About the service:

Fieldway Residential Home is a residential care home that was providing personal care to 16 people aged 65 and over at the time of the inspection. People who used the service had physical disabilities, sensory needs and mental health needs such as dementia.

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

People’s experience of using this service:

Improvements were needed to ensure records were consistently up to date. The registered manager was working towards their action plan and some improvements were still being implemented and imbedded into the service.

Improvements were needed to ensure mental capacity assessments were consistently reviewed when people’s needs changed and to ensure the assessments were decision specific.

People were supported by safely recruited staff who had the skills and knowledge to provide safe and effective support. People were supported to manage their risks, whilst maintaining their independence. Systems were in place to ensure people received their medicines as prescribed. Effective care planning was in place which guided staff to provide support that met people’s needs which were in line with their preferences.

People were supported to eat and drink sufficient amounts in line with their assessed needs. People’s diverse needs had been planned for which ensured people received individualised care in all aspects of their life. Professional advice had been sought and acted on to ensure people’s health and wellbeing was maintained.

Staff were kind and caring towards people and promoted choices in line with individual communication needs. People were treated with dignity and their right to privacy was upheld.

People had opportunities to be involved in activities. People and their relatives were involved in the planning of their care, which meant people were supported in line with their preferences. There was a complaints system in place, which people and relatives knew how to use. There was no one receiving end of life care at the time of the inspection. However, people’s advance decisions were recorded.

There had been improvements to the governance at the service. There was an open culture within the service, where people and staff could approach the registered manager who acted on concerns raised to make improvements to people’s care. Feedback was gained from people and staff which was acted on to make improvements.

Rating at last inspection:

Requires Improvement (Report published 21 August 2018)

Why we inspected:

At the last comprehensive inspection in July 2017 the service was rated Requires Improvement overall (in the key questions of Safe, Effective, Caring and Responsive) The key question of Well-Led was rated inadequate. There was a breach in Regulation 17 because the provider’s governance systems were not effective in identifying and mitigating poor care. We served a notice of proposal which asked the provider to forward a monthly action plan to us (CQC) to show how they planned to make improvements to people’s care.

At this inspection, improvements had been made to meet the regulations. However, further improvements were still needed in the key questions of Effective and Well-Led. The service had met the characteristics of Good in Safe, Caring and Responsive. Therefore, the overall rating is Requires Improvement.

Follow up:

We will continue to monitor the service through the information we receive.

We completed an unannounced inspection at Fieldway Residential Home on 17 July 2018. When we completed our previous inspection on 8 November 2017, we found breaches in Regulations 12, 17 and 19. The provider did not have safe medicine management systems in place, the environment was not managed to keep people safe from the risk of harm, staff were not always recruited safely and the systems to monitor the service were not effective. The service was rated as Requires Improvement overall.

Following the last inspection, we served a warning notice and we asked the provider to complete an action plan to show what they would do, and by when, to improve the key questions safe, caring and well led to at least good. At this inspection we found that the provider continued to be in breach of Regulation 17 as sufficient improvements had not been made. You can see what action we told the provider to take at the back of the full version of the report.

Fieldway Residential Home is a ‘care home’. People in care homes receive accommodation and personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Fieldway Residential Home accommodates up to 18 people in one adapted building. At the time of the inspection there were 15 people using the service.

There was a registered manager at the service. 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.

There has been a consistent failure to implement sustainable improvements in the service and the provider has failed to implement effective systems to monitor the quality or safety of care provided to people.

The system in place to manage staff vacancies was not effective and had impacted on other areas of the service. For example; the effective cleaning of the service. This meant that areas that required improvement had not always been identified because the registered manager had not monitored the service as required.

Records did not always contain accurate and up to date information to ensure that people’s risks were mitigated. There was a lack of proactive planning and management of the service, which meant there was not a clear view of the improvements needed.

