Upton Dene Residential and Nursing Home

Upton Dene 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.

Upton Dene residential and nursing home provides a range of support options including residential care, dementia care, nursing care, palliative care and respite care. The service has 74 bedrooms all with ensuite facilities. At the time of our inspection there were 59 people living at the service.

The service had a manager who was applying to become registered with us. 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 manager was present during the days of our visit.

We previously carried out an unannounced comprehensive inspection of this service on 15 February 2017. At that inspection we rated the service as requires improvement as we identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Following the last inspection, we asked the registered provider to complete an action plan to show what they would do and by when to improve the key questions of safe and well-led to at least good.

On this visit, we found the two breaches identified at our last visit had been addressed.

We found the ordering system for medications had been improved and was made more robust. This meant that people always received their prescribed medicines and that there were sufficient stocks of medication available for people. PRN care plans were in place to enable staff to identify when PRN medication such as pain relief medication should be offered and administered.

This visit found that medication audits were more robust and if any issues where identified; immediate action was taken to address these. This meant that medication systems were more robust and in turn people could be sure that they would receive their medication. A clinical lead had been employed by the service since our last visit in February 2017. As part of this person’s role, pressure mattresses were checked to ensure that they reflected the weight of individuals in order to promote their skin integrity. Records outlined that checks were made frequently and our checks confirmed that pressure mattresses were at the appropriate setting.

Medication management was now robust. Medication was appropriately stored with people receiving their medication when they needed it. Staff had received training in medication awareness and had had their competency checked.

Staff were aware of the types of abuse that could occur. Systems were in place for the reporting of allegations and staff were aware of who they could contact to raise any concerns,

Risk assessments were in place for individuals. These related to risks from health or other conditions they may have had as well as form the environment. These were up to date and checked regularly. Personal evacuation plans were in place for each person. These considered the support people needed if an evacuation of the building had to be made in an emergency.

The premises were clean and hygienic. Equipment used such as portable hoists had been serviced and were fit for purpose. Portable appliance, fire detection and firefighting equipment had been serviced.

Recruitment of new staff was robust. Appropriate checks had been made to ensure that people who came to work at Upton Dene were suitable to support vulnerable people.

Accidents and incidents were recorded. These in turn were analysed to ensure that future prevention or re-occurrence could be minimised.

The registered provider had acted in respect of the breaches we had identified during our last inspection. A plan of action and remedial steps had been devised to ensure that any issues were addressed.

The nutritional needs of people were met. We have made a recommendation about the delivery of meals at lunchtime.

People had the risk of being malnourished assessed with appropriate action taken. People’s weights were monitored in line with recommendations from risk assessments. People were referred to appropriate health professionals when dietary or other health issues had been identified.

Staff received the training and supervision they required. The registered provider was operating within the principles of the Mental Capacity Act 2005.

The design of the building offered people with internal and external communal space available. The decoration and signage included within the building assisted those who were living with dementia.

Staff interactions with people were patient and kind. People told us that they felt that their privacy was respected and that they were treated in a dignified manner.

People were given the information they needed. This was either done verbally or in a pictorial format as determined by their communication needs.

Assessments used by the registered provider identified the main health and social needs of people who used the service. These were then translated into a care plan which in all cases were person centred and evaluated regularly.

A structured programme of activities was in place. Practice ensured that people’s preferred level of activities, for example, in groups or on a one to one basis, were met.

A robust complaints procedure was in place. Complaints made were investigated promptly. The manager had sought to adopt a proactive approach to dealing with complaints by canvassing the views of people and acting before a formal complaint was made,

The manager maintained a presence within the building and was knowledgeable about the needs of people. The manager was seen as supportive and approachable by the staff team.

A series of effective audits were in place covering medication, care planning and environmental issues. The registered provider also had systems in place to comment on the quality of care within the service.

The views of people who used the service and their families were gained and acted upon.

The registered provider always informed CQC of significant events and displayed their current rating in line with legal requirements.

