Dimensions Fountain House Innox Lane

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• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

In this key question we looked at 4 quality statements. We looked at how people were supported to transition into other healthcare services, recruitment and training for staff, people’s management of risks, and how medicines were managed. Staff were recruited safely, and there were enough staff to ensure people’s safety and meet their needs. However, we found a breach of the legal regulation in relation to governance. We found people’s care and support records did not always contain clear and accurate information, and found information about people’s needs was not always consistently recorded.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

Relatives told us that people were supported to access health care professionals when required. Comments included: “They ring for the doctor or arrange dental appointments as [person] requires. If [person] is unwell or they think something is not right they are quick to call the doctor.” We observed a member of staff taking clothes, medicines, and personal care equipment to the hospital so a person would have access to the items they needed whilst they stayed in hospital.

Staff told us they work closely with external professionals. One staff told us: “We have specific people such as physiotherapists, doctors, and the speech and language team. [We contact healthcare professionals] for guidance in sleep positioning to avoid bed sores, and foam material is on the bed rails to protect [people’s] feet and legs/arms/hands from injury or harm, eating consistency levels to reduce the risk of choking. We speak with doctors for guidance on the safe administration of medications.” One staff member explained how they recently took a person to the accident and emergency department and stayed with the person at the hospital. This meant the person had consistent support and were accompanied by staff who knew the person well.

We received positive feedback from a healthcare professional working closely with the service. They told us: “The service works well with us. We are in contact with some of the clients in Fountain House on a weekly [basis] at minimum. If there are any issues, then the staff at Fountain House are quick to contact us to come and review. Occasionally, they can be over cautious with some of their contact with us, but this is something we’d rather than a lack of contact.”

People had hospital passports in place, which were detailed in some areas. However, we found one person’s hospital passport did not include clear information about their medical condition. We found there was no information on how this condition should be managed, if any intervention was required by hospital staff, and if there were any information the hospital staff should be aware of in order to manage this person’s condition safely. We also found information was not always consistent with what was recorded in people’s care and support plans. One person was recorded to be ‘nil by mouth’ however this person’s care plan stated the person could eat some foods for pleasure. During our site visit we observed this person being given a hot drink.

We did not look at Safeguarding during this assessment. The score for this quality statement is based on the previous rating for Safe.

Relatives told us they were involved in risk management and care planning. Comments included: “They send me all the information for [person’s] care reviews. I go to the meetings if I can, but they keep me informed. I think the last time it was all changed was after [person’s] hospital stay and the SALT team were also involved, and it was all written down in the report.” Another relative told us: “[Person] does have a care plan that is reviewed annually. I can’t always attend but they always invite me and send copies of the paperwork. Generally, they are with her all the time, so they know her well.”

Staff felt people’s risks were managed well. One staff member told us: “We are very aware of people’s needs as far as epilepsy goes, we recognise when a person will have a seizure, because you are working with people all the time. You would see if a person required support with a pressure area, we’d use creams, maybe need to use district nurse team. We have had that a few occasions, where the district nurses prescribe a plan.” Another staff told us: “I think people's risks are managed well and the risk assessments are updated regularly. On the spot risk assessments are being made as we go through each day and adaptations or safety measures are put into place immediately. For example, foam tubes are being placed on the hoists to avoid any injury to someone.

We observed staff supporting people appropriately with modified textured food to reduce the risk of choking. We observed another member of staff checking someone’s temperature as feeling too hot was known to trigger this person’s seizures.

People had risk assessments in place, and these were detailed in some areas. However, the information recorded in people’s risk assessments did not always contain clear information on how to mitigate these risks. For example, we found one person was at risk of dehydration, however there was no information recorded on how this risk would be managed. Additionally, we found people’s care and support plans did not always contain clear information to support staff to manage people’s risks. For example, one person was supported with enteral nutrition. The person’s care and support plan stated they were able to eat some foods for pleasure and that staff were required to follow the person’s Speech and Language therapy (SALT) guidelines. However, there was no information recorded about what type of food the person could safely eat orally, how frequently the person could eat orally, and the texture of food the person required to manage this safely, as recommended by the SALT guidelines. We raised this with the manager during feedback, however the manager did not provide us with assurances that this would be amended.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

Relatives told us there were enough staff at the service to support people safely and to support people to do things they enjoyed. Comments included: “I think there are enough staff because person goes out often… I think there is enough staff for [person’s] needs, they call often, and we have time to chat, and they tell me where they have been.”

