Archived: Fieldgate Nursing Home

Fieldgate Nursing Home is a residential home providing personal and nursing care for up to 39 people aged 65 and over. At the time of the inspection the service was supporting 20 people.

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

People did not always receive a service that ensured their safety.

Risks to people's health and wellbeing had not been effectively assessed, monitored or mitigated. Risks associated with the environment had not always been safely managed.

The provider had not established an effective system to ensure people were protected from the risk of abuse. Lessons had not been learnt when things went wrong.

Medicines were not always managed safely. Staff were not deployed effectively to ensure people received support in a timely way that met their needs and preferences.

The service was not well led.

There had been a lack of effective oversight of the service by the provider, caused by inconsistent management and inadequate governance processes.

The service was highly disorganised and records were not always complete. People were not always given the opportunity to feedback about their care. The lack of robust quality assurance meant people were at risk of receiving poor quality care.

When things had gone wrong, the provider had not acted in line with the requirements of the duty of candour.

The provider was aware of the need to make significant improvements in the service and had engaged the support of other partner organisations to enable this to happen. Following the inspection, we were provided with evidence that demonstrated improvements were taking place.

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 18 December 2019). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection the service had deteriorated, and the provider was in breach of multiple regulations.

Why we inspected

We received concerns in relation to the management of people’s nursing care needs, how people were protected from the risk of harm and abuse and a lack of leadership at Fieldgate Nursing Home. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We have found evidence that the provider needs to make improvements. The overall rating for the service has changed from requires improvement to inadequate. This is based on the findings at this inspection. Please see the safe and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Fieldgate Nursing Home on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to safe care and treatment, safeguarding people from abuse or harm, staffing, governance systems, being honest and open when things went wrong and reporting to CQC.

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Conditions of registration are already in place at Fieldgate Nursing Home and these remain relevant. We have requested an action plan and continuous improvement plan from the provider to understand what they will do to improve the standards of quality and safety. We are regularly meeting with the provider to discuss how they will make changes to ensure they improve their rating to at least good. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our inspection programme. If we receive any concerning information we may inspect sooner.

Fieldgate Nursing Home is a residential and nursing care home providing personal and nursing care for up to 39 people aged 65 and over. At the time of the inspection the service was supporting 31 people

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

Overall, improvements had been made to the risks to people and safety monitoring, but these needed to be further embedded to ensure that people were consistently being kept safe from harm.

People told us they felt safe. However, environmental risks were not managed effectively; fire safety actions were still outstanding. People did not have regular fire evacuations to keep them safe. Water management safety procedures were not in place.

Improvements were still needed to ensure people received person centred care which was responsive to their individual needs. For example, people living with dementia.

Relevant recruitment checks were conducted before staff started working at the service to make sure they were of good character and had the necessary skills.

Medicines administration records (MAR) confirmed people had received their medicines as prescribed.

Staff had received training in safeguarding adults and knew how to identify, prevent and report abuse. There were enough staff to keep people safe.

Staff working at the service understood people’s needs and supported people in a personalised way. Care was provided respectfully and sensitively, considering people’s different needs.

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

Staff received more frequent support and one to one sessions or supervision to discuss areas of development. They completed more training and felt it supported them in their job role.

People were supported with their nutritional needs when required. People received varied meals including a choice of fresh food and drinks. Staff were aware of people’s likes and dislikes

People were treated with kindness and compassion. Staff were able to identify and discuss the importance of maintaining people’s respect and privacy at all times.

The provider’s quality assurance system helped the management team implement improvements that would benefit people. Action had been taken to become compliant with most of the breaches of regulation identified at the previous inspection.

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 inadequate (published 19 February 2019) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made; however, there was a need to sustain the improvements made and to make further improvements

This service has been in Special Measures since February 2019. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This was a planned inspection based on the previous rating.

The overall rating for the service has changed from inadequate to requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Fieldgate Nursing Home on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

• People did not receive a service that provided them with safe, effective, compassionate and high-quality care.

•The management of risk and medicines was ineffective and placed people at risk of harm.

•The environments had not been considered for people living with dementia and infection control risks had not been mitigated.

• People who remained in their rooms at all times were at risk of social isolation.

• People’s human rights were not always upheld as the principles of the Mental Capacity Act 2005 were not adhered to. People were not empowered to make choices and have control over their care and people were not provided with support that was personalised to them.

