An unannounced comprehensive inspection visit took place on 07 January 2019.

Fountain Lodge Care Home is registered to provide personal care to older people including people living with dementia. Fountain Lodge Care Home is a nursing home, which provides care for up to 30 people across two floors. At the time of our inspection there were 28 people living at Fountain Lodge Care Home. People had their own bedroom and four bedrooms were allocated for shared use, although only one of these rooms was occupied with two people. All bedrooms had a basin, but no toilet or shower facilities. People had the use of shared communal lounges, a dining room, toilets and bathrooms on each floor. To aid people’s movement around the home, a passenger lift, stair lift and stairs helped people move between floors.

People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

At our last inspection we rated the service Requires Improvement overall, and in each key area. We found risks associated with people’s care were not always managed safely and certain medicines were not being given as prescribed. This meant there was a breach of the Health and Social Care Regulations for safe care and treatment. The provider sent us an action plan telling us how they would improve the quality of care people received. We completed this inspection visit to check improvements had been made.

At this inspection visit we continued to find risks to people were not effectively managed and the breach continued. People with a diagnosis of epilepsy, diabetes or people who were known to display behaviours that challenged as a result of their mental ill health, did not have associated risks assessments to match their complexity of need. This put people at potential risk, because there was no consistent approach or records to tell staff, how to consistently manage those associated drinks.

The service had a registered manager. 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.

People received consistent care from staff who they found were kind, caring and patient. Our observations during this inspection, were mostly of positive and friendly interactions between staff and people. There was limited engagement for people who spent time in their own bedrooms due to their health condition. Staff did not always treat people with dignity and respect because they did not always ask for people’s permission to enter their bedroom. When we needed to speak with staff confidentially, they wanted us to go into a person’s unoccupied room without the person’s permission which was not acceptable. At lunchtime, staff assisted some people to eat their meal but there was limited conversation with the person and staff did not maintain people’s dignity when they spilt food on them.

Staff had a good understanding of abuse and the safeguarding procedures that should be followed to report abuse and incidents of concern.

People’s care plans provided information about the person’s preferences and included some knowledge staff had gained about the persons interests and life history. Care records were reviewed and evaluated to ensure they remained up to date. However, some care plans for people who had been at the home a short period of time, required more specific information about people’s health and emotional needs to ensure staff provided safe and consistent care. People’s needs changed over time and staff were kept informed. Staff felt communication of people’s needs was good.

A process was in place which ensured people could raise

At our previous two inspections the service was rated as 'requires improvement'. This included our last inspection undertaken on 20 September 2016.

This inspection took place on Wednesday 6 September and was unannounced. At this inspection the service continued to be rated as requiring improvement. However, the provider had recently made changes in their senior management structure and this had started to improve the quality of the service provided.

Fountain Lodge is a nursing home which provides care and support to people who require nursing care in their old age, and who require support to live with dementia. The home can support a maximum of 30 people. On the day of our visit 26 people lived at the home and one was in hospital.

The home had a registered manager until recently. 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. The manager left the service in May 2017 and submitted an application to cancel their registration. The current acting manager will be applying to register with the CQC.

The acting manager and new regional manager were open and transparent about the service and the improvements required.

Medicines were mostly managed safely, but we were concerned that one person's pain was not managed well. This was responded to on the day of our inspection visit.

Risks to people's health and well-being had been identified, but the actions taken by staff to reduce the risks related to one person were not in the person’s best interest as intended. Staff monitored those who were at risk of malnutrition or dehydration, but monitoring systems were not effective.

There were enough staff to meet people's needs, but the use of agency staff meant people did not always get support from staff who knew them or their needs well. The provider was recruiting new staff and their own ’bank’ staff, to make sure people were familiar with the staff who cared for them.

We received mixed opinions about the quality and choices of food available.

Not all staff had received the training the provider considered essential to meet people’s health and safety needs. The home provides specialist dementia care and staff had not received specialist dementia training. The acting manager was putting training in place to ensure staff had the skills and knowledge to support people effectively.

People told us most staff were kind and caring, and treated them with respect and dignity. Staff interaction with people was mostly when undertaking tasks as they did not have time to engage with people at other times. Sometimes some staff did not fully understand written or spoken English.

