Fieldhead Court

Fieldhead Court is a residential care home providing accommodation and personal care to up to 45 people in one building. The service provides support to older people and those with dementia. At the time of our inspection there were 44 people using the service.

People’s experience of using this service and what we found

Staff had received regular training in safeguarding and were aware of their safeguarding responsibilities. People told us staff responded to requests for support. Medicines were stored and administered safely, and people raised no concerns about their medicines. Staff had good knowledge of how to respond to accidents and incidents.

People's needs were assessed when they moved into the service. People were happy about the support they received. Staff had received training that was relevant to their role. People's nutritional and hydration needs were being met and they were offered a varied choice of foods. The service worked closely with other health professionals.

Staff had good knowledge of people’s communication needs. The service had clear signage to enable people to navigate around. The service offered activities daily to people in communal areas or in their own rooms. People were supported to maintain relationships with their loved ones. People's wishes for end-of-life care were identified by the service.

Staff had good knowledge of people’s needs. We observed staff speaking to people in a caring and empathic way. Relatives felt staff cared about their loved ones. People were actively engaged in developing the care they received. Quality assurance systems were in place, but the service failed to monitor air flow mattress settings.

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

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 24 May 2019.)

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

Why we inspected

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions safe, effective, responsive and well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good based on the findings of this inspection.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Fieldhead Court provides accommodation, care and support for up to 45 people over 65 years old including people living with dementia, people receiving end of life care and people on respite care. At the time of our inspection, there were 36 people living at the service.

People's experience of using this service:

¿ People and relatives told us they felt safe with the care provided. One person said, “I am safe because I am taken care of.”

¿ We found the service had deteriorated in some domains since our last inspection.

¿ The service met the characteristics of requires improvement in four out of the five key questions. This is the second time this service is rated as ‘requires improvement.’

¿ At this inspection, we found not enough improvements had been made since our last inspection because the management of records of people’s medication, consent, care plans and care delivered was not always robust and the provider continued in breach of regulations.

¿ We found two breaches of the regulations. One breach in relation to safe care and treatment because the provider was not always managing the risks to people’s skin integrity appropriately, people who were using specialist seating had not been assessed to use this equipment, information in people’s risk assessments was not always detailed or updated and we found several concerns with the management of medicines. The provider continued in breach of regulations in relation to good governance because of lack of consistency in the quality of records relating risks to people’s care, support plans and their consent; we also found a continued lack of effective quality assurance systems in place.

¿ We have made 2 recommendations in relation to management of medicines in care homes and effective quality assurance systems.

¿ The management of risks was not always consistent. We found known risks to people’s care were not always identified in their risk assessments and their care plans lacked information to give clear guidance to staff on how to manage those risks.

¿ Medicines were not always managed safely. We found concerns in relation to the quality of the recording in people’s medicines administration (MAR) charts, we could not be certain people’s medicines were administered in an effective way, protocols for ‘as and when required’ medicines and instructions for creams were not always detailed.

¿ The provider had several systems in place to monitor the quality of the service but these had not been effective in identifying and addressing the issues found at this inspection.

¿ People were supported by staff who were motivated, enjoyed their job and felt well supported through regular supervisions and training.

¿ The registered manager had developed several links with the community and partnerships to support care provision and service development.

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

Rating at last inspection:

At our last inspection the service was rated requires improvement overall. Our last report was published on 20 April 2018.

Why we inspected:

This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received.

Enforcement:

Please see the ‘action we have told the provider to take’ section towards the end of the report.

Follow up:

We will continue to monitor the service to ensure that people received safe, high quality care.

Further inspections will be planned for future dates. We will follow up on the breaches of regulations and recommendations we have made at our next inspection.

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

Fieldhead Court is registered to provide accommodation and personal care for up to 45 people, some of whom are living with dementia. There were 43 people living at the home at the time of our inspection.

Fieldhead Court 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 home had previously been inspected during December 2015 and was rated good in the key questions of safe, caring, responsive and well-led. The home was rated as requires improvement in the key question of effective. There were no breaches of regulations identified at the previous inspection.

