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CQC report explained · a residential care home

What the CQC found at Field View

Requires improvementpublished 3 October 2023, 3 years ago

Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.

The five questions inspectors ask
Safe?
Requires improvement
Risks were not always properly assessed, reviewed or reduced after incidents. Staffing, recruitment, safeguarding, infection control and medicines management were stronger areas.
Effective?
Requires improvement
Staff did not always understand the Mental Capacity Act or receive training for people's particular communication needs. People were supported with nutrition, healthcare and daily activities.
Caring?
Good
This key question was not inspected during this visit, so the report does not give a current rating for it.
Responsive?
Good
This key question was not inspected during this visit, so the report does not give a current rating for it.
Well-led?
Requires improvement
Quality checks did not identify important shortfalls, records were not always secure, and there had been no engagement to gather feedback from people and others. Staff were supported and worked well as a team.
The latest report, explained

What inspectors found, October 2023

Requires Improvement; inspectors found safer staffing and medicines, but risks, staff training and management oversight were not reliable enough.

The inspection was unannounced and took place on 25 July and 2 August 2023. Two inspectors and an Expert by Experience observed care, spoke with relatives and staff, and checked care, medicine, recruitment and management records.

The home had enough staff and medicines were managed safely. Staff knew people well, treated them kindly and helped them access healthcare, social activities and work. People were supported with food, drink and personal choices.

However, risks were not always properly assessed or reviewed. Some care records conflicted, staff did not always have training for people's specific needs, and the Mental Capacity Act was not consistently understood or applied. The home's quality checks had not found these problems.

The overall rating remains Requires Improvement. Safe and well-led were also Requires Improvement. Effective fell from Good to Requires Improvement. The report says the provider must send an action plan and that progress will be monitored.

What inspectors praised
  • Staffing and recruitment

    The home had recruited enough staff, reduced its use of agency workers and completed relevant checks before employment.

    “The provider and registered manager had completed a review of recruitment and successfully recruited sufficient staff to meet the needs of people.” from the report
  • Medicines

    Medicines were stored and given safely, and records were completed properly. This was an improvement since the previous inspection.

    “Systems were in place to ensure the safe storage and administration of medicines. Medication records were completed appropriately.” from the report
  • Food and daily choices

    People received enough food and drink in line with their preferences. They were involved in choosing and preparing meals.

    “Staff supported people to be involved in choosing, preparing and cooking their own meals in their preferred way.” from the report
  • Kind relationships

    Staff knew people well, spoke kindly and helped them make choices about their daily routines.

    “Staff interacted with people positively. Staff spoke to people kindly and respectfully.” from the report
What inspectors were concerned about
  • Unmanaged risks

    serious

    Some risk assessments were out of date or conflicted with care plans. Incident records did not always show what had been done to prevent the same problem happening again.

    “The provider had failed to ensure risks were fully assessed, reviewed and mitigated against to ensure people’s safety and wellbeing.” from the report
  • Restrictions and mental capacity

    needs fixing

    Staff and managers did not always understand what counted as a restrictive practice. Records did not always show why decisions were made for people or whether less restrictive options had been considered.

    “The management and staff team were not always aware of what might constitute restrictive practice.” from the report
  • Training for individual needs

    needs fixing

    Some staff had not received training linked to people's specific communication or support needs, including Makaton and first aid.

    “Staff had not always received additional training in line with people's specific communication needs.” from the report
  • Weak quality checks

    serious

    The home's audits did not identify missing records or training gaps. The provider remained in breach because it had not effectively monitored and improved quality and safety.

    “The provider had continued to fail to assess, monitor and improve the quality and safety of the service and maintain secure and accurate records.” from the report
  • Privacy and dignity

    needs fixing

    The report found that care was not always dignified or person-centred. The manager did not always consider how support affected people's privacy and dignity.

    “The service did not always provide dignified care to people in line with the registered provider’s values.” from the report
Questions to ask them, based on this report
  1. 01How are you now checking that every person's risk assessment and care plan agree and are updated after incidents?
  2. 02What training has each staff member completed for the specific communication, health and first aid needs of the person we are considering?
  3. 03How do you assess restrictions on access to rooms, areas or belongings, and how do you record best-interest decisions and less restrictive alternatives?
  4. 04What changes have you made to your quality audits so they identify missing records, training gaps and lessons from incidents?
  5. 05What action plan did you send to the CQC, and what progress has been made since this inspection?

This was an unannounced inspection initially covering Safe and Well-led, then expanded to Effective; Caring and Responsive were not inspected and their previous ratings carried over into the overall rating. This explanation was written from the published report of 3 October 2023 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.

