The inspection took place on 10 and 11 July 2018 and was unannounced. The service was last inspected on 12 April 2016, where we found the provider met all the legal requirements but was rated requires improvement in Well-led domain. Following the last inspection, we carried out a focused inspection on 21 August 2017 which was prompted in part by notification of an incident following which a person who used the service had died and the incident indicated potential concerns about the management of risks in relation to the safety of the premises. At the focused inspection, we found the provider to be in breach of a regulation in relation to good governance.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key question Well-led to at least good. At the inspection on 10 and 11 July 2018, we found that the provider had made improvements.

Mary Feilding Guild is a ‘care home’. People in care homes receive accommodation and nursing or 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.

Mary Feilding Guild is registered to provide accommodation and personal care support to 43 people in an adapted building across five separate units, each of which have separate living areas and outdoor spaces including terraces, and a communal garden. Mary Feilding Guild is set up to provide a service to people who can maintain an independent lifestyle. People’s rooms have ensuite and kitchenette facilities. At the time of our inspection, 35 people were living at the service.

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 told us they felt safe living at the service. Relatives told us staff supported people safely. Staff were trained in safeguarding, health and safety and first aid. They knew their responsibilities in keeping people safe from avoidable harm and abuse. People’s risk assessments and risk management plans provided sufficient support to staff on how to minimise risks to people. People were supported with medicines by well trained staff. The provider had robust processes in place to record and learn from accidents and incidents. Staff wore correct personal protective equipment whilst providing care to avoid the risk of spread of infection. The service was clean and there was no malodour. The provider had made several premises improvements and were undergoing additional building works to ensure people and staff safety. Staffing levels during daytime were sufficient however staff told us night time staffing levels were not enough. We have made a recommendation in relation to staffing numbers.

People’s needs were appropriately assessed before they moved to the service permanently. Staff were aware of people’s needs and abilities. They received regular supervision and training to support people with their individual needs. People told us their needs were met and were happy with nutrition and hydration support. Most people told us they liked the food. The premises were adapted to meet people’s individual needs. The provider had processes in place to ensure people who deemed to lack capacity were supported in line with the MCA principles. People were offered choices and their consent sought.

People and their relatives told us staff were caring, helpful and friendly. Staff were trained in equality and diversity and told us they treated people with dignity and respect. People’s religious and spiritual needs were met by staff when requested and recorded in their care plans. Staff supported people to lead independ

This unannounced inspection of Mary Feilding Guild took place on the 21 August 2017.

The inspection was a focused inspection and was prompted in part by notification of an incident following which a service user died. The information shared with CQC about the incident indicated potential concerns about the management of risks in relation to the safety of the premises. This inspection examined those risks.

This report only covers our findings in relation to two outcomes, safe and well-led. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Mary Feilding Guild on our website at www.cqc.org.uk. At the last inspection the service was rated 'Good' overall.

Mary Feilding Guild is a not for profit charitable organisation registered to provide accommodation and personal care for up to 43 older people. The aim of the service is to provide support to older people who are independent both physically and mentally. At the time of the inspection there were 39 people using the service.

The provider had recently recruited a new manager who had applied to be registered 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 2008 and associated Regulations about how the service is run.

In response to the serious incident that had occurred in July 2017, the provider had commissioned an external contractor to carry out a risk assessment of people’s rooms and communal areas. This assessment had highlighted a number of risks to people’s safety. The provider was taking action to make sure these risks were mitigated.

Individual risks had been identified for people using the service in connection with their care provision. There was detailed information for staff about how to mitigate these risks, for example, to make sure people had their mobility aids with them at all times.

The systems used to identify and assess potential risk to people’s safety were not always clear which meant there might be risks that were not picked up by staff.

Systems to assess, monitor and improve the safety and maintenance of the building were not always effective and there was no management oversight of this process.

We identified one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This breach was in relation to good governance. You can see what action we told the provider to take at the back of the full version of the report.

We inspected this service on 12 April 2016. The inspection was unannounced. Mary Feilding Guild is a care home registered for a maximum of 43 people.

At the time of our inspection there were 43 people living at the service. The service was located in a large detached building with access to a back and side garden. We previously inspected the service on 7 August 2014 and the service was found to be meeting the regulations inspected.

