, “I am safe because I am taken care of.”

¿ We found the service had deteriorated in some domains since our last inspection.

¿ The service met the characteristics of requires improvement in four out of the five key questions. This is the second time this service is rated as ‘requires improvement.’

¿ At this inspection, we found not enough improvements had been made since our last inspection because the management of records of people’s medication, consent, care plans and care delivered was not always robust and the provider continued in breach of regulations.

¿ We found two breaches of the regulations. One breach in relation to safe care and treatment because the provider was not always managing the risks to people’s skin integrity appropriately, people who were using specialist seating had not been assessed to use this equipment, information in people’s risk assessments was not always detailed or updated and we found several concerns with the management of medicines. The provider continued in breach of regulations in relation to good governance because of lack of consistency in the quality of records relating risks to people’s care, support plans and their consent; we also found a continued lack of effective quality assurance systems in place.

¿ We have made 2 recommendations in relation to management of medicines in care homes and effective quality assurance systems.

¿ The management of risks was not always consistent. We found known risks to people’s care were not always identified in their risk assessments and their care plans lacked information to give clear guidance to staff on how to manage those risks.

¿ Medicines were not always managed safely. We found concerns in relation to the quality of the recording in people’s medicines administration (MAR) charts, we could not be certain people’s medicines were administered in an effective way, protocols for ‘as and when required’ medicines and instructions for creams were not always detailed.

¿ The provider had several systems in place to monitor the quality of the service but these had not been effective in identifying and addressing the issues found at this inspection.

¿ People were supported by staff who were motivated, enjoyed their job and felt well supported through regular supervisions and training.

¿ The registered manager had developed several links with the community and partnerships to support care provision and service development.

¿ For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection:

At our last inspection the service was rated requires improvement overall. Our last report was published on 20 April 2018.

Why we inspected:

This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received.

Enforcement:

Please see the ‘action we have told the provider to take’ section towards the end of the report.

Follow up:

We will continue to monitor the service to ensure that people received safe, high quality care.

Further inspections will be planned for future dates. We will follow up on the breaches of regulations and recommendations we have made at our next inspection.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

The inspection of Fieldhead Court took place on 26 February 2018 and was unannounced. This meant the registered provider did not know we were coming.

Fieldhead Court is registered to provide accommodation and personal care for up to 45 people, some of whom are living with dementia. There were 43 people living at the home at the time of our inspection.

Fieldhead Court 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.

The home had previously been inspected during December 2015 and was rated good in the key questions of safe, caring, responsive and well-led. The home was rated as requires improvement in the key question of effective. There were no breaches of regulations identified at the previous inspection.

The home had 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 told us they felt safe living at Fieldhead Court. The registered manager and staff were aware of relevant procedures to help keep people safe and staff could describe signs that may indicate someone was at risk of abuse or harm. Staff had received safeguarding training.

Staff were recruited safely and we observed there were sufficient numbers of staff deployed to meet people’s needs. Staff told us they felt supported and we saw evidence staff had received training and ongoing supervision.

Risks to people had been assessed and measures were in place to reduce risks. However, not all risk assessments were up to date and one we looked at had been completed incorrectly so did not accurately reflect the person’s level of risk. Some moving and handling plans provided staff with relevant information to safely assist people to move. However, we found one contained conflicting information.

Medicines were administered in a kindly manner. However we found some issues with the recording of topical creams.

There were pockets of malodours within the home which did not dissipate through the day. Some wheelchairs were also odorous.

The building was well maintained and regular safety checks took place. The environment had recently improved due to some refurbishments.

Our observations showed people were supported to have choice and control of their lives and we observed staff supported people in the least restrictive way possible. However, records relating to people’s mental capacity and best interests decision making were inconsistent.

We made a recommendation about the recording of people’s mental capacity assessments and best interests decision making.

People received appropriate support in order to have their nutritional and hydration needs met.

People told us staff were caring and we observed staff to be kind and considerate. We observed people’s privacy and dignity was respected. People were encouraged to maintain links with their family. People’s diverse needs were considered.

Although care records contained personalised information, some care records contained conflicting information. People told us they could make their own choices in relation to their daily lives.

There was a complaints policy in place and people told us they would feel able to complain if the need arose, although no complaints had been made.

Staff told us they felt supported and people and their relatives spoke positively about the registered manager. Regular audits and quality assurance checks took place, although further development was required in order for the registered provider to be fully complaint with the regulations.

