People’s experience of using this service:

People told us that they felt safe living in the home but some processes needed improving to ensure people were protected from potential harm. Staff were not following recommended infection control procedures and improvements were needed to some aspects of the environment to make it a safer place to live.

Staff were not always supported to keep up to date with best practice and to develop their skills as they did not receive regular supervision and refresher training sessions. Audits and checks had not identified some of the issues found at this inspection and action was not always taken to address issues found in audits.

People had easy access to food and drink throughout the day and were supported to see health professionals when required. Medication was managed safely and people received the right medication at the right time.

People enjoyed having a choice of sitting in a range of different communal areas and there was a good range of activities on offer which people enjoyed.

People told us they felt well cared for and looked after by the staff team and were consistently treated with respect and dignity. Relatives were also happy with the quality of the care and felt welcome in the home. People were able to make choices for themselves when they were able to do so and decisions were made in peoples’ best interests when they lacked capacity.

Peoples’ needs were assessed and care plans reflected peoples’ wishes and preferences. People and their relatives knew how to complain and had no concerns about how the service was being led and managed. People told us they were receiving responsive end of life care which was important to them.

The manager had addressed some of the concerns highlighted at the last inspection and staff felt supported to deliver and improve the service.

More information is in the detailed findings below.

Rating at last inspection:

Requires improvement (report published 01 August 2017)

About the service:

Fountain Nursing and Care Home is a care home that provides nursing and personal care for older people, some of whom are living with dementia. At the time of the inspection, 23 people lived at the service. The home was established over three floors, with a range of communal areas included dining spaces, a large garden and smaller lounge spaces.

The service had a manager who had had applied to become the registered manager with Care Quality Commission (CQC). Their application was pending and they will be referred to as the manager in this report.

Why we inspected:

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

Enforcement:

No enforcement action was required.

Follow up:

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

We carried out an unannounced comprehensive inspection of this service on 30 March 2017. After that inspection we received concerns in relation to how people were kept safe from the risks associated with their specific condition. As a result we undertook a focused inspection to look into those concerns. This report only covers our findings in relation to those topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Fountain Nursing and Care Home on our website at www.cqc.org.uk

This focused inspection took place on 6 July 2017 and was unannounced. The inspection team consisted of one inspector. Fountain Nursing and Care Home Limited is a care home with nursing for up to 27 people, some of whom are living with dementia. At the time of our inspection 27 people were using the service.

At the time of the visit the service had a registered manager who was present during 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 of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At this inspection we found that the provider had not taken appropriate action to protect people from avoidable risks and plans to respond to emergencies were not robust. Several items of equipment designed to protect people from harm were broken or not working properly. Rubbish and equipment stored in the garden presented a trip hazard. The provider conducted regular checks of fire detection systems and equipment but evacuation and fire training for staff was not robust.

People received their medicines from nursing staff that were trained to do so. The registered manager had recently taken action to improve the safe storage and recording of medicine. However, we found that the management of some medicines meant that people could not be assured they would receive medication which remained effective.

People we spoke with told us that they felt safe at the home. Staff we spoke with demonstrated that they were aware of the action to take should they suspect that someone was being abused. On several occasions we saw that staff did not support people in a dignified and respectful manner.

The provider did not have robust systems in place to assess the quality of the service and drive a culture of sustained improvement. The provider did not always have regard to concerns raised by other agencies in order to improve the service or demonstrate a learning culture. Quality audits had failed to identify several faults with equipment and the environment. Care plans were not audited on a daily basis as planned.

There were enough staff, suitably deployed, to support people promptly. The registered manager conducted suitable recruitment checks to ensure people were supported by suitable staff.

The registered manager demonstrated knowledge of the type of events they were required to notify us of and their latest inspection ratings were displayed appropriately. People who used the service and staff told us they were pleased with how the service was led.

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

The comprehensive inspection took place on 10 March 2017 and was unannounced. Fountain Nursing and Care Home Limited is a care home with nursing for up to 27 people, some of whom are living with dementia. At the time of our inspection 26 people were using the service.

There was a registered manager in place who was present during 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 of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We last inspected this service in August 2016 and found that the provider was breaching Regulation 9 of the Health and Social Care Act 2008. This was because care provided did not consistently put the needs and preferences of the people who used the service first. Following that inspection the registered provider sent us a plan detailing the action they would take to make improvements in these areas. Most of this action had been completed and the provider was no longer in breach of this regulation.

People told us that they felt safe in this home. Staff were aware of the need to keep people safe and they knew how to report allegations or suspicions of poor practice.

People were protected from possible errors in relation to their medication and there were robust systems for checking that medication had been administered in the correct way.

People who lived in this home and people’s relatives, told us that they were very happy with the care provided. People had opportunities to participate in a range of activities in the home and community. Staff respected and supported people in line with their lifestyle choices.

