Care Home: Fountain House

What the care home does well Relatives who wrote to us said the home does provide the care and support they expect. People are treated well by staff and supported to live fulfilling lives. The health professionals who wrote to us said the home seeks their advice and acts upon this to manage and improve individuals` health care and respects each person`s privacy and dignity. The small group of people we observed being provided with care and support were treated with dignity and respect. Staff communicated with each person effectively, supported them to make choices and decisions and make the best use of their own skills and abilities. There is a person centred approach and each person is treated as an individual. This ensures the people who live in the home are the focus of the care and support provided. The home works very closely with other health care professionals to ensure each individual is provided with the specialist support they require. The home has adaptations and specialist equipment to ensure the care needs of each individual are well met and their welfare and dignity is promoted. The home`s staff team remain committed to supporting each individual to lead a fulfilling life both within the home and within the local community. What has improved since the last inspection? Each person has now been provided with an updated guide to their service. This helps to ensure each person knows what services are provided by the home. Contracts continue to be exchanged between the home and each Funding Authority. This helps to ensure that each individual receives the correct level of care and support they require. The care planning format used in the home has been improved. This provides staff with clearer information to ensure each persons care and support needs are met. What the care home could do better: The Manager must complete the Registration process with us. This would ensure an accountable service is provided to each person who lives at Fountain House. The strategy for improvements within the service should be prioritised and demonstrate that these are effectively planned, are realistic and can be reflected upon. This will help to ensure an improvement in the service provided to each person wholives in the home. Communication between staff members and the morale within the staff team must be improved. This is crucial in ensuring the staff team are effective and provide good quality support to each person who lives in the home. The management team must show clear leadership in the delivery of consistent care for each individual and support for each member of the staff team. This will ensure each individual is provided with safe and consistent care whilst changes within the home are being implemented. The organisational monitoring and support offered to the home must remain high. This will help promote the safety of individuals and support the management team within the home during a time of significant development and change. Staff should be supervised or meet formally on a more regular basis and this process must be effective. This would offer staff improved support and help them contribute to the ongoing improvement of the service. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Fountain House Innox Lane Upper Swainswick Bath Bath & N E Somerset BA2 4QB     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: David Smith     Date: 2 2 0 5 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 35 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 35 Information about the care home Name of care home: Address: Fountain House Innox Lane Upper Swainswick Bath Bath & N E Somerset BA2 4QB 01225858836 01225859809 debbie.mitchell@dimensions-uk.org Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Dimensions (UK) Ltd care home 8 Number of places (if applicable): Under 65 Over 65 0 0 learning disability physical disability Additional conditions: 8 8 The maximum number of service users who can be accommodated is 8 The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories: Learning disability (Code LD) Physical disability (Code PD) Date of last inspection Brief description of the care home Fountain House is a care home operated by Dimensions (UK) Ltd, an independent voluntary organisation, to accommodate up to eight people with multiple profound learning and physical disabilities and additional sensory impairments. People for Places owns the building. The home is situated in a rural location in Upper Swainswick approximately three miles from Bath city centre. The house itself is an extended property offering accommodation on two floors. The first floor is accessible by passenger lift. Care Homes for Adults (18-65 years) Page 4 of 35 Brief description of the care home The home is set in its own grounds and there is an extensive rear garden and patio area offering far reaching views of the surrounding countryside. The patio has been designed to be accessible by wheelchair users. Car parking is available for staff and visitors. The home has its own minibus, which is essential to provide access to local social and community venues. Care Homes for Adults (18-65 years) Page 5 of 35 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The last Key Inspection of this service was completed on 01/06/07. The first day of our inspection was unannounced; we arranged to return for a second day when more of the people who live at Fountain House would be at home and the newly appointed Manager would be available. We spent a total of 14 hours in the home to enable us to complete this Key Inspection. The inspection was carried out by one inspector, but the term we is used in this report. This is because the report, and the judgements within it, are on behalf of the Care Quality Commission (CQC). Care Homes for Adults (18-65 years) Page 6 of 35 