Fountain Nursing and Care Home Limited

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question good. At this assessment the rating has changed to inadequate. This meant there were widespread and significant shortfalls in people’s care, support and outcomes.

The service was in breach of 2 legal regulations in relation to meeting people’s nutrition and hydration needs and gaining people’s consent.

This service scored 33 (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 make sure people’s care and treatment was effective because they did not assess, review and discuss people’s health, care, wellbeing and communication needs with them.

The provider failed to robustly review people's care plans to ensure these continued to reflect their current needs. For example, 1 person was unable to effectively communicate verbally and there was a lack of guidance for staff on how to recognise if they were sad, in pain or wanted something. The care plan referred to the use of flash cards to support with communication. However, during the days of our assessment, we found these were not used by staff to aid effective communication. For people whose first language was not English, they did not have information on their care available to them in their preferred language to allow them to be effectively involved in their support planning and review. We also observed all people were given plastic beakers for their drinks. For some people this was due to their assessed needs and was included in their care plans. However, for most people, this was not the case. When we spoke to the registered manager, they told us this was due to the risks of some people who throwing their cups. This information was not included in people’s care plans and the associated risks had not been assessed. This demonstrated an ‘institutionalised’ and not a person centred approach when assessing the needs of people on the equipment needed to drink safely. One person we spoke to about this told us they did not mind using beakers, although they had not been asked or given the choice of whether to have plastic beaker or china cup. This meant that the planning of support needs and support plans were not reflective of the people as individuals, to demonstrate a holistic, person-centred approach.

Although people and relatives were happy overall with communication with the service, they told us they were not involved in reviewing support plans, and some had never seen a care plan.

The provider did not plan and deliver people’s care and treatment with them. They did not follow legislation and current evidence-based good practice and standards.

The provider failed to ensure people’s support plans included all their needs, including health, personal care, emotional support, social interests, and activities and cultural, religious, and spiritual needs. People's needs were not always assessed, and care and support were not always delivered in line with current standards. The provider’s processes for ensuring people were consistently involved in their care planning and that the information recorded in support plans was accurate, were not effective. Important information about people’s care and support needs had been omitted from some support plans. Some people’s support plans did not reflect national and best practice guidance in relation to support with specific health care needs, such as diabetes and strokes.

For people who required enhanced monitoring or support with repositioning in relation to their skin integrity and hourly safety checks, there was a lack of evidence this had been consistently provided. For people whose fluids were being monitored due to being at risk of dehydration, there was a lack of evidence to demonstrate their fluid targets were being met or monitored. The provider failed to carry out checks or monitor the completion of such records to ensure people's care and support achieved effective outcomes.

People and relatives told us they were not involved in reviews or assessments completed by the provider once starting to use the service.

Where people were assessed as requiring specialised diets, we found these needs were not suitably met. The choice of meals, pudding and snacks on offer were very limited and did not meet individual needs and known food preferences. We found that often meals were declined but alternative choices were not made available. This was of particular concern for people who were losing weight and required food supplements due to the risk of malnutrition. One person was observed to be given food which was not in line with their assessed needs which placed them at risk of choking. For other people who had cultural preferences in relation to foods they ate, these were not considered. In addition, we saw from records that 1 person was given foods which were detailed in their care plans as foods ‘they did not like’. We also saw from food records that the registered manager and provider had failed to identify this and had not taken action to improve the mealtime experience for such people. Another person who was visually impaired was observed to have their meal placed in front of them without being told what was on the plate or where each individual food item was positioned on the plate. This meant the person had to try to identify this for themselves by touch.

We observed drinks were accessible in the communal areas and people’s bedrooms; however, snacks including fresh fruit were not.

Where people were unable to make verbal choices regarding their mealtime choice, pictorial menus were not in place nor were they visually shown the options to give them the opportunity to choose at mealtimes. This meant people unable to communicate their preferences were not given the same options as those who were.

At mealtimes a choice of drinks were not offered; people were given the same squash to drink. Condiments were not offered and were not available and people had clothes protectors put on them without consultation or this being identified as a need or wish in their care plans.

The provider did not use a dependency tool to assess the level of staffing needed to meet the needs of the people using the service. The registered manager told us that if a person needed 1:1 support, they would increase staffing levels. However, there was not a robust system in place to periodically assess the needs of people and demonstrate the staffing levels met these. The registered manager told us they carried out call bell response times checks. This was not a structured or robust approach which clearly demonstrated if these were managed in an acceptable timeframe and met the needs of people. Some relatives told us they felt that staff levels, particularly at the weekend and night, were low. One relative told us, “They definitely could do with more staff, like all care homes. There are less (staff) around at weekend.”

The provider did not always work well across teams and services to support people. They did not always share their assessment of people’s needs when people moved between different services.