Staff told us training met people’s needs well. One staff member told us: “We have a big list of training, in house and extra training. We have training in epilepsy, midazolam, hoisting, a lot of people have outside qualifications too.” Another staff member told us: “I feel that the training we receive is adequate and service specific. We have a mixture of online training which refreshes our knowledge and understanding and also classroom based training for more practical training such as CPR. We have specialised training such as giving medication and feed through a gastric tube.” The staff member also told us there are a high number of agency staff working within the service but felt agency staff were provided with information required to support people safely.

We observed there were enough staff to support people safely. Staff appeared to know people well, however some people did not receive the same level of interaction from staff and at times people were supported in a way that was not in line with their care and support plans. For example, we observed one person who was being spoken to in a different language and was being played music in a different language. There was no evidence in this person’s care plan this was their first language. Additionally, this person was deaf and blind, and their care plan highlighted the need for physical touch and smell. The staff member supporting this person did not utilise this, and the person was calling out. We later observed this person being supported by a different staff member who utilised touch by stroking this person’s hair and forehead. The person appeared to enjoy this and stopped calling out. We observed one person was spoken to and engaged with multiple times by staff. This person appeared to have a good relationship with staff and enjoyed these interactions, however another person received very little interaction in the same time period. We observed some members of staff did not always actively interact and engage with people, but would sit and observe. Other members of staff actively engaged with people; people appeared to enjoy these interactions.

Staff were recruited safely and had completed training. However, at the time of our site visit, there was one person who used an adapted form of Makaton, a form of sign language aimed for people with learning disabilities. We found there was no training for staff in this language programme, meaning staff may not have understood what this person was trying to communicate. We raised this with the manager, who explained they were trying to explore this and work on staff’s understanding of Makaton.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

People’s medicines were seen to be given in a safe and caring way. People’s preferences and individual circumstances were considered, in the manner and timing they liked to take their medicines, if it was safe to do so. General Practitioners (GP's) visited people at the home, due to difficulties getting the residents to the GP surgery. People’s health and conditions were reviewed by a GP annually, in addition to an annual medication review by the practice pharmacist. People's relatives had no concerns with the way their relative's medicines were managed. One relative told us: "[Person] does have medication but I don’t know what it is now. I know the staff manage all this for him and there hasn’t been any difficulties. Sometimes he can be difficult about things if he is having an off day, but staff manage it all well so it doesn’t cause any problems.”

Staff we spoke to told us they managed the administration of people’s medicines well, with two members of staff being present with each administration, including people requiring nebulised medications. Staff told us they received medicines training online during their induction, followed by shadowing and a period of supervised assessments before being signed off. Staff told us they had regular competency assessments. Staff we spoke with were knowledgeable about people’s needs and their medicines.

Mental capacity assessments (MCA’s) and best interest forms relating to people’s medicines were present for 5 people; and 3 were waiting on completed documentation from the local council. One person who has epilepsy, did not have their rescue medication evidenced on their medication administration record (MAR) chart, although this was prescribed and available. Incidents and errors were recorded on an online system. MAR charts were generally well completed, however there were instances where current MAR charts differed to the labelling instructions on the original packaging. There was one instance of a different strength of medication, that was stated on the MAR chart. We found this was not identified in the services medication audit from February 2024, which checked that all medication administration records were accurate and up to date. On a number of occasions, risk assessments were lacking in regard to creams and emollients containing paraffin. Some medicines ‘when required’ (PRN) protocols were either missing or no longer in date. Medicines were administered in a timely manner and recorded on people’s MAR charts. Both room and fridge temperatures were monitored, and there were suitable arrangements for storage, and disposal of medicines. Medicines policies and procedures were in place to support staff. The process for ordering medicines was streamlined and known by staff.