• At our last inspection in August 2016, the provider was found to be in breach of Regulation 18 registration Regulations 2009 (failure to notify). At this inspection, we found improvements had been made and all notifiable events were being reported to the Care Quality Commission (CQC).

• We found a range of institutional practice taking place at Fieldgate nursing Home. People did not consistently receive person centred care that was based on based practice guidelines.

• The service was not well led and there was a lack of quality assurance processes in place. However, people told us staff were kind and treated them with respect.

Rating at last inspection: Good, last report published 19 August 2016.

About the service: Fieldgate Nursing Home is a residential and nursing home that was providing personal and nursing care to 32 people at the time of the inspection.

Why we inspected:

This was a planned inspection based on the rating at the last inspection.

At this inspection the service has been rated ‘Inadequate’. Therefore, the service is now in ‘special measures’. Services in special measures will be kept under review and, if we have not already taken immediate action to propose to cancel the provider’s registration of the service, it will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not, enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Fieldgate Nursing Home is registered to provide care for up to 39 people. The home is registered with the Care Quality Commission to provide nursing or personal care for older people. At the time of our inspection there were 33 people in receipt of care from the provider.

The home 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.

Registered managers and providers are required to send statutory notifications to the Care Quality Commission (CQC) when a significant event occurs. For example, receiving an injury. The provider had sent very few notifications to CQC and during the inspection we found two incidents that had not been notified to CQC.

People told us they felt safe in the home and staff were aware of the procedure to take if abuse was suspected.

Staff were recruited safely and records included appropriate checks as well as proof of identity to ensure they were appropriate for the role they were employed to undertake.

Medicines were stored and secured appropriately and people received their medicines on time.

The registered manager was knowledgeable about the Mental Capacity Act 2005 (MCA) and Deprivation of Safeguards (DoLS). When people were assessed as unable to make decisions for themselves the MCA 2005 process had been followed. DoLS are put in place to protect people where their freedom of movement is restricted to prevent them from possible harm. The registered manager had taken appropriate action for people who needed their movement restricted.

People had sufficient to eat and drink and were supported to maintain a balanced diet. They had access to a range of healthcare professionals and services.

People were looked after by kind and caring staff who knew them well. They were supported to express their views and to be involved in all aspects of their care. People were treated with dignity and respect.

People and their relatives thought that the home was well-led. They all spoke positively about the registered manager and the staff group.

Complaints policies and procedures were in place and were available to people and visitors. People and their relatives told us they were confident that they could raise concerns or complaints and that these would be dealt with.

We found one 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 this report.

Care for people was provided over two floors with single or double occupancy rooms available. Many people chose to remain in their rooms throughout the day, however there were three communal lounge or dining areas available for people to use.

We saw that a wide variety of foods were on offer to people living at this home including options for people with specific dietary needs.

Staff encouraged people to participate in activities. One person was encouraged to listen to their 'talking books' in the lounge area. People told us they were happy with the level of organised activities at the home such as bingo, quizzes and board games.

One person told us they would like to have some different activities organised to include more physical activity.

We saw that clear care plans were in place to support people who lived in this home. The home was introducing a computerised system for managing care plans and other care records.

People had their care discussed and agreed with them although consent for care and sharing of information was not always clearly documented.

People told us they were happy living at this home and that the staff, 'Couldn't be more helpful.'

People told us that the service was good. Care plans were in depth, but easy to navigate, and we saw evidence that people who used the service and their families were involved in care planning. Risks to people using the service were identified and reviewed at regular intervals according to specific risk and these were recorded in care plans.

One person who used the service said the home was clean and inviting, 'The staff were very kind and the food was good'. One person said this was the best home they had ever been in.

A relative told us the home looked after their parent very well, and they wouldn't want them to be anywhere else, They said they would recommend the home to anyone that asked.

Although people said they were happy in the home and their health and care needs were being met we found that improvements were needed in the areas of infection control and recruitment.

The provider did not have an effective system in place to reduce/remove the risk of infection when cleaning and laundering.

The home's recruitment process was being followed in part but some of the areas missed out could put people at risk. These were the lack of satisfactory references and a Criminal Records Bureau (CRB) certificate before the member of staff commenced employment.