Fountains Lodge Care Home

Fountains Lodge Care Home is a residential care home with nursing for 74 older people and younger adults who have physical adaptive needs or who live with dementia. It can also accommodate people who have sensory adaptive needs.

At the time of this inspection there were 65 people were living in the service.

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

People's experience of using the service:

People and their relatives were positive about the service. A person said, “I’m quite settled here now. I have my own room and the staff are fine with me.” Another person said, “I’ve no complaints as this place has lived up to what I expected.” A relative said, "I’m very happy knowing my family member lives In Fountains Lodge because quite simply she couldn’t get better and we’re lucky to have such a good service so local to us.”

People were safeguarded from the risk of abuse.

People received safe care and treatment in line with national guidance from nurses and care staff who had the knowledge and skills they needed.

There were enough nurses and care staff on duty and safe recruitment practices were in place.

People were supported to use medicines safely.

Lessons had been learned when things had gone wrong.

Good standards of hygiene were maintained to prevent and control the risk of infection.

People had been helped to receive medical attention when necessary.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

The accommodation was well maintained and provided people with a comfortable setting in which to receive care.

Nurses and care staff were courteous and polite.

People’s privacy was respected and confidential information was handled in the right way.

People received person-centred care including having information presented to them in an accessible way.

People were supported to pursue their hobbies and interests.

There were robust arrangements to manage complaints.

People were treated with compassion at the end of their lives so they had a pain-free death.

Quality checks were completed to ensure the service was running in the right way.

People had been consulted about the development of the service.

Good team work was promoted and regulatory requirements had been met.

Why we inspected:

This was a planned inspection based on the previous rating.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit in line with our re-inspection programme. If any concerning information is received we may inspect sooner.

Fountains Lodge is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Fountains Lodge Care Home is a purpose built detached building with the accommodation spread over two floors. Fountains Lodge Care Home is a dementia residential and a dementia nursing home. The ground floor provides support to people who require residential dementia care and the first floor provides support for people with nursing dementia care.

At our last inspection in June 2017, the service was rated Inadequate and placed in special measures. We asked the provider to take action and they sent us an action plan. The provider wrote to us to say what they would do to meet legal requirements in relation to the breaches we found. We undertook this inspection to check that they had followed their plan and to confirm that they now met legal requirements. At this inspection we found that all the breaches of regulation we previously found in relation to risks, medicines, safeguarding, quality monitoring, dignity and respect, and staff training and supervision had all been met and the service is no longer in special measures.

There was a registered manager employed at the service. 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.

Quality monitoring systems had been improved and implemented effectively so that shortfalls were being identified and acted upon. However, there were several vacancies in the service and we will need to be able to evidence that improvements can be sustained over time, and if and when the service admits new people. We have made a recommendation about this in our report.

People were being kept safe from abuse. Staff understood their responsibilities in keeping people safe from abuse and had been trained. Staff knew how to report any possible concerns. People were supported safely around risks and were encouraged to take positive risks after control measures were applied. Environmental risks were managed safely and there were protections in place in relation to possible hazards such as fire. Staffing levels met people's needs and people told us that they could find staff to help them when they needed to and we observed staff were not rushed when helping people.

People received their medicines safely and when they needed them by staff trained to administer them. Medicines were stored and managed safely. The risk from infection was reduced by effective assessments and cleaning rotas and the housekeeping team kept the home clean. When things went wrong the service had learned from these and had shared that learning with staff.

People had received an holistic assessment of their needs and their needs were tracked though care plans to ensure effective outcomes were achieved. Staff had the necessary skills and competencies to support people and had been trained in key areas such as moving and handling, food safety as well as in additional areas that met people’s needs, such as dementia training. Some staff supervisions recorded in 2017 were not of a high quality and although these had improved in 2018 we want to see this improvement sustained to ensure staff are supported adequately. We have made a recommendation about this in our report.

People received enough food and drink to maintain good health and they told us that they liked the food. Staff worked in partnership to provide consistent support when people moved to or from the service, or moved between the two floors of the service. People had access to healthcare professionals and were supported to maintain good health. Staff responded in a timely way when people were unwell and medical guidance was followed correctly.

The premises were suitable to meet people’s needs and there had been changes made to the environment to meet the needs of people living with dementia. People were supported to have maximum choice and control of their lives. Staff supported people in the least restrictive way possible; the policies and systems in the service supported this practice. The principles of the Mental Capacity Act were being complied with and any restrictions were assessed to ensure they were lawful, and the least restrictive option.

Staff treated people with kindness and compassion. Staff knew people’s needs well and people told us they liked and valued their staff. People and their relatives were consulted around their care and support and their views were acted upon. People’s dignity and privacy was respected and upheld and staff encouraged people to be as independent as safely possible.