The pre-inspection planning involved reviewing the report of the last Key Inspection completed in June 2007 and the Annual Service Review carried out in June 2008. We also looked at the service history, which details all other contact we have had with, or about, this home. We provided a number of surveys for people who live in the home, their relatives, staff members and health professionals to enable us to carry out the last Annual Service Review. We sent new surveys to the individuals who live here, health professionals and staff members as part of this Key Inspection. Staff members have previously completed surveys for the people who live in the home; only one was returned to us this time and, from speaking with staff, it is clear that these surveys are not appropriate for the people who currently live here. The people who live at Fountain House have communication difficulties; staff communicate with each person using clear speech and also by interpreting signs, body language and gestures, but these need to be learned over time. It is not possible for us to ask each person about what life is like in the home. We therefore spent a significant amount of time observing the care being given to a small group of people who live in the home. The care of three people was looked at in depth when comparisons with the observations were made with the homes records and the knowledge of the staff team. We spoke with the Manager and staff members who were working in the home on the days we visited. Four members of staff were spoken to on the telephone, at their request. We spoke with the Area Manager on the second day of our visit. We also viewed all communal areas of the home and all of the bedrooms used by the people who live here. We gathered additional information for this report by looking at a number of records within the home such as individuals care records, risk assessments, accident and incident reports, medication administration, staffing rotas and other staff records and some health and safety procedures. We have described the people who live at Fountain House as people who live in the home, or individuals, rather than service users. Dimensions (UK) Ltd generally uses the term people we support. It is important to note this inspection was carried out during a time of significant change for this service, particularly during the last few months. These are explained in more detail in this report, particularly within the Staffing and Conduct and Management standards. What the care home does well: What has improved since the last inspection? What they could do better: The Manager must complete the Registration process with us. This would ensure an accountable service is provided to each person who lives at Fountain House. The strategy for improvements within the service should be prioritised and demonstrate that these are effectively planned, are realistic and can be reflected upon. This will help to ensure an improvement in the service provided to each person who Care Homes for Adults (18-65 years) Page 8 of 35 lives in the home. Communication between staff members and the morale within the staff team must be improved. This is crucial in ensuring the staff team are effective and provide good quality support to each person who lives in the home. The management team must show clear leadership in the delivery of consistent care for each individual and support for each member of the staff team. This will ensure each individual is provided with safe and consistent care whilst changes within the home are being implemented. The organisational monitoring and support offered to the home must remain high. This will help promote the safety of individuals and support the management team within the home during a time of significant development and change. Staff should be supervised or meet formally on a more regular basis and this process must be effective. This would offer staff improved support and help them contribute to the ongoing improvement of the service. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 35 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 35 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals are given the information they need about the home to enable them to make an informed choice about where to live; some people do have a contract explaining their rights and responsibilities. People are confident the home can support them as their needs are thoroughly assessed before they are given the opportunity to move in. Evidence: The home has a Statement of Purpose, which is updated regularly. Each person now has their own guide to the service; some information within it is slightly out of date, such as referring to the National Care Standards Commission instead of the Care Quality Commission. This should be amended when this is next updated. There have been no new admissions to the home for a number of years and there are no vacancies. However, if a vacancy were to arise, the home has a thorough assessment process which would show whether the home would be suitable for any Care Homes for Adults (18-65 years) Page 11 of 35 Evidence: person interested in living here. The home continues to exchange formal contracts with individuals Funding Authorities: copies are to be kept as part of each persons care plan or guide to their service. It is hoped that formal contracts for each person who lives in the home can continue to be exchanged as part of the annual review process. Care Homes for Adults (18-65 years) Page 12 of 35 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals needs and goals are met and each person has a plan that they, or people close to them, have been involved in making. Each person is supported to make decisions about their lives and to take risks to enable them to live as independently as possible. Evidence: We looked at the care