Upton Grange Residential Home

Upton Grange is one of three care homes owned by the Cheshire residential Homes Trust, which is a charitable non-profit making organisation. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates the premises and the care provided, both were looked at during this inspection. It can accommodate up to 25 people. At the time of our inspection there were 20 people living there.

People’s experience of using this service and what we found

Quality assurance processes were carried out by the registered manager. However, issues regarding the management of activity records, health and safety records, risk assessments, deployment of safe staffing needs further review to improve monitoring and record keeping.

Risks to people’s health and safety were assessed and managed but paperwork was not always up to date.

People told us there were enough staff around to help them receive care and support. However, they did not always know how many staff were on duty.

Care plans were in place and generally contained the correct level of information in relation to the support people needed. Some areas of recording needed updating.

Feedback received about the support provided was positive. People received good support from a committed staff team. People and relatives told us they loved the home-made food and felt it was a lovely environment to live in and enjoy. People told us they felt safe and comfortable.

Complaints were dealt with in accordance with the organisation's complaints procedure, people said they knew how to complain.

Recruitment checks were organised and showed appropriate records to ensure staff were suitable to work at the service. The staff team were well trained and skilled in effective communication to ensure people felt supported.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was 'good' (published July 2018.) At this inspection we found a breach of regulations and rated the service as 'requires improvement.'

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to good governance at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will continue to monitor intelligence we receive about the service until we return to visit as per our inspection programme. If any concerning information is received, we may inspect sooner.

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress.

Upton Grange is one of three care homes owned by the Cheshire Residential Homes Trust, which is a charitable non-profit making organisation. The home provides personal care and accommodation for up to 25 older people. At the time of our inspection there were 22 people living at the home.

There was 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 on 4 February 2016, we found that the provider was not meeting the requirements of the Health and Social Care Act 2008 in relation to safe care and treatment, fit and proper persons employed and good governance. We conducted this inspection to review whether sufficient improvements had been made since the last inspection. We found that improvements had been made in all of these areas.

Overall people and relatives spoken with were positive and complimentary about the service they received at the home. People told us that they felt safe and were cared for. People received their medicines in a way that protected them from harm. Staff understood their responsibility to keep people safe from abuse and harm.

During this inspection we found there were enough staff available to meet the needs of people living at the home. We saw that there were processes in place to ensure the home regularly assessed and monitored staffing levels to ensure sufficient staff were available to provide the support people required. Improvements had been made to the recruitment processes and the registered manager was able to check that staff were suitable and qualified for the role they were being appointed to and not putting people they care for at risk.

We examined training records which demonstrated that regular training was provided and staff underwent an induction. At this inspection we saw that staff had received training in dementia care but found that practice in this area could still be improved further. Staff had regular supervision and appraisals. Staff confirmed that they had the opportunity to meet with the registered manager on a regular basis.

Staff had an understanding of the Mental Capacity Act 2005, and where a person was being restricted or deprived of their liberty, applications had been appropriately made to the supervisory body under Deprivation of Liberty Safeguards.

We found that people’s nutritional needs were being met. People’s views on the quality of the food were generally positive. We looked around the home and found the environment to be conducive to the needs of the people who lived there. The environment was decorated to a high standard and well maintained. Rooms were bright and people had been encouraged to bring in personal items from home and many rooms were personalised

People told us that they were well cared for and in a kind manner. Staff knew the people they were supporting well and understood their requirements for care. We found that people were treated with dignity and respect. People were supported and involved in planning and making decisions about their care. We saw that where they were able to, people had been involved in the development of their care plans and had signed them to say that they had been consulted with.

At the last inspection we asked the registered provider to make improvements because the registered provider had not ensured that risk assessments relating to the health, safety and welfare of people using the service were appropriately updated to reflect people's needs. At this inspection we saw that improvements had been. We saw that care plans reflected how people liked to receive their care. They were very detailed and included information about what was important to people and how best to support them.

The provider had a complaints procedure in place, which was on display in the reception at the home. People told us that they felt able to raise any concerns with staff.

The registered manager explained that since coming into post she had identified a number of areas for further improvement and had made some necessary changes. She understood her responsibilities and had worked hard to ensure that the service met the appropriate regulations. All of the breaches identified at the last inspection had been met at this inspection.

Staff expressed mixed views about the management style but we found the registered manager engaged well with the inspection process and responded positively to any suggestions regarding possible improvements to the service. People and relatives told us they knew who the manager and were positive about the leadership of the home.

Quality assurance systems had been implemented more robustly since the last inspection and regularly reviewed the quality of the service provided. Audits were undertaken for aspects of care such as medicines, care plans, infection control and the dining experience.

The service was previously inspected in August 2014 when it was found to be meeting all the regulatory requirements which were inspected at that time.

Upton Grange Residential home provides personal care and accommodation for up to 25 older people.

Upton Grange is an older style large country house, with a pleasing and spacious interior. There are 25 single bedrooms, all of which have en-suite facilities. Communal space consists of two lounge areas and a dining room. There is a large private garden with walkways and seating areas and an enclosed courtyard. A laundry room and hairdressing salon is also available for people to access.

Twenty three people were being accommodated at the time of the inspection.

At the time of the inspection there was a manager at Upton Grange Residential home. The manager started her post in August 2015 and provided evidence to the inspection team that she had applied to be the registered manager, however this process had not yet been completed.

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.

During this inspection visit we found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, relating to ineffective quality assurance and auditing systems, recruitment processes, and lack of systems in place for safe care and treatment. You can see what action we told the registered provider to take at the back of the full version of the report.

The manager was present during our inspection and engaged positively in the inspection process. The manager was observed to be friendly and approachable and operated an open door policy to people using the service, staff and visitors. During the inspection we found Upton Grange to have a warm and relaxed atmosphere and overall people living in the home appeared happy and content.