There was a complaints policy and form, available to people. Staff were open to any complaints and understood that responding to people’s concerns was a part of good care. People received a pain free and dignified death at the end of their lives. Staff supported people with compassion and worked with local hospice teams. People were supported in a personalised way that reflected their individual needs. However, some people’s care plan documentation was not written in a way they could understand. We have made a recommendation about this in our report.

There was an open and inclusive culture that was implemented by the management team. People and staff spoke of a friendly and homely culture that was empowering. People, their families and staff members were engaged in the running of the service. There was a culture of learning from best practice, and working with other professionals and local health providers to ensure partnership working resulted in good outcomes for people.

The inspection took place on 23, 24, 25, 26, 27 June 2017 and was unannounced.

Fountains Lodge Care Home is registered to provide accommodation for up to 74 people who require nursing or personal care support. There were 71 people living at the service at the time of the inspection, some people were living with dementia. Fountains Lodge Care Home is a purpose built detached building with the accommodation spread over two floors. Fountains Lodge Care Home is a dementia residential and a dementia nursing home. The ground floor provides support to people who require residential dementia care and the first floor provides support for people with nursing dementia care.

The service is run by a registered manager, who was present on the days of the inspection visit. 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 registered manager was supported to manage the service by a unit manager on each of the two floors.

The management of the two floors, or units, was not the same. People’s experience of care was different depending on which unit they lived on. People on the ground floor unit received a good standard of care. However, people living on the first floor, especially those with more complex needs did not receive consistently safe, effective and compassionate care. Some people and relatives spoke positively about the service, but not everyone was happy about the care they received.

People were not always kept safe. When people had accidents these were not always recorded and looked into. When concerns about possible abuse or harm had been recorded the registered manager had dealt with them appropriately. However, not all concerns were recorded so no action was taken. Some people had unexplained bruising, which was not investigated. One person was restricted from moving around the service by staff, often being told to remain seated when they tried to stand and walk around. These restrictions had not been assessed as necessary and had not been agreed to.

Risks to people were not always managed safely and staff did not always follow the guidance in place to reduce risks. For example, some people were at risk of developing pressure sores. They were not always supported to use pressure relieving equipment and other people were not given the nutrition and drinks they needed to help their skin stay healthy. People were referred to health professionals when required, although this was not always completed promptly for everyone. Guidance from healthcare professionals was not always recorded in people’s care plans or followed by staff. One person’s wound was not dressed as required, resulting in them picking at the wound, which could increase the risk of infection.

People’s medicines were managed safely, but there was not always guidance about when to give ‘as and when required’ medicines used to reduce people’s anxiety or to help them sleep. There was a risk people were being given these medicines unnecessarily or may not be given the medicine when they needed it. Risks to the environment were assessed and managed.

There were enough staff to keep people safe but they did not always have the skills and support needed to meet people’s needs. Staff completed training including dementia awareness; however, further training was required for staff to fully understand and support the needs of people living with dementia. Staff did not always receive supervision in line with the provider’s policy and staff had not received annual appraisals. The support given to staff varied between the two units. Some managers offered staff mentoring and role modelling, but this was not consistent across the whole service. Staff were recruited safely.

People were asked to give consent when possible and staff had some understanding of the Mental Capacity Act. However, assessments about capacity in people’s care plans were not always clear. We have made a recommendation about this.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS). The registered manager had applied for DoLS authorisations because some people were restricted or were constantly supervised. One person was restricted from standing and moving around and this had not been assessed as being in people’s best interests or the least restrictive option.

Staff did not always treat people with dignity or respect their wishes about how they preferred to be supported. Some people had specified what was important to them about their appearance and this had not been followed by staff. The language used by some staff to describe people was not always respectful. Some people went for long periods of time without any interaction or engagement from staff and activities were limited for people cared for in bed or for people with more complex needs. People and their relatives told us staff were kind and people could have visitors whenever they wanted. People told us the food was good and they had a variety of options. The chef aware of people’s individual requirements.

Some people’s support was based on staff availability rather than their individual needs. People were not all supported to use the bathroom regularly and were left to rely on the use of incontinence pads. Some people’s care plans gave staff details about their needs and preferences but others contained less detail and needed updating. Clear and up to date care plans were important as the service was suing a high level of temporary staff from an agency.

There was a complaints policy in place, however, one complaint was not recorded and people told us they did not always feel their complaints had been resolved. We have made recommendations in relation to activities and the management of complaints.

The management of the two floors was not consistent and this had a direct impact on the quality of the care and support people received. Audits had raised some areas of concern which had not been appropriately addressed and other concerns found at this inspection had not been identified. Systems to review documentation had not been effective in identifying inaccurate or out of date information in people’s care plans. People were asked for their views about improving the service and these had been acted on, including improving the garden. Some staff told us they were reluctant to air their views as they did not feel listened to.

Services that provide health and social care to people are required to inform the Care Quality Commission, (CQC), of important events that happen in the service. The registered manager had submitted notifications in a timely manner.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.You can see what action we told the provider to take at the back of the full version of the report.

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.