records for three of the people who live in the home. Each person has a detailed plan which describes the care and support they require and how staff should provide it; information is also included about their life history, who the important people in their life are, how they communicate and what daily routines they may have. The care planning system in the home is currently being improved. Due to the complex needs of the people who live here, care plans contain lots of information. The new care Care Homes for Adults (18-65 years) Page 13 of 35 Evidence: planning format is much clearer and still contains all the information staff need to know to enable them to support people in a safe and consistent way. Staff write daily records which gives an overview of each persons day. These are currently written in an individual diary, although this format may change as part of the general improvements being made in care records. Formal reviews are held regularly. The records we looked at show that each person is encouraged to attend their review, together with their relatives, staff from the home and a representative from their Funding Authority. All aspects of their care and support should be discussed at these meetings, although it is not clear if all intimate personal care tasks have been openly discussed in the past. Some of these tasks have now been raised by the new Manager with each persons funding authority, and the people close to them if this is appropriate. Each member of staff we spoke with or who wrote to us said they are always given up to date information about the people they support. They also feel that the way information about the people who live in the home is passed between them works well; this ensures they know of any changes and how to provide support which meets each persons current or changing needs. The people who live at Fountain House have communication difficulties. Staff use a number of methods to ensure people are supported to make choices and that they recognise them. Some individuals communicate through facial expression, body language or gestures or through certain vocal sounds, but these do need to be learned over time. It is therefore very important that each person is supported by a consistent group of staff, who know them well. During our observation of the care and support provided to three people who live at the home we saw staff communicating with people effectively. Staff understand how each person communicates and how they are able to make choices. For example, one member of staff recognised when one person wanted something to eat and another staff member knew when to stop an activity by watching one persons reaction to it. We also saw staff asking individuals if they wished to go on a trip out of the home; staff watched carefully and interpreted peoples reactions. If it was clear they would be happy to go out, they went with staff. If they did not appear happy to go, this was respected and they remained at home with staff. There are several person centred Risk Assessments for each individual who lives in the home, which supports them to take risks as part of their lifestyle. These are now Care Homes for Adults (18-65 years) Page 14 of 35 Evidence: written in a new, improved format and have additional guidelines included. Each of the assessments we looked at is regularly reviewed. Care Homes for Adults (18-65 years) Page 15 of 35 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Each person is treated as a individual and has opportunities and appropriate support to access leisure and educational facilities. Each persons rights are respected. Individuals are able to keep in touch with families and friends. People have healthy, well presented meals which they are involved in choosing. Evidence: The home supports individuals to use facilities within the home and in the wider community. Several people who live in the home continue to attend day centres where they are involved in a variety of sessions including physiotherapy, art, music and communication. Staff continue to support this process by accompanying each person Care Homes for Adults (18-65 years) Page 16 of 35 Evidence: whilst travelling to and from the day centre. The staff team support individuals with activities in the home such as massage, physiotherapy and music. The home has a very well equipped sensory room and another recently developed sensory area; these provide extremely valuable resources for each individual who lives in the home. During our visits individuals were attending their usual day services; other people spent time at home and some chose to go out for the day. During our observation of the care and support provided to three people who live at the home we saw one person spending time in the sensory room and one other being offered a massage, which they appeared to enjoy. Another person was positioned in front of the piano; they could then touch the piano keys without staff support, which they did several times, and appeared to enjoy the sounds they made. The homes staffing rota has been changed; it is hoped this will give individuals more opportunity to access the community. Extra staffing is now generally provided each day to support people who may wish to go out in the evening; this may also help people attend social events in some of the organisations other homes. The staff we spoke with said there are ongoing problems with the new rota and they do not feel some of the trips out in the evening are always appropriate. Staff gave examples of one person going out for the evening after they had been at the day centre for most of the day. Another example was given where one member of staff has been left with five individuals to support, as two other people were out with staff. One staff member said my biggest concern is not giving 1: 1 time. Other comments