Feedback received from people using the service spoken with was generally complimentary about the standard of care provided. People living at Upton Grange told us the manager was approachable and supportive.

The provider did not have an effective recruitment and selection procedure in place and did not carry out relevant checks when they employed staff.

Staff were supported through induction, regular on-going training, supervision and appraisal. A training plan was in place to support staff learning. There were however, gaps in dementia care and Deprivation of Liberty Safeguards (DoLS) training.

The service lacked governance systems to assess, monitor and improve the quality of the service. For example, effective systems to seek feedback of the experience of service users were not in place and auditing systems were not robust.

The registered provider has not ensured that risk assessments relating to the health, safety and welfare of people using the service were appropriately updated to reflect people’s needs.

We found that the home was properly maintained and ensured people’s safety was not compromised.

Staffing levels were structured to meet the needs of the people who used the service. There were sufficient numbers of staff on duty to meet people’s needs.

A process was in place for managing complaints and the home’s complaints procedure was displayed so that people had access to this information. People and relatives told us they would raise any concerns with the manager.

The registered provider had policies and systems in place to safeguard people from abuse. Staff were aware of the whistle blowing policy and they told us they would use it if required. Staff told us they were able to speak with the manager if they had a concern.

Medicines were ordered, stored, administered and disposed of safely. People using the service had access to a range of individualised and group activities and a choice of wholesome and nutritious meals. Records showed that people also had access to GPs, chiropodists and other health care professionals (subject to individual need).

During the inspection we spoke with the registered manager, the administrator and two staff members. We also spoke with five of the people who lived in the home and one visitor.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service and their relatives, the staff supporting them and from looking at records.

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

Is the service safe?

We looked at the safeguarding policy. This was available in the office. All the staff we spoke to were aware of the policies and how to access them. The registered manager and the administrator were able to demonstrate a good understanding of the reporting systems for the local authority and the Care Quality Commission in relation to safeguarding people. We discussed the Mental Capacity Act and the Deprivation of Liberty Safeguards with the registered manager and the administrator. They told us about the applications that they were currently making for people who lived in the home to protect them from harm.

Is the service effective?

We asked about quality assurance questionnaires and we were told that these were completed annually by people who lived in the home and their relatives. We saw that these had been sent out in May 2013. Eighteen questionnaires had been received and all made positive comments about the home, the staff, the manager and the food.

Is the service caring?

We spoke with five people who lived in the home. They all spoke highly of the care that they received and of the staff who supported them. One person said "I like it. I get good care here." Another person said "It's a lovely home. I'm very happy here." We also spoke with a visitor and they told us "I've been coming here for years and you won't find a home as clean and well-kept as this one."

Is the service responsive?

At our previous inspection we had concerns that people who lived in the home could not always choose what time they got up each morning. The registered manager told us that the staff rota had been adjusted and now an extra staff member commenced work at 7am to support people who wished to get up early.

We saw that people's needs were assessed and care and treatment was planned and delivered in line with their individual care plans. We looked in some detail at the care and support provided to four people who lived in the home. In order to do this we met the people concerned, we spoke with the staff and registered manager and we looked at people's records.

These records included the person's care plans, risk assessments, and records about the support they had received from professional people outside of the home. We found the information in people's care plans was detailed and they clearly reflected people's individual wishes and choices. Care plans also included detailed pieces of information and guidance about particular aspects of people's care. We saw that the home worked with people and their families to produce comprehensive life histories.

Is the service well led?

We asked about audits and we were shown a variety of audits that were carried out by the registered manager and the administrator on a monthly basis. We saw that care plan audits were completed every month and then action plans had been developed and signed off when tasks were completed. The administrator told us that they ensured that every care plan was audited regularly.

We asked about staff meetings and we were told that these were rarely held. The registered manager told us that they discussed concerns with staff when they occurred and as they were a small staff team, communication was good. They also told us that they had an open door policy so that staff, relatives and people who lived in the home could talk to them when they liked.

We looked at the home's procedures for protecting vulnerable adults as we had concerns at our previous inspection. We saw that the policies had been updated and some work around the staff's understanding of safeguarding was in progress.

We looked at the policies and arrangements for supporting people who lived in the home with their medication and saw that staff were following the procedures for safe medication administration.

We looked at the care files and we had some concerns about the recording and reviewing of care plans.

We spoke to eight people who lived in the home. Seven of them told us that they enjoyed living in the home and that the care was good. They also told us that they had good relationships with the staff and felt well supported by them. One person raised some concerns but told us that they had complained and that their complaint had been resolved, however they did express some issues about some of the staff and their conduct.

We spoke to the registered manager, the trust's administrator and 12 members of staff, some of whom were on duty that day and some by telephone. Most of the staff we spoke to were happy working at the home and felt well supported by the management team. A small number of staff expressed concerns about how some staff conducted themselves.

We looked at the safeguarding policies in the home and found that the home was not following procedures correctly. We also had concerns about the staff's understanding of whistle blowing and their responsibilities within this. We looked at the complaints procedure and the procedures for employing staff and found that these were adequate.

As part of this review, we asked people who used the service to comment on the management of their records and about the care and support they received. People who used the service told us that they were happy with the care and support provided by the staff.

The people we spoke with told us they had no complaints or concerns they wished to raise. One person told us: "The staff know me really well, they respect me as I do them and we get along fine. The manager is lovely and you can tell her anything, she's very kind." Another person said: 'It's excellent here, I really can find no fault with the staff or the services offered and believe me if I did I would tell them.'

We found that staff were able, from time to time, to obtain further relevant qualifications and that there were systems in place to assess and monitor the quality of service that people received.

People who used the service told us that they were confident the manager would appropriately address any issues they had if they had any to raise.