Upton Dene Residential and Nursing Home

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We found two breaches of the legal regulations in relation to safe care and treatment and the need for consent. People’s needs and risks were not always appropriately assessed. Staff lacked adequate and accurate information about people’s needs, risks and care. Staff lacked adequate guidance on how to appropriately support people with mental health conditions such as dementia who became distressed or agitated. This included a lack of clear and consistent information on people’s communication needs and how to communicate with them effectively. These shortfalls placed people at risk of inappropriate and ineffective care that did not promote positive outcomes. People’s legal right to consent to their care was not always respected in accordance with the Mental Capacity Act. Some people’s care files contained contradictory information about their ability to consent which increased the risk of inappropriate decision making on the person’s behalf. A service improvement plan was in place to ensure improvements to care planning, risk assessment and the application of the mental capacity act were made. These improvements were still in progress at the time of our assessment. People told us they were given a choice in how they lived their life and staff respected their wishes. Staff told us team working across the service was good and people we spoke with confirmed this. One person told us, “ They are very efficient”. People told us they got enough to eat and drink and there was always a choice of what to have. Referrals to other health and social care professionals in respect of people’s needs were made as and when required. People told us medical attention was sought quickly if they felt unwell and that staff were attentive and responsive to any signs of ill-health. People’s day to day progress such as their weight, nutritional intake, pressure sore progress and continence care was monitored daily.

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Records did not show that people were regularly involved in reviews or discussions about their care. However most people felt that their needs and wishes were met. One person told us, "The staff know what I want and what I need so we have a routine that works well". Relatives told us they were kept up to date with a loved one's progress and if there were any changes in people's needs or care.

Information about people's health, wellbeing and communication needs was not always clear or consistent. Staff told us that care plans and risks assessments were updated when people's needs changes. However a staff member told us they did not always have time to read them.

People's health needs were not assessed, this included the medical needs of people who required nursing care. There were no clinical care plans in place to guide nursing staff in the provision of nursing care. People's mental health needs were identified, but the care plans in place, did not always ensure staff had sufficient guidance on how to provide effective and appropriate person-centred care. Information about people's communication needs and level of understanding was at times contradictory. This did not show the service was proactive in ensuring people were supported to communicate their needs and wishes effectively to promote positive outcomes in care and wellbeing.

We did not look at Delivering evidence-based care and treatment during this assessment. The score for this quality statement is based on the previous rating for Effective.

Overall, people felt the regular staff team did a good job, knew what they were doing and worked well together as a team.

A staff member told us they were supported effectively by team leaders and the management team to work together as a team. During our assessment, we observed that staff worked well together and co-ordinated responsibilities well.

The Local Authority told us the provider and the management team were working with them proactively to make improvements to the service. They told us in order to improve how care and nursing staff work together, “A senior carer has been introduced on the nursing floor to provide leadership for the care team, allowing the nursing team to carry out their duties”.

There was no robust system in place to ensure staff teams always had up to date and accurate care plans to inform the care they provided. There was a handover system in place to share important information and updates between staff and teams, which included daily 10am meetings and weekly clinical updates. Staff told us they felt able to raise any issues or concerns about people's wellbeing and care with team leaders and the management team.

People told us they had a choice of what to eat and drink. We saw that a menu was available for people to chose from at mealtimes. People told us that they had enough to eat and drink. They told us their ability to be independent was supported and they had a choice in how they lived their lives in the home. The people we spoke with felt well looked after.

The management team told us that people had access to support from dieticians, tissue viability, occupational therapy, the falls team and speech and language teams in support of their needs. Records confirmed this.

Referrals to other health professionals were made in a timely manner to support people’s health and wellbeing. Information on how to mitigate risks in relation to people’s health and wellbeing and identify early signs of ill-health was not always clear. This increased the risk of health referrals not being made in a timely manner.

People told us staff helped them with their day to day living activities. They said that staff checked on their health and wellbeing regularly and everyone we spoke with was aware they had access to a weekly GP or Advanced Nurse Practitioner ward round. People’s comments included, “Staff check on me regularly”; “I would see a doctor (if unwell). He comes in Wednesday, staff check on me regularly”, and “They do invisible checks on me just to make sure I am still here. They are very good”.

Staff told us that regular handover meetings between shifts help them keep track of people’s progress. Weekly clinical meetings also took place to discuss and monitor outcomes.

There were some systems in place to track outcomes in respect of people’s day to day care. Records showed however that baseline care information and documented progress was not always correct. Record keeping in respect of how and when people received the care they needed were not kept contemporaneously. This meant it was difficult to tell if people received the support they needed, when they needed it. There were no care plans in place for people’s physical health conditions and no records of the support they received in respect of these conditions. This meant it was impossible to tell if people’s health conditions were being managed appropriately to promote good outcomes. Care plans did contain some information on the expected outcome people wished to achieve for example, maintaining their mobility or completing their own personal care. There were also mechanisms in place to monitor and track outcomes in respect of wounds, falls infections and accident and incidents.

People told us staff always sought their consent prior to the delivery of care. Everyone we spoke with felt confident their wishes would be respected by staff if they did not consent to the care being provided. They told us staff members were always willing to help, respected their preferred routines and their ability to do some things for themselves. People's comments included, "I can say I don't want help"; "They know me well and know what I like"; "They help me get dressed and have a shower in the morning. I like to get up about 7.30 to 7.45am and if they haven't arrived, I just ring the bell" and "I don't have any restrictions on me, I chose what I want to do". Records in relation to people's ability to consent and communicate their needs was at times unclear and contradictory. This increased the risk of people’s ability to make independent decisions being compromised.

Staff and the manager were aware of the Mental Capacity Act, but we found they did not fully understand the principles of this act or associated deprivation of liberty safeguard legislation. The management team recognised that the MCA was not widely understood across the service or consistently applied. They acknowledged staff and managers needed additional training on how to apply the MCA in practice and provided evidence that further training and coaching had been booked. Staff demonstrated they were respectful of people's right to refuse and said that if they had any concerns about a person continuously refusing care, they would report this to management. Staff told us they needed more training on how to support people with dementia whose condition had declined.

Some people's capacity to consent to decisions had been assessed but these assessments lacked evidence of any best interest decision making with the person and relevant others. Some of the assessments undertaken did not show a personalised approach to assessing the person's capacity to consent or a personalised approach to applying for deprivation of liberty safeguards to keep them safe. The wording in some people's capacity and DoLS applications were identical which did not suggest a real time description of the person's capacity at the time the decision was taken or a person centred approach had been undertaken. We found that the provider could not be assured that staff were effectively sharing information and monitoring outcomes effectively during these meetings, due to people’s care plans and progress not always been recorded, accurate or up to date. Information about people's level of understanding and capacity to consent was often contradictory. Some of the wording used in people's mental capacity assessments also suggested that by reason of a diagnosis of dementia, the person was automatically assumed to lack capacity. This directly contradicts the principles of the MCA which states people must be assumed to have capacity in the first instance, unless proven otherwise. The process in place to apply and monitor people's deprivation of liberty arrangements was not effective. For example, we found no evidence that the conditions applied to one person's DoLS had been complied with. An inappropriate application to deprive one person of their liberty had also been submitted to the Local Authority. We discussed this with the management team and requested this application be reviewed as a matter of urgency.