Fountain Lodge Care Home Limited

Fountain Lodge Care Home is a residential care home providing accommodation for persons who require nursing or personal care and treatment of disease, disorder or injury . The service provides support to older and younger adults with a range of needs including people who have physical disabilities, dementia or support with their mental health. Fountain Lodge accommodates up to 30 people in one adapted building. At the time of our inspection there were 26 people living at the service.

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

People received safe care and support because systems for assessing and managing risk were robust and staff knew how to safeguard people. Care plans included up to date and comprehensive individual risk assessments which gave staff the information they needed to maintain people's safety. Clear processes were in place to prevent and control infection within the home. The provider had been proactive in following government and local guidance in relation to managing the COVID-19 pandemic. Systems for recruitment of new staff were safe. Staffing was well organised and was appropriate to the needs of people using the service.

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 . Staff received the training and support they needed to care for and support people safely and effectively. People's nutritional needs and preferences were assessed, and plans put in place to make sure they were met.

Staff were kind and caring. There was good interaction between staff and people who live at the home. There was evidence of people's and relatives' involvement in the care planning. Reviews were undertaken regularly. People's dignity and privacy was respected.

The provider assessed peoples' needs before they began to use the service and regular reviews took place to make sure care plans reflected people's current needs. People were supported by a range of health and social care professionals to maintain their overall health and wellbeing.

Changes in management systems had been effective in improving quality assurance systems. Analysis of accidents and incidents enabled the provider to learn lessons from previous events and implement positive change.

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

Rating at last inspection and update

The last rating for this service was Requires Improvement (published 28 July 2021) and there were breaches of regulation. The provider completed an initial action plan after the last inspection to show what they would do and by when to improve. The provider then sent us monthly updates about what actions had been taken. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since 28 July 2021. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

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.

Fountain Lodge Care Home Limited is a residential care home providing personal and nursing care to up to 30 older people and younger adults with a range of care needs including physical disability, sensory impairment, mental health needs and dementia. At the time of the inspection there were 24 people living at the home.

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

This is the fifth consecutive inspection where the provider has failed to achieve the minimum expected rating of good.

The provider had failed to take action to meet regulatory requirements and to improve the service people received. We found there continued to be a lack of effective governance, provider and management oversight at the home to ensure a safe and quality service.

People were supported by staff who had received training about how to recognise and report signs of abuse or neglect however not all incidents of potential abuse had been referred to local safeguarding teams for further investigation. The registered manager had not taken fulfilled their regulatory responsibilities to notify us of these incidents.

Quality assurance checks in place were not robust and did not consistently drive improvement within the service. Improvements had been made to improve the home’s environment and areas had been redecorated.

Risk assessments for people included information about how to mitigate the risks they identified however we found some care records contained conflicting information.

There were enough staff to support people safely and staff knew about people well. There was a robust recruitment procedure which prevented unsuitable staff from working with vulnerable adults.

People received their medicines as prescribed. Medicines were ordered, stored, administered and disposed of safely. Good infection control processes were followed.

People had been supported to maintain communication and see their family members during the COVID-19 restrictions.

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

Rating at last inspection and update

The last rating for this service was Requires Improvement (published 29 May 2019) and there were multiple breaches of regulation. This service has been rated Requires Improvement for the last six consecutive inspections.

Following our last inspection, we imposed a condition on the providers registration which required them to provide us with an action plan stating how they were going to make the necessary improvements. At this inspection we found some improvement had been made but this was insufficient, and the provider remained in breach of regulations.

The last rating for this service was requires improvement (published 18 May 2019). The service remains rated requires improvement. This service has been rated requires improvement for the last six consecutive inspections.

Why we inspected

We received concerns in relation to the safety of people living at the home. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

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

The overall rating for the service has remained Requires Improvement. This is based on the findings at 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 see what action we have asked the provider to take at the end of this full report.

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to protecting people from abuse, good governance and failing to notifying us of certain incidents.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Fountain Lodge Care home is a care home providing personal and nursing care to a maximum of 30 adults. Some of those people lived with dementia, had learning disabilities, mental health conditions, physical disabilities, sensory impairments and substance misuse problems. At the time of our inspection 27 people lived at the home.

We found the following examples of good practice

¿ A ‘visitor code’ was in place. The code detailed the responsibilities and safe practice requirements of visitors during the pandemic.

¿ On arrival visitors completed a Covid - 19 health screening questionnaire. Their temperature was recorded, and they were provided with personal protective equipment including disposable gloves, aprons and masks to protect people.

¿ The provider had purchased tablet computers to help people stay in touch with their families and friends during lockdown.

Fountain Lodge Care Home is registered to provide personal care to older people including people living with dementia. Fountain Lodge Care Home is a nursing home, which provides care for up to 30 people across two floors. At the time of our inspection there were 28 people living at Fountain Lodge Care Home. People had their own bedroom and four bedrooms were allocated for shared use, although only one of these rooms was occupied with two people. All bedrooms had a basin, but no toilet or shower facilities. People had the use of shared communal lounges, a dining room, toilets and bathrooms on each floor. To aid people’s movement around the home, a passenger lift, stair lift and stairs helped people move between floors.