include the new rota isnt working, the support for people is a little haphazard and doing the bare minimum for people is becoming normal. When asked if the latest staff meeting would help resolve these issues, staff said they are a little more confident than they were before the meeting. One person said we wanted some things to change and another said there are lots of changes but I know we will get there. It is clear from speaking with the Manager and the Area Manager that each of the changes are designed to improve opportunities for each person who lives in the home; giving people more opportunities to go out, letting people have a greater choice over the time they wish to go to bed, experience new things and for the home to feel more a part of the organisation. Both told us they felt the last staff meeting was very constructive, however it may now be a good time to review the amount and pace of changes being introduced. The health professionals who wrote to us said the home supports people to live the life Care Homes for Adults (18-65 years) Page 17 of 35 Evidence: they choose, responds well to their different needs and respects each persons privacy and dignity. If an individual has specific cultural needs, this is known to staff who provide appropriate support. One family do practice a religion and they accept that their relative may not wish to, or be able to, follow their religious beliefs. They have asked for certain food choices to be respected and the staff we spoke with knew of these and told us they are also noted in care records. Individuals are supported to choose and attend holidays, as well as day trips. One persons records we looked at showed they had enjoyed a recent holiday in Somerset, where they were supported by two staff. This enabled staff to provide intensive support to enable this individual to enjoy their holiday as much as possible and allowed staff some time to themselves while they were away. Each person is supported to maintain close links with their family and friends. Visitors to the home are welcome and people can meet with relatives in private if they wish. Relatives continue to have a high regard for the care and support provided at Fountain House. Those who wrote to us said the home always helps their relative keep in touch with them, they are kept up to date with important issues and the home supports their relative to live the life they choose. The home continues to provide a variety of meals and snacks, which are healthy and nutritious. Each person is given a choice but the staff we spoke with said they help people choose or sometimes choose on their behalf. They are confident doing this as each persons likes and dislikes are recorded and they know each person well. Staff support individuals to eat and drink and receive appropriate training to do so. Individuals usually eat their meals in the homes dining room, which overlooks the rear garden. However, each person can choose to eat their meals in other parts of the home, such as on the rear terrace overlooking the garden or in their own room if they wish. A new stock control of food kept in the home has been introduced. Staff said there were problems when this was first introduced, but this system now seems to be working reasonably well. The home does access specialist support from the Dietician in relation to individuals dietary requirements and food supplements and from the Speech and Language Therapist to ensure each person is offered appropriate support in both eating and drinking. This is good practice. Care Homes for Adults (18-65 years) Page 18 of 35 Care Homes for Adults (18-65 years) Page 19 of 35 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive personal support in they way they prefer and their healthcare needs are well met. The home supports each person with their medicines in a safe way. Evidence: Care plans provide clear guidance for staff on how they should support those living at the home with their personal and healthcare. Each person registered with a local G.P., dentist and optician. The health care monitoring is excellent. Each person has separate healthcare notes as part of their care records, which contains details of any contact with healthcare professionals and the outcome of each appointment. Other specialist services are accessed when an identified need arises; these are provided by Bridges Community Learning Disability Team. The records we looked at show the home is regularly supported by Speech and Language Therapists, Occupational Therapists and Consultant Psychiatrists. The home continues to have an extremely close working relationship with Bridges and this provides an extremely Care Homes for Adults (18-65 years) Page 20 of 35 Evidence: valuable resource to assist the home in planning and providing a specialist service for individuals with complex needs. The staff we spoke with or those who wrote to us said each persons care plan contains very detailed information on the care and support they need. Staff said they use each persons records, and also their observations when supporting individuals each day, to alert them to any changes which may cause them concern. Due to the needs of the people who live at the home, staff do spend much of their time providing intimate personal care. People have individual routines and require the use of hoists; some people have sleep systems which require cushions to be placed in certain positions to enable them to sleep comfortably. One member of staff said the staff do appreciate the time it takes with routines and personal care. The health professionals who wrote to us said each persons health care needs are well met and the home seeks their advice and acts upon this to manage and improve individuals health care. One said staff are very aware of each persons needs and offer individual care. The home