Upton Manor

Upton Manor is a residential care home providing personal and nursing care to up to 67 people aged 65 and over. At the time of the inspection there were 26 people using the service. The service has purpose-built premises which is provided over three floors, two of which were almost vacant during our inspection. The upper floor accommodates people living with dementia and the provider intends to support people with residential and nursing care on the other two floors.

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

At our last inspection in September 2020 risks were not sufficiently managed, at this inspection improvements had been made. Robust risk assessments had been completed to minimise risks to people during care delivery or from the environment. The use of restraint had reduced and staff were supportive of people taking some risks in order to lead fulfilling lives. Management of healthcare conditions had improved, and person-centred care plans ensured care delivery was how people wanted it. Safety of the premises and of equipment was monitored. Staff were safely recruited and completed an in-depth induction and shadowing period on commencement. The provider was recruiting to staff vacancies before admitting new residents to the service to ensure staffing levels remained safe. At our last inspection, medicines had not been managed safely. This inspection found that significant improvements had now been made to the way in which medicines were administered and stored and the auditing procedures were more robust. At our last inspection we were not assured that infection prevention and control was effective. Improvements had been made and the provider was no longer in breach of this regulation. There had been concerns that suitable mental capacity assessments and best interest decisions had not been completed before including people in COVID-19 testing. There were now clear assessments in place which were in line with legislation.

At our last inspection we were concerned that a lack of oversight and auditing increased risks in the service. There have been significant improvements and we were now assured that audit processes were being used effectively to reduce risk and drive improvements. Relatives and staff were regularly asked to comment on the service. There were positive relationships with health and social care professionals.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 20 November 2020). There were multiple breaches of regulations. At this inspection we saw many improvements and the provider was no longer in breach of regulations.

Why we inspected

We carried out an inspection of this service on 17 September 2020. Breaches of legal requirements were found. The provider completed an action plan to show what they would do and by when to improve safe care and treatment, fit and proper persons employed, good governance and need for consent.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Upton Manor on our website at www.cqc.org.uk.

Waypoints (Upton) is a purpose-built nursing home registered to provide care for up to 67 people. The home was divided into five separate living units. At the time of our inspection there were 38 people living there. This was due to a major refurbishment that was taking place. The people living in the home had complex care needs associated with their dementia.

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

Governance and oversight of the service was not robust: shortfalls and concerns have been identified at this inspection which internal audits and assessments had failed to highlight. Where internal systems had identified issues that needed to be addressed, this had not been done in a timely manner, leaving known issues unresolved.

Since the last inspection, the ownership of the registered provider has changed. The transition between different policies, procedures and ways of working had left staff confused and uncertain.

Systems and management of areas such as the administration of medicines, infection prevention and control and matters relating to the safety of people and the environment were not satisfactory. Records did not show people received their medicines in the way that they had been prescribed, appropriate infection prevention measures were not always maintained and checks and tests of important areas such as fire prevention were not always completed.

Risks to people’s health and wellbeing were not consistently managed. As well as living with dementia, many people lived with other conditions or specific needs. We could not be certain that people received the correct support to manage conditions such as diabetes or epilepsy or that areas such as moving and assisting people, preventing skin damage or dehydration were managed effectively.

Staff had not received the required training and competency checks to ensure they had the necessary skills to meet people's needs.

Staffng was provided in accordance with the provider's own policy and assessment tools. We identified times where, due to some people's needs, staff were not always be available for everyone in the home.

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 28 August 2019)

Why we inspected

We received concerns in relation to people not receiving the care they needed, staffing and poor management. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to infection prevention and control, medicines management, assessment of risk, consent, safe recruitment of staff and governance of the service.

You can see what action we have asked the provider to take at the end of this full report.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Waypoints (Upton) on our website at www.cqc.org.uk.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Waypoints (Upton) is a purpose-built nursing home registered to provide care for up to 67 people in the centre of the village of Upton. At the time of our inspection there were 61 people living there. People were living across three floors. The people living in the home had complex care needs associated with their dementia.

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

People who could speak with us told us they felt safe and happy living at Waypoints (Upton). Relatives were reassured by the care and attention their family members received. Staff understood how to keep people safe and felt confident that they would be listened to, and timely action taken, if they had any concerns that people were at risk of harm and abuse.

People were supported by well trained staff who were competent in helping them meet their individual needs, desired outcomes and live their lives with as much independence as possible. 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; the policies and systems in the service supported this practice.

Staff understood the importance of helping people to stay healthy by supporting them to access relevant healthcare services. A local GP practice provided pro-active weekly visits which helped people to stay well and access specialist services when required. Risks people faced were minimised by the actions staff had taken and regularly reviewed.

People were supported by staff who were patient, caring and respectful. Staff had got to know people well which created warm and mutually beneficial interactions. People were listened to and encouraged to make decisions about the care and support they received. Staff supported people to make meaningful choices throughout their day and gained their consent before providing them with care.