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

At our last inspection we rated the service Requires Improvement overall, and in each key area. We found risks associated with people’s care were not always managed safely and certain medicines were not being given as prescribed. This meant there was a breach of the Health and Social Care Regulations for safe care and treatment. The provider sent us an action plan telling us how they would improve the quality of care people received. We completed this inspection visit to check improvements had been made.

At this inspection visit we continued to find risks to people were not effectively managed and the breach continued. People with a diagnosis of epilepsy, diabetes or people who were known to display behaviours that challenged as a result of their mental ill health, did not have associated risks assessments to match their complexity of need. This put people at potential risk, because there was no consistent approach or records to tell staff, how to consistently manage those associated drinks.

The service had a registered manager. 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.

People received consistent care from staff who they found were kind, caring and patient. Our observations during this inspection, were mostly of positive and friendly interactions between staff and people. There was limited engagement for people who spent time in their own bedrooms due to their health condition. Staff did not always treat people with dignity and respect because they did not always ask for people’s permission to enter their bedroom. When we needed to speak with staff confidentially, they wanted us to go into a person’s unoccupied room without the person’s permission which was not acceptable. At lunchtime, staff assisted some people to eat their meal but there was limited conversation with the person and staff did not maintain people’s dignity when they spilt food on them.

Staff had a good understanding of abuse and the safeguarding procedures that should be followed to report abuse and incidents of concern.

People’s care plans provided information about the person’s preferences and included some knowledge staff had gained about the persons interests and life history. Care records were reviewed and evaluated to ensure they remained up to date. However, some care plans for people who had been at the home a short period of time, required more specific information about people’s health and emotional needs to ensure staff provided safe and consistent care. People’s needs changed over time and staff were kept informed. Staff felt communication of people’s needs was good.

A process was in place which ensured people could raise any complaints or concerns.

The provider had systems to monitor the quality of the service. During our visit, the registered manager had taken action to make some improvements and was committed to drive improvements. There were examples of completed audits and checks that gave the provider confidence people received a safe, responsive and effective service. However, some of these audits had not identified the issues we found.

Training records showed staff training was provided and refreshed when needed. Staff were equipped with the skills and knowledge to look after those in their care.

Staff worked within the principles of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). Staff for the majority of time, sought people’s consent before any care and support or choices were provided but there was inconsistency in staff practice, especially for people who had limited or no communication.

People received support from nursing staff and other health care professionals. People were registered with a GP practice who visited people when needed. If people required other healthcare support in an emergency, staff were available 24 hours a day to seek that help or medical intervention.

People received their medicines safely by trained staff and regular checks on administration and storage ensured medicines were given safely. However, improvements were required for specific medicines to ensure they continued to be given as prescribed.

The environment did not compliment good dementia care. There was limited signage to help people easily navigate different areas of the home. Each person’s bedroom had a number but no name or personal possessions to indicate whose room it was. Rooms, corridors and communal areas were similarly decorated so it was not obvious which part of the home people were in. Some people’s private room and communal bathroom areas required updating in terms of décor and in some cases, posed a potential infection control risk, coupled with a lack of liquid gel, soap or paper towels. Storage of linen goods had potential to cause an infection control risks and environmental risks such as poor quality flooring and unsafe window restrictors, meant people were exposed to unnecessary risk.

Changes in the management of the home and the staff team in the last seven months meant some of those changes needed to become embedded within the care practices of the home to become more successful. Some staff practice continued not to promote the values and principles the registered manager expected. Since the registered managers appointment in June 2018 they had made some positive changes and knew people’s needs well. People were complimentary of the registered manager. It was clear the registered manager wanted to drive improvements and for them and their staff team to deliver good care outcomes for people.

This inspection took place on Wednesday 6 September and was unannounced. At this inspection the service continued to be rated as requiring improvement. However, the provider had recently made changes in their senior management structure and this had started to improve the quality of the service provided.

Fountain Lodge is a nursing home which provides care and support to people who require nursing care in their old age, and who require support to live with dementia. The home can support a maximum of 30 people. On the day of our visit 26 people lived at the home and one was in hospital.

The home had a registered manager until recently. 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 left the service in May 2017 and submitted an application to cancel their registration. The current acting manager will be applying to register with the CQC.

The acting manager and new regional manager were open and transparent about the service and the improvements required.

Medicines were mostly managed safely, but we were concerned that one person's pain was not managed well. This was responded to on the day of our inspection visit.

Risks to people's health and well-being had been identified, but the actions taken by staff to reduce the risks related to one person were not in the person’s best interest as intended. Staff monitored those who were at risk of malnutrition or dehydration, but monitoring systems were not effective.

There were enough staff to meet people's needs, but the use of agency staff meant people did not always get support from staff who knew them or their needs well. The provider was recruiting new staff and their own ’bank’ staff, to make sure people were familiar with the staff who cared for them.

We received mixed opinions about the quality and choices of food available.

Not all staff had received the training the provider considered essential to meet people’s health and safety needs. The home provides specialist dementia care and staff had not received specialist dementia training. The acting manager was putting training in place to ensure staff had the skills and knowledge to support people effectively.

