Upton Dene Residential and Nursing Home

Updated 27 June 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

The inspection was carried out to assess if any improvements following our last inspection on 15 February 2017 had been made.

This inspection took place on the 21 and 24 May 2018. Both visits were unannounced.

The inspection team consisted of one Adult Social Care Inspector and an Expert By Experience. An expert-by-experience is a person who has experience of caring for someone who uses this type of care service.

Before our visit, we reviewed all the information we had in relation to the service. This included notifications, comments, concerns and safeguarding information. Our visit involved looking at seven care plans, four recruitment files, training records, policies and procedures, medication systems and various audits relating to the quality of the service. In addition to this we spoke to seven people who used the service and four relatives. We also spoke to the registered manager, deputy manager, area manager and six members of staff and a volunteer. We also observed care practice and general interactions between the people who used the service and the staff team.

As part of our inspection, we ask registered providers to complete a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. A PIR was returned to us when we asked.

We also spoke to the local authority contracting and safeguarding teams to gather information they had on the performance of the registered provider. They were continuing to monitor quality of support within Upton Dene.

We checked to see if there had been a recent visit from Healthwatch. Healthwatch is an independent consumer champion created to gather and represent the views of the public. No visit had been made since our last visit in February 2017.

Updated 27 June 2018

We carried out an inspection of Upton Dene on the 21 and 24 May 2018. Both visits were unannounced.

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.