We carried out a review of the data available to us about The Fountains Care Centre on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about The Fountains Care Centre, you can give feedback on this service.
The Fountains Care Centre is a residential care home providing personal and nursing care to 33 people aged 65 and over at the time of the inspection. The service can support up to 62 people.
This is a purpose-built care home over four floors. The kitchen and laundry facilities are located on the basement floor and only staff have access to this area. The ground and first floors were in use at the time of inspection. The second floor was not in use, but the provider was planning to open this as a designated setting service, to accommodate people coming out of hospital who had COVID-19.
People’s experience of using this service and what we found
Systems were in place to protect people from the risk of abuse. Risk assessments had been carried out to identify the risks people faced. These included information about how to mitigate those risks. Steps had been taken to help ensure the physical environment was safe. There were enough staff working at the service to meet people's needs and the provider had robust staff recruitment practices in place. Medicines were managed in a safe way. Infection control and prevention systems were in place. Accidents and incidents were reviewed to see if any lessons could be learnt from them.
Assessments were carried out of people's needs prior to the provision of care to determine if their needs could be met at the service. Staff were supported through training and supervision to gain knowledge and skills to help them in their role. People were supported to eat a balanced diet and were able to choose what they ate. The premises were clean and well maintained. People had access to health care professionals.
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.
People and relatives told us staff were caring and that they treated people with respect. Staff understood how to support people in a way that promoted their privacy, independence and dignity. The service sought to meet people's needs in relation to equality and diversity.
Care plans were in place for people which set out how to meet their needs in a person-centred way. Information was provided to people in a way that was accessible to them. Systems were in place for dealing with complaints, and complaints had been dealt with accordingly. People had been unable to participate in some of their preferred community-based activities due to government restrictions related to COVID-19. However, they had been supported to engage in a variety of in-house activities. People’s end of life care needs were met.
Quality assurance and monitoring systems were in place to help drive improvements at the service. People and staff told us there was an open and positive culture at the service. People were supported to express their views. The provider was aware of their legal obligations, and worked with other agencies to develop best practice and share knowledge.
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 inadequate (published 20 September 2021) and there were multiple breaches of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. 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 16 August 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 in May 2021. The overall rating for the service has changed from Inadequate to Good. This is based on the findings 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.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
The Fountains Care Centre is a residential care home providing personal and nursing care to 46 people at the time of the inspection. The service can support up to 62 people.
People’s experience of using this service and what we found
People were not always supported in a way that was safe. Risk assessments contained inaccurate, out of date and contradictory information, especially in relation to skin care. In some cases, risk assessment were missing altogether, for example, in relation to epilepsy and diabetes, and care was not always provided in line with risk assessments. Medicines were not managed in a safe way. There were gaps in medicines administration recording sheets and guidance was not always available to staff about when to administer PRN (as required) medicines.
There were significant gaps in staff training, in particular, in relation to people’s health care conditions and care planning. We found maintenance issues at the service were not addressed in a timely fashion. People were not always offered a choice of food and records relating to food and fluid intake were not properly maintained. Suitable arrangements were not in place for ensuring people received care that was person-centred. People were not always supported to express their views, for example, in relation to the food they ate.
Quality assurance systems were ineffective and failed to identify shortfalls within the service. Some of the providers stated quality assurance systems had not been used at all, for example in relation to monitoring staff competence and performance. People and relevant others were not regularly consulted about the service, despite senior staff telling us this should have been done. Some staff expressed concerns about the management culture at the service.
Systems were in place for dealing with safeguarding allegations and staff were aware of their responsibility to report any safeguarding concerns. Checks had been carried out on the premises to help ensure safety in relation to fire and other issues. Robust staff recruitment practices were in place. Appropriate arrangements were in place in relation to controlling the spread of Covid-19.
Assessments were carried out of people’s needs before they were admitted to the service. Staff received some training relevant to their roles, along with regular one to one supervision. The provider worked with other agencies to meet people’s health care needs.
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.
People and relatives told us staff were caring and they were treated with respect. People’s needs were met in relation to equality and diversity issues.
Care plans were in place, which for the most part, were of a satisfactory standard. Information was available in a format which was accessible to people. People were supported to take part in various activities. The provider had a complaints procedure, and complaints were dealt with in line with the procedure. Appropriate end of life care arrangements were in place for people.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
The last rating for this service was good (published 14 December 2018).
Why we inspected
The inspection was prompted in part due to concerns received about wound management, hydration, lack of referrals to other health care agencies and ineffective quality assurance systems. A decision was made for us to inspect and examine those risks.
We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, responsive 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.
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 provider has begun to take steps to mitigate the risks we identified. Following the inspection, we received some assurances from the provider that they had started to make improvements to the care and support provided to people. However, the report is written based on our findings and judgements at the time of the inspection.
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 safe care, risk assessments, staff training and knowledge, the premises, food and drink and management of the service at this inspection.