People told us most staff were kind and caring, and treated them with respect and dignity. Staff interaction with people was mostly when undertaking tasks as they did not have time to engage with people at other times. Sometimes some staff did not fully understand written or spoken English.

The provider understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty safeguards. People told us they were asked if they consented to care tasks being undertaken most of the time.

The provider had systems in place to ensure the premises were safe for people to live in, and the equipment was safe to use. The gardens were not safe or accessible for people to use.

The provider employed an activity worker who supported activities in the home on Mondays to Fridays. There were limited activities from external organisations.

The provider's recruitment practice mostly reduced the risks of employing people unsuitable to provide care. Staff received training to safeguard people however this was not always put into practice.

Relatives and friends were welcomed at the home at any time during the day or evening.

We found one breach 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. We have also asked the provider to send us an action plan informing us of how they will continue to improve the service.

During our last inspection on 24 March 2015, we found the provider was not fully meeting the standards required. This meant we allocated an overall rating of “Requires Improvement”. During this inspection we found there continued to be areas needing improvement.

There was a new registered manager in post who registered with us in September 2016, shortly prior to our inspection. 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 not available during our visit due to being on leave.

People told us they felt safe living at the home. The provider carried out a range of recruitment checks but records were not always clear to show staff employed were safe and suitable to work with people. We found some improvements were required to how risks were managed to ensure the ongoing safety of people in the home. This included risks associated with the use of specialist equipment. There were also some areas of risk in relation to medicine management that required improvement.

There were sufficient numbers of staff employed to meet people’s needs. Staff completed training on an ongoing basis to help them develop their skills and competence to carry out their role safely and effectively. However, there were some gaps in staff training that needed to be addressed.

Staff had some understanding of the Mental Capacity Act. The manager had ensured applications to the supervisory body (the local authority) had been made where restrictions had been placed on people’s care amounting to a deprivation of their liberty.

People said they had enough to eat and drink and there were meal choices provided each day. Where people were at risk of poor health, due to not eating or drinking enough, there were processes to monitor their food and fluid intake to help ensure their nutritional needs were met.

Visitors were made to feel welcome at the home at any time to help people maintain relationships with people important to them. There were minimal social activities provided to support people’s hobbies and interests. The atmosphere in the home was quiet and relaxed with staff interactions usually only when there were care tasks to be completed. However, individual staff members were caring towards people and we saw that staff were mindful of protecting people’s privacy and dignity.

Each person had a care plan which contained the information staff needed to meet people’s care needs. These were being reviewed to ensure they provided staff with more detailed information about people’s needs and preferences to help deliver more person centred care.

There were systems to monitor the quality of the service and drive improvement within the home but these were not consistently effective to ensure people received safe, effective care that was responsive to their needs.

Staff understood their roles and were supported by the registered manager through one to one supervision meetings and staff meetings. People and staff told us the registered manager was approachable.

We also visited the service to follow up on concerns we identified during our last visit about the management of medicines. We issued the service with a compliance action.

The service sent us an action plan for both areas of concern which set out what they were going to do to ensure they complied with the regulations.

During this visit we looked at the areas we had judged as non compliant. We were satisfied the service had acted quickly to improve cleanliness and infection control, and to improve its medication management. We also noted the providers had redecorated many parts of the home and people told us they liked the changes made to their environment.

We spoke with four people living at Fountain Lodge Care Home. They also told us they were happy with the cleanliness, and the support given by staff. One person told us, "Staff are marvellous, they couldn't be better." Another told us, "We're being well looked after."

We found people were treated well and their dignity and privacy was respected. We observed good and open interaction between people living in the home and staff who cared for them.

We looked at the care and welfare of people living at Fountain Lodge. Records demonstrated that people's care and treatment needs were being effectively and safely managed.

We checked medication management. We were satisfied that day to day management of medicines was safe. We had concerns that a medical device used for one person living at the home had not been used appropriately. Some supporting medication documentation was not in place.

We looked at the cleanliness of Fountain Lodge and infection control procedures. We were not satisfied that the levels of cleanliness and infection control measures kept people safe. We served a warning notice for non compliance in this area.

We checked the safety of equipment in the home. We were satisfied there were satisfactory systems in place to ensure that equipment used by people was safe. Some of the furniture in the home, whilst safe, was worn and in poor condition.

We checked staffing levels and were satisfied there was sufficient staffing to meet the needs of people living at Fountain Lodge.

We saw staff were friendly and approachable and people felt at ease to approach them. We observed people watching television in the lounge or listening to music in the dining room.

We saw that people had care plans in place detailing their care needs. These contained instructions to staff on what support they needed to provide. Records did not detail how people liked to spend their day. There was also limited information to show that people or their families were involved in their care.

People and visitors knew how to make a complaint if they needed to. They told us: 'If we have a concern he (manager) will sort it out, he seems genuinely interested.' 'Although there is the odd issue, it is generally dealt with.'

During our tour of the home we found no unpleasant odours other than in sluice areas. We identified some actions were required in regards to the management of laundry and cleaning of carpets to ensure infection control was suitably managed.