Archived: The Fountains Nursing Home

The Fountains Care Home is owned by Liberty Healthcare Solutions Ltd. The home is situated in large grounds overlooking Victoria Park and is close to Swinton town centre in Salford. The home provides both residential and nursing care for up to 98 people who require personal care for both physical and mental health related illnesses. The home is registered with CQC (Care Quality Commission) to provide care for up to 98 people.

There are four units at the home, known internally as Parkview (Residential Dementia), Garden Rooms (General Residential), Victoria Suite (General Nursing) and The Lowry (Dementia Nursing). At the time of the inspection there were 92 people living at the home, across the four units.

Our last comprehensive inspection of The Fountains Nursing Home was in May 2016 where the home was rated as Requires Improvement overall and for the key questions Safe and Well-led. The key questions for Effective, Caring and Responsive were rated as ‘Good’. At that inspection we identified breaches of regulations 12 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, with regards to safe care and treatment and staffing. The home also didn’t have a registered manager in post meaning that the Well-led key question could only be rated as Requires Improvement.

At this inspection, the home had 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.

At our previous inspection in May 2016, we identified a concern with the safe storage of the supplement thick and easy which is a prescribed medication given to people who may have difficulties swallowing. This was still an issue at this inspection, as was the storage of topical creams which were kept in people’s bedrooms with no risk assessment in place. This presented the risk of people consuming these medicines unsafely, if they did not understand the risks it could present. One person in particular had a risk assessment in their care plan relating to the unsafe consumption of certain liquids.

We looked at how other prescribed medicines were handled. We noted some gaps in signatures from staff when medication had been give which was on the Lowry Unit.

We reviewed building safety and maintenance checks. The electrical installation check was due in April 2017, however the work had not been undertaken at the time of our inspection. The provider made arrangements for this to be completed by early September 2017.

We found there were enough staff to care for people safely. Staffing levels had been increased on both Victoria and Lowry units which had been an area of concern brought up at our last inspection.

We found the home to be clean with appropriate infection control processes in place, with the home achieving a score of 97% during the most recent audit from Salford City Council in August 2017. All of the toilets and bathrooms contained appropriate hand hygiene equipment and guidance, with personal protective equipment (PPE) readily available and worn by all staff when necessary.

Both people living at the home, visiting friends and relatives told us they had no concerns about safety at the home. Staff demonstrated an understanding of safeguarding procedures and how to keep people safe.

The home was working within the requirements of the MCA (Mental Capacity Act). DoLS (Deprivation of Liberty Safeguards) applications were made where people were deemed to lack capacity to make their own choices and decisions about their care.

Staff were complimentary about the training provided by the home, regarding both induction and on-going refresher sessions. An online system was available which allowed staff to complete training in their own time. Practical training was also available in subjects such as moving and handling.

Staff confirmed they received supervision as part of their on-going development. We looked at a sample of these records during the inspection and found they were completed with good detail about the discussions that had taken place. Although annual appraisals had not yet taken place, the registered manager provided us with a schedule of when these would be undertaken.

We found appropriate action was taken when people were deemed to be at risk of losing weight, with referrals made to the dietician service as required. Specialised diets such as soft and pureed were provided where people had been assessed as being at risk of aspiration.

People received the support they needed to eat and drink from staff at meal times. People were also supported to eat their meals in their bedroom if they were unable to do this themselves, with staff allowing people to take their time to eat and drink.

The people we spoke with and their families told us a good standard of care was provided at The Fountains, across each of the four units of the home. People said they felt treated with dignity, respect and that staff promoted their independence as necessary.

We identified issues with record keeping and found contradicting information in people’s care plans. This presented the risk of both regular and agency staff, not having access to up to date information about people’s care needs.

The home employed several activity coordinators, who planned and oversaw the activities completed within the home. During the inspection we observed a number of one to one activities taking place such as reminiscence sessions and discussing past experiences with people from earlier in their life.

There were systems in place to seek and act on feedback from people living at the home such as satisfaction surveys, staff/residents meetings and a complaints procedure. The home maintained a record of compliments in addition, where people had expressed their satisfaction with the service provided.

The home had a range of systems and procedures in place to monitor the quality and effectiveness of the service. However we found the homes internal quality assurance systems had not been fully effective. For example, where there were discrepancies in care plans, where record keeping was poor and where creams and the supplement thick and easy was not stored safely. The electrical installation check of the home had also not yet been completed, despite being due in April 2017.

We last inspected The Fountains Nursing Home in October 2015 which was given the rating of ‘Requires Improvement’ overall and in each of the five key questions against which we inspected against. These included Safe, Effective, Caring, Responsive and Well-led. During this inspection we identified several breaches of regulations with regards to Safe Care and Treatment, Good Governance and Staffing. We issued a Warning Notice due to concerns about staffing levels.

The Fountains Nursing Home is in Swinton, Salford and is owned by Liberty Healthcare. It provides residential and nursing care, as well as care for people living with Dementia. The home provides single occupancy rooms with en-suite facilities and is registered with the Care Quality Commission (CQC) to provide care for up to 98 people.

There are four units at the home, known internally as Parkview (Residential Dementia), Garden Rooms (General Residential), Victoria Suite (General Nursing) and The Lowry (Dementia Nursing). At the time of the inspection there were 86 people living at the home, across the four units.

