The Fields 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 Fields accommodates up to 24 people in one building and provides accommodation over four floors which are served by a lift. At the time of our inspection, 18 people were accommodated in the home. These were older people who require personal care, including people who live with a dementia or sensory impairment. The home is not registered to provide nursing care.

This inspection took place on 24 and 25 September 2018 and the first day was unannounced.

At our previous focused inspection on 16 and 24 May 2018 the home was overall rated ‘Requires Improvement’. At this inspection we found that there had been improvements and the service is now rated as ‘Good’.

At this inspection there was no registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run. The manager of the service has submitted an application to be registered but that is yet to be assessed by CQC.

Where risks were identified to people who used the service or to the environment these were assessed and plans put in place to reduce them. Risks in the environment identified at the last inspection had been removed.

People received their medicines safely and were supported to access the support of health care professionals when needed. Medicines processes were being monitored and actions taken when errors occurred.

People were protected from the risk of abuse because staff understood how to identify and

report it.

There were enough staff to meet people’s needs and people told us they felt safe because staff were available to help them. Staff had been recruited in a safe way and checks made to ensure they were suitable to work with vulnerable people.

Staff told us they received training to be able to carry out their role. The manager monitored this and had planned the training updates required so that staff continued to have the necessary knowledge and skills. We saw that staff had received recent training to meet the needs of people living in the service.

Staff received effective supervision and we saw that their appraisals were in progress for this year. They told us they found the manager very supportive and that they were given the daily supervision they needed to do their jobs effectively.

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 practice. Staff were not always clear about which people were deprived of their liberty, but care files were updated to make it easier for staff to access this information.

People received a varied and nutritional diet that met their preferences and dietary needs. The service provided homemade food and drinks which were adapted for different diets.

The interactions between people and staff showed that staff knew the people well.

Care was planned and delivered in a way that responded to people’s assessed needs. Care plans contained detailed information about people’s personal preferences and wishes as well as their life histories. We found that the care files we checked had inconsistencies as people’s needs had changed and sections had not been updated correctly. We spoke to the manager and staff and saw that practices reflected current needs and care plans were updated immediately once we highlighted these errors.

The management team were approachable and they and the staff team worked in collaboration with external agencie

The Fields 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 Fields accommodates up to 24 people in one building and provides accommodation over four floors which are served by a lift. At the time of the first day of our inspection 16 people were accommodated in the home; by the second day of our inspection this had increased to 19 people. These were older people who require personal care, including people who live with a dementia or sensory impairment. The home is not registered to provide nursing care.

We carried out an unannounced comprehensive inspection of this service on 27 and 29 November 2017. 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 the breaches. We also met with the provider to confirm what they would do and by when to improve the key questions of safe, effective, caring, responsive and well-led to at least ‘Good’.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for The Fields Care Home on our website at www.cqc.org.uk.

This inspection was unannounced and took place on 16 and 24 May 2018 to follow up on areas where the regulations had not been met when we inspected the home in November 2017 and following concerns raised around people’s safety and the management of the service.

At our previous inspection in November 2017 the home was overall rated ‘Requires Improvement’. The service remains ‘Requires Improvement’.

At this inspection the registered manager was no longer working in the home. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run. There had been a registered manager in post when we inspected in November 2017 but this manager had since resigned, and a new manager was in post who told us it was “likely” that they would apply to be registered to manage the home.

We found that individual risks to people had not always been identified and appropriately documented and those that were in place did not always contain sufficient guidance for staff.

The premises were not always maintained to a standard that ensured people’s safety and wellbeing.

Medicines records were inconsistently completed and it was not always documented that people received their medicines as prescribed. We found that the way medicines were stored had improved but this was not done safely and in-line with good practice.

We found staffing levels to be sufficient during our inspection and observed that care was offered in a timely way. Staff told us staffing levels had very recently improved.

We found that fire safety arrangements were better but still required some further detail to ensure staff knew how to keep people safe in the event of a fire.

Systems to monitor the service had been improved but were still not effective and some shortfalls found during this inspection had not been identified by either the manager or registered provider. Some of these shortfalls had also been identified at the previous inspection and the provider had been made aware of these.

We received mainly positive comments about the manager, but some people who used the service were not sure who the manager was. Most staff, people and relatives we spoke with told us they felt the culture in the home had imp

This unannounced inspection took place on 27 and 29 November 2017. This meant the provider, registered manager, staff and people using the service did not know that we would be carrying out an inspection of the service.

This service was registered on 1 October 2010. The last inspection of the service was carried out on 12 and 13 October 2015. We rated the service to be Good.

The Fields care home 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.

The Fields care home is an established building which has been adapted to become a care home. People have their own room and can access three communal areas and an outside courtyard. The service can accommodate up to 24 older people who require personal care, including people who live with a dementia or sensory impairment. It is not registered to provide nursing care. At the time of the inspection, there were 23 people using the service.

