Archived: Uphill Grange Care Home

Updated 18 August 2015

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.

This inspection took place over three days on 11 May, 13 May and 18 May 2015 and was unannounced.

The inspection team consisted of three adult social care inspectors on the first day, one on the second day and two on the third day.

Before we carried out this inspection we looked at the provider information return (PIR). This document enables the provider to give key information about the service, what the service does well and improvements they plan to make. However this document had been completed before their last inspection in September 2014. We therefore looked at the action plans the provider had sent in to show us how they planned to meet the requirements of the warning notices we served following the last inspection.

At the time of the inspection there were 23 people living in the home. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us. We spoke with eight people, five relatives and eight staff members. We also spoke with the registered manager, the deputy manager and the regional manager.

We also looked at records which related to people’s individual care and the running of the home. Records included six current care and support plans, four staff recruitment files, quality assurance records and medication records.

Updated 18 August 2015

This inspection was unannounced and took place on 11 May, 13 May and 18 May 2015.

Uphill Grange is registered to provide personal and nursing care for up to 44 people, at the time of our inspection there were 23 people living in the home. The home specialises in the care of older people.

There is a registered manager in post. 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.

At the last inspection in September 2014 we asked the provider to take action to make improvements. We took enforcement action and served four warning notices around, managing risk, complying with the Mental Capacity Act 2005 (MCA), providing safe care and identifying risk through quality assurance processes. The provider sent us an action plan which said they would be compliant with all areas by the end of January 2015 and this action has been completed.

Throughout the inspection we received varied opinions from people staff and relatives about the way they felt the home was managed and the care provided. Some staff said the manager was not open and approachable and did not act on issues identified around some staff in the home. Whilst others said they felt the home was well run and they could approach the manager at any time. People told us they knew the registered manager and could talk to them openly.

Risks had been identified and recorded in people’s care plans however; the records to monitor the risks were not always completed. For example one person’s care plan said they needed to be checked every 15 minutes. The records did not show this had been carried out. The fluid records for another person who was at risk of dehydration were inconsistently completed. This meant the person was placed at a higher risk of dehydration as staff did not know what fluids they had had.

People and fire personnel were also placed at risk as the records provided for emergency services about people in the home were out of date and had not been reviewed since January 2015. The registered manager reviewed and updated the record on the first day of our inspection.

Some people and staff said they felt there were not enough staff to meet people’s needs. However some people said they thought there was plenty of staff on duty. The home is over two floors providing care for people with both nursing and residential needs. Twenty of the twenty three people in the home required two staff to provide personal care. One staff member said, “We used to have a floating care worker to help between floors, but we don’t now”. Some people commented on the time it took for call bells to be answered and one relative said, “They are so short of staff”. When asked about completing records, one staff member said, “We just don’t have enough time”. We observed through the day that staff were task orientated and did not have time to socialise with people.

People and staff said the home used a lot of agency care staff, which was sometimes difficult as they did not know people or their needs. The registered manager confirmed they had used agency staff to provide the extra cover they needed. They said they had carried out a recruitment programme and had found some new staff which they hoped would become permanent staff following their induction process.

People were not always treated with dignity as we observed at lunchtime some people wore protective covers however they were not asked if they wanted to wear them. During lunch a person who required one to one help with eating was assisted by four different staff members who were busy going between other people. We saw another person who was able to eat their meal independently, albeit slowly. We saw staff assisted this person to eat their meal to speed the mealtime up. This meant this person was disempowered as staff gave assistance when it was not required.

We found people were not routinely involved in the reviews of their care plan. Of the eight care plans we looked at only one person had been involved and consulted. However people told us they could make decisions on a day to day basis and chose how they spent their day. We have recommended the service seek advice and guidance from a reputable source, about supporting people to express their views and involve them in decisions about their care, treatment and support.

Although there was an activities coordinator and programme of activities on the noticeboard we did not observe any meaningful activities throughout our inspection. On the first day people were invited to attend an exercise group in the dining room just before lunch. On all three days people sat in the lounge, the garden or in their own rooms. Some people said they knew there were activities whilst others said they did not do any activities. We have recommended the service seek advice and guidance to ensure all people have the opportunity to take part in activities based on their interests and abilities.

At out last inspection the registered manager had failed to identify shortfalls in the home in their quality auditing processes. We found the manager’s quality auditing had improved however they had failed to identify issues such as staff recording best interest meetings in the wrong part of the care plans. Staff failing to complete monitoring forms and staff failing to act on issues when they had been identified and discussed.

At our last inspection In September 2014, we found the registered manager failed to protect people from harm and abuse, had not monitored accidents and incidents and had not completed best interest decisions in line with the Mental Capacity Act 2005.(MCA) The MCA provides the legal framework to assess people’s capacity to make certain decisions, at a certain time. When people are assessed as not having the capacity to make a decision, a best interest decision is made involving people who know the person well and other professionals. Where relevant a Deprivation of Liberty Safeguards (DoLs) application is made to the local authority. DoLS provides a process by which a person can be deprived of their liberty when they do not have the capacity to make certain decisions and there is no other way to look after the person safely.

At this inspection we found the manager had met all these shortfalls. We found the registered manager had risk assessments in place regarding the safe use of equipment. They had also taken action to report unwitnessed injuries to the relevant authorities. We found they had carried out best interest meetings with people’s relatives and Deprivation of Liberty Safeguards applications had been made. However it was difficult to at first to evidence this had been carried out as staff had recorded the meetings in the wrong section of the person’s care plans.

Staff had received training in identifying and reporting abuse. Staff were able to explain to us the signs of abuse and how they would report any concerns they had. They stated they were confident any concerns brought to the manager would be dealt with appropriately. There was a robust recruitment procedure in place which minimised the risks of abuse to people. People told us they felt safe in the home and they all knew who to talk to if they wanted to raise a concern or complaint.

People saw healthcare professionals such as the GP, district nurse, chiropodist and dentist when they needed to. Staff supported people to attend appointments with specialist healthcare professionals in hospitals and clinics. Staff made sure when there were changes to people’s physical well- being, such as changes in weight or mobility, effective measures were put in place to address any issues.

A regular survey had been in place asking people and their relatives about the service provided by the home. However the response from people and relatives was very low. The organisation had introduced a system where people and visitors to the home could comment at any time through an iPad in the entrance hall. This iPad could also be taken to people who could be assisted to comment on their care and experiences. Suggestions for change were listened to and actions taken to improve the service provided. All incidents and accidents were monitored, trends identified and learning shared with staff to put into practice.

We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.