This inspection took place on 30 May and 1,4 June 2018. The first day was unannounced, however we informed staff we would be returning for a second and third day to complete the inspection and announced this in advance.

The Fountains Nursing Home is owned by SPV4 Limited . The home is situated in large grounds overlooking Victoria Park and is close to Swinton town centre. 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 consists of four units, known internally as Victoria (General Nursing), Lowry (Nursing Dementia), Garden Rooms (General Residential) and Park View (Residential Dementia). At the time of the inspection there were 89 people living at the home.

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

This was the first inspection we had carried out at The Fountains Nursing Home, since the provider, SPV4 Limited purchased the home and registered with CQC in October 2017.

During this inspection we identified breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 with regards to person centred care, safe care and treatment, safeguarding people from abuse and improper treatment, good governance and staffing. We have also made a recommendation regarding responding to information received in satisfaction surveys. You can see what action we have asked the home to take at the end of this report.

People living at the home did not always receive their medication safely. We found two instances (one on Park View and one on Garden Rooms) where staff had signed on the medication administration record (MAR) that medicines had been given, however the medication was still in the blister pack. Drink thickening supplements such as thick and easy were not stored securely and were accessible in cupboards on Park View unit and could place people at risk of harm.

People were placed at risk of skin break down because equipment such as pressure relieving mattresses were not at the correct settings. This was predominantly on Victoria unit.

We noted several environmental risks, again on Victoria unit, which could place people at risk. These included sluice room doors being left unlocked with keys in the door, meaning cleaning products could be accessed and place people at risk of harm. Areas of concern identified during the last fire risk assessment were not being acted on and we observed fire doors being held open with a drinks trolley and wedged with people’s slippers. This meant the door would not close properly in the event of a fire. Corridors on Victoria unit were cluttered with hoists and wheelchairs and could affect people’s exit in an emergency situation.

People living at the home said they felt safe and staff had a good understanding about how to safeguard people from abuse. We were informed about one incident where a member of staff had reported concerns to the manager about how another member of staff had behaved towards a person living at the home, as they felt this was being done in a threatening manner. This had not been reported as a safeguarding incident to the local authority. This was subsequently sent following our inspection.

We found there were not enough staff deployed to effectively meet people’s needs on Park View Unit, particularly at meal times. We observed staff were unable to assist people with tasks such as mobilising around the unit due to supporting people who needed full support to eat and drink.

We looked at the safety and suitability of the premises. A refurbishment plan was in progress at the time of our inspection and we observed several of the units had new carpets, chairs and window frames. The Lowry unit was still in need of refurbishm