Upton Dene Residential and Nursing Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We found two breaches of the legal regulations in relation to safe care and treatment and staffing. Information about people’s needs, risks and care was not always accurate or up to date. People’s physical health conditions had not been assessed to ensure staff knew how to support these needs appropriately. Some people did not receive the support they needed in accordance with their care plan to mitigate risks to their health and safety. Learning from accidents and incidents was not always implemented effectively to drive up improvements. Additional measures for sharing and embedding learning across the service had been introduced as part of the provider’s service improvement plan. Staff received adequate training to do their job role. A staff member felt more advanced dementia training was however needed. Staff supervisions and appraisals were not up to date which meant some staff may not have received sufficient support to do their job role well. Staff were recruited safely. Staffing levels on the day of the assessment were adequate. However, people living in the home and staff had mixed opinions as to whether these levels were always safe and sufficient. Some people told us at times they had to wait for help from staff. People also said agency staff whose first language was not English were difficult to understand. We fed this back to the management team. There were systems in place to protect people from the risk of abuse. There was a system in place to apply for and monitor deprivation of liberty safeguards, however this system was not always followed appropriately. People told us they felt safe and able to raise any concerns they had about their care with the staff team. The home was clean and well maintained.

This service scored 59 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not ask people for their direct feedback in this area. We did however review accident and incident records to understand how accidents and incidents were experienced by people living in the home. We found some accidents and incidents were repetitive in nature. Some of the recommendations made to prevent similar accidents and incidents from happening again had not been acted upon consistently. This placed people at risk of experiencing similar accidents and incidents that were potentially avoidable. For example, the position of one person’s bed meant that they sustained a minor head injury when they fell from their bed. The learning from this incident, was to ensure all beds were correctly positioned against the bedroom wall. During our visit, we saw that two people’s beds were not correctly positioned. Other intelligence collated by CQC with regards to accidents and incidents at the home showed recurring themes relating to falls, pressure area care and poor record keeping resulting in shortfalls in care.

Staff were aware of how to record and respond to accidents and incidents at the time they occurred. This included how and when to seek medical advice.

There was an electronic system in place to record and monitor progress on accidents and incidents. Accident and incidents were reviewed by the management team to ensure appropriate action was taken. The provider had identified improvements were required with regards to how learning was shared and acted upon. Additional measures had been put in place to ensure information and learning was shared between staff teams. This included daily'10 at 10' meetings and weekly clinical meetings. At the time of assessment these measures were not yet fully embedded within service delivery to assess their effectiveness.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

People told us they felt safe and staff were kind and caring. People's comments included, “I feel safe and they are kind to me” and “She always looks safe and well looked after”.

Staff spoken with knew what action to take if abuse was suspected. Staff completed safeguarding training. A staff member told us "I would not hesitate to raise a concern, it is about the safety of the resident and staff. I would raise (any concerns) with management".

During our visit, staff members were warm, friendly and respectful. It was clear people were comfortable with the staff team and that they knew each other well.

There were safeguarding policies and procedures in place for staff to follow in the event of an allegation of abuse. There was a system in place to monitor safeguarding events and the action taken. Records showed appropriate action had been taken to report, investigate and protect people from harm. We found however that there was a lack of understanding with regard to the application and monitoring of deprivation of liberty safeguards. Deprivation of Liberty Safeguards (DoLs) are designed to deprive people of their liberty in order to keep them safe.

Most people felt they were supported to manage some of the risks involved with their care. However, some people were not able to answer this with clarity. People told us they were supported to maintain their independence as much as possible and that they were able to live their lives without unnecessary restriction.

Care plans and risk assessments did not always clearly identify people's risks and did not always provide sufficient guidance to staff on how to keep people safe. The management team told us they were in the process of reviewing care plans and risk assessments as part of their service improvement plan. At the time of our assessment insufficient progress in making improvements had been made.

Staff were observed to support people’s ability to be independent whilst protecting their dignity and safety. For example, some people had specialised mobility equipment to help them walk around safely. Staff ensured this equipment was close by at all times to ensure people could move about freely. There were pictorial signs around the home to help people living with dementia to find their way. There were also memory boxes and names badges on bedroom doors to help them identify their bedroom. This helped people manage risks associated with memory loss and disorientation. Some people did not have call bells in their bedrooms to enable them to seek help if they needed it. We spoke with the manager about this who told us new call bell equipment was on order.

