The Fountains Care Centre

The Fountains Care Centre is a residential care home providing nursing and personal care for up to 45 people. The service supports older people, some of whom are living with dementia. At the time of our inspection there were 35 people using the service.

People’s experience of using this service and what we found

Advice wasn't always sought from a GP or pharmacist when people needed their medicines differently from how it was prescribed. Cleaning wasn't always effective in people's rooms and communal areas. Improvements were needed to staff deployment to promote people receiving consistent support. Staff were recruited safely, were trained and knew how to safeguard people from abuse. The provider supported people to manage their health-related conditions and maintain records.

The provider's systems and processes were not always effective in ensuring infection prevention and control standards and safe medicines management. However, people were treated with dignity and respect, had access to activities and their independence promoted. The provider had systems to receive feedback which enabled continuous improvement.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 20 November 2018).

Why we inspected

We received concerns in relation to people’s safety, infection prevention and control and the leadership and management of the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

The inspection was also prompted in part by notification of a specific incident. Following which a person using the service sustained a serious injury. This incident is potentially subject to an investigation. As a result, this report does not cover the circumstances of the incident.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Fountains Care Centre on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

On the day of our inspection 31 people were living in the home.

At our last inspection on 2 and 3 March 2016 we rated the service ‘good.’ At this inspection we found the evidence continued to support the rating of ‘good’. There was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

People continued to receive a safe service where they were protected from avoidable harm, discrimination and abuse. Risks in relation to people’s daily life had been identified and planned for. There were enough staff, who were safely recruited to ensure people received care when they needed it. People received their medicines as prescribed from staff who were trained to manage medicines in a safe way. There were systems in place to minimise the risk of infections.

People continued to receive an effective service. Staff were trained and supported to understand and provide care that met people’s individual needs. People were supported with their health and nutritional needs and had access to appropriate healthcare services when required. The policies and practices within the home supported people to exercise choice and control in their lives and care was provided in the least restrictive way.

People continued to receive care that promoted their dignity and privacy and respected their individuality. Staff understood what was important to people and provided care in a kind and supportive manner.

People continued to receive a responsive service. Their needs were assessed and planned for and regularly reviewed to ensure they continued to receive the care they required. Staff knew and understood people’s needs well and people and their relatives were consulted about the care they received. The manager was taking action to ensure people and their relatives had access to their written care plans.

There was a complaints procedure in place and action had been taken to address any complaints that had been raised.

There was a new manager in post who had applied to register with the Care Quality Commission (CQC) in a timely manner. The home was well led and the manager encouraged an open and inclusive culture where people could speak out about their views and any concerns they had. Systems were in place to regularly check the quality of the services provided and the manager was taking action to address identified issues.

People living at the home were older people. Some people required more assistance either because of physical illnesses or because they were experiencing memory loss. The home also provides end of life care and care for those with specific nursing needs.

There was a registered manager in post. 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.

CQC is required by law to monitor the operation of the Mental Capacity Act 2005 Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves or others. At the time of our inspection there was one person subject to such an authorisation.

We found that there were sufficient staff to meet the needs of people using the service. The provider had taken into consideration the complex needs of each person to ensure their needs could be met through a 24 hour period.

We found that people’s health care needs were assessed, and care planned and delivered in a consistent way through the use of a care plan. People were involved in the planning of their care and had agreed to the care provided. The information and guidance provided to staff in the care plans was clear. Risks associated with people’s care needs were assessed and plans put in place to minimise risk in order to keep people safe.

People were treated with kindness, compassion and respect. The staff in the home took time to speak with the people they were supporting. We saw many positive interactions and people enjoyed talking to the staff in the home. The staff on duty knew the people they were supporting and the choices they had made about their care and their lives. People were supported to maintain their independence and control over their lives.

People had a choice of meals, snacks and drinks. Meals could be taken in dining rooms, sitting rooms or people’s own bedrooms. Staff encouraged people to eat their meals and gave assistance to those that required it.

The provider used safe systems when new staff were recruited. All new staff completed training before working in the home. The staff were aware of their responsibilities to protect people from harm or abuse. They knew the action to take if they were concerned about the welfare of an individual.

People had been consulted about the development of the home and quality checks had been completed to ensure services met people’s requirements.

Each person had a care plan which had been reviewed on a regular basis. People told us they knew staff kept records on them. One person said, "I was asked whether I agreed to the care plan and I shared this with X (a family member)"

The provider had policies in place to ensure staff knew had to administer medicines safely. The storage areas were clean and tidy and the records we saw were accurate.

People told us if they had to wait for staff to attend to their needs an explanation was given, but this had not compromised their care needs. One person said, "Staff answer my call bell quickly." The provider had a sytem in place to calculate the dependency of each person who lived at the home and to look at how many staff were required to enable those needs to be met.

The people who used the service told us they knew about the complaints procedure, but had not had to use it. One person told us, "Staff are so approachable." Records told us how the provider had dealt with previous complaints and the satisfactory outcomes for each person.

There was sufficient evidence to show the provider was regularly assessing the needs of people who used the service and adjusted staffing levels to suit their current needs.

Staff were pleased with the amount of supervision and training they had received. There was documented evidence to support supervision occurred on a regular basis and staff received training.

The provider had an effective system in place to monitor the quality of the service being provided.

One person told us, "When I want to get up at 7am staff are there for me." Another person told us,"I know I can see my care notes, but staff respect I would rather my family looked at them."

Some people told us that at times their needs were not always met because of shortages of staff. One person told us, "I don't like asking them to come for little things but some days I just cant manage on my own." Another person told us how they sometimes had to wait a long time for their call bell to be answered.

We found that people's care records were evaluated on a regular basis and people told us they knew staff kept notes on them.