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.
The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.
If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will act in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.
We found the following examples of good practice.
Visitors to the service were admitted safely. Anyone entering the building had their temperature checked and recorded and contact details were kept for track and trace purposes. Signs were prominently displayed at the entrance of the service requesting anyone who enters comply with government guidance about personal protective equipment (PPE). There was ample supply of PPE for visitors and staff to use and also hand sanitiser to reduce risk of bringing Covid-19 into the service. Signage also provided instructions on how to don and doff PPE and to remind people about the risk of Covid-19 transmission.
Staff had been trained on how to use PPE correctly and we noted them wearing it appropriately during both days of inspection. Relatives were not permitted to visit unless visiting in exceptional circumstances, such as visiting people receiving end of life care.
People and staff were tested for Covid-19. The registered manager was hopeful of allowing more visitors depending on the outcome of their next staff and residents Covid-19 testing cycle. The provider also planned to roll out rapid testing kits to support visitors attend the service. These kits would quickly provide results as to whether visitors were Covid-19 positive or not. This meant the service could further lessen the risk of Covid-19 being transmitted to people using the service. People were able to communicate with relatives either by telephone or through video calls. Support was provided to those who tested positive.
People who were new admissions were supported in line with best practice guidance. Staff worked with people living with dementia and used face shields to support people to see their faces to enhance communication and lessen anxiety. The provider had previously contingency managed Covid-19 outbreaks safely. The risk of infection was minimised through robust procedures and enhanced cleaning schedules.
The provider had made adaptations to the building to support people better in isolation and in order to become a designated care setting. A designated care setting is temporary accommodation for people discharged from hospital who have a Covid-19 positive status. We were assured that this service met good infection prevention and control guidelines as a designated care setting.
Further information is in the detailed findings below.
We found the following examples of good practice.
Visitors were received safely. Visitor’s temperatures were checked and recorded upon entry and people’s contact details recorded for track and trace purposes. Signs were displayed in prominent places requesting staff and visitors adhere to government guidance about personal protective equipment (PPE), and to be cautious about the potential to bring Covid-19 into the service. Staff had received training on correct use of PPE and were observed wearing it appropriately during our visit. At the time of the inspection visitors were not allowed due to local Covid-19 restrictions. When visits were facilitated visitors were supplied with appropriate PPE. The provider had previously permitted relatives visit people and had facilitated garden visits with social distancing in place. The provider hoped to restore these visits when deemed safe to do so. People were supported to use video calls to communicate with relatives.
People and staff were tested for Covid-19. The provider supported them should they test positive. The provider was not accepting admissions at the time of our visit but expected to do so in the near future. New admissions would be supported in line with best practice guidance and the provider was able to support people in isolation.
The provider had sourced face shields by which to support people see staff faces when people found difficulty with face coverings, Staff at the service were aware of the impact face coverings could have on communication with people living with dementia.
The provider had contingency planned working with outbreaks of Covid-19. There was an isolation unit for people who tested positive which could be staffed separately from the rest of the care home during outbreaks. There were robust procedures in place to ensure risk of infection were minimised.
Further information is in the detailed findings below
The Fountains Care Centre can accommodate 62 older people with dementia and/or nursing needs. There were 53 people using the service during the inspection.
This inspection took place on 15 November 2018. The inspection was unannounced and was the first one since the service has been registered with the Care Quality Commission (CQC). However, the service was previously registered with CQC under a different legal entity.
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.
The service had safeguarding procedures in place and staff had received training in these. Staff had a good understanding of what constituted abuse and how to report any concerns to keep people safe. Potential risks to people’s health and well-being were identified, reviewed and managed effectively.
There were sufficient numbers of staff available to meet people’s individual needs. Effective recruitment practices were followed to ensure staff employed were suitable to support people.
People received their medicines safely and when they should. There was a comprehensive medicines policy in place.
Staff were supported to maintain and develop their skills through training and development opportunities. There was a training programme in place to address identified training needs.
Staff were aware of the Mental Capacity Act 2005 and had undertaken training to make sure they had knowledge and skills to support people who did not have capacity to make their own decisions. People and their relatives were involved in the assessment and planning of their care and support. People received care and support that was personalised and responsive to their individual needs.
People were supported to eat and drink and maintain a balanced diet based on their needs and preferences. Staff had developed good relationships with people who used the service. They were caring in their approach and had a good understanding of people’s likes, dislikes and preferences. People’s privacy and dignity were respected.
People’s health care needs were monitored and met as referrals were made to the appropriate health care professionals when needed. Staff encouraged people to participate in activities that were meaningful to them.
There were effective management systems to monitor and improve the quality of service provided. The provider sought feedback about the service from people who used the service, their relatives and other health professionals.
The provider had a complaints policy and procedures which included the timescales in which a person would receive a response. The importance of confidentiality was understood and respected by staff.