Upton Grey Close Care Home

We found the following examples of good practice.

¿ People were supported to keep in touch with their family and friends and alternative forms of maintaining social contact were being used. For example, people were supported to use technology such as tablets to have video calls with their family. People were supported to walk to their families houses so that they might wave at their family members and ‘drive-bys’ were used for the same purpose.

¿ Socially distanced visits by family and friends, to the home, were well organised and planned to reduce risk and avoid the spread of infection.

¿ Information was readily available on arrival at the home to ensure that visitors followed infection control protocols.

¿ All visitors were screened for signs of infection on arrival and all staff and people using the service were assessed twice daily for a raised temperature. This helped staff to act to keep those who might be symptomatic of COVID 19 from those who were not.

¿ Staff had thought about innovative ways to support people to understand the symptoms of COVID 19. For example, people had been involved in taste and smell experiments to understand how these senses might be affected by COVID 19.

¿ Some arrangements were in place so staff could appropriately socially distance during breaks, handovers and meetings. Staff supported people to understand and follow social distancing guidance through regular redirection and advice although this was an ongoing challenge. Practical examples had been used to support this process, for example, people were supported to make socially distanced queues for the homes tuck shop and helped to understand the reasons why this was important.

¿ Social stories were being used to support people to understand the impact of COVID 19 and the risks it presented. Staff were currently creating a social story about the new lock down procedures and social bubbles. Social stories are used to illustrate certain situations and problems and how people might deal with them.

¿ All staff in high risk groups had been risk assessed, and adjustments made to how they were deployed.

¿ Staff had received training in infection control and COVID 19. They had also been trained in the correct way to put on and take off personal protective equipment. Their compliance with this was regularly assessed by the services infection control lead. People using the service had also received information about this. One person demonstrated to us how they washed their hands and they were also wearing a mask. Staff told us they tried to make tasks, such as regular handwashing, fun for people but doing this with them and singing songs to help them understand how long the handwashing needed to take to be effective.

¿ The provider had ensured that ‘whole home testing’ had been implemented. Staff were tested weekly and people monthly. Staff had implemented more robust infection control measures including isolation to care for people with symptoms to avoid the virus spreading to other people and staff members.

¿ Staff have adapted the way in which shopping was ordered and the types of food provided. For example, whilst biscuits remained a favourite of people using the service, single wrap options have been ordered instead to help prevent cross contamination.

¿ The provider encouraged people to talk about any concerns they have or the things they found difficult. For example, we saw that at monthly house meetings, people discussed issues such as isolation and what it meant, the national slogan, ‘hands face and space’, the importance of cleaning and what was going to happen at Christmas.

¿ Cleaning schedules had been implemented to clean a number of high touch areas such as door handles, remote controls and light switches, three times a day.

¿ The provider ensured that current guidance was shared in a timely and accessible way with staff.

¿ Contingency plans were in place to manage ongoing or future outbreaks effectively.

Upton Grey Close supports adults with learning disabilities or autistic spectrum disorder. At the time of our inspection there were five people living in the service. The home is located two miles from the town centre of Winchester. The home is two adjoining houses each with their own access. People were accommodated in single bedrooms with en-suite facilities. Communal areas included; a garden, kitchen dining room and a lounge.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

At our last inspection in January 2016 we rated the service requires improvement. There were three breaches of the regulations. We asked the provider to take action to make improvements. For example, we found care plans did not reflect people’s changing needs, the provider had not acted in accordance with the Mental Capacity Act 2005 and the provider had not kept accurate records of how risks were mitigated and how quality was monitored and at this inspection we found action has been completed.

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.

People are 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 support this practice.

There have been improvements since the last inspection. Including detailed monitoring of the home. The staff team are stable and feel supported by the registered manager. Records have been improved and are relevant and updated in a timely way when changes occur.

Support staff are very aware of people’s needs and preferences and respond quickly to any concerns by contacting the relevant professionals.

People are supported by staff who are skilled and knowledgeable. Staff are passionate about their role and working with the people living at Upton Grey Close.

