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 improved and that the manager was approachable and proactive.
There were regular meetings for staff, people who use the service and their relatives. Staff received supervision and support to undertake their role and they felt well supported by the manager. We saw that the way new staff were supported when they started working at the home had improved and staff were supported during their induction period. Staff had supervision but ongoing appraisal, and assessment of their competency to undertake certain tasks where errors had been found, were not yet in place.
We saw that the provider had become more involved in the running of the service, including meeting regularly with the manager, and was committed to improving the home.
The provider, manager and staff told us that improvements were planned to the home that would address some of the concerns raised at this and at the previous inspection. However, these had not been documented so that progress towards meeting these aims could be tracked.
As a result of our findings we found there continued to be a breach 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 the report.