People had the opportunity to participate in various group and individual activities that reflected their interests and abilities. People could choose to spend their day how they wished with freedom of movement actively encouraged. When people wanted to spend time alone or with visitors this was respected and supported. Relatives felt welcomed and involved.

People, relatives and staff had the opportunity to submit their views and influence what happened at the home via annual surveys. Team meetings were used to discuss issues such as upcoming training, regulatory changes and practice development.

The home had a strong senior management team whose skills and vision complemented each other. Some staff felt the registered manager was not always approachable. The registered manager told us they were aware of this perception and were actively working to improve this, for example, by being more visible around the home and making opportunity for conversations with staff.

The culture of the home was open, friendly and supportive. Staff felt valued and recognised. Their professional development was encouraged and supported.

Regular quality and safety checks helped ensure people remained safe and were protected from harm. A programme of audits helped identify areas for improvement with learning shared with staff. This oversight helped ensure practice standards were maintained and improved.

The home had developed good working relationships with other agencies including district nurses, clinical commissioning group, GP practice and a local university to support student nurse placements.

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 3 February 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

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

Waypoints (Upton) is a purpose built nursing home registered to provide care for up to 67 people in the centre of the village of Upton. At the time of our inspection there were 46 people living there. People were living across three floors. Only half of the third floor was open. The people living in the home had complex care needs associated with their dementia.

Our last inspection on 2, 7 and 8 September 2015 found that systems and processes were not in place to ensure robust assessing and monitoring of quality, safety and risks. We saw that accurate records were not maintained. We also found that some people did not receive safe care and treatment. Risks were not assessed or mitigated effectively. People did

not receive their medicines safely and the risks of cross infection were not being managed effectively. During this inspection we found that improvements had been made.

The service had a registered manager in place. 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, relatives, a health professional and staff told us that the service was safe. Staff were able to tell us how they would report and recognise signs of abuse and had received training in safeguarding.

Care plans were in place which detailed the care and support people needed to remain safe whilst having control and making choices about their lives. Each person had an online care record and associated files which included guidelines to make sure staff supported people in a way they preferred. Risk assessments were completed, regularly reviewed and up to date.

Medicines were managed safely, securely stored, correctly recorded and only administered by on duty nurses that were trained and qualified to give medicines.

Staff had a good knowledge of people’s support needs and received regular local mandatory training as well as training in response to people’s changing needs for example some people were displaying behaviour which challenged the service and staff had been trained in this area.

Staff told us they received regular supervisions which were carried out by the management team. Staff told us that they found these useful. We reviewed records which confirmed this.

Staff were aware of the Mental Capacity Act and training records showed that they had received training in this. Capacity assessments were completed and best interest decisions recorded as and when appropriate.

People and relatives told us that the food was good. We reviewed the menu which showed that people were offered a variety of healthy meals. We saw that food was regularly discussed and recorded on food preference sheets. The chef told us that the majority of meals are home cooked.

People were supported to access healthcare appointments as and when required and staff followed professional’s advice when supporting people with ongoing care needs. Records we reviewed showed that people had recently seen the GP, physiotherapist, mental health team and a chiropodist.

People told us that staff were caring. We observed positive interactions between staff, managers and people. This showed us that people felt comfortable with the staff supporting them.

Staff treated people in a dignified manner. Staff had a good understanding of people’s likes, dislikes and interests. This meant that people were supported by staff who knew them well.

People had their care and support needs assessed before being admitted to the service and care packages reflected needs identified in these. We saw that these were regularly reviewed by the service with people, families and health professionals when available.

Relatives and stakeholders were encouraged to feedback. We reviewed the relative’s satisfaction survey results for 2016 which contained mainly positive feedback. We were told that the service would start to produce a results report following these for easy analysis.

There was an active system in place for recording complaints which captured the detail and evidenced steps taken to address them. We saw that there were no outstanding complaints in place. This demonstrated that the service was open to people’s comments and acted promptly when concerns were raised.

Staff had a good understanding of their roles and responsibilities. Information was shared with staff so that they had a good understanding of what was expected from them.

People and staff felt that the service was well led. The registered and service manager both encouraged an open working environment.

The service understood its reporting responsibilities to CQC and other regulatory bodies they provided information in a timely way.

Quality monitoring audits were completed by the registered manager and head of care. The management team analysed the detail and identified trends, actions and learning which was then shared as appropriate. This showed that there were good monitoring systems in place to ensure safe quality care and support was provided to people.

Waypoints Upton had a set of Aims and Values which put people in the centre of the care they received. These reflected delivering a professional service which was person centred, customising activities to suit individuals and meeting their needs. During our inspection we found that staff and management demonstrated these through using person centred approaches by acknowledging them, promoting choice and talking them through the support they were providing in an empowering way.