People and, where appropriate, their relatives, were consulted about their preferences and people were treated with dignity and respect.

Staff working in this home understood the needs of the people who lived there. We saw that staff communicated well with each other. Staff had the skills and knowledge they required to meet people’s specific needs.

Staff knew and respected people’s wishes. People were supported to make decisions which were in their best interests.

People were provided with a good choice of food in sufficient quantities and were supported to eat meals which met their nutritional needs and preferences. Meal times did not always promote people’s independence.

The registered manager assessed and monitored the quality of care through observation and regular audits of events and practice.

The registered manager consulted people in the home, their relatives and visitors to find out their views on the care provided and used this information to make improvements, where possible.

This inspection took place on 15 August 2016 and was unannounced. At the last inspection on 29 July and 1st August 2015 we found the provider had breached regulations 15 and 22 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. This was because the provider had not taken into consideration the impact of the building’s design and layout on people who used the service. The provider had also failed to ensure there were sufficient staff available to promote people’s interests and prevent long periods of inactivity. At this inspection we found that staff took effective action to minimise the impact of the building’s layout on people and how they were supported by staff. There was still little stimulation and meaningful activities available. People were not receiving care which was centred to their individual needs and preferences.

Fountain Nursing and Care Home is a care home with nursing for up to 27 people, some of whom were living with dementia. The property is a large, adapted house and accommodation is on two floors with a passenger lift to facilitate access. During our inspection there were 26 people using the service.

At the time of the visit the home 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 of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The provider had taken action to ensure there were enough staff to meet people’s care needs and appeared unhurried. Staff however continued to remain focused on completing tasks rather than promoting people’s independence and social inclusion.

People’s nutritional needs were met but meal times were task orientated and did not promote people’s enjoyment of the dining experience. Drinks and snacks were limited outside of designated times.

The provider had taken action to ensure people were supported to move safely when space was limited. Staff did not always follow guidance designed to minimise the risk of harm to people such as keeping the premises secure.

People who used the service and their relatives said the service was caring. Staff responded promptly to people’s requests for support and in line with their care plans, but people were not always supported to engage in activities they may like or receive care which reflected their individual preferences. Staff did not always put people’s needs before the completion of administrative tasks.

Staff could recognise the possible signs of abuse and how to report any suspicions. People received their medicines safely and when they needed them.

Staff knew and understood the implications of people’s mental and physical health conditions on how they needed care and support, but did not demonstrate a detailed understanding of how to support people living with dementia.

Staff asked people how they wanted to be supported and they respected their views. When a person lacked mental capacity the registered manager had taken action to ensure decisions were made in their best interests.

People in the home were supported to make use of the services of a variety of healthcare professionals.

Staff supported people’s dignity by helping them to maintain their appearance. People’s right to confidentiality was not always respected.

The home had clear policies and procedures for dealing with complaints. Complaints had been investigated and responded to in line with these systems.

People living in the home, relatives and staff told us that they felt that the home was well run.

The registered manager had a clear vision of how the service should support each person’s individual needs, however this was not generally practised by staff.

The registered manager had systems for monitoring incidents and accidents to ensure that there had been an adequate respons

Although this was a scheduled inspection we also checked this service where it had been non-compliant at a previous inspection in November 2012. On the day of this visit 23 people were living at this care home. We subsequently spoke to seven people who lived there, three of their relatives and five members of care and nursing staff.

We spoke to people about the care staff who supported them. Comments included, “The staff are okay to me, they are kind but there are not many to look after me” and “They don’t have time to sit and talk.”

The relatives we spoke to were complimentary about the service being provided. Comments included, “They are brilliant carers, they can’t do enough for my relative” and “My relative is safe and content.”

From our observations it was apparent that care staff were attentive, polite and sought consent before providing care and support. However, it was also apparent that care staff did not always have sufficient time to spend time with people particularly at busy times such as the morning when they were assisting other people.

Although the premises were reasonably well maintained, the design, size and layout of some rooms made it unsuitable and unsafe for people with mobility disabilities.

We found that care and support was not always planned and delivered in a way that ensured people’s safety and welfare and that there were not always enough qualified, skilled and experienced staff to meet people’s needs.

On the day of our inspection, 25 people were using the service. We spoke to three of these people, three of their relatives and three members of staff. People told us, “It’s a nice home” and “They keep my clothes clean and there is plenty of food.”

Relatives of people using the service also made complimentary comments about the home. Comments included, “My relative gets good care” and “We are more than pleased.”

The findings of our inspection identified that, overall, care and treatment was delivered in a way that ensured people’s safety and welfare. There were sufficient numbers of staff on duty who had appropriate skills and experience. However, we found that the bathing records did not identify whether personal care had been provided to some of the people using the service. It was unclear if this was a recording omission or if some people had not been bathed regularly. This placed some people at risk of not having their care needs met.