An earlier report, explained

What inspectors found, December 2021

Rated Requires Improvement; inspectors found concerns about medicines, staffing, cleanliness and management oversight.

This was an unannounced focused inspection on 20 October, 27 October and 5 November 2021. Inspectors looked only at Safe and Well-led, including infection control. They spoke with relatives, staff and health professionals, visited one person's home, and checked care, medicine, recruitment and management records.

The home was not always safe. Medicine records were incomplete, some medicines guidance was missing, and one medicine was given without enough time between doses. There were not enough employed staff, so the home relied heavily on agency staff. Some areas were not clean, and risks and incidents were not always reviewed properly.

The home was also not well-led. Its checks had not found or fixed some problems, and records were not always accurate or up to date. CQC found a breach of Regulation 17 on governance. The overall rating fell from Good at the previous inspection to Requires Improvement.

What inspectors praised
  • Safe recruitment

    The home followed the recruitment checks reviewed by inspectors, helping ensure staff were suitable for their roles.

    “Safe recruitment practices were in place and followed to ensure staff were of suitable character.” from the report
  • Caring staff

    Relatives gave positive feedback about the care. Staff were described as caring and relatives said their relatives were safe.

    “We received positive feedback regarding the caring nature of staff.” from the report
  • Supportive management

    Staff said they felt supported by the management team. The manager was open and honest during the inspection.

    “Staff told us they felt supported in their role.” from the report
  • Choice and control

    People were supported to make choices about their lives and how they spent their time.

    “People told us they chose what they wanted to do and how they wanted to spend their time.” from the report
What inspectors were concerned about
  • Medicine safety

    serious

    Medicine administration records had gaps and some guidance for as-needed medicines was missing or not reviewed. One person received a medicine without enough time between doses.

    “Medication records were not always robust, accurate or complete.” from the report
  • Staffing levels

    needs fixing

    There were not enough employed staff, creating heavy reliance on agency workers. This sometimes affected people's activities and daily lives.

    “There was insufficient staff employed meaning the service heavily relied on agency staff.” from the report
  • Risk and incident reviews

    serious

    Some risk assessments were not updated after incidents. Records did not always show what action had been taken or what had been learned.

    “Risk assessments had not always been reviewed and updated to ensure accurate records were in place.” from the report
  • Cleanliness and environment

    needs fixing

    Some areas were not clean or easy to clean. The medication room's cleaning rota had not been completed since March 2021, and flooring and furniture needed attention.

    “The service was not always clean and tidy.” from the report
  • Weak oversight

    serious

    Management checks had not identified some problems, and action was not always taken when checks did identify them. This led to a breach of the governance regulation.

    “Systems were not effective at identifying or addressing areas we found at this inspection.” from the report
Questions to ask them, based on this report
  1. 01How have you made sure medicine administration records are complete and that as-needed medicines have clear, reviewed instructions?
  2. 02How many permanent staff vacancies are there now, and how do you make sure enough trained staff are available for people's planned activities?
  3. 03What has changed in the cleaning system, especially for the medication room, flooring and furniture?
  4. 04How are risk assessments updated after incidents, and how do you record the lessons learned?
  5. 05What actions have you completed in response to the Regulation 17 governance breach, and what evidence can you show us?

This was a focused inspection of Safe and Well-led only; Caring, Effective and Responsive were not inspected and their previous ratings were carried forward. This explanation was written from the published report of 4 December 2021 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.

The story over the years

Every inspection of Field View

5 rated inspections over 8 years: the service has slipped, from Good to Requires improvement.

  1. October 2023Requires improvementcurrent ratingstayed Requires improvement
    Safe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement

    Read what inspectors found at Field View →

  2. December 2021Requires improvementdown from Good
    Safe: Requires improvementWell-led: Requires improvement

    Read what inspectors found at Field View →

  3. March 2020Goodstayed Good
    Safe: GoodEffective: GoodWell-led: Good

    Read this report on cqc.org.uk

  4. July 2017Goodstayed Good
    Safe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good

    Read this report on cqc.org.uk

  5. June 2015Good
    Safe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement

    Read this report on cqc.org.uk

  6. October 2013

    Report published without a new overall rating.

    Read this report on cqc.org.uk

  7. April 2013

    Report published without a new overall rating.

    Read this report on cqc.org.uk

  8. February 2012

    Report published without a new overall rating.

    Read this report on cqc.org.uk

  9. December 2010

    Registered with the Care Quality Commission on 23 December 2010.

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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