About the service: About the service: Tewkesbury Fields is a care home that was providing accommodation and nursing care to 49 people at the time of the inspection. Care is offered to people living with dementia, physical disabilities and older people.

People’s experience of using this service:

• Services that provide health and social care to people are required to inform the Care Quality. Commission (CQC), of important events that happen in the service. Provider checks had not identified this did not always happen promptly, and this had led to delays in CQC being advised of some important events.

•A registered manager was not in place at the time of the inspection, but a new manager had been appointed and was in the process of applying to become the registered manager for the home.

• People saw the manager regularly and found them approachable.

•People told us Tewkesbury Field was managed so the care they wanted was made available to them. People told us although there had been some changes in the staff running the home, and the care staff supporting them, they enjoyed living at the home, and would recommend living at Tewkesbury Fields to other people.

• Further meetings were planned by the manager with people, their relatives and staff, to ensure there were on-going opportunities to communicate information regarding the development of care and the business.

• Staff knew how to recognise the signs of abuse and understood risks to individual people’s safety and supported them to stay as safe as possible. Staff were confident if they raised any concerns these would be promptly dealt with by senior staff.

• There were sufficient staff to care for people at times people wanted assistance, but staff experienced busy periods. The manager advised us they would review the current deployment of staff to address this.

• People were supported to have their medicines safely and checks were undertaken to ensure these were administered as prescribed.

• The risk of infections and accidental harm was reduced, as staff had received training and used the knowledge and equipment provided to do this.

• People told us they had opportunities to discuss the care they wanted. Staff explained how they assessed people’s needs, and incorporated people’s, their relatives’ and other health professionals’ views into their findings. This helped to ensure people were offered appropriate care, based on their preferences.

• Training had been provided to staff and people told us staff knew how to look after them. The manager had planned further training for staff, so they would develop the knowledge and skills needed to support people.

• People were very positive about their meal time experiences and told us they enjoyed making their own decisions about dining and snacks. Where staff had any concerns about people having enough to eat and drink action was taken to support them, so they would remain well.

• Staff knew people’s health and well-being needs well, and ensured people had prompt access to the healthcare they needed from other health and social care professionals. This helped to ensure people’s health and well-being needs were met.

• People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this.

• People had developed good bonds with the staff who cared for them and told us they enjoyed sharing a joke with staff, and found staff caring.

• People were confident to ask for assistance and reassurance from staff when they wanted this, and staff took time to support people as people preferred.

• Staff knew what was important to the people they cared for and ensured they promoted people’s rights to dignity, independence and privacy.

• People made their own decisions about their lives and care. Where people needed support to make some decisions staff assisted them, using people’s preferred ways of communicating.

• The view

We carried out an unannounced comprehensive inspection of this service on 23 and 29 September 2015. Two breaches of legal requirements were found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to Regulation 18 HSCA (RA) Regulations 2014 Staffing and Regulation 9 HSCA (RA) Regulations 2014 Person-centred care.

We undertook a further comprehensive inspection on 26 and 27 July 2016 which was unannounced. This was to check the provider had followed their plan and to confirm that they now met legal requirements and to review the ratings of the service. We found that the provider was now meeting the legal requirements in relation to both breaches. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for (location's name) on our website at www.cqc.org.uk”

Tewkesbury Fields provides accommodation and nursing care for up to 74 older people. There were 61 people who were living at the home on the day of our inspection. There was no registered manager in place at the time of our inspection. There were two regional support managers working at the home at the time of our inspection. We spoke with the area manager who explained that one of the recently appointed regional support managers would register with the CQC while they recruited a permanent manager into 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 lived in a safe environment as staff knew how to protect people from harm. We found staff recognised signs of abuse and knew how to report this. Staff made sure risk assessments were in place and took actions to minimise risks.

There were sufficient staff on duty to meet people’s needs. People told us that staff helped them when they needed assistance. Regular reviews of people’s care and deployment of staff meant staffing levels were reflected the needs of people who lived at the home. People’s medicines were administered and managed in a safe way.

The regional support managers supported staff by arranging training so staff developed the skills to provide care and support to people which was in-line with best practice. People and relatives told us of the positive benefits this had on the care and support received. We found that staff provided people’s care with their consent and agreement.