People who used the service told us they felt safe. We looked to see how the service sought to protect people from abuse and found there were appropriate safeguarding and whistleblowing policies and procedures in place. All the staff we spoke with demonstrated they had a good understanding of the types of abuse and the procedure to follow if they suspected that a person was at risk.

At the previous inspection, we had concerns about staffing levels at the home. At this inspection we still had concerns about night time staffing numbers on the Lowry unit, mainly in relation to how staff monitored people who were up early in the morning. We saw the unit was staffed by a nurse and two care assistants during the night. The manager said there should be a staff presence in the lounge at all times, however we observed this was not the case during the inspection. We observed one of the people in the lounge during this period had been involved in a high number of altercations and incidents when we looked at incident records. This could place people at risk.

We looked at how medication was handled on each of the four units at the home. Overall we found medication was given to people safely, however we found there was no guidance available for staff about when or where to apply creams. This would be important due to agency staff working at the home. We also found that the home had not sought GP’s authorisation for the use of a specific homely remedy for people living at the home. We raised these issues with the home manager.

We checked to see that the environment was safe for people living at the home. At the last inspection sluice room doors were left unlocked which posed a risk to people. At this inspection on two occasions on the Lowry unit, we saw the food supplement ‘thick and easy’ was left unattended on the trolley whilst the drinks round was in progress. This was in an area where people were mobile. We also saw the kitchen door in the Lowry unit was left unlocked on one occasion, an area where there was a hot water dispenser. Staff on the unit said this door should be locked. This could present the risk of people scalding themselves. We also raised these issues with the home manager.

We saw people had risk assessments in their care plans. We saw these were regularly updated and covered areas such as mobility, nutrition and pressure care managements. This provided staff with clear guidance about how to mitigate any potential risks to people.

We noted there was a strong smell of urine on the Lowry Unit, throughout the course of the day. Staff said this was because certain people often urinated in corridor areas as they walked around the unit. The environment was also still in need of updating in areas where carpets were stained and worn, as well as skirting boards which were scratched and damaged. We were told improvement to the environment were on going and that this work was being scheduled.

Staff told us they had enough training available to them and felt supported to undertake their roles effectively. We saw staff had completed training in areas such as safeguarding, moving and handling and health and safety. At the last inspection we saw staff hadn’t completed training related to DoLS and behaviours that challenged. We saw staff still hadn’t completed training in this area during this inspection. The manager said she had prioritised getting all mandatory training up to date first and that this would be scheduled following the inspection.

We saw improvements had been made to make the environment more ‘dementia friendly’, particularly on the Lowry Unit, which was one of two dementia units at the home. We saw themed corridors had been introduced along with pictures of famous actors, the queen, sporting memorabilia, famous singers and sensory objects people could touch. This would help people to become more familiar with the environment they lived in.

People living at the home told us they received enough to eat and drink. We observed the meal time experience on three of the four units at the home to establish how people’s nutritional needs were met. We saw people had their own nutrition care plans and risk assessments available, which detailed any information staff needed to be aware of.

The service worked within the legal requirements of the Mental Capacity Act (2005) (MCA) and Deprivation of Liberty Safeguards (DoLS). Staff demonstrated a good working knowledge of capacity issues and DoLS.

People told us they felt staff were caring, as did relatives we spoke with. We saw staff displayed a good understanding of people’s needs and treated people with dignity and respect.

Care and support plans contained person-centred information which detailed people’s likes, dislikes, personal preferences and life and social history. We saw the home had even gone to the extent of sourcing different photographs of people from earlier in their lives and stored these with individual life history records. The manager said she aimed to introduce these across all care plans.

There was a complaints policy & associated procedure and information about how to make a complaint was available. There was also a comments and suggestions box located in the reception of the home.

The home had a manager, although they were not yet registered with the Care Quality Commission. 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.

The manager had introduced a number of audits and quality assurance checks within the service. These covered areas such as medication, care plans, weekly weights, pressure areas, bedrails and continence. The manager also closely monitored any incidents that occurred. This was an area we felt had improved since the last inspection.

Staff said they felt the home was well-led and had seen improvements and changes since our last inspection.

We saw staff had regular opportunities to voice their opinion and raise concerns. We saw meeting minutes were available from team meetings that had taken place.

We looked at how people were able to provide consent to their care and we found there were appropriate systems in place. One person told us; 'Staff have talked to me about the kind of care I want and need in the past'.

We looked at how the home ordered, stored, administered and disposed of people's medication and we found this had been done safely and effectively. One person told us; 'Staff also take care of my medication. Sometimes it's a bit late. One night it was 10-30pm when it arrived but that's ok I don't mind'.

As part of our inspection we also looked at how staff were supported. There was an induction programme in place and staff told us they felt well supported to carry out their work. In addition, the quality of service was monitored by regular auditing, unit meetings, residents meetings and the learning from accidents and incidents.

Feedback from people using the service was positive. One person told us, 'I'm comfortable here', 'The staff are able to meet my needs without a doubt'. Another person using the service told us,' I like to spend a lot of time in my bedroom', 'The staff come in regularly to check that I'm ok and have everything I need' and 'They respond straight away to the buzzer' and 'I like living here, I feel so much safer'.

We looked at eight care plans and found that they to be person centred and in conjunction with peoples needs. We saw that peoples preferences in relation to how they wanted their care delivered had been recorded. Risk Assessments were in place along with prevention measures.