We found a breach of regulation in relat

The inspection of Fieldhead Court took place on 9 December 2015 and was unannounced. We previously inspected the service on 30 October 2013. The service was not in breach of the Health and Social Care Act 2008 regulations at that time.

Fieldhead Court is a nursing home currently providing care for up to a maximum of 45 older people. The home is a converted property with a purpose built extension. The home stands in its own grounds with mature gardens. On the days of our inspection 42 people were living at the home.

The service had a registered manager in place. 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. Say when the inspection took place and whether the inspection was announced or unannounced. Where relevant, describe any breaches of legal requirements at your last inspection, and if so whether improvements have been made to meet the relevant requirement(s).

People told us they felt safe and staff understood their responsibilities in keeping people safe from the risk of abuse.

Risks to people’s welfare had not been robustly assessed and relevant risk assessments had not always been implemented.

One of the staff recruitment files we looked at did not contain references to support their application to work at the home.

Staff received regular training and supervision, new staff were supported in their role.

Staff understood the principles of the Mental Capacity Act 2005, but, where people lacked capacity, there was a lack of documented evidence regarding the decision making process.

People told us staff were caring. We observed staff to be kind and attentive to people’s needs. Staff respected people’s right to privacy and dignity.

There was a varied programme of activities available for people and the activities organiser had plans to further develop the programme for people.

Care records contained a number of plans providing instructions for staff as to how people’s needs were to be met. Documents within the files were easily located and were reviewed at regular intervals.

There was a system in place to record and respond to complaints.

The home had an experienced registered manager. Staff spoke highly of the registered manager and felt supported by them.

The registered manager and senior management team conducted regular checks to monitor the quality of the service people received.

Meetings were held with people who lived at the home and staff.

During our inspection we spoke with the manager, members of staff, people who lived at the home and one of their relatives.

People were very complimentary about the care that was provided. They told us they were involved in planning their care. A service user said "they help me to look after myself, I am clean, warm and very well looked after".

People's dignity had been respected. Relatives had been involved in supporting people with planning their care and their choices had been respected. Care was planned and records had been maintained. Reviews of care had been conducted regularly and changes made when necessary.

People were safeguarded from the risk of harm because staff had a clear understanding of their roles and responsibilities in this area. People had access to a range of health care professionals.

Staff had been supported to do their work and told us that they had received appropriate training. Staff received regular training that enabled them to deliver care to an appropriate standard.

There were effective systems in place to ensure that people were cared for in a clean and hygienic environment. All areas of the home were clean and free from odour. Staff were aware of infection control and prevention guidelines and had received appropriate training.

We found that medicines were prescribed and given to people appropriately; however the home needed to be more vigilant in ensuring its medication procedures were consistently adhered to.

People told us they were happy living at the home. Comments included;

"The staff are all very good and they cannot do enough for you.”

A visitor told us they came to the home regularly and said the staff were all very good and they had no concerns.

People told us they could have a drink between meals and should it not be the time when drinks were usually served, all they had to do was ask one of the staff and they would be provided with one.

Visitors told us they were always offered drinks when they visited the home and made to feel welcome.

People told us the food was lovely and there was always a choice.

There were enough qualified, skilled and experienced staff to meet people's needs. On the day of our inspection, the atmosphere within the home was relaxed, and staff had a pleasant manner towards people as they went about their duties.

People told us they had not needed to complain but they knew who they would speak with if they were not happy. A visitor also told us they knew how to complain. They said all the staff were approachable and they would have no hesitation in talking with them if they had a concern.

During the visit we observed staff providing support to people in a sensitive and dignified way.

People we spoke with were complimentary about the care they receive. One person told us “We are looked after very well and the staff are brilliant”. Another person said, “Staff are helpful’.

Visitors and people who use the service said there were activities taking place on a daily basis. One person said, “You can join in if you like, but I am alright”.

Another person told us there was always something going on and this included, visits to the ice cream parlour, train museum and the fish and chip restaurant.

People told us that they feel safe and had confidence that any concerns would be properly dealt with.

A relative told us, “I have no worries, and if anything happens they keep me up to date”.

People told us that if they were worried about anything they would talk to the staff. They said, “The manager is so accessible, and I am lucky to be here”.

People told us there were always enough staff to look after people. One person said, There was a phase when the manager left and there were less staff, but now she’s back it is alright”.