The provider understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty safeguards. People told us they were asked if they consented to care tasks being undertaken most of the time.

The provider had systems in place to ensure the premises were safe for people to live in, and the equipment was safe to use. The gardens were not safe or accessible for people to use.

The provider employed an activity worker who supported activities in the home on Mondays to Fridays. There were limited activities from external organisations.

The provider's recruitment practice mostly reduced the risks of employing people unsuitable to provide care. Staff received training to safeguard people however this was not always put into practice.

Relatives and friends were welcomed at the home at any time during the day or evening.

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 the report. We have also asked the provider to send u

This inspection took place on 20 September 2016 and was unannounced. Fountain Lodge Care Home Limited is registered to provide nursing care for up to 30 older people. At the time of our inspection there were 25 people living in the home.

During our last inspection on 24 March 2015, we found the provider was not fully meeting the standards required. This meant we allocated an overall rating of “Requires Improvement”. During this inspection we found there continued to be areas needing improvement.

There was a new registered manager in post who registered with us in September 2016, shortly prior to our inspection. 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. The registered manager was not available during our visit due to being on leave.

People told us they felt safe living at the home. The provider carried out a range of recruitment checks but records were not always clear to show staff employed were safe and suitable to work with people. We found some improvements were required to how risks were managed to ensure the ongoing safety of people in the home. This included risks associated with the use of specialist equipment. There were also some areas of risk in relation to medicine management that required improvement.

There were sufficient numbers of staff employed to meet people’s needs. Staff completed training on an ongoing basis to help them develop their skills and competence to carry out their role safely and effectively. However, there were some gaps in staff training that needed to be addressed.

Staff had some understanding of the Mental Capacity Act. The manager had ensured applications to the supervisory body (the local authority) had been made where restrictions had been placed on people’s care amounting to a deprivation of their liberty.

People said they had enough to eat and drink and there were meal choices provided each day. Where people were at risk of poor health, due to not eating or drinking enough, there were processes to monitor their food and fluid intake to help ensure their nutritional needs were met.

Visitors were made to feel welcome at the home at any time to help people maintain relationships with people important to them. There were minimal social activities provided to support people’s hobbies and interests. The atmosphere in the home was quiet and relaxed with staff interactions usually only when there were care tasks to be completed. However, individual staff members were caring towards people and we saw that staff were mindful of protecting people’s privacy and dignity.

Each person had a care plan which contained the information staff needed to meet people’s care needs. These were being reviewed to ensure they provided staff with more detailed information about people’s needs and preferences to help deliver more person centred care.

There were systems to monitor the quality of the service and drive improvement within the home but these were not consistently effective to ensure people received safe, effective care that was responsive to their needs.

Staff understood their roles and were supported by the registered manager through one to one supervision meetings and staff meetings. People and staff told us the registered manager was approachable.

This inspection took place on 24 March 2015. It was unannounced.

Fountain Lodge nursing home provides nursing care for up to 30 older people. At the time of our inspection there were 21 people living at the home.

The home’s registered manager resigned in December 2014. 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. A registered manager from another home owned by the provider had been working at the home three days a week on an interim basis until arrangements are finalised for them to work at Fountain Lodge on a full time basis.

People told us they felt safe. They were supported by a staff team who had undergone recruitment checks by the registered manager to check staff’s suitability to work in the home. Staff understood safeguarding policies and procedures, and followed people’s individual risk assessments to ensure they minimised any identified risks to people’s health.

There were sufficient numbers of staff with experience, qualifications and knowledge to support the safety and well-being of people.

Most medicines were managed safely; however some medicine records had not been completed following good practice guidance.

Staff had received, or were booked on training considered essential to meet people’s health and safety needs. We saw staff used their training to support people’s needs well.

The manager understood, and was working to ensure the home met the requirements of the Mental Capacity Act and Deprivation of Liberty safeguards. The manager was aware there were some people who lived at the home who required applications sent to the supervisory body (the local authority) because their freedom had been restricted. They were in the process of doing so.

People were supported to have enough to eat and drink and enjoyed the food provided. The provider ensured people’s dietary needs were catered for. People who were not drinking or eating sufficiently to stay healthy were referred to the right health care professionals for further guidance.