At the time of the inspection, the manager of the service was in the process of applying for registration as the ‘registered manager’ at the service. Since the inspection the person has been confirmed in this role by 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 2008 and associated Regulations about how the service is run.

There was a warm and friendly atmosphere at the service. People using the service informed us that they were happy with the care and services provided. Staff talked positively about their jobs telling us they enjoyed their work and felt valued. The staff we met were caring, kind and compassionate and treated people with dignity and respect.

We saw staff were aware of people’s needs and that care plans were up to date, although we found records were hard to navigate. Risk assessments had been carried out and updated regularly. We noted falls had not always been managed well in the past but there was now a new system in place to support staff to deal with these more effectively.

People were supported to maintain good health through regular access to healthcare professionals such as GPs and the local general hospital. In general people spoke well of the food, and we saw there was a plentiful and varied range of meals available. People’s cultural and religious needs were facilitated by staff.

People had their medicines managed safely and received their medicines as prescribed. Medicines were stored in a locked cupboard, and the documentation was accurate and checked regularly by the registered manager.

Staff had been carefully recruited and there were enough staff to meet people's needs. Staff felt supported and there was evidence of supervision taking place across the last 12 months. Staff knew how to recognise and report any concerns or allegations of abuse and described what action they would take to protect people against harm. Staff and people using the service told us they felt confident any incidents or allegations would be fully investigated.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. We found the service to be compliant with the legislation.

We found the premises were exceptionally clean and tidy, and measures were in place for infection control. There was a record of essential services such as gas and electricity and being checked, and equipment safely maintained. There was clear documentation relating to complaints and incidents.

People living at the service and their relatives and friends told us that the registered manager, director and other managers had a very visible presence within the home. There were a wide range of activities that took place at the service and people living there spoke highly of the person-centred care they received. There was a library and multiple laundry and kitchen facilities to encourage those who were able, to maintain their independence in these areas.

There was a lift to access upsta

We considered all the evidence we had gathered under the outcomes we inspected. The focus of the inspection was to answer five key questions: is the service safe, effective, caring, responsive and well-led?

We met with several people who were staying in the home and spoke with 15 people, five visitors including relatives and seven members of staff. The director and the registered manager were present at the time of our inspection.

This is a summary of what we found:

Is the service safe?

People felt involved in making decisions about their care and treatment. The care plans were detailed and reflected their needs and preferences as to how they wanted the care to be delivered. A person said, “They look after us wonderfully well. We get as much care as we require.”

The provider had an effective recruitment and selection process. This had ensured people were safely cared for and supported by skilled and experienced staff.

People were cared for in a clean and comfortable environment, which was well maintained and secure. A visitor said, “The place is always fresh and clean.” Another visitor commented, “The front door is always locked and we have to press the doorbell each time we visit and a member of staff lets us in.”

Equipment had been appropriately checked and serviced. Fire equipment had been serviced regularly. Each person who used the service had a personal evacuation plan which had been regularly reviewed and updated as their needs had changed.

Staff understood what constituted abuse and had received training on the protection of vulnerable adults. They knew the procedures they would follow if they had concerns about safeguarding issues.

The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards (DoLS), which apply to care homes. Staff had received training on the Mental Capacity Act 2005 (MCA) and DoLS and had an understanding of when an application under DoLS should be made and how to submit one to be authorised by the local authority. There had been no DoLS applications since the last inspection.

Is the service effective?

People we spoke with confirmed they led independent lives and staff gave support and assistance when needed. A member of staff said, “Most of the people here are able to do things for themselves. We encourage them to lead an independent lifestyle.”

Staff interacted well with people. They had knowledge of people’s care needs and assisted them accordingly. Staff had received appropriate training to enable them to meet people’s needs and had ensured people’s personal, social and healthcare needs were closely monitored and met. Reviews of people’s care needs and risk assessments had been carried out regularly, where appropriate.

A person commented “They look after us extremely well. When you are ill, they are there for you.”

Is it caring?

