We inspected Fieldview on 6 and 8 February 2018. Fieldview provides accommodation and personal care for six people with mental health needs. Fieldview also covers two supported living houses called Pearcroft and Westend where project workers assisted people with mental health needs. Additionally the provider provided community care for 12 people living within the local area. Fieldview is located in Stonehouse and is near to a range of amenities including shops, GP practices and a train station.

We last inspected Fieldview in January 2017. At this inspection the service was rated as “Requires Improvement”. At the January 2017 inspection we found improvements were being made in relation to the management of the service and maintaining people’s care records, however these improvements had not been fully implemented or sustained. At this inspection we found these improvements had been fully imbedded into the service and the service was rated ‘Good’ overall.

There was a manager in post who was in the process of registering with the Care Quality Commission. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 were happy, safe and benefitted from an active and full life. People's ability to be as independent as possible was promoted and respected by project workers. People were supported to take positive risks and to be in control of their care and support. Where possible, people understood what their medicines were for and how they assisted with their wellbeing. Project workers ensured people had their medicines administered safely. There were enough project workers deployed to meet people’s individual needs.

People where possible were involved in writing and reviewing their care plans, which were tailored to their individual needs. People were at the centre of their care. Project workers knew people well and knew how to support people live a full life and achieve their goals. The manager and staff looked for opportunities to offer people that would help them develop, gain confidence and live a fulfilled life.

Project workers were well supported and trained which enabled them to ensure they could provide people with the best possible care and support. Project workers understood and worked to the values of the registered manager and the provider and put people at the heart of everything they did. Project workers were supported to develop professionally through dedicated management training programmes.

The service had a strong leadership presence. The manager and deputy manager were committed and passionate about the people they supported. Thorough and frequent quality assurance processes and audits ensured that all care and support was delivered in the safest and most effective way possible.

This inspection took place on 12 and 13 January 2017 and was unannounced. Fieldview is a service based over two individual buildings called Fieldview and Westend. Fieldview and Westend provide support for people living with mental health conditions. Fieldview provides residential care for seven people. Six people were living at Fieldview at the time of our inspection all of who required assistance with their personal care. People living at Westend received support and care to meet their needs. Five of the seven people living at Westend were receiving support with personal care from project workers. The service is located near the centre of Stonehouse, close to a range of local amenities.

There was not a registered manager in place for Fieldview. The last registered manager left the service after our inspection in August 2016. However a manager, (who was registered manager of another of the provider’s services) was in place and was in the process of registering with the Care Quality Commission. 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 and associated Regulations about how the service is run.

We last inspected the service on the 16, 18 and 19 August 2016. At this inspection we found the provider was not always acting in accordance with the requirements of the Mental Capacity Act 2005 and the associated code of practice. The service had not always recorded where people could or couldn’t consent to their care. We issued the provider and the former registered manager with a warning notice compelling them to take action by 30 September 2016. Additionally, the provider did not always ensure people’s care records were complete or current. There were not always effective systems in place to assess, monitor and improve the quality and safety of the service provided. We issued the provider and the former registered manager with a warning notice compelling them to take action by 30 November 2016. Finally, we found the provider did not always ensure project workers were of good character before they started working at the service. At our inspection in January 2017 we found that appropriate action had been taken by the provider and registered manager to meet the relevant regulations. Whilst the service was meeting the regulations, it was not always possible to sufficiently evidence the consistency and positive impact these improvements had had on people living at Fieldview or Westend. However, it was clear that the negative impact on people had been minimised.

People’s legal rights were protected and they received treatment and support that they had consented to or was in their best interests. People’s capacity to consent to aspects of their care and treatment were being recorded, however these were not always accurately recorded. The manager was taking immediate action to address this, however it had no impact on people. Where people were being deprived of their liberty, the manager and provider was making appropriate applications.

The provider and registered manager had implemented new systems to assess, identify and improve the quality of service people received. These systems were new and therefore it was difficult to ascertain the impact they had on driving the quality of the service. However the manager and project workers had carried out some audits and improvements which had a positive impact on the service people received.

The provider and manager ensured that new staff were of good character before they worked with people. People’s care records were detailed and often reflected people’s needs. There were some records which had not been updated, however this had limited impact and risk on people.

People in Fieldview benefitted from positive engagement with project workers. People were supporte

This inspection took place on 16, 18 and 19 August 2016 and was unannounced. Fieldview is a service based over two individual buildings called Fieldivew and Westend. Fieldview and Westend provide support for people living with mental health conditions. Fieldview provides residential care for seven people. Seven people were living at Fieldview at the time of our inspection all of who required assistance with their personal care. People living at Westend received support and care to meet their needs, five of the seven people living at Westend were receiving support with personal care from project workers. The service is located near the centre of Stonehouse, close to a range of local amenities.

Fieldview had a registered manager for one of its regulated activities. The registered manager for Westend had left in June, therefore there was not currently a registered manager for the regulated activity ‘personal care’. The provider was currently restructuring the management of all of two of their care services. 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 and associated Regulations about how the service is run.

We last inspected the service on the 24 and 25 July 2015. At this inspection we found the provider was not always acting in accordance with the requirements of the Mental Capacity Act 2005 and the associated code of practice. The service had not always recorded where people could or couldn’t consent to their care. The provider did not always ensure people’s care records were complete or current. There were not always effective systems in place to assess, monitor and improve the quality and safety of the service provided. At our inspection in August 2016 we found that appropriate action had not been taken by the provider and registered manager to meet the relevant regulations.

People’s legal rights were not always protected and people could be at risk of receiving treatment and support they did not consent to. People’s capacity to consent to aspects of their care and treatment were not always recorded. Some people were being deprived of their liberty without appropriate authorisation.

