Archived: Field View

Updated 24 June 2016

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 3 May 2016 by two inspectors which was unannounced. We told the registered manager we would return on 4 May 2016. On day two, one inspector visited the home.

Before the inspection visit we looked at our own systems to see if we had received any concerns or compliments about Field View. We analysed information on statutory notifications we had received from the provider. A statutory notification is information about important events which the provider is required to send us by law. We considered this information when planning our inspection to the home.

The provider is required to send us a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. This inspection was a follow up visit to check improvements had been made, so the provider did not have an opportunity to complete this. During this inspection, we asked the registered manager and provider to supply us with information that showed how they managed the service, and the improvements regarding management checks and governance of the home following our last visit.

Many of the people living at the home were not able to tell us, in detail, about how they were cared for and supported because of their complex needs. However, we used the short observational framework tool (SOFI) to help assess whether people’s needs were appropriately met and identify if they experienced good standards of care. SOFI is a specific way of observing care to help us understand the experiences of people who could not talk with us.

To gain people’s experiences of living at Field View, we spoke with three people and one relative. We also spoke with the provider who was the owner of the home, registered manager, deputy manager, three care staff, a maintenance person and the cook. We also spoke with two visiting community nurses.

We looked at four people’s care plan records to see how they were cared for and supported. We looked at other records related to people’s care such as medicine records, daily logs, risk assessments and care plans. We also looked at quality audits, records of complaints, incidents and accidents at the home and health and safety records.

Updated 24 June 2016

The inspection took place on 3 May and 4 May 2016. The visit was unannounced on 3 May 2016 and we informed the registered manager we would return on 4 May 2016.

Field View is a residential home which provides care to older people including some people who are living with dementia. Field View is registered to provide care for up to 20 people. At the time of our inspection there were 14 people living at the home, however one person was in hospital.

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.

At our previous inspection in May 2015, we rated the home as requires improvement. At this inspection we looked to see if the provider had responded to make the required improvements. Whilst we found some areas of improvement had been made, we found additional areas of concern that had potential to place people at risk of harm.

There was a lack of management oversight by the provider to check delegated duties had been carried out effectively. The quality monitoring systems included reviews of people’s care plans, health and safety checks and checks on medicines management. These checks and systems were not regularly reviewed and completed so it was difficult for the provider to be confident people received a quality of service they deserved. Accidents, incidents and falls were not regularly analysed to prevent further incidents from happening. Improvements were required in assessing risks to people and how staffing levels were determined to ensure safe levels of care were maintained to a standard that supported people’s health and welfare.

We checked the registration status of the provider and found the partnership was no longer active as a partnership because there was only one partner remaining. This suggested the remaining partner was carrying on without the appropriate registration. Where we refer to the 'provider' in the report we do so within this context.

Health and safety checks were not always completed to ensure risks to people’s safety were minimised. We identified some health and safety issues to the registered manager and the provider on the day of our inspection where we had immediate concerns to people’s safety.

Risks to people’s health and welfare were identified but not effectively managed and where people were at risk of harm, actions had not been taken to keep people safe. Care plans provided information for staff that identified people’s support needs and associated risks. However, some care plans and risk assessments required information to be updated to ensure staff provided consistent support that met people’s changing needs.

There were not enough staff on duty to respond to people’s health needs and to keep people safe and protected from risk. The registered manager completed a dependency tool to establish safe staffing levels but there was no effective formula that calculated what those safe staffing levels should be. The registered manager and deputy manager regularly supported staff on shift which meant some quality checks and improvement actions were not always identified and resolved. This affected the quality of service people received.

At the last inspection we found people were not supported in line with the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). At this inspection there were some improvements in how people’s capacity was determined, but further improvements were still required. Mental capacity assessments were completed but these were not always decision specific and records of those involved were not always completed. Five people had a DoLS in place at the time of our inspection. The registered manager acknowledged people’s care plans around mental capacity required improving.

Staff knew how to keep people safe from the risk of abuse. People told us they felt safe living at Field View and a relative agreed their family members felt safe and protected from abuse or poor practice.

People felt cared for by staff who had the skills and experience to care for them. Staff understood people’s needs and abilities and received updated information at shift handovers. Staff training was completed, but not all staff had received training to update their skills in line with the provider’s expectations. There was no effective system to identify which staff required training updates.

People were offered meals that were suitable for their individual dietary needs and preferences. People were supported to eat and drink according to their needs, which minimised risks of malnutrition but there was limited interaction and conversation with those staff who supported them. Staff ensured people obtained advice and support from other health professionals to maintain and improve their health.

People said staff provided the care they needed. Care plans were reviewed although some information required updating to ensure staff had the necessary information to support people as their needs changed. Some people felt their physical and mental stimulation was limited because they were not proactively supported to pursue their own hobbies and interests.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also found the provider’s registration status was no longer valid and asked the provider to take immediate action to ensure this service was registered in accordance with the Regulations. You can see what action we told the provider to take at the back of the full version of the report.