The lack of robust systems and documentation meant that information available to share with other services and health professionals was not robust. For example, records for people who were at high risk of developing pressure sores did not have the condition of their skin robustly monitored and recorded as per their support plan. This meant in the event of a deterioration of the skin condition, the information available to help understand how, when and why the skin had deteriorated was not available. Effective treatment could be delayed due to this lack of information when transferring between services. We were told by staff and records demonstrated that team meetings took place; however, they were not consistently used to drive improvements. This meant there were missed opportunities where areas of concern or positive feedback could be discussed and actioned. However, staff told us they felt supported by the registered manager.

Feedback from health professionals we spoke with was mixed. Some felt that communication with the service still needed to be improved, as did the records, to clearly demonstrate the support people received met their needs. One health professional told us they felt the recently improved communication had led to better care for people using the service, but there was still room for improvement.

There was positive feedback overall from people and relatives about the service. Several relatives felt 1 care staff member in particular was very good. All people and their relatives told us they had either spoken with or seen the registered manager. One relative told us, “The manager is friendly and will action concerns. I usually see the head nurse. Most communication is by phone. I have completed questionnaires in the past.” Feedback from people and relatives about whether they had been asked to complete feedback forms was mixed.

The provider did not always support people to manage their health and wellbeing, so people could not always maximise their independence, choice and control. Staff did not always support people to live healthier lives, or where possible, reduce their future needs for care and support.

The system and processes to ensure care records and risk assessments were reflective of the support people required with their health needs were not robust. This meant staff did not always have the correct guidance on how to support people appropriately to manage their health and wellbeing, whilst encouraging independence. We observed restrictions were in place for 1 person who was able to mobilise but was at high risk from falls. These restrictions had not been correctly assessed in line with the person’s rights under the Mental Capacity Act (MCA) 2005 and risk assessments were not in place. This placed the person at increased risk from falls due to them trying to get out of bed when the bed rails were up.

Nursing staff could tell us how they would access additional support from healthcare professionals to help people manage their health, should this be required. However, records demonstrated that staff had not received training to support people with their specific health conditions, such as strokes, drug and alcohol dependency and associated dementia, specific communication needs and supporting people with suicidal expressions or distressed behaviours.

People told us they were able to make choices and decisions, but not all people were involved in reviewing or consulted about their health and well-being needs.

People or their relatives told us they felt medical referrals were made where necessary, in a timely way, and were happy with this area of support. One relative told us, “[Name] can see the GP, chiropodist, optician and hairdresser. They recently had new glasses.”

The provider did not routinely monitor people’s care and treatment to continuously improve it. They did not ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

When carrying out reviews of care plans the provider did not include people or relatives. The robustness of these reviews needed to be improved as we identified areas where required changes and updates to care plans had not been made. Compliments and complaints about the service were recorded; however, these were not analysed to help drive improvement.

Supervisions and appraisals had taken place but did not demonstrate that staff were provided with an opportunity to discuss any concerns they may have about people’s care or how it could be improved. The provider failed to carry out robust investigations when incidents occurred taking lessons from these to drive improvements for positive outcomes for people. Such lessons could be used to ensure people using the service were safe and received appropriate care and support.

The provider did not tell people about their rights around consent or respect these when delivering care and treatment.

The provider was not compliant with the Mental Capacity Act (MCA) 2005. The provider had not consistently obtained evidence that those making decisions on people’s behalf had the necessary legal authority to do so. This meant the provider could not assure themselves people were being supported in the least restrictive way and decisions were not being made on their behalf inappropriately. Where best interest decisions had been made on people’s behalf, these were not clearly recorded in people’s support plans. Applications for Deprivation of Liberty Safeguards (DoLS) authorisations were also not clearly recorded or monitored. The registered manager did have a list of people for whom they had made referrals for and when they had been approved.

Some staff members we spoke with were unable to tell us which people had DoLS authorisations in place or how to find this information. This was of particular concern as without staff knowing this information it was unclear how they could ensure they were adhering to the specific conditions on these once approved. This placed people at risk of being unlawfully or inappropriately restricted.

We observed staff entering rooms without consistently knocking and waiting to be invited in. Some people told us staff did speak to them prior to providing support. However, 1 person told us staff often walked in their room and started to carry out tasks, such as cleaning without asking them first. Another person told us, “Some staff enter my room without proper acknowledgment or respect, which I find intrusive.”

The provider could only demonstrate that 1 staff member had received training in relation to consent, MCA and DoLS. We found a shortfall in MCA and DoLS training at our last inspection which continued at this assessment. However, another staff member we spoke with could tell us what this legislation and the associated principles meant for people using the service, even though they had not received this training from the provider.