Upton Dene residential and nursing home provides a range of support options including residential care, dementia care, nursing care, palliative care and respite care. The service has 74 bedrooms all with ensuite facilities. At the time of our inspection there were fifty three people living at the service.

The service does not currently have a registered manager. 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 service had a manager in place who has recently applied to the Care Quality Commission to become the registered manager.

At the last comprehensive inspection on the 14 and 15 September 2016 we identified a breach of regulations 12 and 17 of the Health and social care Act 2008 (Regulated Activities) 2014 and found that a number of improvements were required at the service. The management of medicines at the service was not safe. The registered provider did not effectively use systems and processes in place to assess, monitor and improve the quality and safety of care. People were at risk of receiving care and support that was not suited to their needs as care plans did not contain personalised, up to date and accurate information. The registered provider was issued with a warning notice for Regulation 12. We asked the registered provider to take action to address these areas.

After the inspection, the registered provider wrote to us to say what they would do to meet legal requirements in relation to the breaches identified. They informed us they would meet all the relevant legal requirements by 30 November 2016. This inspection found that improvements had been made at the service, however we found a continued breach of Regulation 17 of the Health and social care act. You can see what action we have told the registered provider to take at the back of the full version of this report.

Records relating to the management of medicines were not always accurately maintained. Information relating to the administration, application and ordering of medicines was not consistently recorded in a timely manner. PRN care plans were not in place for six people living at the service on the first day of our inspection. Action was taken by the registered provider by the second day of our inspection to minimise and prevent any further potential risks to people supported.

Quality assurance audits completed by the registered provider in relation to medicines management had highlighted some of the issues we raised. However, we found that these were not always completed in full detail to outline the actions that had been taken in response to issues raised by the management team. Audits in relation to pressure relieving equipment had not been completed in line with the registered managers own timescales.

Care records had improved since the last inspection. An assessment of people’s needs was carried out and appropriate care plans were developed. Care plans detailed people’s preferences with regards to how they wished their care and support to be provided. Staff updated these in a timely way and in partnership with other professionals to ensure continuity of care. Risk assessments were in place and described the support people required and how best to support them at times of increased risk.

Staff were supported in their roles and responsibilities and provided with relevant training. They were inducted into their roles and underwent refresher training as required in a range of topics. One to one supervisions had been arranged to commence from April 2017 with the new manager. This would provide staff with an opportunity to discuss matters relating to their work and any training and development needs.

Health and safety checks had been carried out and equipment serviced. The service was clean and tidy and the manager and maintenance staff carried out regular checks of the environment to ensure it was safe. There was a fire risk assessment in place and checks of the fire safety equipment had been carried out. Staff had received training in fire prevention and safety.

People told us they felt safe at Upton Dene and family members said they had no safety concerns. Nobody we spoke with or observed expressed any issues regarding their safety. People were safeguarded from abuse as the registered provider had relevant guidance in place and staff were knowledgeable about how and who to report concerns too. There was a friendly atmosphere in the home and people and staff on each unit were welcoming.

Observations showed there was enough staff to carry out care in a timely manner. Staff were attentive to the needs of people and no one appeared to be in distress through lack of attention. Staff had been employed following appropriate recruitment checks that ensured they were suitable to work in health and social care. We saw that staff recruited had the right values and skills to work with people who used the service.

People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service supported this practice. Staff and managers had a good understanding of the Mental Capacity Act 2005 (MCA) and put it into practice. Where people were being deprived of their liberty for their own safety the registered manager had made Deprivation of Liberty Safeguard (DoLS) applications to the local authority.

People were supported to eat and drink what they liked. Where concerns were identified, people received support from health care professionals to ensure their well-being. Health concerns were monitored and people received specialist health care intervention when this was needed.

People told us the care staff were caring and kind and that their privacy and dignity was maintained when personal care was provided. People were encouraged to be involved in their care planning and delivery. Support was tailored to meet individual needs, wishes and aspirations. People who could not express their thoughts and feelings verbally were settled and supported well. Staff were observed to be attentive to people's care needs as they arose.

