• Care Home
  • Care home

Archived: Uppermead Care Home

Fabians Way, Henfield, West Sussex, BN5 9PX (01273) 492870

Provided and run by:
Dr Shafik Sachedina and Shiraz Boghani

All Inspections

16 October 2014

During an inspection looking at part of the service

The focus of this inspection was to follow up on previous concerns over the provider's arrangements in relation to consent to care and treatment and check whether the provider had made improvements.

Our inspections on 1 November 2013 and 13 August 2014 found that the provider was not meeting the regulations with regard to consent to care and treatment. They were unable to demonstrate that suitable arrangements were in place to gain and review consent from people. Following our visit on 13 August 2014 we issued a Warning Notice to the provider and required them to achieve compliance with the regulations by 10 October 2014.

An inspection manager and an inspector carried out this inspection. We focused our visit on the Chestnut Unit, which cares for people living with dementia. We spent time observing people's experiences during the morning. We spoke with four people, the manager and three members of staff. We reviewed six people's care records, including the notes made by staff on a daily basis.

We found that where people did not have the capacity to consent, the provider had acted in accordance with legal requirements. The Warning Notice had been met.

13 August 2014

During a routine inspection

Two adult social care inspectors carried out this inspection. The focus of the inspection was to check whether the provider had taken sufficient action to meet the compliance actions set at our visit in November 2013. During this inspection we looked to answer five key questions: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

This summary is based on our observations during the inspection and discussions with eight people, four relatives, the manager, two representatives of the provider, two nurses, five carers, the activities coordinator and a member of the domestic staff team. We reviewed records relating to the management of the service and six people's care and health records.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

There were enough suitably qualified and experienced staff on duty to meet people's needs. We observed that staff responded quickly to meet people's needs and to ensure their safety. One member of staff told us, 'It's really good here; even the nurses come on the floor to cover shifts and our breaks'. Another said, 'Now the team is back on it is so much better. There was a bad stage'. We found that the provider had taken action and that the compliance action related to staffing was met.

People were supported by staff who knew them well and who understood their needs and preferences. Staff told us that they received detailed handovers and were kept informed as to any changes in people's care or treatment. We found, however, that people's care records were not always up to date. This meant that people were at risk of receiving inappropriate care or treatment because there was a lack of proper information about them. A compliance action has been set for this and the provider must tell us how they plan to improve.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Since our last visit one application had been made and records confirmed that safe processes had been followed. However, other evidence gained during our visit demonstrated that some people who lived on the secured Chestnut Unit may have been deprived of their liberties without legal processes being followed in full. A relative that we spoke with told us their views on depriving people of their liberty. They said, 'You don't want to lock people in and people do wander into other people's rooms. It's really difficult to get the balance right. You want people to keep their freedom'.

Is the service effective?

At our last visit, we found that the provider did not have suitable arrangements in place to ensure that people living in the Chestnut Unit had consented to their care and treatment. This was because the door to this part of the service was secured by a key code. Since this visit the service had carried out a risk assessment for each person regarding the use of the key code. They had identified that people lacked capacity to consent to the use of the lock and that best interest meetings were needed. This was to safeguard people and ensure that their freedom was not unlawfully restricted. We found that, although the service had identified the need for best interest meetings in January 2014, none had taken place. During our visit some people expressed, verbally and by trying to exit, that they wished to leave the unit. They were unable to do so. Some of the staff that we spoke with did not fully understand how people's capacity should be considered. We found that that people's rights with regard to consent were still not promoted by the service. We are following this matter up with the provider and will report on our actions at a later date.

Throughout our inspection we observed that people received person centred care based on their individual needs and preferences. People that we spoke with expressed satisfaction with the service provided. One relative told us, 'Even people who come here distressed become happy'. Another person told us, 'Since I've been here I feel quite at home'. Staff demonstrated skill and experience when supporting people. One relative told us, 'It's very good, I'm very pleased'. Another said, 'It's lovely here. There's a really good atmosphere'.

Staff had received training to meet the needs of people living at the service. Staff that we spoke with told us that they felt supported and able to deliver good care. We found, however, that staff had not received regular supervision and that just one member of staff had received an appraisal. This meant that staff were not supported in their professional development. A compliance action has been set for this and the provider must tell us how they plan to improve.

