Archived: Field House

At previous inspections we found the provider to be in breach of a number of regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014. Our inspection focused on those regulations specific to the concerns which were raised to us. As a result we did not follow up on the breach of Regulation 19 of the Health and Social care Act 2008 (Regulated Activities) Regulation 2014.

The service did not have a registered manager in place at the time of our inspection and has not had one since the service was registered with the Care Quality Commission in 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.

Our inspection focused on the environmental and personal safety of the people who lived in the home following serious water damage to the property and whether the provider had met the legal requirements in protecting people from unnecessary risk.

We found people were not protected from risks to their safety as the provider had not assessed the risks which had occurred as a result of a significant leak and damage to the premises.

There was a lack of regular maintenance of the building which had led to areas of the home and the fixtures and fittings being in poor repair. There was a lack of environmental audits which would have highlighted these shortcomings and possibly prevent the subsequent damage to the property. The provider showed a lack of oversight in regard the safety of the people who lived at the service and was slow to respond and support staff in times of crisis.

The provider did not fulfil their legal responsibilities to inform us of significant events that affected the safe running of the service.

Field House is registered to accommodate up to 12 people and provides care and support for people who live with a learning disability. At the time of the inspection there were seven people using the service.

On the day of the inspection there was a manager in place. However, a registered manager had not been in place since November 2011. 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. After the inspection we received a registered manager’s application for the manager.

At the previous inspection on 1 and 3 December 2015 we asked the provider to take action to make improvements to the risks associated with unsafe or unsuitable premises because of inadequate maintenance and assessing and monitoring the quality of service provision. At this inspection we found some improvements had been made but others were still needed.

Improvements had been made to the maintenance of the building and the manager told us further improvements would be made. Safe recruitment and selection processes were not in place, checks on staff member’s suitability for their role had not been carried out.

People told us they felt safe living at the home. Staff understood how to identify and report allegations of abuse; however these were not always reported to the CQC. Information was available for people on how they could maintain their safety and the safety of others. People’s safety was placed at risk because personal emergency evacuation plans (PEEP's) were not in place. Procedures were also not in place to protect people in the event of an emergency, such as a flood or fire. People were supported by an appropriate number of staff in order to keep them safe and to meet their individual needs. Medicines were managed and stored.

Staff did not receive regular supervision or training. Not all staff had an understanding of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards . This put people at risk of not receiving care and support that is in their best interest. People received sufficient to eat and drink and their nutritional needs were catered for. People’s healthcare needs had been assessed and were regularly monitored. The service worked well with visiting healthcare professionals to ensure they provided effective care and support.

People told us staff were kind and caring. People were encouraged to be independent and make individual choices. Staff were aware of people's support needs and their personal preferences. Most of the time staff respect people's privacy and dignity.

Care plans were generally disorganised and had not been regularly reviewed and were not always updated to show when there had been a change to people’s needs. People were supported to participate in activities, interests and hobbies of their choice. The complaints policy was accessible for everyone.

The provider did not have a series of audits in place to enable them to ensure that people received a high quality, safe and effective level of care. The provider was not fully aware of their responsibilities to inform the CQC of incidents that could affect the health, safety and welfare of people. People, relatives and staff spoke highly of the manager.

We identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations 2009. You can see the action we have told the provider to take at the back of this report.

Is the service caring?

On the day of our inspection visit we found the service to be caring. People we spoke with told us that they were happy with the care that had been delivered to them and their needs had been met. It was clear from our observations and from speaking with staff that they had a good understanding of the people's care and support needs and that they knew them well. One person told us, "I've lived here most of my life and the staff are like friends."

Is the service responsive?

On the day of our inspection visit we found the service to be responsive. People living at the service told us they sat with their key worker each month and talked about the things that were important to them. One person said, 'We can talk about anything we want.' We spoke with people about their physical health needs and they all said they saw their doctor if they needed to. They also told us they visited the dentist regularly and where necessary, had eye tests. Records showed that people received assessment and treatment from NHS health care professionals when required.

Is the service safe?

On the day of our inspection visit we found there were some areas of concern around safety. These were with regard to the environment and we have discussed our concerns with the provider. CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications had been submitted, proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made, and how to submit one. People we spoke with confirmed that they felt safe at the home and would speak to the acting manager or any of the staff if they had any concerns.

Is the service effective?

On the day of our inspection visit we found the service to be effective. There were enough staff on duty to meet the needs of the people living at the home. We spoke with seven of the people who used the service. They were positive about the care and support they received. They told us they were well cared for and were encouraged to be as independent as possible. One of the people we spoke with said, "I go out on my own.'

Is the service well led?

On the day of our inspection visit we found the service to be well led. People who used the service, their representatives and staff were asked for their views about their care and treatment and they were acted on. Staff we spoke with told us they felt well supported by the acting manager and enjoyed working at the service. One said, "I love this kind of work. We have regular, structured supervisions for us to discuss our work and appraisals. There is always someone available if you have a problem." They also said, "The training is great. I enjoy it and it's really helpful.'

Staff had a good understanding of the ethos of the home and quality assurance processes were in place.

We did not speak with people using the service at this inspection. We spoke with staff and inspected training records and other documentation.

We found action had been taken to improve staff training levels. Additional training courses had been attended by almost all staff and staff would be contacting the provider to ensure that additional training was made available for those staff unable to attend the original training dates. Staff told us they would also be discussing specific learning disability training with the provider.

We spoke with three people using the service. A person said, 'I like to listen to music and do sewing. You can choose what you like here.' Another person said, 'I am happy living here.'

We found that people's privacy and dignity was respected but they did not receive accessible information. We also found that people received care that met their needs and were safe.

We found that people using the service, visitors and staff were not in surroundings that promoted their wellbeing. We also found that staff had not received up to date training and the provider did not take appropriate action in response to monitoring of the quality of service provision.

We found that care was being provided appropriately though care plans required some improvement. We found the environment to be adequately maintained and there were enough staff to meet people's needs.

We found that staff were not receiving regular supervision and they were not receiving all appropriate training. We also found that there were systems in place to monitor the quality of the service.