The home had 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 Fieldhead Court. The registered manager and staff were aware of relevant procedures to help keep people safe and staff could describe signs that may indicate someone was at risk of abuse or harm. Staff had received safeguarding training.

Staff were recruited safely and we observed there were sufficient numbers of staff deployed to meet people’s needs. Staff told us they felt supported and we saw evidence staff had received training and ongoing supervision.

Risks to people had been assessed and measures were in place to reduce risks. However, not all risk assessments were up to date and one we looked at had been completed incorrectly so did not accurately reflect the person’s level of risk. Some moving and handling plans provided staff with relevant information to safely assist people to move. However, we found one contained conflicting information.

Medicines were administered in a kindly manner. However we found some issues with the recording of topical creams.

There were pockets of malodours within the home which did not dissipate through the day. Some wheelchairs were also odorous.

The building was well maintained and regular safety checks took place. The environment had recently improved due to some refurbishments.

Our observations showed people were supported to have choice and control of their lives and we observed staff supported people in the least restrictive way possible. However, records relating to people’s mental capacity and best interests decision making were inconsistent.

We made a recommendation about the recording of people’s mental capacity assessments and best interests decision making.

People received appropriate support in order to have their nutritional and hydration needs met.

People told us staff were caring and we observed staff to be kind and considerate. We observed people’s privacy and dignity was respected. People were encouraged to maintain links with their family. People’s diverse needs were considered.

Although care records contained personalised information, some care records contained conflicting information. People told us they could make their own choices in relation to their daily lives.

There was a complaints policy in place and people told us they would feel able to complain if the need arose, although no complaints had been made.

Staff told us they felt supported and people and their relatives spoke positively about the registered manager. Regular audits and quality assurance checks took place, although further development was required in order for the registered provider to be fully complaint with the regulations.

We found a breach of regulation 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.

Fieldhead Court is a nursing home currently providing care for up to a maximum of 45 older people. The home is a converted property with a purpose built extension. The home stands in its own grounds with mature gardens. On the days of our inspection 42 people were living at the home.

The service had 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. Say when the inspection took place and whether the inspection was announced or unannounced. Where relevant, describe any breaches of legal requirements at your last inspection, and if so whether improvements have been made to meet the relevant requirement(s).

People told us they felt safe and staff understood their responsibilities in keeping people safe from the risk of abuse.

Risks to people’s welfare had not been robustly assessed and relevant risk assessments had not always been implemented.

One of the staff recruitment files we looked at did not contain references to support their application to work at the home.

Staff received regular training and supervision, new staff were supported in their role.

Staff understood the principles of the Mental Capacity Act 2005, but, where people lacked capacity, there was a lack of documented evidence regarding the decision making process.

People told us staff were caring. We observed staff to be kind and attentive to people’s needs. Staff respected people’s right to privacy and dignity.

There was a varied programme of activities available for people and the activities organiser had plans to further develop the programme for people.

Care records contained a number of plans providing instructions for staff as to how people’s needs were to be met. Documents within the files were easily located and were reviewed at regular intervals.

There was a system in place to record and respond to complaints.

The home had an experienced registered manager. Staff spoke highly of the registered manager and felt supported by them.

The registered manager and senior management team conducted regular checks to monitor the quality of the service people received.

Meetings were held with people who lived at the home and staff.

People were very complimentary about the care that was provided. They told us they were involved in planning their care. A service user said "they help me to look after myself, I am clean, warm and very well looked after".

People's dignity had been respected. Relatives had been involved in supporting people with planning their care and their choices had been respected. Care was planned and records had been maintained. Reviews of care had been conducted regularly and changes made when necessary.

People were safeguarded from the risk of harm because staff had a clear understanding of their roles and responsibilities in this area. People had access to a range of health care professionals.

Staff had been supported to do their work and told us that they had received appropriate training. Staff received regular training that enabled them to deliver care to an appropriate standard.

There were effective systems in place to ensure that people were cared for in a clean and hygienic environment. All areas of the home were clean and free from odour. Staff were aware of infection control and prevention guidelines and had received appropriate training.

We found that medicines were prescribed and given to people appropriately; however the home needed to be more vigilant in ensuring its medication procedures were consistently adhered to.