This inspection took place on 22 and 23 March 2018 and was unannounced.

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

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

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

There was a registered manager employed at the service. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

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

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

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

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

People received enough food and drink to maintain good health and they told us that they liked the food. Staff worked in partnership to provide consistent support when people moved to or from the service, or moved between the two floors of the service. Peop

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

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

The service is run by a registered manager, who was present on the days of the inspection visit. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The registered manager was supported to manage the service by a unit manager on each of the two floors.

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

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

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

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

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

People were

Fountains Lodge Residential and Nursing Care Home was purpose built and opened in February 2015. It is registered to provide accommodation for 74 persons who require nursing or personal care and treatment of disease, disorder or injury. There were 60 people living in the home at at the time of our inspection, 57 of whom lived with dementia. Not all of the people living in the service were able to express themselves verbally and some people preferred not to communicate with us. Some people required nursing care and may also have had sensory loss and mobility difficulties.

This inspection was carried out on 19 August 2015 and 20 August 2015 by two inspectors and an expert by experience. It was an unannounced inspection. The home provides personal care and temporary or permanent accommodation for a maximum of 74 older people living with dementia.

There was a manager in post who was registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC 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.

Staff were trained in how to protect people from abuse and harm. They knew how to recognise signs of abuse and how to raise an alert if they had any concerns. Risk assessments were centred on the needs of the individual. Each risk assessment included clear measures to reduce identified risks and guidance for staff to follow or make sure people were protected from harm.

Accidents and incidents were recorded and monitored to identify how the risks of recurrence could be reduced. There were sufficient staff on duty to meet people’s needs. Staffing levels were calculated and adjusted according to people’s changing needs. There were thorough recruitment procedures in place which included the checking of references.

Medicines were stored, administered, recorded and disposed of safely and correctly. Staff were trained in the safe administration of medicines and kept relevant records that were accurate.

People’s bedrooms were personalised to reflect their individual tastes and personalities.

Staff knew each person well and understood how to meet their support and communication needs. The home was well maintained and suited people’s needs. All areas were accessible to everyone and equipment was in use to aid people’s independence, stimulate their interest and help people find their way around.

Staff had received essential training and were scheduled for refresher courses. New recruits who had not yet received their training were scheduled to train and did not work on their own. Staff had the opportunity to receive further training specific to the needs of the people they supported. All members of care staff received regular one to one supervision sessions and were scheduled for an annual appraisal. This ensured they were supported to work to the expected standards.

The CQC is required by law to monitor the operation of Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Appropriate applications to restrict people’s freedom had been submitted and the least restrictive options were considered as per the Mental Capacity Act 2005 requirements.

Staff sought and obtained people’s consent before they helped them.

The staff provided meals that were in sufficient quantity and met people’s needs and choices. People praised the food they received and they enjoyed their meal times. Staff knew about and provided for people’s dietary preferences and restrictions.

Staff communicated effectively with people, responded to their needs promptly, and treated them with kindness and respect. People told us they were very satisfied about how their care and treatment was delivered.

People were involved in their day to day care. People’s care plans were reviewed with their participation and relatives were invited to attend reviews that were scheduled.

Clear information about the home, the facilities, and how to complain was provided to people and visitors. Menus and the activities programme were provided for people in a suitable format which made them easy to read.

People were able to spend private time in quiet areas when they chose to. People’s privacy was respected and people were assisted in a way that respected their dignity.

People were promptly referred to health care professionals when needed. Personal records included people’s individual plans of care, life history, likes and dislikes and preferred activities. The staff promoted people’s independence and encouraged people to do as much as possible for themselves.

People’s individual assessments and care plans were reviewed monthly with their participation and updated when their needs changed. People were at the heart of the service.

People were involved in the planning of activities that responded to their individual needs. A broad range of activities was available that included innovative and creative ways to keep people occupied and stimulated. The planning of activities took account of latest research on dementia care. Varied outings were available and attention was paid to individual social and psychological needs.

People’s feedback was actively sought, encouraged and acted on. A relative told us, “My mother is getting outstanding care in this home; the staff took the time to really get to know her and meet her needs.”

Staff told us they felt valued and inspired by the registered manager to provide a high quality service. The registered manager was open and transparent in their approach. Emphasis was placed on continuous improvement of the service. The registered manager told us, “We want to deliver outstanding care and are working every day towards that goal.” From what people and the staff told us and from our observations, the staff took action to make sure these principles were followed in practice. Relatives described the staff as, “Exceptional people”, and “Absolutely marvellous.”

Relatives described the management of the service as “Truly excellent, very well-led by a management team who have great insight in dementia.” They said, “This service is extremely well managed.” Staff from local authority who oversaw people’s care in the service told us, “This service is managed by a team who understand the needs of people with dementia and who select the right staff.” The registered manager kept up to date with any changes in legislation that might affect the service and carried out comprehensive audits to identify how the service could improve. They acted on the results of these audits and made necessary changes to improve the quality of the service and care.

The evidence provided by families, our observations and by speaking with staff show there are many very positive aspects to the care people receive at Fountains Lodge which have been developed in less than a year since the home opened. The registered manager and staff are clearly providing a service people have a right to expect and which enhances their lives and meets each of their particular needs. Although much of our evidence shows that some aspects of people’s care is outstanding we will be able to see at our next inspection, and by what people tell us, if this is sustained consistently over a period of time.