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We are carrying out a review of quality at Upminster Nursing Home. We will publish a report when our review is complete. Find out more about our inspection reports.

Reports


Inspection carried out on 5 April 2017

During a routine inspection

This unannounced inspection took place on 5 and 6 April 2017. Upminster Nursing Home is a purpose built 35 bed care home providing accommodation and nursing care for older people, including people living with dementia. The service is accessible throughout for people with mobility difficulties and has specialist equipment to support those who need it. For example, hoists and adapted baths are available. When we visited, 30 people were using the service.

The service had a registered manager. 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 and associated Regulations about how the service is run.

At our last inspection of this service on 27 January 2016 we found that the provider met regulations but there were some areas that needed improvement. These were in relation to the availability of snacks and hot drinks during the night, making the internal environment more dementia friendly and responding to people’s needs in a timely way. At this inspection we found improvements in all these areas.

Systems were in place to minimise risk and to ensure that people were supported as safely as possible. The staff team worked closely with other professionals to ensure that people were supported to receive the healthcare that they needed.

People told us they felt safe at Upminster Nursing Home and that they were supported by kind, caring staff who treated them with dignity and respect. We saw that staff supported people patiently, with care and encouraged them to do things for themselves. Staff knew people’s likes, dislikes and needs. They provided care in a respectful way.

People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

The provider monitored the service provided and people were asked for their feedback about the quality of service. When issues or concerns were identified action was taken to address these. The management and staff team were committed to developing and improving the service.

People were happy with the food and drink provided and their nutritional needs were met. If there were concerns about their eating, drinking or weight this was discussed with the GP and support and advice was received from the relevant healthcare professional. People were offered refreshments throughout the day and night.

Systems were in place to review staffing levels in line with people’s needs and staffing levels were adjusted accordingly.

People’s care plans were reviewed and updated to ensure that they contained the necessary information to enable staff to support them safely.

Staff provided caring support to people at the end of their life and to their families. This was in conjunction with the GP and the local hospice.

Arrangements were in place to meet people's social and recreational needs.

Staff suitability to work with people who need support was checked before they started their employment at the service.

People lived in an environment that was suitable for their needs. Improvements had been made to make the environment more ‘dementia friendly’. Systems were in place to ensure that equipment was safe to use and fit for purpose.

Staff received training and support to carry out their duties and felt that this was the right training for the job they did.

The arrangements for administering medicines were safe and people received their medicines as prescribed.

Staff were trained to identify and report any concerns about abuse and neglect and felt able to do this.

Inspection carried out on 27 January 2016

During a routine inspection

This inspection took place on 27 January and 3 February 2016 and was unannounced on 27 January 2016.

Upminster Nursing Home is a purpose built 35 bed care home providing accommodation and nursing care for older people, including people living with dementia. The service is accessible throughout for people with mobility difficulties and has specialist equipment to support those who need it. For example, hoists and adapted baths are available. People live in a clean and safe environment that is suitable for their physical needs.

The service had a registered manager. 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 and associated Regulations about how the service is run.

We last inspected this service on 23 February 2015. During that inspection we found that the provider was in breach of the regulations that related to safe care and treatment, consent and also dignity and respect. People were not protected as actions had not been taken to address issues of risk that had arisen. People were not protected from the risk of being deprived of their liberty inappropriately and were not always treated in a caring way. The provider did not have effective systems in place to assess and monitor the quality of the service or to respond to recommendations made in monitoring reports. The provider sent us an action plan stating the steps they would take to address the issues identified. At this inspection we found that improvements had been made and the regulations were now being met.

Systems were in place to minimise risk and to ensure that people were supported as safely as possible. The staff team worked closely with other professionals to ensure that people were supported to receive the healthcare that they needed.

People told us they felt safe at Upminster Nursing Home and that they were supported by kind, caring staff who treated them with respect. One visitor said, “I’m delighted with it here. I come every week and I have never witnessed anything that has made me upset.”

We saw that staff supported people patiently, with care and encouraged them to do things for themselves. Staff knew people’s likes, dislikes and needs. They provided care in a respectful way.

Staff supported people to make choices about their care. Systems were in place to ensure that their human rights were protected and that they were not unlawfully deprived of their liberty. Systems were in place to ensure that people received care and support in line with the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.

The provider monitored the service provided and people were asked for their feedback about the quality of service. When issues or concerns were identified action was taken to address these.

People told us that they were happy with the food and drink provided and their nutritional needs were met. If there were concerns about their eating, drinking or weight this was discussed with the GP and support and advice was received from the relevant healthcare professional. However, people were not always consistently offered hot drinks and snacks throughout the day and night.

Systems were in place to ensure that people received their prescribed medicines safely and appropriately.

Staffing levels were sufficient to safely meet people’s needs. Systems were in place to review staffing levels in line with people’s needs.

People’s care plans were reviewed and updated to ensure that they contained all of the necessary information to enable staff to support them safely.

Staff provided caring support to people at the end of their life and to their families. This was in conjunction with the GP and the local hospice.

Arrangements were in place to meet people's social and recreational needs.

The provider’s recruitment process ens

Inspection carried out on 23 February 2015

During a routine inspection

This unannounced inspection took place on 23 February 2015. Upminster Nursing Home provides accommodation and nursing care for up to 35 older people, some of whom may have dementia. There were 25 people living at the home when we visited. The home was based in a large purpose built building and the bedrooms were on four floors. The communal rooms were on the lower ground and ground floor.

The last inspection was on 1 November 2013, when we judged that the service was meeting the regulations we looked at.

The home had a registered manager at the time of 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 told us they felt safe in the home. The provider took appropriate steps to protect people from abuse, neglect or harm. Training records showed staff had received recent training in safeguarding adults at risk.