We observed that the nursing and care staff were attentive, polite and that the manager was approachable and responsive to feedback. It was clear that the staff had a good knowledge of all of the people who lived at the home and were familiar with their preferences and health conditions.

We found the home to be clean, homely and well maintained.

We carried out this review to check on the care and welfare of people using this service.

We spent some of our time watching what was going on in the home to help us understand what it was like for the people living there. We saw that there were good relationships between the staff and the people living in the home. Staff were friendly and respectful when speaking to people. They were able to communicate effectively with people.

We spoke with some of the relatives of the people living at the home. Their comments included:

‘Quite happy with the home.’

‘I am very happy, good staff always ready to answer questions.’

‘Care second to none.’

People were able to have a choice of food. Any specific diets were catered for, for example, medical diets. The way staff were serving people’s meals could be improved to ensure people can enjoy their food.

We saw little evidence of any social activities taking place in the home.

There was a well trained, stable staff team at the home which was good for the continuity of care of the people living there.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service. This was an unannounced inspection where the provider did not know that we were visiting.

Fountain Nursing and Care Home provides accommodation for up to 27 older people who have care and nursing needs. There were 25 people living at the home when we visited. The home had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

At this inspection we also reviewed the areas of this service which we were concerned with at a previous inspection in August 2013 to see if they had improved. On our last inspection we found that the design, size and layout of some rooms made it unsuitable and sometimes unsafe for people with mobility disabilities and there were not always enough qualified, skilled and experienced staff on duty to meet people's needs.

At this inspection we found that the design, size and layout of some rooms (corridors and communal areas) made it unsuitable and sometimes unsafe for people with mobility disabilities. We spoke to the manager of the home about this and were told that since our last inspection (in August 2013) detailed plans had been drawn up to modernise and significantly improve the building. We looked at the plans and noted that the refurbishment included the creation of more single rooms, a new treatment room and the re-development of the second floor to create improved facilities.

Although plans had been drawn up and arrangements made to commence the building work, the provider is in breach of Regulation 15(1)(a) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 until the work has been completed.

At our previous inspection in August 2013, we found that people’s health and welfare needs were not always being met because there were not always sufficient numbers of suitable staff on duty at all times. We spent several hours in the communal areas of the home observing the people who lived there and saw that there was not enough staff to regularly engage with people who were exposed to long periods of inactivity. The people we spoke to said that they were well cared for at the home but were concerned about the lack of care staff to support them. The provider is in breach of Regulation 22 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

We spoke with people who lived at the home and their relatives. They told us that they were reasonably happy with the care provided and the staff who delivered support.

We found that people were supported by kind and knowledgeable staff. Staff were caring and polite and usually sought consent before providing care and support. However there were occasions when staff did not always seek consent and provide an explanation before delivering care.  We raised this concern with the manager of the home who assured us he would take this up and discuss it at the next staff meeting.

People’s health needs were met and care and support was provided by well trained staff. We found that people’s health and care needs were assessed and care was planned and delivered in a consistent way. From the seven plans of care we looked at, we found that the information and guidance provided to staff was detailed and clear. People had regular access to a range of health and social care professionals which included general practitioners, dentists, chiropodists and opticians.

The CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and to report on what we find.  There were no people who used the service who were deprived of their liberty. However we saw that the provider had proper policies and procedures in relation to the MCA and DoLS should they need to apply for a such  an order.

We found that the home followed safe recruitment practices. We checked records and saw that all new employees were appropriately checked through recruitment processes to ensure that they were suitable to work with people. Staff were well trained and had a good knowledge of the people they were caring for. We found that the home’s had a safeguarding policy and procedure and there were arrangements in place to deal with foreseeable emergencies.

People were encouraged to make their views known about the care, treatment and support they received at the home. This was achieved by holding group meetings, sending out survey questionnaire forms and seeking ‘one to one’ feedback.

We found that not all people living at the home had access to or were supported to engage in hobbies and interests. We noted that there were limited activities provided at the home and few available for people with more complex health needs. No one from the care home attended a day centre and rarely left the building or participated in any outside interests.  We spoke to the manager about this and the non-involvement of some people who lived there. The manager acknowledged our concerns and told us that not everyone wished to participate.

People who lived at the home and their relatives were complimentary about the manager of the home and the newly appointed quality assurance manager. The care and nursing staff also made similar positive comments about the management team at the home.

Records showed that the provider had a system to regularly assess and monitor the quality of service that people received at the home and a system to manage and report accidents and incidents. Findings from these systems were analysed and used to make improvements.

You can see what action we have told the provider to take at the back of the full version of the report.