uses a monitored dosage system of medication administration, which is generally well managed. Each person has their own medicine profile as part of their care records; these give staff clear instructions to follow, such as how and when people prefer to take their medicines and also explain what the medicines are for. Staff support each person to take their medicines; no one self medicates. Staff always make sure people take their medicines and only sign the records when they have done so. Each member of staff who supports individuals with medication is trained to do this in a safe and effective way. If any errors are made, these are recorded and we are informed. We did note that some individuals have been able to reduce the amount of medication they take. This is a positive development and shows the good quality of healthcare support people receive from the staff team. Care Homes for Adults (18-65 years) Page 21 of 35 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. If individuals who live in the home, or people close to them, have concerns about their care they know how to complain; their views would be listened to and acted on. People are safeguarded from abuse, neglect and self harm and the home would take action to follow up any allegations. Evidence: The home has a formal Complaints Policy, a Safeguarding and a Whistle Blowing Policy, which staff can use in confidence to raise any issue or concern they have regarding the service. Each person who lives here has their own copy of the complaints procedure, although they would rely on staff members raising concerns on their behalf. Peoples care records also contain a complaints section which describes behaviours which may indicate that individuals are unhappy or distressed, such as being vocal or making certain facial expressions. Staff learn to recognise these signs and try to help; it is important that all staff recognise and respond to these signs in a consistent way. Relatives and health professionals who wrote to us said they do know who to speak to if they have any concerns regarding the care and support provided at Fountain House; they feel their views would be listened to and taken seriously. There have been no Care Homes for Adults (18-65 years) Page 22 of 35 Evidence: complaints made to the home since our last visit. The staff we spoke with and those who wrote to us are clear about the important role they have to ensure people are happy with their service and remain safe; they know what to do if an individual, family member or a friend is concerned about any aspect of the care and support provided at Fountain House. Staff said they also observe individuals and use their knowledge of them to help determine how people are feeling; they can often recognise when people are unhappy, in pain or feeling unwell as they learn to recognise these signs. Clear records are kept of any accident or incident which happens in the home. We are always informed of any significant event. Care Homes for Adults (18-65 years) Page 23 of 35 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Fountain House provides a homely, comfortable or suitably adapted environment for people to live in. Evidence: Fountain House is a large detached property with accommodation set over two floors. It is situated within its own grounds and has gardens and car parking spaces at the front of the house. It has a very large rear garden, with a patio area, offering far reaching views of the surrounding countryside. The home is in a rural location, in Upper Swainswick, which is approximately three miles from Bath city centre. There is level access on the ground floor to ensure accessibility as each person who lives in the home uses a wheelchair or adapted seating. There is a lift to the first floor, where several bedrooms are located. There are eight single bedrooms, which are all equipped with a wash hand basin. There are two communal lounge areas, a dining room and a sensory room all equipped with ceiling track hoists. The area between the two lounges has been decorated and furnished so it may be used as an additional sensory area. Staff spoken with said this is used regularly and enjoyed by the people who live in the home. Care Homes for Adults (18-65 years) Page 24 of 35 Evidence: There are two adapted bathrooms with toilets, equipped with ceiling track hoists, and three separate toilet facilities. The home also has specialist equipment such as height adjustable baths to ensure dignity and comfort is maintained for each person who lives in the home. We viewed each of the individuals own rooms. These were all clean and tidy, decorated in different colours and styles; each person has many personal items, pictures and photographs, which help to make their room personal to them. All of the communal areas are clean and tidy; however staff spoken with said they do struggle at times to ensure the home is kept clean and tidy. Some areas of the home show signs of wear and tear, such as doors and doorways; this is understandable given the amount of equipment and adapted seating used by the people who live here. Care Homes for Adults (18-65 years) Page 25 of 35 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Each persons needs are met and they are generally provided with safe and appropriate support by a competent and well trained staff team. Thorough checks are carried out on new staff to ensure they are suitable to work in the home. Evidence: Fountain House has a number of well-established staff with varying abilities who are skilled and experienced to meet the needs of those living in the home. There are current vacancies for two full time support workers; two other Support Workers are currently suspended. Their shifts are covered by existing staff working extra hours or by Bank staff working in the home. We spoke with eight members of