There was an effective complaints system in place. People and staff knew who to raise concerns with and there was clear line of accountability amongst senior staff.

People were provided opportunities to give their views about the care they received from the service. Some people chose to use these opportunities to become more involved with their care and support. Family members were also encouraged to give their feedback on how they viewed the service.

People were provided opportunities to give their views about the care they received from the service. Some people chose to use these opportunities to become more involved with their care and support. Family members were also encouraged to give their feedback on how they viewed the service.

Upton Dene residential and nursing home provides a range of support options including residential care, dementia care, nursing care, palliative care and respite care. It is a new and purpose built home registered in December 2015. The service has 74 bedrooms all with ensuite facilities. At the time of our inspection there were 46 people living at the service.

We were informed during our visit that the registered manager was leaving 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. The service had an interim manager in place whilst recruitment for a new registered manager is undertaken.

The service had not been previously inspected by Care Quality Commission. We carried out this inspection following concerns that had been raised in regards to the safety and effectiveness of the support provided at the service.

At this inspection we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

People told us they received their medication at their preferred times. However, we found that the management of medicines was not safe. Concerns with administration had not been identified or highlighted by the staff. Records relating to medicines were not accurate and were not kept up to date. Care plans for PRN (as required) medication were not always in place for staff guidance. Medication stock checks were not always accurate and completed in line with the registered providers own policy and procedures. This meant that people were not protected from the risks associated with unsafe practice in regards to medicines. We asked the registered provider to provide us with an action plan within 12 hours of our visit addressing the immediate risks regarding the poor practice and unsafe management of medicines which we had identified.

The management team were currently implementing regular supervision and appraisal for all staff. However, the registered provider had not taken the appropriate steps to ensure that staff who looked after people had received the appropriate competency assessments and training required for their role and responsibilities.

Staff understood the needs of the people they cared for. Records on the residential unit and the unit for those living with dementia evidenced people's preferences for support. This helped staff to deliver person centred care. However, care plans and supporting documentation on the nursing unit did not always accurately reflect the current care needs of those people to whom support was provided. Care plans were ‘task orientated’. This meant that there was a risk that staff less familiar with the person they would not be able to deliver care required.

Quality assurance systems in place were not effectively used to assess and identify the improvements needed to ensure the quality and safety of the care provided. Issues we raised during our inspection relating to care planning and the safe management of medicines had not been identified or fully addressed through the registered provider’s quality assurance processes.

The service was clean and checks of the environment and equipment were completed. However, records showed that these had not always been completed in line with the registered providers own timescales. Actions had been taken by the registered provider to address this.

People told us they felt safe living at the service. Staff understood how to identify abuse and were aware of the action to take if abuse was suspected or reported. We saw safeguarding procedures had been followed when incidents had occurred.

The service provided support for people who are living with dementia. We found that the environment was dementia friendly and adaptions had been made to aid and support people with wayfinding. The overall décor, colour schemes of the flooring, walls and accessories such as curtains had been carefully considered and created a warm, calm and welcoming environment across the service.

People were complimentary about the food and told us that they enjoyed the options that were available. People were given the option of having a second helping of food if they still felt hungry and alternatives were sourced if they did not like the choice of meal presented. Staff offered appropriate support where people required assistance with eating.

Staff were caring and treated people with kindness and respect. People and their family members were happy with the overall care that they had received. Observations showed that staff were mindful of people’s privacy and dignity and encouraged people to maintain their independence. Consent was sought by staff prior to support being undertaken. Staff understood the principles of the Mental Capacity Act (2005) and how this would be applied to their work.

People told us that they would feel confident in making a complaint, and felt their concerns would be addressed. The registered provider had received a number of complaints and records showed that these had been appropriately addressed. People and their family members had written ‘thank you’ cards in response to the quality of the service they received.