Archived: Uplands Nursing Home

Uplands Nursing Home is a care home providing personal and nursing care to 30 people at the time of the inspection. The service can support up to 38 people. The home accommodates people within one large, extended and adapted home across the ground and first floors. Some rooms had en-suite facilities and there were also a small number of shared bedrooms.

People’s experience of using this service and what we found

Since the last inspection there had been some improvement to the provider’s governance systems to monitor the delivery and quality of the service provided for people. However, further improvement was required to make sure governance processes were embedded into staff working practices.

People were safe using the service. Staff knew how to protect people from risk of harm and reduce the risk of accidents and incidents. At the time of our site visit, we found there were enough suitably recruited staff on duty to meet people’s needs and to keep people safe. People were supported by staff who knew their needs well. Staff supported people with their medicines and this was done safely. Staff understood how to prevent and control the spread of infection.

People had been assessed before being accepted to the service to ensure the provider could meet their needs. Assessments addressed people's physical and health needs, their cultural and language needs, and what was important to them. Staff received training which helped them to deliver personalised care. People were happy with the choice of food available and where appropriate, received additional support with their dietary needs. The provider worked well with external health and social care professionals and people were supported to access these services to maintain their health.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way and in their best interests; the policies and systems in the service required some improvement to ensure the provider continued to support this practice.

Staff were knowledgeable about people’s care and support needs. People and relatives told us how friendly and caring the staff were. Staff enjoyed their work and got on well with the people they supported. Staff encouraged people’s independence, protected their privacy and treated them with dignity.

Some of the people using the service at the time of the inspection could not always tell us about their experiences. However, whilst on site, we saw positive interactions between people and staff and people looked comfortable with the way they were supported. Relatives we spoke with gave us positive feedback on the service and were happy with the way the staff supported their family members to remain safe. Staff provided care to people in line with their preferences and choices. If people communicated non-verbally staff knew how to engage with them.

People were supported by staff who knew their preferences. Complaints made since the last inspection had been investigated and families knew who to contact if they had any concerns. Relatives and staff were happy with the way the service was being led and there was a culture amongst the staff team in providing person-centred care.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection: The last rating for this service was requires improvement (published 27 March 2019) and there was one breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Uplands Nursing Home provides nursing care and accommodation for up to 38 people. Since our previous inspection the registered provider has increased their registration number from 27. At the time of our inspection there were 31 people using the service. Most people lived there permanently while some people spent a short period of time there on discharge from hospital.

Most bedrooms were on the ground floor with a smaller number on the first floor. All communal facilities were on the ground floor.

People’s experience of using this service:

¿ Risks to people were not always identified as part of the provider’s own quality checks.

¿ Improvement was needed in respect of some areas of medicine management.

¿ Staff needed to make improvements in personalised care to ensure opportunities to engage with people were used to the fullest.

¿ Further improvements and refurbishment to the environment were taking place.

¿ People felt safe and relatives believed their family members to be safe living at the home

¿ Staff were aware of their responsibilities regarding safeguarding of people.

¿ People were supported by staff who were kind and caring.

¿ People had their privacy and dignity respected.

¿ People were able to see their visitors at any time. Visitors were welcomed by staff.

¿ People had their healthcare needs met by nurses and visiting professionals.

¿ The environment was clean and tidy.

¿ Staffing numbers were sufficient to meet the needs of people living at the home.

¿ Safe recruitment checks were in place for new staff members.

¿ The registered manager analysed accidents to reduce the risk of similar incidents happening in the future.

¿ Since our last inspection people were receiving a choice of menu. People enjoyed the food provided.

¿ Staff received training to ensure they had the skills and knowledge to perform their role effectively.

¿ People were able to make choices about their daily living such as staying in their own bedroom and where they spent their day.

¿ People’s consent was sought prior to them receiving care and support.

¿ Staff were supported by the registered manager and received training to fulfil their role.

¿ Relatives and staff spoke highly of the registered manager and their efforts to make improvements at the home.

We found the service met the characteristics of ‘Requires Improvement’ overall; more information is in the full report.

Rating at last inspection: Requires Improvement (report published July 2017).

Why we inspected: This was a planned inspection based on the rating at the last inspection. At this inspection we found some improvements had taken place. However, we also identified some areas requiring improvement.

Enforcement: Action we told provider to take refer to end of full report.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

We carried out a comprehensive inspection in March 2016 where we found that the service required improvement and that the provider had not met legal requirements in relation to the governance of the home. We last inspected the service in November 2016 where we carried out a focussed inspection to check whether these legal requirements had been met. At that inspection we found that the provider had followed their action plan and was no longer breaching regulation.

The service has a registered manager who was present throughout the inspection. 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 received support from staff who were aware of the signs of abuse and whom could describe appropriate action to take should they be concerned about people. There were sufficient staff available to support people. The staff had been safely recruited.

People were happy with the support they received with their medicines. Whilst many aspects of medicine management were safe we identified that improvements were required in some parts of medicine administration and storage. We found that improvements had been made to the systems involving the administration of covert medicines.

The individual risks associated with people’s care had been identified and in the most part steps had been put in place to reduce the risk for the person. We found that some elements of practice needed improving to ensure people were cared for safely all the time.

People were supported by staff who had received the training they needed for their roles.