the staff team during the inspection process. Each staff member confirmed that although they enjoyed working in the home, there had been a number of changes in the last few months. The last Registered Manager has been dismissed and their Deputy is currently suspended under the homes disciplinary policy. A new Manager has been recruited who, with the support of the organisation, is Care Homes for Adults (18-65 years) Page 26 of 35 Evidence: introducing many changes designed to improve practices in the home and the support for people who live at Fountain House. There is a general feeling amongst staff that too many changes are being implemented too quickly; staff said that some are not improving support for individuals. This had led to low morale within the team, staff feeling under pressure, unsure of their current work practice, no longer valued and some considering finding alternative employment. Staff members said they do try to raise their views at both supervision meetings and team meetings. This does not always appear successful; there is a general feeling amongst staff that their views are not listened to or acted upon. Comments from staff include communication is poor, I am not listened to, I am unsettled and frustrated. The changes are not working for individuals, the morale is low as we are not consulted about changes, I was told If I dont like it I know where the door is and I am very wary of what I say, I feel a little bit bullied. All staff recognise that good morale is a key factor in providing good quality support for each person. They appear genuinely committed to improving the service where this is possible but are very concerned that morale is being adversely affected by the pace and number of changes and the poor lines of communication. It is clear the home also suffers from staff shortages times; staff said they no longer pick up extra shifts as they once used to. One staff member said I dont pick up extra shifts now as the atmosphere is so bad and another said I do not pick up any overtime because I am not happy. The staff team continues to meet regularly. During the last staff meeting, which was also attended by the Area Manager, many of these issues were discussed. It appears that this may have helped improve the morale in the team and may have led to some reflection on the changes being made and how these can be best put in place. The home has an effective recruitment process. New staff need to complete an application form, attend a formal interview, provide documents proving their identity and eligibility to work in the UK, at least two satisfactory references and an Enhanced Criminal Record Bureau Disclosure, before they start work in the home. The staff we spoke with and those who wrote to us said all of these checks were carried out before they began working at Fountain House. Relatives who wrote to us said the staff team had the right skills and experience to support each person who lives in the home. Healthcare professionals also said the staff team had the right skills to meet peoples needs and generally the staff worked in a Care Homes for Adults (18-65 years) Page 27 of 35 Evidence: consistent way with each person. One professional said the staff are excellent. Staff are provided with a variety of training opportunities. The records we looked at show that staff have attended the following sessions: first aid, fire safety, food hygiene, how to move and handle people safely, medication administration, risk assessment, epilepsy and safeguarding of vulnerable adults. Each member of staff is provided with supervision; this is a 1:1 meeting with the Manager, although the current Deputy Manager will start to supervise some of the staff team shortly. Each member of staff has a supervision contract, their supervision meetings are recorded and these records are kept within each staff members personnel file. Staff members said that supervisions have become irregular during the last few months; the records we looked at confirmed this. This is perhaps understandable given the changes in the management within the home. The new Manager has supervised each member of staff once and the next supervision meetings are planned. It is hoped these can also be used to discuss the changes being made at Fountain House and improve morale within the staff team. Care Homes for Adults (18-65 years) Page 28 of 35 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is generally well run and each individual benefits from how it is managed. The views of the people who live in the home, or those close them, are sought to help the home review their practice. Each person is safeguarded as the home keeps clear records, staff understand the ways things should be done and health and safety practices are carried out. Evidence: The last Registered Manager was suspended under the homes disciplinary policy for issues not directly related to the people who live at Fountain House; they were subsequently dismissed in December 2008. The Deputy Manager, who was effectively managing the home during the managers suspension, has now also been suspended. A new Manager, Jane Colenso, has now been appointed. She is an experienced manager who has worked for the organisation for some time; she is currently going Care Homes for Adults (18-65 years) Page 29 of 35 Evidence: through the fit persons process with us to become the Registered Manager. She is supported by one Deputy, who is an experienced member of Fountain House staff working in this role while the permanent Deputy is suspended. They are supported by the Area Manager and this is effectively the management team who oversee the home on a day to day basis. The changes within the management team now provide an opportunity to improve some of the practices in the home and also to develop the care, support and opportunities for the