The registered manager has been registered with the Care Quality Commission since 1 October 2010. 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 no evidence of oversight by the provider for the service or registered manager. This lack of oversight had led to deterioration at the service. The quality assurance procedures were ineffective and they had not identified any of the concerns highlighted during this inspection. People, relatives and staff spoke positively about the registered manager. Staff worked together as a team.

The management of medicines needed to be improved. Doors to rooms which should have been locked for people’s safety had been left open. Water temperatures were below safe bathing temperature limits. Personal emergency evacuation plans did not reflect individual needs.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible; the policies and systems in the service did not support this practice. Staff did not work in line with the Mental Capacity Act 2005.

There were gaps in supervision and training. New staff were not appropriately supported through their induction. Competency assessments were not carried out following training. The service was not dementia friendly or suitable for people with sensory impairments.

Care plans and risk assessments were not always person-centred and were in place regardless of individual needs. There were no care plans or risk assessments in place for people with specific needs such as sensory impairments. Staff did not effectively monitor people at risk of dehydration or developing pressures ulcers. Health professionals were involved in people’s care. Systems were in place to provide end of life care to people.

People had access to regular meaningful activities. A complaints procedure was in place which everyone was aware of. Good procedures were in place for recruitment and there were sufficient staff on duty. Staff understood and had followed safeguarding procedures. The service was clean and infection prevention and control procedures had been followed. The registered manager understood the actions they needed to take to follow procedures for ensuring lessons were learned.

People received good care from a staff team who knew them well. Privacy and dignity was maintained whenever people received care and support. People were not always involved in making decisions about the care and support they received. Advocacy services were available. People had access to assistive technologies to maintain their independence.

W

People who used the service told us staff in the home were polite and courteous. People were asked if they wanted help to carry out tasks and their wishes were respected. One person told us "They (the staff) ask me if I want anything or need help."

We saw there was an activities co-ordinator employed at the home. All the people who used the service were encouraged to take part in activities including things like shopping trips, live entertainment, gardening, bingo, quizzes, sing-a-longs, craft mornings and gentle exercise to music. One of the people who used the service was celebrating their birthday on the day of our inspection. We saw staff had organised a celebration of this and a birthday cake had been made and specially decorated. In addition the home had a small dog who lived on the premises. People who used the service are encouraged to spend time with dog and some service users took the dog for walks.

We saw staff using Personal Protective Equipment (PPE), like gloves, aprons and hand gel when carrying out various duties around the home. This included assisting with meal, providing personal care and cleaning. There was a good supply of PPE throughout the home which was easily accessible to staff.

We saw staff who worked at the home had been screened using Disclosure and Barring Service (DBS), previously Criminal Records Bureau (CRB) checks. These checks are used as a tool so providers can risk assess whether they staff are suitable to work in their home.

We spoke with people about their care. They said staff met all their personal needs. One person told us, “They look after me very well.” Other comments included, “I have no grumbles – I am happy here”

This inspection took place on 12 and 13 October 2015 and was unannounced. This meant the staff and provider did not know we would be visiting.

The Fields Care Home provides care and accommodation for up to 24 older people and people with a dementia type illness. On the day of our inspection there were 22 people using the service.

The home had a registered manager in place. 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.

The Fields Care Home was last inspected by CQC on 10 October 2013 and was compliant.

There were sufficient numbers of staff on duty in order to meet the needs of people who used the service. The provider had an effective recruitment and selection procedure in place and carried out relevant checks when they employed staff.

Accidents and incidents were recorded and monthly analysis was carried out.

People were protected against the risks associated with the unsafe use and management of medicines.

Staff training was up to date and staff received regular supervisions and appraisals, which meant that staff were properly supported to provide care to people who used the service.

The home was clean, spacious and suitable for the people who used the service.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The Deprivation of Liberty Safeguards (DoLS) are part of the Mental Capacity Act 2005. They aim to make sure that people in care homes, hospitals and supported living are looked after in a way that does not inappropriately restrict their freedom. We discussed DoLS with the registered manager and looked at records. We found the provider was following the requirements in the DoLS.

People had given written consent to their care and treatment.

People who used the service, and family members, were complimentary about the standard of care at The Fields Care Home.

Staff treated people with dignity and respect and helped to maintain people’s independence by encouraging them to care for themselves where possible.

We saw that the home had a full programme of activities in place for people who used the service.

Care records showed that people’s needs were assessed before they moved into The Fields Care Home and care plans were written in a person centred way.

The provider had a complaints policy and procedure in place and complaints were fully investigated.

The service had a positive culture that was person-centred, open and inclusive.

The service had links with the local community.

The provider had a robust quality assurance system in place and gathered information about the quality of their service from a variety of sources.