Improvements were needed to ensure the registered manager had a system in place to ensure they pro-actively identified areas of concern and lessons were learnt went things went wrong.

Improvements were needed to ensure that medicines were managed safely and infection risks were mitigated to protect people from potential harm.

Improvements had been made to ensure the environment was safe. However, further improvements were needed to the design and décor to meet people’s needs.

Risks to people’s health and wellbeing were managed because staff knew people well, which ensured people were supported safely.

People were protected from the risk of abuse, because staff understood how to recognise and report suspected abuse.

There were enough suitability recruited and skilled staff to provide support to people. Staff had received training to ensure they had sufficient knowledge to carry out their role effectively.

People were supported with their nutritional needs and advice was sought from health and social care professionals to maintain people’s health and wellbeing.

There were systems in place to ensure people received consistent care from staff within the service and also from staff from external agencies.

People received the least restrictive care and treatment to keep them safe in line with the Mental Capacity Act 2005.

People received support from staff that were kind and compassionate. People’s dignity was respected and their right to pri

This inspection took place on 5 October 2017 and was unannounced. At our previous inspection in November 2016 we found that the service was not always responsive or well led. We found a breach of Regulation 16 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 as complaints were not managed appropriately. At this inspection we found that improvements had been made in this area and they were no longer in breach of this regulation. However we found further concerns and a further three breaches of Regulations as the service was not consistently safe and well led. You can see what action we have taken at the end of the report.

Fieldway Residential Home provides accommodation and personal care to up to 18 people. There were 17 people using the service at the time of this inspection, several who were living with dementia.

There was a registered manager in post who supported us throughout the 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.

The maintenance and management of the building and environment was not sufficient to maintain people's safety.

There were sufficient staff to meet the needs of people who used the service as the registered manager took action to increase the staff. However checks to ensure people who volunteered or regularly visited the service were not carried out to ensure their suitability.

People who manage their own medicines were not supported to do so safely.

People were not always considered and at the centre of the service as action was not always taken to keep people safe.

The systems the provider and registered manager had in place to monitor and improve the quality of the service were not always effective.

Risks of harm to people were reduced following incidents and accidents.

People were safeguarded from the risk of abuse as the registered manager followed the local safeguarding procedures.

The principles of The Mental Capacity Act 2005 were followed to ensure that people who lacked the mental capacity to agree to their care were supported to do so in their best interests.

Staff received training and support to be able to fulfil their roles effectively.

People were encouraged to eat and drink sufficient amounts of food and drink to remain healthy. When people became unwell or their health care needs changed the appropriate health care support was gained in a timely manner.

People's care was regularly reviewed and the staff and registered manager responded to any changes to ensure people's needs were met.

People were supported to be involved in hobbies and activities that met their individual preferences. People knew how to complain and complaints were responded to appropriately.

People told us they were treated with dignity and respect and their right to privacy upheld. People were offered choices about their care and these choices were respected.

There were plans in place to improve the service which were yet to be implemented. People, relatives and staff liked and respected the registered manager.

This unannounced inspection took place on 3 November 2016. At our previous inspection in February 2016 we found the provider was in breach of Regulation 11 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 as people who lacked mental capacity were not being supported to consent to their care. We also had concerns that the service was not safe, responsive or well led. At this inspection we found that the provider was no longer in breach of Regulation 11, however we found the service was still not always responsive to people's individual needs and they were in breach of Regulation 10 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Fieldway Residential Home provides accommodation and personal care to up to 18 people. There were 15 people using the service at the time of this inspection, several who were living with dementia.

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's emotional and social needs were not always recognised and responded to and complaints were not always managed sensitively. The provider did not create an open culture in which people felt able to complain.

Limited opportunities were available to people to engage in hobbies and interests of their choice. Records did not reflect the activities staff told us that people participated in.

People were safeguarded from harm and the risk of abuse as staff and the manager knew what to do if they suspected abuse had occurred.