People are included in the planning and delivery of care. They were confident in raising concerns and expressing themselves.

People have access to healthcare services when they need them.

Improvements to the management structure had resulted in staff feeling well led and supported.

Further information is in the detailed findings below.

The home is located two miles from the town centre of Winchester. People were accommodated in single bedrooms with en-suite facilities. Communal areas included; a garden, kitchen dining room and a lounge.

The service did not have a registered manager in post as required. The provider had informed us on 20 October 2015 that the service was being managed by the deputy manager. The provider has now successfully recruited to the post of manager and this person has submitted an application to become the 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.

People told us they were safe and their relatives told us people were cared for safely. Staffing levels during the day had recently been increased to meet people’s individual needs. Overnight staffing was provided by one or two sleep in staff. Most staff working in the home were new in post since July 2015. Not all staff had completed the required training to support people with their needs for example; in moving and handling. This meant that some planned activities to the gym had not taken place due to a shortage of trained staff. This was important for a person to help them maintain their mobility. At the time of our inspection staff training needs were being addressed and a plan was in place to prevent a reoccurrence of missed activities.

People were supported by staff who understood how to recognise the signs of abuse and how to report their concerns. The manager had acted on information of concern to prevent a reoccurrence. Risks to people’s health and wellbeing were assessed and plans were in place to guide staff on how to support people safely.

People were supported with their medicines by trained staff who were assessed as competent to do so. Detailed guidance was in place to guide staff on the safe administration of medicines taken when required. We found some recording errors in people’s medicine records. Ensuring people’s medicine records are accurately completed is important to avoid mistakes in the administration of medicines. Although records were not always accurately completed, people had received the medicines they required.

We checked whether the service was working within the principles of the Mental Capacity Act (MCA) 2005 and whether applications to deprive a person of their liberty had been appropriately made and authorised. No applications to deprive a person of their liberty had been made. We found the provider had not carried out an assessment of people’s mental capacity to agree to their care and treatment and any restrictions within this. This meant people’s rights under the MCA may not be met.

Staff made prompt referrals to healthcare professionals when people’s healthcare needs changed. However, the information required to inform staff of people’s healthcare support needs and to monitor their progress was not always available and completed as described in their care plan. For example, a person’s exercise regime was not readily available to staff, up to date and monitored in line with their assessed needs. This meant people were at risk of not receiving the care and support they required to maintain their health.

People were supported by staff that completed an induction and received on-going supervision in their role. A training programme was in place to enable staff to meet people’s individual needs and staff were unable to support people alone until they had completed the relevant training. There had been delays in some staff completing the provider’s required training. This was being addressed at the time of our inspection to ensure all staff completed all the required training to meet people’s needs.

People were provided with nutritious food, which met their dietary preferences and requirements. People were supported to eat a healthy diet of their choice.

People told us staff were ‘kind’ and people’s relatives told us staff cared about the people they supported. Staff spoke knowledgeably about people’s interests and preferences and were attentive to people’s needs. People were supported to make decisions about their day to day care and staff treated people with respect and promoted their dignity. People were supported by kind and caring staff.

People received person-centred care in line with their assessed needs. Care plans were easy to follow and were focused on people’s individual needs and preferences. People were supported to achieve positive outcomes and improve the quality of their life. This included the management of behaviours that challenged others, a reduction in social isolation and the achievement of identified goals. People participated in a range of activities to meet their needs and preferences.

A complaints procedure was in place and displayed within the home. Complaints were investigated and responded to. When a complaint was made by a person living at the home they had received support from an independent advocate to ensure their views were represented. Complaints were managed appropriately.

There were not robust systems in place to ensure effective governance. Records were not always accurate or complete. This included records about people’s support needs in the event of an emergency evacuation from the home. Feedback from people and their relatives was not sought consistently. The monthly process in place to record feedback from people had not been used since May 2015. People’s relatives told us they could talk to the manager about their concerns and information about their relatives care. However they were not routinely asked for their feedback on the service. This meant the provider may not have the feedback from people and their relatives to effectively evaluate and improve the service. This was important to effectively evaluate and improve the service.