We found people were supported to eat a healthy balanced diet and with enough fluids to keep them healthy. People had access to healthcare professionals, such as the dentist and their doctor when they required them and where supported to attend hospital appointments.

We saw people were involved in the planning around their care. People’s views and decisions they had made about their care were listened and acted upon. People told us that staff treated them kindly, with dignity and their privacy was respected.

We found people knew how to complain and felt comfortable to do this should they feel they needed to. We looked at the providers complaints over the last four months, since the regional support manager had been in post. We found seven complaints had been received, all of which had been responded to with satisfactory outcomes for the complainants.

The area manager had placed two regional support managers into the home to improve the standards of care as the provider had recognised further improvement was required to the care people received. One regional support manager had been in place since April 2016 while the second since July 2016. The area manager explained they were actively sourcing a new manager for the home; however until this time a regional support manager would become the registered manager with CQC,

This inspection took place on 23 September 2015 and was unannounced.We visited the service again on the 29 September, which was announced, to conclude our findings. Tewkesbury Fields provides accommodation and personal care for up to 73 people, some of whom have nursing care needs. There were 63 people who were living at Tewkesbury Fields on the day of our visit.

There was a manager in place who had worked at the service for two weeks prior to our inspection. The manager was being supported by a regional manager. The service is required to have 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. The regional manager explained that once the manager had been fully inducted into the service they would be applying for their registration with the Care Quality Commission.

People felt safe living at Tewkesbury Fields. Staff knew how to protect people from harm as staff recognised signs of abuse and knew how to report this. Staff made sure risk assessments were in place and took actions to minimise risks without taking away people’s right to make decisions. We found that staffing levels did not always reflect the care needs of the people who lived there, while staff minimised risk to people and kept people safe, some of their care needs were not delivered in a timely way due to insufficient staffing numbers.

We found that some medication records were not always recorded accurately to ensure people received their medicines correctly. Concerns had been identified with the timeliness of the monthly stock of medicines from the pharmacy supplier. In September 2015 staff were not given enough time to check that the medicines received were correct. The regional manager told us that a meeting was being held with the pharmacy to discuss a way of improving the service delivery.

People who we spoke with felt that staff were knowledgeable about how to care for them. Staff told us they received training but would benefit from more specific training that was tailored to the people who lived at Tewkesbury Fields. We saw that management had recognised this as an area for development and training had been arranged for staff. Care and support was provided to people with their consent and agreement. Staff understood and recognised the importance of this.

We found people were supported to eat a healthy balanced diet and were supported with enough fluids to keep them healthy. However people raised concerns about the choices of their meals. We found that people were provided with meals which were not what they had originally ordered. The regional manager told us that an external agency was being brought in to work with the kitchen staff to help them create meals and a dining experience people would enjoy. We found that people had access to healthcare professionals, such as their doctor.

People told us that all the staff were caring and respectful. Some people who lived at Tewkesbury Fields were unable to tell us verbally if the staff were kind and caring however we observed that people were relaxed and calm in the home. People told us that they were listened to and were able to make day to day decisions about their care. We saw staff spoke kindly to people and maintained their dignity when providing assistance. People were supported to remain independent and received assistance when they needed it.

We found that people did not always receive care that was responsive to their personal needs. People’s personal preferences had not always been sought and we found that staff were guided by a bathing schedule. However staff could not demonstrate how this reflected people’s personal choice. We found that the service was not always responsive towards people’s individual care needs. Staff did not always recognise that people required further support with their hearing aids or glasses for example.

We found that people knew how to complain and felt comfortable to do this should they feel they needed to. Where the provider had received written complaints, these had been responded to. While there were no patterns to the complaints, learning had been taken from complaints received and actions were put into place to address these. However we found that verbal concerns had not been recorded so the provider could not demonstrate that actions and learning had happened with these.

We found that the service had not fully promoted a positive culture within the home to empower staff and people who used the service. We found that most staff felt that they had not been listened to about certain aspects of the way the home was run, for example with staffing levels. This was because clear leadership and communication had not been maintained. It was recognised that a new manager had been in place for two weeks at the time of our inspection. The provider had recognised that improvements in the service delivery were required.

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