Archived: The Fountains Nursing Home

Updated 5 October 2017

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

The inspection took place on 15 and 17 August 2017. The first day of our inspection was unannounced, however we informed the registered manager and provider we would be returning for a second day to complete the inspection and announced this in advance.

The inspection team consisted of two adult social care inspectors from the Care Quality Commission (CQC) and two experts by experience. An expert by experience is a person who has experience of caring for someone similar to the people who used this type of service.

Before commencing the inspection we looked at any information we held about the service. This included any notifications that had been received, any complaints, whistleblowing or safeguarding information sent to CQC and the local authority. We also contacted other healthcare professionals involved with the service such as the local Safeguarding, Infection Control and Environmental Health teams based at Salford City Council. We also contacted the local Clinical Commissioning Group (CCG) and Salford Healthwatch. The feedback we received was used to inform our inspection judgements.

We had also asked the provider to complete a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and when we made the judgements in this report.

During the course of the inspection we spoke to the registered manager, two of the providers, the clinical lead, 13 care staff including nurses, eight people who lived at the home, two visiting healthcare professionals and 16 visiting friends/relatives.

Updated 5 October 2017

We carried out this unannounced inspection of The Fountains Nursing Home on 15 and 17 August 2017.

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.