People we spoke with were all complimentary about the staff and the care provided. One person said, “All the staff are very good.” One person’s visitor commented, “The staff are attentive; they are quick to help and they are always respectful.” Another person’s friend commented, “Staff are excellent in what they do and they really care for the people here.”

We observed the interaction of staff with people throughout the day, including during mealtimes and during activity sessions. The staff we spoke with had a good knowledge of people’s needs, their daily routine and their preferences and were therefore well able to meet their needs. A person remarked, “The staff are gentle, patient and respectful, as always.” Another person said, “The staff are kind and warm.”

One person’s visitor said, “Every time I visit, the staff are friendly and polite. They check on my friend in their bedroom every so often to make sure my friend is all right. The staff are very good.”

People’s well-being had been promoted by taking account of their physical needs, including nutrition and hydration. There was a selection of soft drinks, desserts and fresh fruits for people to help themselves. A person said, “The food served is satisfactory; I must say the food is quite good today. It’s rice with sweet and sour pork and a dish of mixed vegetables. It’s so nice I can help myself to a second helping.”

Is the service responsive?

People were treated with respect and dignity and were encouraged to get involved in making decisions. They had been encouraged to attend residents’ meetings, where views and opinions had been welcomed and discussed and action had been taken to improve the service. The weekly activity records were detailed and reflected each person’s preferences and lifestyle.

People’s care plans reflected their wishes and preferences as to how they wanted care to be delivered. The care records showed people’s needs had been assessed and regularly reviewed. This enabled staff to provide appropriate care and treatment.

Is the service well-led?

People and relatives were complimentary about the service and the care provided. Annual surveys and monthly audits had been carried out as part of the provider’s quality monitoring process. Shortfalls had been promptly addressed to improve the service.

Staff had a good understanding of the provider’s ethos in providing a care service. There was a clear reporting structure and staff had clearly defined job descriptions, with clear responsibilities. Staff were well supported through staff appraisals, supervision meetings and monthly team meetings. Each member of staff had a personal development plan.

When we visited the home we spoke with 14 of the residents. They told us that they liked living at the home and thought that the support they had was good. When we asked residents about how they found the home the comments we received included the following:

“It is very nice. I am perfectly glad to be here.”

“Oh yes. I am happy here. You have your own freedom, yet you know you are protected.”

“The staff are very kind and helpful.”

“I was wonderfully looked after when I wasn’t well.”

“It is very nice. They keep it nice and tidy.”

People’s views and experiences were taken into account in the way the service was provided and delivered in relation to their care.

People experienced care, treatment and support that met their needs and protected their rights.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard.

The provider had an effective system to regularly assess and monitor the quality of service that people receive.

There was an effective complaints system available. Comments and complaints people made were responded to appropriately.

We spoke to 11 people living at the Mary Feilding Guild. All of them were positive about living at the home and said that they liked it. Comments included the following: “It is an excellent place. If you’re going to be in a community place, it is ideal”; “What it offers is extremely good”; and “I’m sure you’ll find this is what all care homes should be like.”

People said that they liked the freedom that they had in the home. For example one person said, “It is wonderfully relaxed and open. There are no visiting rules. I’m very, very lucky to be here.” However, people felt that if they needed help that they would get it, “It is very free, but if you need any help they are there.”

People liked the food that they had and thought that they had a good selection of options. All of the people that we spoke to said that they liked the food.

People said that they felt they were respected in the home. Many said that the members of staff were polite and will always knock before coming into their rooms.

Most people that we spoke to were highly complimentary about the staff at the home. They felt that they worked hard, delivered good care and were nice people. Comments included the following: “The staff are very respectful and patient. They genuinely like us and put up with us with a good heart”; “The staff are very, very nice”; and “They are very caring”. We also saw a range of thank you cards and compliments for the home. One said that “your care staff are quite superb”.

Those that needed care felt that it was good. One person commented “They meet needs and most are very helpful. When you ring the bell, they come quickly”.

People told us that there were lots of activities available if they wanted to do them. We were told that - amongst other things - there was a poetry club, a reading club, an exercise class, and films. People felt that the home was good at providing activities. One person said that “they always try to do different things”, another said that “they will try and do things for you”. People were also keen to say that they valued their independence and liked their own time to do their own things.