People had access to other health and social care professionals when required. These included their GP, dentist, social workers and dieticians.

Staff were caring and considerate to people who lived at Fountain Lodge Nursing Home. People told us staff treated them with dignity and respect.

Visitors were welcome at any time during the day and evening at the home, and were encouraged to be involved in the care of their relations. We saw some activities were available to people who lived at Fountain Lodge, but these were limited and people told us they were bored.

The new manager was considered by staff and people who lived at the home to be open and approachable.

We visited Fountain Lodge Care Home on Monday 10 June 2013 to follow up concerns we identified at our last visit about the cleanliness of the home. We were concerned the service did not have effective systems in place to maintain standards of cleanliness and prevent the spread of infection. We issued a warning notice to the service and asked them to make sure they were compliant in meeting the regulations relating to cleanliness and infection control by 31 May 2013.

We also visited the service to follow up on concerns we identified during our last visit about the management of medicines. We issued the service with a compliance action.

The service sent us an action plan for both areas of concern which set out what they were going to do to ensure they complied with the regulations.

During this visit we looked at the areas we had judged as non compliant. We were satisfied the service had acted quickly to improve cleanliness and infection control, and to improve its medication management. We also noted the providers had redecorated many parts of the home and people told us they liked the changes made to their environment.

We spoke with four people living at Fountain Lodge Care Home. They also told us they were happy with the cleanliness, and the support given by staff. One person told us, "Staff are marvellous, they couldn't be better." Another told us, "We're being well looked after."

Two inspectors visited Fountain Lodge on 18 April 2013. The inspection was part of our annual inspection programme as well as a follow up to check on areas of concern identified at our last inspection in November 2012.

We found people were treated well and their dignity and privacy was respected. We observed good and open interaction between people living in the home and staff who cared for them.

We looked at the care and welfare of people living at Fountain Lodge. Records demonstrated that people’s care and treatment needs were being effectively and safely managed.

We checked medication management. We were satisfied that day to day management of medicines was safe. We had concerns that a medical device used for one person living at the home had not been used appropriately. Some supporting medication documentation was not in place.

We looked at the cleanliness of Fountain Lodge and infection control procedures. We were not satisfied that the levels of cleanliness and infection control measures kept people safe. We served a warning notice for non compliance in this area.

We checked the safety of equipment in the home. We were satisfied there were satisfactory systems in place to ensure that equipment used by people was safe. Some of the furniture in the home, whilst safe, was worn and in poor condition.

We checked staffing levels and were satisfied there was sufficient staffing to meet the needs of people living at Fountain Lodge.

We spoke with five people and four visitors about their experiences of the home. We also observed what daily life was like for people living at Fountain Lodge. Visitors and people we spoke with about the care provided told us: “They are ok, I am quite happy with day to day care.” “Generally on the whole I am happy with the care X gets.” “We all get on well together.” “I think it’s quite good.”

We saw staff were friendly and approachable and people felt at ease to approach them. We observed people watching television in the lounge or listening to music in the dining room.

We saw that people had care plans in place detailing their care needs. These contained instructions to staff on what support they needed to provide. Records did not detail how people liked to spend their day. There was also limited information to show that people or their families were involved in their care.

People and visitors knew how to make a complaint if they needed to. They told us: “If we have a concern he (manager) will sort it out, he seems genuinely interested.” “Although there is the odd issue, it is generally dealt with.”

During our tour of the home we found no unpleasant odours other than in sluice areas. We identified some actions were required in regards to the management of laundry and cleaning of carpets to ensure infection control was suitably managed.

During our visit we spoke with seven people who live at Fountain Lodge. They told us they felt happy and safe at the home. One person commented, "I am very settled here. The ladies (staff) are all nice to me and treat me well."

A person who had recently moved in said that they had received "a warm welcome."

People told us the food was "very filling" and "excellent." Two choices were available, which included vegetarian options.

Two visitors said they had no concerns about the care of their relatives. One visitor went on to say, "I am more than happy with the care."

We observed people who, because of complex communication needs, could not answer questions about their experience of living in the home. People had clearly made positive relationships with the staff team on duty; seeking them out for company and choosing to sit next to them during activities.