Care plans showed staff assessed the risks to people's health, safety and welfare. However where risks were identified, the actions to minimise these were made as general statements and not as measurable actions. People were not protected as well as they could be because actions had not been taken to minimise falls.

We observed that the provider did have a system to assess and monitor staffing levels in relation to people’s needs but we saw appropriate staffing levels were not provided at all times to meet the needs of people who used the service.

People were supported by staff to take their medicines when they needed them. They were protected against errors in medicine administration by the steps the provider had taken.

We saw the home was generally clean and free of malodours. We did see some chairs had torn material and bed rail protectors were ripped; these may be difficult to keep clean because of the damage seen.

People were cared for by staff who received appropriate training and support. Records showed there was an annual training programme in place, and most staff were up to date with their training programme. Information showed supervision should take place quarterly, although not all the staff we spoke with were aware of this. The recruitment processes were appropriate, in that staff were appointed following an application form, interview, criminal record checks and suitable references.

The service had not taken appropriate action to ensure the requirements were followed for the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). These safeguards ensure that a service only deprives someone of their liberty in a safe and correct way, when it is in their best interests and there is no other way to look after them.

People were supported to eat and drink sufficient amounts to meet their needs.

People were supported to maintain good health by having access to healthcare professionals.

Overall, we saw people being treated kindly by staff. People were happy with the care they received, but we also heard from other family members and a visitor who were not so happy with the care given by staff. It was evident from our observations the staff knew the people they were caring for and their preferences.

But at times, staff did not explain what they were doing and did not engage in a meaningful way with the person. We heard staff speaking loudly and in harsh tones on several occasions.

Staff carried out half hourly checks on people who were staying in their rooms, as well as comfort rounds each hour. Almost all people had a call bell close by when they were in their bedrooms, although we saw five people who were in bed did not have a call bell within reach. We did hear several people continually calling for a nurse for help and although staff did attend to them we observed at times there could be a delay for up to 15 minutes.

A pre assessment visit was carried out before a person came to live at Upminster Nursing Home. This was followed with a longer and more detailed assessment when the person moved in. As far as possible where a person had capacity and family that could help, they were encouraged to be part of the assessment and care planning process.

We observed people’s dignity was maintained when staff were caring for peoples personal needs. We heard people spoken to in a kind manner as the staff assisted them and being treated with respect most of the time, but we also observed a person being ignored when they tried to engage with staff. People were not always given the opportunity to develop positive relationships with staff and other people at the home.

The service employed an activities coordinator. The coordinator was not on duty on the day of our visit and the manager told us staff had been organising activities while the coordinator was absent and at weekends but we did not see any evidence of this. People were involved in the development of the new dementia friendly garden but told us access to the garden was restricted and they could only go out when a member of staff escorted them. The manager said they would review this arrangement.

The provider had arrangements in place to respond appropriately to people’s concerns and complaints. People we spoke with were confident to raise any concerns with either the nurse in charge or the manager.

Complaints were dealt with in a timely manner.

The provider did not have effective systems in place to assess and monitor the quality of the service. The provider commissioned an external organisation to carry out unannounced quality assurance visits on a quarterly basis. However, there was a lack of evidence to demonstrate the service had responded to their recommendations.

The provider conducted half yearly surveys with people and relatives and a telephone monitoring survey, where relatives and friends of a person were contacted for feedback on the care provided. Overall the feedback from all the surveys seen was positive. Action plans had been developed to address any issues mentioned but there was no evidence that the action plans were met, how they were shared with people and staff or whether the impact of any changes had improved services for people.

The manager also undertook unannounced night visits, to ensure the quality of service was maintained at night and to have the opportunity to speak to night staff, who may not be available during the day for a meeting.

The registered manager had regular meetings between the home’s owners; these meetings ensured the manager was up to date on any issues or changes that may affect the running of the home.

We observed staff were supportive of each other and the atmosphere in the home was friendly. However we did not see any evidence that staff were empowered to contribute to the running of the service, through team meetings, information sharing or the development of the service provided.

Inspection carried out on 1 November 2013

During a routine inspection

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. People we spoke with said staff told them what care or treatment they were going to provide and asked for their permission. One person said "they do ask. I can say no and they respect my wishes."

People’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan. People said they were happy with the care and treatment they received. Comments included "Yes, they're alright, they're good" and "we're very impressed."

People were supported to be able to eat and drink sufficient amounts to meet their needs. They could request other meal options. For example one person requested eggs rather than fish and another requested a pasty. One person said "they sit down and ask what you want for the following day."

Staff we spoke with said they received adequate support in their roles to carry out their duties. Comments included "I get all the training I need" and "the nurses are very good at cascading information to the carers."

The service had a complaints system in place. This was provided in a format that met people's needs. Some people were aware of the complaints policy. A relative said "it was in the pack I received when I first came here." We were told the service had not received any recent complaints.

Inspection carried out on 5 March 2013

During a routine inspection

People using the service told us they or their relatives had selected the service after comparing several alternatives and had decided this was the best service of this type. One relative told us she ‘couldn’t speak too highly of the care [provided by the service]’. A member of staff said it was the ‘sort of place I’d like my mother to come to’.

We observed that people appeared happy and content. They were respected and their often complex needs were being met. Relatives felt supported and included in discussions about people’s needs and care plans.

Support plans and risk management were in place and the provider was protecting people from abuse.

We had concerns about the amount of training staff were receiving and whether the induction and orientation of new staff was being supported and monitored effectively. The evidence we saw suggested that there was no system of staff appraisal in place.

The provider has been slow to respond to concerns and feedback from its professional advisors about shortcomings in the service.

Reports under our old system of regulation (including those from before CQC was created)