People’s needs and risks were not always accurately described. None of the care files we looked at, contained an assessment of people’s physical health needs or any guidance on how to manage these conditions. Some people required nursing care for complex health needs such as epilepsy, motor neurone disease, stroke and Parkinsons disease. Staff had little information on these needs or guidance on the support or monitoring they required, the signs and symptoms to spot in the event of ill-health or the action to take. Some people required a special diet and thickened fluids to mitigate the risk of choking. We found one person had been offered inappropriate food items that were not safe for them to consume. In addition, their fluid intake chart did not always show their drinks were thickened to a safe consistency. Some people had allergies which were not risk assessed or properly identified. For example, one person had a serious life-threatening allergy that required special medicine to be administered to prevent a medical emergency. Despite this, their care plan provided little information on what the person’s allergic reaction was or the action to take. Catheter care was not always clearly planned. Some care plans did not contain details of the type and size of catheter, catheter bag changes or how to safely position the catheter for effective drainage. We found one person's catheter was inappropriately positioned on the floor with tubing looped around the bag. This was not very dignified and increased infection control risks. Wound management was satisfactory to mitigate risks to people's skin integrity with ongoing support from the Tissue Viability Service. People's welfare after a fall was closely monitored to mitigate further risks to their health and well-being. Moving and handling support was provided safely and there was appropriate lifesaving equipment in place such as evacuation pads and life vac anti choking equipment on each floor.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

People had mixed opinions and experiences with regards to staffing levels and whether they were sufficient. The majority of people who felt there were enough staff on duty were able to do a lot of things for themselves. Whereas others, who were possibly more dependent on staff support, told us they sometimes experienced delays in accessing support due to staff shortages. People's comments included, "I think there is enough staff knocking about. I've never had any problems. I can do everything for myself, so I do not heed help really"; "The staff have been very helpful but I can manage to do most things myself"; "I use the call bell if I need the toilet and sometimes, they can take their time. It's been half an hour wait on occasions, but they do what they can" and "Sometimes they are short staffed and I don't get the help needed". Some people raised concerns over the ability to understand and communicate with agency staff whose first language was not English. They also said sometimes agency staff did not know them well. People felt regular staff were trained and had the knowledge and skills to support them safely.

A staff member told us, "Domestics very short staffed"; "Majority of the time there is enough staff" and "Not great at the minute, eight months ago it wasn't too bad but lately a lot of agency staff or short staffed".

On the day of assessment, we had no concerns about the number of staff on duty. Staff were visible in communal areas and accessible.

Staff supervisions and appraisals were not up to date to support staff to do their job role well. We looked at eight staff files and found that none of the staff had had an appraisal. Most staff had also only had one supervision which had taken place in 2023. The provider had a tool in place to help them assess safe staffing levels. Staff rotas were in place. There were some days were the number of care staff on duty was one less than expected, but on the whole the rotas showed the number of staff on duty corresponded with the staffing levels determined as safe by this tool. Agency staff were sometimes used to fill gaps in the rota. The provider tried to book the same agency staff for consistency. There were profiles in place for agency staff identifying their skills and experience. Staff had completed training to do their job role. A regional in house trainer provided face to face training courses to staff in addition to on-line learning modules and webinars.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

People told us they received their medicines as needed. Their comments included, "I have several tablets during the day and they sort all that out for me"; "I get my tablets every day" and "I have Parkinson's so I have to have my tablets at a certain time which works just fine".

Staff told us they received training in medicine administration and had their competency to do so assessed. Staff spoken with were knowledgeable about how to safely administer and record medicines. Records confirmed this.

There were systems in place to ensure medicines were managed safely. Medicines were stored safely and at the right temperature to ensure their efficiency in a locked cupboard or trolley in the medicine room. Checks and balances were in place to account for medicines given and those remaining in stock. Codes were used appropriately when medicines were offered and refused or not given, with the reason noted. This was good practice. There was a system in place to ensure insulin was safe to give to people living with diabetes. People had 'as and when required' medicine plans in place to guide staff on how and when to administer as and when required medicines such as painkillers. Controlled drugs were stored and given correctly. Stock levels were correct on the day of assessment. On the day of our assessment, we observed a staff member leave medicine on the top of the medicine trolley in a communal corridor whilst administering medicine to a person in their bedroom. This medicine was accessible to other people. We spoke with the nurse on duty about this and it was addressed immediately.