People were mainly involved in daily choices surrounding their care and improvements had been made to support people in line with requirements of the Mental Capacity Act (2005).

People were happy with the meals they received. Some aspects of the meal time experience needed to be improved further for people.

People benefitted from access to a variety of healthcare professionals to meet their individual needs. Guidance on some aspects of people’s healthcare had not considered individual people's needs and wishes.

Some people at the home were living with dementia. Staff had received training on how to support people with dementia and many interactions between staff and people were positive. Further work was needed to ensure communication aids were available at all times to support people living with dementia.

People and their relatives told us they felt the staff were caring. Staff enjoyed supporting people who lived at the home and had got to know people well. Care plans had been developed with people’s relatives to ensure people’s preferences for care had been documented which staff told us they followed.

People were treated with dignity and respect. A number of people at the home shared a bedroom. In these instances efforts had been made to ensure people’s privacy had been maintained and that personal belongings were available.

Since our last inspection the provision of activities for all people living at the home had improved. People were happy with the activities they took part in and all people now had the opportunity for regular activities and stimulation which were based on their interests.

People’s care had been reviewed to ensure it continued to meet their needs, although these reviews did not involve the person themselves.

People and their relatives felt able to raise concerns should any arise. There were systems in place to ensure any complaints received would be investigated .

People and their relatives were happy with how the service was managed. Staff informed us they felt supported in their roles. Quality monitoring systems were in place although we found they had not been entirely effective in identifying the issues found at this inspection. Whilst relatives had been involved in feedback about the service, people had not been given the opportunity to feedback their experiences of living at the home in order to drive improvement within the service. We have made a recommendation about involving people in expressing their views about the service.

We carried out an unannounced comprehensive inspection of this service on 15 and 16 March 2016. At that inspection we found that the provider had not ensured that there were effective systems in place to monitor and improve the quality and safety of the service. We found that the registered provider was in breach of Regulation 17 of the Health and Social Care Act (2008) Regulations 2014, Good Governance. After that inspection the registered provider sent us an action plan detailing plans they had made to meet the legal requirements to have an effective system in place to monitor and improve the service.

We undertook this unannounced focussed inspection on 4 November 2016 to check if the provider had followed their plan with regards to the monitoring of the governance of the service. This report only covers our findings in relation to whether the service was ‘Well Led’. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Uplands Nursing Home on our website at www.cqc.org.uk.

At this inspection we found that some improvements had been made and the home was no longer in breach of regulation.

The registered manager had improved systems to ensure all staff received the training they needed for their role and had improved their own knowledge of the regulations.

One relative told us that people had access to activities within the home. Opportunities people had for meaningful activities had been improved in the home although we found that the monitoring systems in place had failed to identify that not all people using the service had been provided with opportunities to engage in activities of interest to them. We had been informed that the registered provider had improved the systems for people to feedback their experiences of care. Relatives informed us that staff spoke with people daily to check on their well-being. However, we found that the system introduced had failed to identify that many people had not engaged in providing and sharing their views and feedback on the quality of the service.

Following our last comprehensive inspection we received information of concern from the local fire safety officers. We contacted the registered provider to gather evidence of what they were putting in place to meet these concerns. We looked at the action that had been taken as part of this inspection and found that there had been improvements made to the fire safety systems.

There was a registered manager at the service who was present throughout the inspection visit. 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 that we spoke with told us they felt safe living at the home. Staff described the appropriate action they would take should they have any safeguarding concerns. Safeguarding training had been provided to some staff working at the home. Individual risks to people had been identified and steps to minimise the risk to the person had been taken.

Medicines were stored and given safely. Staff were able to describe their responsibilities for safe medicine administration. However, the provider had not followed current guidance for the administration of medicines given covertly.

Most people told us that there were enough staff available to meet their needs. Safe recruitment practices had been carried out to ensure staff were suitable to support people.

The Mental Capacity Act (2005) sets out what must be done to protect the rights of people using services who may lack the capacity to make decisions for themselves. Not all staff were confident in their knowledge of this legislation although they were able to tell us how they supported people in ways that followed the principles of the MCA. There was limited evidence of how decisions had been made to determine if people lacked capacity and what this meant for their care provision.

People told us they were happy with the mealtime provision at the service and that their preferences for food were met. We found that the provider had not assured themselves that safe practice had been carried out when meeting some people’s dietary needs.

The service was proactive in referring people for support with their healthcare needs. People’s healthcare had been monitored and reviewed when necessary.

Staff had received training in some key areas of care to provide them with the knowledge and skills to support people effectively. However, the provider had not ensured that all staff had completed training and refreshed their training in the required timescale.

We saw that staff interacted in a caring way with people living at the service and interactions showed that staff knew people well. Staff were able to describe people’s likes and dislikes and told us they followed people’s care plans to provide care in the way the person had requested.

We observed activities take place during the inspection. People and their relatives informed us that activity provision needed to improve as activities didn’t occur very often and there were limited opportunities for activities for those people who were cared for in their bedroom.

People, their relatives and staff were happy with the management of the home. The provider had sought the views of relatives to monitor the quality of the service provided but little had been done to capture the experience of people living at the home. Systems for monitoring the quality and safety of the service were not effective or robust and had failed to highlight the concerns raised at this inspection. You can see what action we told the provider to take at the back of the full version of this report.