The provider and registered manager did not always operate effective systems to assess, identify and improve the quality of service people received. Systems were not always carried out consistently. Where concerns had been identified action was not always taken to improve the quality of the service. The provider and registered manager did not always ensure that new staff were of good character before they worked with people. People’s care records were not always detailed and did not always reflect people’s needs, this put people at the risk of inappropriate care and treatment.

People in Fieldview did not always benefit from positive engagement with project workers. People were supported to access the local community independently, and some people enjoyed doing tasks around the service. People in Westend enjoyed their time with project workers and enjoyed accessing the community independently.

People felt safe living in Fieldview and Westend. People spoke positively about staff and had access to plenty of food and drink. Project workers knew people, their needs, likes and dislikes.

Project workers had access to supervisions and appraisals. Project workers were supported and had access to training and professional development. There were enough project workers with appropriate skills, deployed to meet the needs of people living at both Fieldview and Westend.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

We were able to speak with four of the seven people who lived at Fieldview when we visited. They told us that they were always asked if they wanted to do things and could make choices. During our visit we heard staff offering people choices and people making decisions for themselves, about what they did, where they went or what they had for dinner.

People were satisfied with the care and support they received. One person said “I like it here, the food is good, the company is good and I am safe”. Other comments we received were “they remind me what I have to do as I forget” and “the staff are here to help and guide us but I can do things the way that I want”.

There were safe systems in place in respect of the management of medicines.

The home was comfortable and well equipped, and people had their own bedrooms and en-suite bathroom facilities.

Safe recruitment procedures were followed to ensure that unsuitable workers were not employed at the home.

During our inspection and in conversations with four of the seven people who lived at Fieldview, no concerns or complaints were raised with us. People would have any comments and complaints they made, listened to and acted upon.

We found that three important events had happened in the home in August 2012 but we had not been informed. The provider is legally required to inform the Care Quality Commission of such events. We have asked the provider to take action so this did not happen again.

We spoke with three people who told us that they had received some information about the home and they had the opportunity to visit before they moved in. They said that the staff were respectful and respected their privacy. They also said that the staff gave them all the help support that they needed. People told us that they could choose how they spent their time and they were encouraged to make their own decisions . They had opportunities to go out into the local community.

People said that the staff asked them about the help and support that they needed, their needs were assessed and they had care plans. They said that they had opportunities to see health professionals such as the GP, optician and dentist. They told us that they felt safe in the home.

People said that the staff gave them all the help and support that they needed and had the right training to do the job. They said that they had opportunities to comment on the quality of the service and make suggestions for improvements.

We announced the start of our inspection to the provider 24 hours before we visited. We did this to ensure that key members of staff would be available for the inspection. Fieldview is registered to provide accommodation for up to seven people in the care home and also provides a personal care service (domiciliary care) to people who live in a shared house and one other person who lives in their own home in the local vicinity. For the purposes of this report we have referred to a community based service (people receive support in their own home) and have used Fieldview when referring to the care home. Both services care for people who have enduring mental health and learning disabilities

At the time of the inspection a community based service was provided to seven people, six who lived in a shared house and one other person who lived in their own home. This service was managed by a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider. 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.

Fieldview is a large detached property within walking distance of Stonehouse, Gloucestershire and the accommodation is spread over three floors. Fieldview is managed by another registered manager who has recently been registered by the Care Quality Commission. There were six people in residence in the care home.

Improvements need to be made with the way in which the staff apply the principles of the Mental Capacity Act 2005 and the associated code of practice. The mental capacity assessments that had been completed were incomplete. This may mean that issues around consent were not considered and best interest decisions not recorded correctly.

People were provided with care and support that met their care and support needs and took account of their individual choices and preferences. However care planning documentation was not completely accurate in respect of do not resuscitate decisions. This may mean that people could be provided with care or treatment that was not agreed.

The systems to assess and monitor the quality and safety of both services were not effectively operated because no action was taken as a result of any findings. No action plans were put in place to drive forward any improvements that had been identified. The service did not gather feedback from families and health and social care professionals about the service.

People from both services said they felt safe and the staff helped them to keep safe. One person in the shared house said they all got on well together. Staff received safeguarding adults training and knew what to do if concerns were raised. Where staff were handling people’s money, there were records in place to account for money spent.

Staff recruitment procedures ensured that unsuitable workers were not employed to work in either service. Staff were well trained and were supported to do their jobs effectively. There were sufficient numbers of staff to meet the care and support needs of people.

Risks were well managed on the whole. However, an environmental risk assessment of the homes of those people support by the community based service had not been completed. This shortfall was highlighted when we inspected in July 2014. By the end of the inspection the registered manager had located a blank document and gave an undertaking to complete the task promptly.

Medicines were well managed. Staff received training in order to administer medicines. People supported by the community based service were assessed to determine the level of support they needed with their medicines and this was recorded in their care plan.

People were provided food and drink they liked and helped with meal preparation where able. Healthy food options were encouraged and body weights were monitored where needed. People said they had enough to eat and drink. People were supported to access the healthcare services that they needed and staff either supported them to attend the surgery or arranged for professionals to visit in the home.

On the whole staff were kind and caring but there was a lack of consistency in the caring approach by staff – we have referred to two specific examples in the body of the report. They had a good rapport with the people they were looking after. People were at ease with the staff and supported them to do daily living activities, be part of the local community and to be as independent as possible. People could raise any complaints or concerns they had during ‘house’ meetings, with their keyworker and through care plan reviews.

Regular meetings were held with people using both services and with the staff team. Staff meetings and management meetings were scheduled regularly and staff were encouraged to express their views.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.