Fountain Nursing and Care Home Limited

On this page

• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

Caring – this means we looked for evidence that the provider involved people and treated them with compassion, kindness, dignity and respect.

At our last assessment we rated this key question requires improvement. At this assessment the rating has remained as required improvement. This meant people did not always feel well-supported, cared for or treated with dignity and respect.

The service was in breach of 1 legal regulation in relation to a failure to always ensure the dignity and respect of people using the service.

This service scored 45 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not treat people with kindness, empathy and compassion, or respect their privacy and dignity. Staff did not treat colleagues from other organisations with kindness and respect.

Systems to assess, monitor and mitigate risks to people, including risks associated with the environment and support planning were not always robust and did not always demonstrate a caring approach. Audits and checks completed by delegated staff had not enabled the provider to identify and address the significant concerns we found during this assessment. These included shortfalls in the assessment and management of risks to people and the safety of the environment. Staff had not always been provided with clear guidance on how to safely meet people's individual needs. Staff did not always report incidents or safeguarding concerns in a consistent or timely manner, which meant people were not always cared for in a safe way.

We saw positive interactions between staff and the people they were supporting during the assessment, and most staff had received training in relation to dignity and respect. The registered manager was unable to explain why this training excluded the kitchen, domestic and maintenance staff members who had contact with the people living in the service. However, at times staff referred to people using terms of endearment which were not identified in people’s support plans. This included addressing people as ‘darling’ and ‘dear’. One person told us, “I experienced being addressed improperly and not by name. While this issue has since been resolved after I raised it, it should not have required my intervention to be corrected.”

Whilst people and relatives told us they felt staff were caring towards them, our findings did not always indicate people were consistently supported safely. Most people told us they felt staff were kind and compassionate and treated them with dignity. One person told us, “The majority of staff are caring in nature and have a willingness to assist. I value their attention and appreciate their care.” However, they also told us, “I have encountered a lack of respect from certain staff members, including being spoken about or around as if I were not present.” They said that this made them feel like staff were being ‘dismissive’ and ‘demeaning’ towards them and their feelings.

Relatives told us they felt staff were caring towards loved ones. However, 2 relatives told us they often had to ask for their loved one’s nails to be cleaned. During our assessment we found multiple people had visibly dirty nails, although the care records indicated staff had cleaned them just a short time before. One person told us, “Although my nails are attended to every other week, the condition of my nails between treatments is not adequately maintained.”

We observed that people’s dignity was not always respected due to the actions of staff and the provider. We saw 1 person who was in a shower room and had been left unattended by staff. They were left alone, sat naked, with the door wide open. Two people who shared a room did not have a suitable divider in the room to preserve their dignity from the other when receiving support with personal care. In several bedrooms the curtains did not fully close as they were too small. This meant it was possible for them to be seen from outside.

The provider did not always treat people as individuals or make sure people’s care, support and treatment met people’s needs and preferences. They did not always take account of people’s strengths, abilities, aspirations, culture and unique backgrounds and protected characteristics.

When decorating the communal areas of the home and people’s bedrooms the needs of people using the service had not been considered. The registered manager was unaware of the guidance on creating a suitable environment for people living with dementia. This included a failure to consider guidance on signage, lighting, individualised doors and decoration. The garden area also required improvements to make it safe for people to use independently and lacked areas of interest, stimulation and seating for people to enjoy the outside space. Most people we spoke with told us they were happy with their rooms, and many had pictures and personal items to make their rooms feel more homely. However, the decoration of these rooms required improvement to reflect best practice for dementia care.

People and relatives told us they felt their individual needs were respected and met. However, some relatives told us of their concerns in relation to the lack of activities and stimulation for people, particularly those cared for in bed or who chose to stay in their rooms. This meant, at times, people were not engaged in meaningful activities for long periods of time and were just sat in their rooms without any stimulation at all. The lack of activities and meaningful engagement were also demonstrated in people’s daily care notes. Staff also failed to recognise the importance of positive interactions and meaningful activities. This was of a particular concern for 1 person who we observed had become distressed. Staff failed to try to engage the person in their known interests to help alleviate their distress.

Two health professionals we spoke with both felt the lack of activities and simulation for people did impact on their wellbeing and quality of life. One felt this led to an increased risk of depression and decline in their cognitive ability.