Is the service caring?

People were supported by kind and attentive staff. For example on Chestnut Unit we saw one person retire to their room to rest in their chair. Staff made sure they were comfortable by placing cushions around their head and shoulders, putting a blanket across their legs and closing a curtain so that the afternoon sun did not cause discomfort by shining on their face.

We saw that staff were patient and gave encouragement when supporting people. People confirmed their satisfaction with the staff that supported them. As a relative told us, 'It's a very caring place. It's the attitude of the staff, they have the right approach. They have managed to keep a caring atmosphere'.

Is the service responsive?

Activities were available that took account of people's capabilities and understanding. The service had a varied activity programme in place which included in-house activities as well as visiting entertainers. During our visit we observed people participating in a number of activities that stimulated and entertained them. One relative told us, 'The entertainment is wonderful, gets them involved'.

People were supported to access health related support in a timely manner. One relative told us, 'They keep us up to date with things such as if they have needed to call the GP. They are good at monitoring and spotting changes'. Another said, 'The nurses keep me informed and they will follow things up'.

We found that the service listened and responded to questions and feedback received from people, their representatives and from staff. One member of staff said, 'We went through bad patch but it has picked up again'.

Is the service well-led?

Since our last visit, a new manager had been appointed and was registered with us. The manager demonstrated a commitment to making improvements to the quality of service provided to people. People that we spoke with expressed satisfaction with the manager. One relative said, 'Now Lynn has taken over it is so much better'.

Since our last visit, new staff had been recruited and people were now supported by a stable staff team who knew them well. One member of staff said, 'Before we had a lot of staff changes, it is much better now'. People, relatives and staff that we spoke with all felt that there had been positive changes in the service.

We found, however, that the systems in place for monitoring the quality of services provided were not always effective. Actions identified to develop the service had not always been completed and some improvements had not been sustained. A compliance action has been set for this and the provider must tell us how they plan to improve.

1 November 2013

During a routine inspection

We spoke with people who used the service and they spoke highly of the service. People said that staff were helpful and the home met their needs. People described the home as "Very nice," "Comfortable" and "Wonderful." Staff were described as "Kind," "Smashing" and "Thoughtful."

People's consent was sought before care and treatment was delivered. People told us that their input was sought and their independence was encouraged. The provider had acted in accordance with legal requirements where people did not have the capacity to consent. However, Chestnut Unit, the dementia care unit was kept locked which restricted people's movement throughout the home. This had not been appropriately assessed to explain the reason for depriving people of their liberty.

People's care was planned and delivered in line with their needs and preferences. A comprehensive assessment of people's needs was completed prior to receiving care and these needs were regularly reviewed. Care records indicated that people's care needs were delivered in line with the care plan.

The premises was well maintained and fit for purpose

We found that there were enough qualified and skilled staff available to meet people's needs.

The service had a robust complaints procedure in place and records indicated that these procedures were followed. This ensured that complaints were investigated and acted upon swiftly.

We saw that confidential care records were not always kept securely. This meant that personal information was not kept securely and there was a risk that care records could be lost or destroyed.

13 March 2013

During a routine inspection

We found that people were given choice and their decisions were respected. People told us that they were treated with dignity and respect and we observed that staff treated people with care and consideration. A person's relative told us "they always keep me informed and they don't force anything on them".

A person told us "I feel I am well looked after". Another person said "I get my needs met - up to a point". We found that people's individual needs were assessed and their preferences were taken into account in the planning and delivery of care and treatment. A person's relative told us "we are satisfied, they understand dementia here - they do a brilliant job".

People told us they felt safe in the home and we saw that the provider had systems in place to ensure that people were safeguarded against the risk of abuse. We found that where people required protection from harm they were supported appropriately and lawfully.

We found that staff were experienced, skilled and qualified to support people with their needs. However, we have asked the provider to ensure that sufficient staff are on duty at all times to safeguard the health, safety and welfare of people using the service.

We found that the provider had an effective system for monitoring and assessing the quality of the service provided, which included the views and experiences of people and their representatives.