CQC report explained · a nursing home
What the CQC found at Church Farm at Field House
Rated Good: inspectors found the home performing well and meeting their expectations.
What inspectors found, April 2019
Rated Good; inspectors found safer, kind and personalised care, with some records and end-of-life planning still needing improvement.
This was an unannounced planned inspection on 5 March 2019. Inspectors spoke with people living at the home, relatives, staff and health professionals. They reviewed care records, staff files, training records and safety records.
The home was rated Good in all five areas: Safe, Effective, Caring, Responsive and Well-led. Inspectors found that risks, medicines, staffing, infection control, the building and quality checks had improved since the previous inspection in 2017.
People said staff were kind and respectful. Care was generally based on people's needs and preferences. There were some small gaps in repositioning records, one mattress was set incorrectly until it was fixed, and end-of-life care plans needed more personal detail.
The overall Good rating means inspectors found the home was meeting the relevant legal requirements and providing consistently good care at the time of this inspection.
Improved safety systems
Risk assessments were reviewed more regularly and audits were being used to identify and address risks. The home had also improved its building safety and infection control arrangements.
“We found they had.” from the report
Medicines management
Medicines were securely stored, temperatures were checked, records had photographs and there were no gaps showing missed doses. Staff had medicines training and competency checks.
“These improved practices meant that people were now protected from the risks associated with medicines.” from the report
Kind and respectful care
People and relatives praised staff. Inspectors saw staff respond compassionately to distress and support people with dignity and independence.
“People and relatives felt staff were caring and kind.” from the report
Personalised support
Care planning considered people's preferences, interests and routines. Companion support helped people who stayed in their rooms to have social contact.
“People received their support from staff in the way they wanted, considering their likes, dislikes and personal preferences and interests.” from the report
Good leadership
The home had regular audits, management reports and action plans. People, relatives and staff said the manager was approachable and listened to concerns.
“Staff felt valued and commented on the "good atmosphere" and that staff "worked well together.” from the report
Incomplete repositioning records
needs fixingMost repositioning charts were complete, but a small number did not show that repositioning had taken place. This could make it harder to check whether planned care was delivered.
“We did find a small number of records where there lacked entries to evidence that a person had been repositioned.” from the report
Pressure-relieving equipment
needs fixingOne of 12 mattresses checked was set too firmly, so the person may not have received the intended support. Staff corrected this during the inspection.
“One was set too firm which meant the person may not have received the support they needed from the equipment.” from the report
Basic end-of-life plans
needs fixingEnd-of-life plans included some wishes but did not give enough detail about personal preferences. The manager agreed that more person-centred planning was needed.
“A basic end of life care plan was in place for people.” from the report
Missed CQC notification
needs fixingThe manager did not notify CQC about one incident when required, although it had been reported to the local authority safeguarding team. The manager said the reporting policy would be amended.
“We did note one statutory notification that needed to be sent to the CQC had not been.” from the report
- 01How do you check that repositioning is carried out and recorded for people who need it?
- 02How often are pressure-relieving mattresses checked, and who confirms they are set correctly?
- 03How will you record my relative's personal wishes and preferences for end-of-life care?
- 04What changes have been made to make sure all incidents that must be reported are notified to CQC?
- 05How are care plans updated when a person's health condition changes or deteriorates?
This was an unannounced planned inspection of the overall service, covering all five CQC questions and checking improvements since the previous inspection. This explanation was written from the published report of 26 April 2019 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, December 2017
Rated Requires Improvement; inspectors found kind staff but concerns about staffing, medicines, people's rights and personalised care.
Inspectors visited on 7 and 8 August 2017. The first day was unannounced. They spoke with people, families and staff, observed care, and reviewed care records and other documents.
The home was not consistently safe. Staff were sometimes too busy, call bells were not always answered promptly, and there were problems with medicines, infection control and risk records. People's rights under the Mental Capacity Act were not always protected.
Staff were generally kind and knew people well. They supported independence, welcomed visitors and usually responded well when people were distressed. However, care was not always personalised, records lacked important information, and activities and dignity were inconsistent.
All five areas were rated Requires Improvement. The previous inspection in November 2014 rated the home Good. Inspectors found four legal breaches and required the provider to say what it would do to improve.
Kind and reassuring staff
Staff were described as kind and showed that they knew people well. Inspectors saw staff respond effectively to distress with reassurance and kind words.
“Staff were kind and knew people well. Staff effectively responded to people showing signs of distress.” from the report
Safe moving support
Inspectors saw staff helping people move safely and found that hoists and slings were checked regularly.
“We saw staff assisting people to move safely and encouraging them to use their walking aids as required.” from the report
Visitors welcomed
People could receive family and friends without unnecessary limits on visiting times.
“Staff told us people's relatives and friends were able to visit them without any unnecessary restriction.” from the report
Healthcare involvement
External health professionals were involved when needed, and records showed input from several professionals.
“Care records contained a record of the involvement of other professionals in people's care, such as the GP, a motor neurone disease nurse specialist and a dietitian.” from the report
Staffing and call bells
seriousPeople sometimes waited a long time for help, including help to use the toilet. Inspectors found that call bells were not always answered within a reasonable time.
“Sufficient numbers of staff were not effectively deployed to meet people's needs at all times.” from the report
Medicines and infection control
seriousMedicines were not always supervised or stored correctly. Staff also did not always follow safe infection control practices, creating a risk of harm or infection.
“Staff did not always follow safe medicines management and infection control practices.” from the report
Risk records and care guidance
needs fixingSome risk assessments and care plans were out of date or missing important instructions. This included information about pressure care, moving people, diabetes and seizures.
“Care plans did not provide sufficient guidance for staff on how to provide people with personalised care.” from the report
Mental Capacity Act
seriousRecords did not consistently show capacity assessments or best-interest decisions. Staff were also not aware of a condition attached to a liberty safeguard authorisation that had expired.
“This meant that people's rights were not being protected when they lacked capacity to make decisions.” from the report
Privacy and dignity
needs fixingInspectors saw one person visible from the corridor while undressed. A toilet lock was not working and care records were not always stored securely.
“We saw that this person was sitting in their bed with the door open and could be clearly seen in a state of undress from the corridor.” from the report
Activities and personal care
needs fixingPeople received varying support with hobbies and activities. Inspectors saw little activity on the inspection day, and records did not always show that planned personal care had been provided.
“This meant people were not consistently supported to remain active, and to participate in activities that interested them.” from the report
- 01What has changed since the inspection to make sure there are enough staff at all times and call bells are answered promptly?
- 02How are medicines now supervised, recorded and stored, including medicines given only when needed?
- 03How do you record capacity assessments and best-interest decisions for people who cannot make particular decisions?
- 04How do you make sure care plans contain current, personalised instructions for moving, pressure care, diabetes, seizures and personal care?
- 05What activities and one-to-one support are available for people who spend much of their time in their rooms?
This was a comprehensive inspection covering all five questions and included observations, discussions with people, families and staff, and reviews of care records and management documents. This explanation was written from the published report of 5 December 2017 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Church Farm at Field House
3 rated inspections over 4 years: the service has held its Good rating throughout.
- April 2019Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- December 2017Requires improvementdown from GoodSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- March 2015GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- March 2014
Report published without a new overall rating.
- January 2013
Report published without a new overall rating.
- October 2012
Report published without a new overall rating.
- October 2012
Report published without a new overall rating.
- January 2011
Registered with the Care Quality Commission on 5 January 2011.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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