People were supported by sufficient staff who had been employed using safe recruitment procedures. Staff had received training to be able to be effective in their role and they felt supported by the registered manager.

Risks of harm to people were assessed and minimised through the effective use of risk assessments and staff knew people's risks.

Medicines were stored and administered safely and staff were trained to administer them in a safe way. People had their prescribed medicines at the times they needed them.

The principles of The Mental Capacity Act 2005 (MCA) were being followed and people were consenting to or being supported to consent to their care.

People's health care needs were met when they became unwell or their needs changed and people were supported to eat and drink sufficient to maintain a healthy diet.

People were treated with dignity and respect and their right to privacy was upheld and they were offered choices and involved in decisions about their care.

The inspection took place on the 24 February 2016 and was unannounced. At our previous inspection in 2013 there were no concerns identified in the areas we inspected.

Fieldway Residential Home provided accommodation and personal care to up to 18 people. There were 13 people using the service at the time of the inspection some of whom were living with dementia.

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 did not always have their medication when they needed it as instructions from the prescriber were not always followed.

The principles of the Mental Capacity Act 2005 were not followed. Some people were being restricted of their liberty and people were not being supported to consent to their care and support.

People were not supported to engage in hobbies and activities of their choice. The environment did not support people living with dementia to orientate to time and place.

There were sufficient staff to meet the needs of people who used the service. Safe recruitment procedures had been followed to ensure they were fit to work with people.

Risks of harm to people were assessed and action was taken to minimise the risk through the use of risk assessment and equipment.

Staff were supported and received training to be able to fulfil their role effectively.

People's nutritional needs were met and if they became unwell health professional support was gained. People were supported to access a range of health care professionals.

People were treated with dignity and respect and their privacy was respected.

People's care was regularly reviewed however people themselves were not involved in the reviewing of their care.

The provider had a complaints procedure and people knew how and who to complain to.

There were systems in place to monitor the quality of the service and action was taken to improve.

There was a breach of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have asked the provider to take at the end of the report.

We saw that people were able to make decisions about their care and treatment at Fieldway Residential Home. People who lacked capacity to make important decisions were supported by staff and where appropriate Mental Capacity Act assessments were completed to ensure decisions were in people's best interests.

People received care and support appropriate to their individual needs. One person pointed to a member of staff and said, “That young lady helped me shower this morning and she did everything perfectly”.

Fieldway Residential Home cooperated with other service providers and the wider health community to provide people with appropriate support and care.

The home was clean and tidy. Staff had been trained in, and were able to describe the principles of infection control. A relative of a person who used the service said, “It is always nice and clean, and people always look smart and tidy”.

The home was registered to provide services to up to 18 people. At the time of our inspection there were 13 people using the service, but the staffing levels for full occupancy had been maintained. A member of staff said, “It’s nice at the moment because you have time to be with people”.

The provider had systems in place to monitor and assess the service provided and was responsive to issues identified or raised.

We carried out this inspection to check on the care and welfare of people using this service. The inspection was unannounced which meant the provider and the staff did not know we were coming. Fourteen people were in residence, we spoke with five people living in the home, three visitors, four staff, the registered manager and provider.

People's privacy and dignity were respected. We saw staff knocking on people's doors and waiting for an answer before entering. People using the service were happy living at the home. They told us they enjoyed their lives there and they liked the staff who cared for them. One person using the service said, “The staff are very approachable.” A visitor told us, “ It is absolutely brilliant I am so pleased with how our relative has been treated.”

We saw that care was provided by skilled staff who knew the needs of people well. They felt that the management of the home was supportive. One staff member told us, “We work as a team.”

We looked at safeguarding procedures; this is how the home ensured people using the service were protected from harm. We saw suitable systems were in place to support and protect vulnerable adults.

We looked at the recruitment procedures for staff and found that the necessary policies and procedures were in place.

We checked records were stored safely and correctly and systems were as required. This was to ensure people’s confidential information was stored appropriately.