people who live at Fountain House. The Manager is passionate and committed to improving the home where possible; it is positive that long standing issues such as staff feeling distanced from the organisation are being addressed as this will improve the service for the people who live here and the support for the staff team. We discussed the development of the home at length with both the Manager and the Area Manager. They listened to the views and concerns raised with us by staff and accepted that there have been many changes in a short period of time; it is clear however that they believe changes and improvements are necessary to enable the home to provide the best possible care and support for each person who lives here. They feel the last staff meeting was helpful and that issues were openly discussed. The Manager said my style is inclusive I have an open door policy. I am self aware and although I took some things on the chin at the staff meeting, things have been very positive since. The team have achieved masses; there is no question about the level of care as the staff are absolutely fantastic. The issues are some areas of practice, but I want to achieve the best for individuals who live here.The Area Manager said the changes are necessary, although how we have put them into practice is a fair point. They said the recent meeting was very positive. The staff we spoke with have found the changes within the management team very stressful at times; it is clear the service has been through a particularly difficult time, especially the last few months. A few staff, although still very concerned with the number and pace of change and the poor communication within the home, do express some support for the new manager. Staff said they wish to be listened to and consulted wherever this is possible. One member of staff summarised these issues by saying we know the individuals very well. Many changes brought in have not been discussed with us, lots of changes at once are very unsettling and lots of staff are insecure. It would be better to slow down and, if the changes are made for good reasons and a person centred approach is used, them maybe some changes are due. Care Homes for Adults (18-65 years) Page 30 of 35 Evidence: The people who live in the home are not able to easily express if they are happy or not or wish for anything to be changed or improved; they rely on staff to ensure they are well supported and remain safe on a day to day basis. Families are always asked their opinion on the quality of care and support provided by the home. Feedback is sought at reviews and through more informal contact, such as when they visit. The management systems and structures are efficient; the record keeping is of a good standard. Files and documentation remain well organised, easy to access and stored securely. Some of the record keeping has been improved since our last visit and some changes are still in the process of being completed, such as care plans. The Area Manager visits the home each month to conduct an audit. They complete a report following their visit, which describes which records they have looked at and who they have spoken with. These are no longer routinely sent to us, although a copy of each report is kept in the home. There are recording systems in place to support health and safety in the home. We examined the fire log, which shows that there is a current Fire Risk Assessment and that regular fire drills are carried out so the staff know what to do if there were a fire. The fire alarm system and fire fighting equipment is tested regularly. Hoisting equipment safety checks have been carried out and the safety of the gas appliances have been checked. They have appropriate insurance cover; the current certificate is displayed in the home. The home has a number of general Risk Assessments to promote the welfare and safety of people who live in or work at the home. These are also in the new format, clearly written and are reviewed regularly. Care Homes for Adults (18-65 years) Page 31 of 35 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 32 of 35 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 37 9 The Manager must complete the Registration process with us. This would ensure an accountable service is provided to each person who lives at Fountain House. 22/08/2009 2 38 12 The strategy for 22/07/2009 improvements within the service should be prioritised and demonstrate that these are effectively planned, are realistic and can be reflected upon. This will help to ensure an improvement in the service provided to each person who lives in the home. 3 38 12 Communication between staff members and the morale within the staff team must be improved. This is crucial in ensuring the staff team are effective and provide good quality 22/07/2009 Care Homes for Adults (18-65 years) Page 33 of 35 support to each person who lives in the home Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 36 Staff should be supervised or meet formally on a more regular basis and this process must be effective. This would offer staff improved support and help them contribute to the ongoing improvement of the service. The management team must show clear leadership in the delivery of consistent care for each individual and support for each member of the staff team. This will ensure each individual is provided with safe and consistent care whilst changes within the home are being implemented. The organisational monitoring and support offered to the home must remain high. This will help promote the safety of individuals and support the management team within the home during a time of significant development and change. 2 38 3 43 Care Homes for Adults (18-65 years) Page 34 of 35 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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