People were supported by staff that demonstrated the provider’s values in their behaviours with people. These included being; person centred, upholding people’s rights and dignity, promoting choice, independence and well-being. There was a positive atmosphere in the home and people were comfortable and confident with staff. People were supported in a positive and engaging environment.

The manager led by example and was supporting the new staff team to develop a positive team culture. The manager focused on ensuring staff were clear about their roles and responsibilities through individual supervision and team meetings, Staff were encouraged to maintain open communication with each other to build a cohesive team.

The manager was responsible for two of the provider’s services. This meant they were not always present at Upton Grey Close. Some staff told us a full time senior staff member was needed in the home for day to day leadership and to ensure consistent practice.

Systems were in place to assess, monitor and address concerns in the safe running of the home. Action was taken to address defects were required. Incidents were recorded and reviewed to inform people’s care plans and prevent a reoccurrence. People's records were stored securely.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of the report.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

We met two of the three people using the service and looked at care and support records. We also spoke with a relative, the deputy manager and two care workers. This is a summary of what we found -

Is the service safe?

There were systems in place to safeguard people who use the service from abuse. We saw that support plans included guidance on how staff should support individuals whose behaviour may sometimes be challenging to the service; and that relevant training was provided. There were enough staff on duty to meet the needs of the people living at the home and a member of the management team was available on call in case of emergencies.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications had needed to be submitted, proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made, and how to submit one.

Is the service effective?

Staff we spoke with had a good understanding of people's needs and interacted positively with them. We saw that they communicated well with people using the service and promoted an inclusive, supportive environment. Staff demonstrated their understanding of using a non-confrontational approach and knowledge of how different individuals may communicate through their behaviours.

People were provided with a choice of suitable and nutritious food and drink and were supported to be able to eat and drink sufficient amounts to meet their needs. A relative told us 'Nutrition and diet has improved dramatically, through more one-to-one support'. They said 'Quite a few staff enjoy cooking and staff monitor when people have packed lunches that they are eating healthily'.

Is the service caring?

We observed that care workers showed patience and gave encouragement when supporting people. We saw that people were able to do things at their own pace and were not rushed. A person using the service told us they enjoyed living at the home. A relative told us: 'The staff and support is excellent'.

Is the service responsive?

People's needs had been assessed before they moved into the home. Each person using the service had a named key worker, whose role was to help co-ordinate the person's care and support. This included involving them in regular care reviews and keeping their relatives informed of changes, if appropriate. We saw that people's health needs were monitored and referred to health professionals appropriately. This helped to ensure that the delivery of care was responsive to people's needs and based on up to date information and guidance. The records showed that any concerns were followed up and appropriate action was taken.

Is the service well led?

There were clear lines of accountability within the service. We saw that regular audits of the quality and safety of the service took place and were recorded. For example, there were audits of the premises, equipment and catering. In addition to these, a services manager for the organisation carried out regular checks that were also recorded. There was a monthly improvement log completed by the managers, which was a record of actions taken in relation to audits, incidents, and feedback from people using the service or others acting on their behalf.

People were protected against the risks associated with medicines because staff had received suitable training and kept accurate records of the medicines people had been supported to take.

People we spoke with said they were able to raise concerns with the staff or manager and were confident that action would be taken to address the issue. One person said they would talk to the manager if they had a problem and was confident the manager would 'sort it out'.

Although people told us they received good care and support, we found that the care and support plans were not accurate or kept up to date. This increased the risk that people may receive care and support that was inappropriate or unsafe.

People told us they were involved in choosing decorations and said maintenance work was completed quickly when required.

People said they would speak to staff if they had any concerns and said they were confident that action would be taken to resolve their problem. However, we found that complaints were not always recorded and it was not clear what action the provider had taken to investigate complaints and resolve the problem.

Staff felt well supported; however, they did not receive regular formal supervision and had not been given training suitable to their role. This increased the risk that staff would not have the skills and knowledge to deliver care and support to people safely and to an appropriate standard. We have told the provider that action is required to put these things right.