Archived: Uphill Grange Care Home

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

If you would like to see the evidence supporting our summary please read the full report.

Is the service safe?

People were not being cared for in a safe way. We found records of unexplained bruising and incidents relating to physical and verbal abuse. The provider had not taken appropriate action to ensure people were safe and not at risk of poor care and treatment or abuse. We have warned the provider they must take action to meet the requirements of the law and ensure people are safeguarded against the risk of abuse.

We saw the home had a high level of staff vacancies especially relating to registered nurses and carers. The registered manager confirmed that new staff would be in post over the next few weeks. We saw that often carers and nurses from an agency were working on the same shift. We found that not all incidents and accidents had been reported onwards after being reported to the nurse in charge. The use of agency nurses increased the risk of this happening. We saw the home only had one trained nurse who was able to provide care and support with male catheterisation. This meant there were not sufficiently trained staff with the right knowledge and skills to support people. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

We found records relating to food and fluid charts were not accurately recording what people had received. We also found lack of records relating to one person who had episodes of variable agitated behaviour. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

There was no current Deprivation of Liberty application at the time of our inspection. This meant that no-one in the home should had restrictive practice imposed on them. We saw one person at the home have restrictive practice imposed on them. It was unclear why this practice was in place as there was no clear evidence why this was in their best interest. We have warned the provider they must take action to meet the requirements of the law in relation to The Mental Capacity Act 2005 and the Deprivation of Liberty safeguards.

Is the service effective?

We found were people were unable to make decisions in relation to their care and support there was not always an assessment and best interest decision in place as required by The Mental Capacity Act 2005. We have warned the provider they must take action to meet the requirements of the law to ensure there are suitable arrangements in place for obtaining and acting in accordance with peoples consent in relation to care and treatment.

We saw care plans lacked detail and important information was not passed onto managers and other health and social care professionals to ensure peoples care and welfare needs were being met. We have warned the provider they must take action to meet the requirements of the law and ensure care planning is detailed and assessed in relation to people care needs.

Is the service caring?

We saw one member of staff talk with the person in a respectful and supportive manner but we saw two other interactions where staff did not always show a caring and supportive manner towards people. We heard one person say they would like their soup a bit warmer and the carer respond but take no action. We also saw another member of staff get a glass of water for someone but the staff member did not respond or acknowledge the person.

Is the service responsive?

We saw where people's needs had changed the home had failed to show a consistent timely response to these changes and involve appropriate health and social care professionals. Where one person had shown discomfort and distress whilst having their care needs met with saw limited action was being taken by the provider. Action should have been taken to ensure this person was not at risk of care that was inappropriate or unsafe. We have warned the provider they must take action to ensure people have their care needs met in a timely and appropriate manner.

Is the service well-led?

We saw the home had undertaken some audits. We found where audits were in place there was no a clear action plan in place to address any shortfalls. We also found the audits had failed to identify areas of concern found at this inspection. This meant that issues had not been picked up and actioned. We have warned the provider they must ensure there are robust audits in place that identify all areas of concern and that there are clear actions to address those concerns.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, relatives, staff supporting them and from looking at records. If you would like to see the evidence supporting our summary please read the full report.

If the service safe?

People were not being cared for in a safe way. We found that where unexplained injuries had occurred the provider did not take appropriate action to ensure people were safe.

We saw the home sought assistance from medical practitioners when required but there was no evidence to show they made referrals and sought advice from other health and social care professionals as the need arose.

We were told there was a high number of vacancies and that the home was using agency and bank staff. On the day of our inspection there were enough staff on duty to meet the needs of people living at the home.

CQC monitors the operation of Deprivation of Liberty Safeguards which applies to care homes. There were no current applications in place at the time of this inspection.

Is the service effective?

Most people we spoke with were happy with the care that had been delivered. We saw staff supporting people, including people living with dementia, in an appropriate way. We found that care plans lacked detail and important information was not passed onto managers and other health and social care professionals. A compliance action has been sent in relation to this and the provider must tell us how they plan to improve.

We observed one person who remained in a wheelchair all day. We saw that their care plan confirmed they required two hourly repositioning; we did not see this happen on the day of our inspection.

Some people were living with dementia. We saw that the home had undertaken their own mental capacity assessments and best interest decisions but there was no evidence that these decisions had been made with family, carers or other health and social care professionals involvement. A Compliance action has been sent in relation to this and the provider must tell us how they plan to improve.

The service provided support to staff, with supervisions and team meetings.

Is the service caring?

We saw staff were polite and respectful to people. They knocked before entering people's rooms and waited to be invited in. Over lunch staff took their time with people and didn't rush them. We saw some people talking and engaging in a positive manner.

Staff we spoke with told us how they supported and cared for people with dementia. They said, 'I read XXX face, their emotions and body language, sometimes they can be very chatty but not always'. Staff confirmed how they offered choice and supported people to make their choices.

Is the service responsive?

People had access to activities and had the opportunity to choose what they wanted to undertake that week, either in a group or individually.

As people's needs changed the home identified and responded to some of these changes and involved the correct health and social care professional. However we found this practice was inconsistent. Where one person's swallowing had changed there was no evidence to show an appropriate referral had been made before their diet had been modified. A Compliance action has been set in relation to this and the provider must tell us how they plan to improve.

Is the service well-led?

Staff we spoke with told us they found the manager approachable and supportive.

We saw the home had undertaken some audits. Where these audits had identified problems there was a clear action plan in place. We found areas which were not covered by the audits that were in place. This meant that issues had not been picked up and actioned.

We found the home had not reported incidents and accidents through its own system. Notifications and safeguarding referrals were also not being made to the Local Authority or the CQC. A Compliance action has been set in relation to this and the provider must tell us how they plan to improve.

We saw the home had a complaints policy and procedure in place. We reviewed one complaint which showed this policy was not being followed. A Compliance action has been set in relation to this and the provider must tell us how they plan to improve.

Staff offered assistance to people in a discreet and dignified manner and they sought their permission before assistance was offered. People told us 'they never do anything without asking me first' and 'they are very good. They offer to help me with a shower but if I don't feel like one they respect that.'

The people we spoke with were positive about the care and support they received. Comments included 'I can't fault anything. I feel really well cared for here' and 'the staff know me very well. They know what is important to me. I get the care I need just how I want it.' A visitor told us 'the care here is incredible. I can't fault it.' They also told us that their relative had 'improved so much' since being at the home.

The home followed appropriate procedures for the management and administration of medicines. This meant that people received their prescribed medicines when they needed them.

Robust staff recruitment procedures had been followed which meant that risks to people who used the service were minimised.

People using the service were provided with opportunities to express a view on the quality of the service they received.