Archived: Fountain View

This inspection was carried out on 15 and 16 July 2015 and was unannounced.

Fountain View provides accommodation and personal care for up to six people who have learning disabilities. At the time of our inspection six people were using the service.

Fountain does not have a registered manager in post. The registered manager was moved to another service a few weeks prior to the inspection. The deputy manager left the service a week before the inspection. At the time of our inspection an acting manager from another service was in managerial charge of the home. 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.

Risks were not always accurately and appropriately assessed. Risk assessments were in place for each person on an individual basis. However, there was an overuse of risk assessment and risk management planning that could be seen as restrictive, in some cases, whilst in others, risk assessments did not reflect all the known and assessed risks.

Restrictive practice was evident within the home. For example the kitchen had a coded door entry, as did the laundry. The fridge was in a cupboard with a lock and there was an alarm on doors at the top of the stairs which staff had to continually deactivate. People’s rooms were locked but not everyone had a key to their room. There were no risk assessments around these restrictions. The physical intervention book contained evidence that restraint had been used inappropriately on occasions.

There were enough staff on duty to meet people’s needs. Disclosure and Barring (DBS) checks were carried out before anyone could be recruited. However, we found that full employment histories had not been obtained. This meant that the provider could not be assured that staff recruited were suitable employees as they had not obtained a full employment history prior to recruitment.

Staff had received safeguarding training and were able to describe sources and signs of abuse and potential harm. They also knew how to report abuse.

Medicines were administered safely by staff who had been trained to do so. Staff had received medication training and had their competency to administer medicines checked. Medicines were stored safely in a locked cabinet.

People were asked for consent before care and support was provided. Staff told us they asked for consent before providing personal care and would do this in a way which people understood. Where people lacked capacity to make specific decisions, the provider should have acted in accordance with the principles of the Mental Capacity Act 2005 (MCA). We found that although staff had received training in the MCA and were able describe the principles, the principles of the MCA were not being followed within the home.

The Care Quality Commission (CQC) monitors the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. These safeguards protect the rights of people using services by ensuring that if there are any restrictions to their freedom and liberty, these have been agreed by the local authority as being required to protect the person from harm. We found that applications had been made without due regard to mental capacity. We also found there were deprivations within the home which were not the subject of DoLS applications such as locked doors.

Staff had received appropriate training to deliver the care and support for people living in the home. Records showed that training covered all essential areas such as medication, food hygiene and fire safety. There was also training about positive behaviour support and specialist training.

People were offered a choice of nutritional food. People were not aware of the menu for the day, without having to ask, because the menus were not displayed on a noticeboard in an accessible way. People were offered some choice of food at mealtimes. Staff told us that drinks and snacks were available whenever people asked for them. People were unable to help themselves to drinks and snacks as the kitchen was kept locked.

Health professionals were appropriately involved in people’s care. Records showed that health needs were met. One person received monthly health checks. Comprehensive health logs were kept within people’s care plans, including appointments such as dental appointments. Psychologists were involved in people’s care.

Staff were supportive and caring and treated people with high regard. Staff showed that they understood people well, describing individuals progress at the home.

People were encouraged to make decisions about their care and these were evident on a daily basis with people choosing when they got up, what they ate and what they did. They were involved in decisions about their medicines and had signed their medicine support plans.

The atmosphere in the home was caring. We observed people were supported in a positive, caring way. Staff communicated well with people and role modelled behaviour reinforcing support recorded in support plans. Staff were seen laughing and joking with people in a positive way. People were seen to be looking after each other as if they were a family. People who were more able looked after those who were less able.

People’s views about their care were sought through regular one to one meetings with their keyworker.

Privacy and dignity was respected. We observed staff knocking on people’s doors before they entered. One person told us he would like to be more independent, but this was not supported in the home.

Some support plans were well written, clearly demonstrating how they met people’s needs, whilst others lacked detail in relation to content and accuracy. Although the support plans lacked information, staff demonstrated that they knew people and were able to meet their needs.

Relatives and people told us they knew how to complain. There was not a clear reporting line for staff to raise concerns at the time of the inspection.

There was a positive culture in the home, even though there was no registered manager at the time of the inspection and the deputy had recently left at short notice. During this period of transition the provider had appointed an interim manager from another home. The interim manager was extremely knowledgeable about systems and processes and inspired confidence.

Records showed that several incidents should have been reported to CQC as a potential safeguarding but were not. For example threats to self-harm, allegations of abuse against staff, behaviour which put other people using the service at risk and choking.

There were systems in place to enable the service to deliver high quality care. Audits included health and safety weekly checks, infection control, expert (peer) audits and provider monitoring visits.

During our inspection we found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we asked the provider to take at the back of the full version of the report.