Fountain Nursing and Care Home Limited

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs.

At our last assessment we rated this key question Good. At this assessment the rating has changed to requires improvement. This meant people’s needs were not always met.

The service was in breach of 1 legal regulation in relation to the lack of consistent person-centred care.

This service scored 46 (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 were at the centre of their care and treatment choices and they did not work in partnership with people, to decide how to respond to any relevant changes in people’s needs.

Records did not always provide staff with detailed guidance about people’s individual needs. The provider did not robustly work in partnership with people and their relatives to decide how to respond to any relevant changes in people’s needs.

Overall, people’s care records lacked detail. For example, where people had expressed particular likes or dislikes, such as dietary preferences, these had not been further explored with them and clearly recorded in their support plans. This meant staff lacked clear guidance to meet people’s individualised wishes. Where people’s known choices had been identified staff failed to consistently consider these. This meant that people did not have their wishes met. Where care plans stated people liked to watch TV, it did not include what they liked to watch. This was of particular concern for people who lacked the ability to communicate such preferences.

The environment had not been adapted to meet the needs of people the provider supported. For example, the environment was not conducive to supporting or promoting the independence of people living with dementia. Signage was poor to help people navigate the service and locate key areas such as lounges and dining rooms. Menus and meal choices were not of a pictorial nature and care plans and other documents were not available in formats to meet people’s needs or preferences.

There were no accessible baths in the service, only showers. This meant that if anyone wished to have a bath, this was not an option. There was no evidence in people’s care plans to demonstrate such conversations had been held in relation to whether they preferred showers or baths. This meant the provider could not be assured they were meeting people’s individual needs and wishes.

The provider failed to operate a robust system involving people and their relatives consistently and routinely in the updating and development of person-centred care plans. We found that changes to people’s needs had not always been reflected in their current care plans or risk assessments. However, relatives told us they received calls from staff if something happened to their loved one.

There were some shortfalls in how the provider understood the diverse health and care needs of people and their local communities, so care was not always joined-up, flexible or supportive of choice and continuity.

People were not supported by the provider to integrate in the community by visiting local shops, cafes or other suitable amenities. The registered manager told us, at times, they had outside entertainers visit the service, but this was not a frequent occurrence and did not include local organisations or groups, in which people may have links or interest. The registered manager told us that none of the people living at Fountain Nursing and Care Home attended any day centres or other community-based activities.

Although we saw that handovers took place between shifts, we could not be assured that when agency nursing staff had been used that they had received a full induction into the service ensuring robust continuity of care. The registered manager was unable to provide assurances and evidence this had been carried out. This was of concern as the care plans and risk assessments were not robust.

Staff had not received specialist or enhanced training in supporting people with complex dementia, including that related to alcohol and drug misuse, which impacted on their ability to take appropriate action when supporting such people when they became distressed. This was also identified by health professionals involved in the service, as being a concern for them.

Relatives told us they felt the service worked with them when they were required to do so, and the same staff supported their loved ones. Rotas also demonstrated there was a stable and consistent staff team.

The provider did not supply appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

Information held electronically was in a written format, and the registered manager acknowledged this was not in a format all people could access. Relatives did not have access to the electronic records, and this had not been explored by the provider.

The provider failed to ensure people’s information was made accessible to meet their individual needs, such as information translated into other relevant languages, braille, pictorial versions, large-print or audio formats. Some staff were of the same ethnicity as people using the service which supported effective communication. However, for 1 person, staff were unable to communicate with them verbally. Other methods of communication, such as the use of online translation applications had not been considered by the provider. This meant the person did not receive information to meet their individual needs and this had the potential to cause isolation and frustration to them when unable to express their needs or wishes. This was compounded further as the person lived with dementia.

We found people’s care records were not secured stored, to prevent unauthorised people from gaining access to their personal information. On all days of our assessment, we found computers operating the provider’s electronic care planning system had been left unlocked and could be accessed by anyone. The provider failed to recognise the risk of potential inappropriate access to people’s personal and private information.

The provider did not always make it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff did not always involve people in decisions about their care or tell them what had changed as a result.

Although the provider sought feedback from people using the service, surveys were not in a format to meet people’s preferred communication methods or their abilities. This meant some people were excluded from providing their views and opinions based upon their abilities to partake in meetings or surveys in the format in which they were presented.

We saw that where ‘residents’ meetings’ took place, these were not inclusive in ensuring all those who lived at the home were encouraged to attend. Where people had shared their views and requested changes during these meetings, we found these had not always been actioned. For example, in August 2024, people had made a request for new garden furniture and a shelter from the sun; however, we found this had not been actioned.

People and relatives we spoke with told us they knew how to raise a complaint and felt overall these would be addressed and appropriate actions taken. However, 1 person told us they had raised concerns with the registered manager, and they were not satisfied with the response they received. The person told us, “The manager is too trusting of staff accounts and lacks awareness of what happens in her absence. I do not feel safe or respected and believe my concerns are often dismissed or undermined.” We found an investigation into allegations raised had taken place. However, this was not robust, and lessons learnt had not been widely shared to help reduce the risk of recurrence.

Where needed, some people had an advocate appointed to ensure their voice was heard.

The provider made sure that people could access the care, support and treatment they needed when they needed it.

People were supported to access healthcare professionals and appointments or with emergency healthcare as needed. This included, dentist, optician, chiropodist, dieticians and other supporting professionals.

There was a GP linked to the service who carried out weekly visits to the service. The nurse on duty was required to prepare a list of people prior to the GP visit of whom they felt needed to be reviewed that week. The GP was reliant on the nursing staff to ensure they referred anyone requiring a check-up or review to prevent any delays in care and treatment. In addition, this included updating the GP on anyone whose health or condition had deteriorated and required further referrals to other health professionals.

Staff and leaders did not always actively listen to information about people who were most likely to experience inequality in experience or outcomes. This meant people’s care was not always tailored in response to this.

The provider and registered manager failed to recognise the inequalities people they supported may face. These inequalities and people’s needs were not always considered. People were not supported to participate in the community and to go out on trips to places of interest. Although some people had advocates to ensure they were not discriminated against, this was not the case for many people who had restricted access to the community and outside areas. People living with dementia or physical disabilities were not actively supported to address and remove barriers ensuring they had equal opportunities to live a full and varied life. Reasonable adjustments within the service had not been considered or made. This included a lack of steps taken to make the garden more accessible and safer for people to use independently and enjoy the outside space.

People were not always supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

At the time of the assessment the provider was not supporting anyone on the end of life pathway, although there were many people who were at different stages of this journey.

Whilst some information had been obtained in relation to people’s end of life wishes, these processes were not robust. We found where people had cultural requirements, these had not been suitably explored and recorded.

Some people living in the service were supported by loved ones and others by advocates. Where people or their relatives were not ready to discuss planning for their future care, this was not clearly documented and there was no robust system in place to ensure this was revisited at suitable intervals.