There was an activity co-ordinator working in the service Monday to Friday who developed an activity plan. The plan did not demonstrate that the hobbies, interests and preferences of all people living at the service had been considered to meet their individual needs.

The provider did not promote people’s independence, so people did not know their rights and have choice and control over their own care, treatment and wellbeing.

We observed on occasions, staff not offering choice at mealtimes for those who found it difficult to choose verbally. We also saw staff putting on people’s clothing protectors without asking. Care plans did not reflect this was their choice or that it was in their best interest. This did not promote people’s choice and control. We did observe staff supporting other people with their meals, although overall the engagement from staff to provide verbal prompts and encouragement at mealtimes was lacking,

Staff had not received training on promoting independence, although they could explain how they supported and encouraged people to maintain independence.

We saw and were told people had access to the garden with supervision from staff due to the risk of falling or mobility restrictions. One relative told us, “I take [name] outside in the wheelchair. Staff get him ready; I sign a disclaimer form. He enjoys sitting and seeing people go past.” Activities did not include trips out to local places of interest or attractions. This was confirmed by people using the service, staff and the registered manager.

Some relatives told us they felt their loved ones would benefit from more meaningful activities to keep them occupied. We were told and saw during our visit evidence of some group activities taking place. At times, competing activities or noise levels in 1 lounge may have been overwhelming for people as the TV was on with no volume on, a staff member was playing music on a mobile phone, and a second staff member was reading a passage from a book out loud. The activities taking place did not reflect people’s individual choices and made it difficult for them to engage in a specific activity. One person told us, “There is a lack of structured activities. there are no offers of things I would enjoy.” They attributed this to staff being ‘too rushed or short-staffed’, telling us, “Especially on weekends when only two staff members are available, which I feel is insufficient even during weekdays for upstairs residents.”

Most people and relatives we spoke with told us they felt they were encouraged to maintain independence and were given choices. People we spoke with and were able to choose, told us there were no restrictions on what time they went to bed or got up or where they wished to spend their day.

The provider did not always listen to and understand people’s needs, views and wishes. Staff did not always respond to people’s needs in the moment or act to minimise any discomfort, concern or distress.

Some people told us when they called for or needed support, particularly at night, they may have to wait longer than they would have liked. The registered manager told us staff carried out hourly checks for people cared for in the rooms and for all people during the night, except for 1 person who chose not to have hourly checks. This was recorded in their care plan. However, we found that often these checks were not completed consistently. This placed people at increased risk of harm, feeling isolated and not being able to alert staff should they need support.

For people who were unable to use the call bell and were able to mobilise, we found the options of pressure alarms or movement sensors had not been implemented to alert staff, should they need help or support. The care plans, risk assessments, mental capacity assessments and best interest decision forms for those who lacked capacity were not robust and contained conflicting information. This meant it could be difficult for staff to understand what was required in relation to ensuring people were safe when in their rooms.

We saw that staff were caring and responsive to people’s immediate needs but at times support could be task orientated rather than a person-centred approach. For example, staff were not able to communicate effectively with 1 person due to language barriers which meant they could not recognise immediately if the person was in pain, discomfort, concerned or wanted something. The provider had failed to look at ways in which they could effectively bridge these gaps and enhance effective communication meeting the person’s individual needs. We also observed staff failed to identify another person’s distress and escalate this to the nurse on duty. This resulted in unnecessary prolonged distress for the person.

The provider did not always promote the wellbeing of their staff. They did not always support or enable staff to deliver person-centred care.

There were 2 staff members who lived at the service. We found the conditions they lived in were of a very poor standard. The provider and registered manager had failed to carry out regular checks of the staff living areas to ensure they were adequately maintained and fit for purpose.

The provider did not operate any staff recognition or well-being programmes to recognise staff performance or achievements or to enhance their well-being.

The registered manager told us they had sought feedback from staff members which was positive overall. They had not analysed this information and generated any actions or shared the findings with the staff members. Positive feedback can also be used to help drive further improvements in the service.

Staff told us they felt listened to and valued by the management team and they felt they could raise any concerns they had.

Staff meetings took place periodically. However, the records of these meetings did not demonstrate how they were used to enable staff to feel valued and included in the improvement and development of the service. Supervisions also took place; however, again, these did not include discussions around staff well-being and their own development. The registered manager said when she asked staff about further training or development, they would often just say they were fine and did not want to progress. However, this was not included within the records made available to us.