Upton Dene Residential and Nursing Home

We found two breaches of the legal regulations in relation to safe care and treatment and staffing. Information about people’s needs, risks and care was not always accurate or up to date. People’s physical health conditions had not been assessed to ensure staff knew how to support these needs appropriately. Some people did not receive the support they needed in accordance with their care plan to mitigate risks to their health and safety.

Learning from accidents and incidents was not always implemented effectively to drive up improvements. Additional measures for sharing and embedding learning across the service had been introduced as part of the provider’s service improvement plan.

Staff received adequate training to do their job role. A staff member felt more advanced dementia training was however needed. Staff supervisions and appraisals were not up to date which meant some staff may not have received sufficient support to do their job role well.

Staff were recruited safely. Staffing levels on the day of the assessment were adequate. However, people living in the home and staff had mixed opinions as to whether these levels were always safe and sufficient. Some people told us at times they had to wait for help from staff. People also said agency staff whose first language was not English were difficult to understand. We fed this back to the management team.

There were systems in place to protect people from the risk of abuse. There was a system in place to apply for and monitor deprivation of liberty safeguards, however this system was not always followed appropriately.

People told us they felt safe and able to raise any concerns they had about their care with the staff team. The home was clean and well maintained.

We found two breaches of the legal regulations in relation to safe care and treatment and the need for consent. People’s needs and risks were not always appropriately assessed. Staff lacked adequate and accurate information about people’s needs, risks and care. Staff lacked adequate guidance on how to appropriately support people with mental health conditions such as dementia who became distressed or agitated. This included a lack of clear and consistent information on people’s communication needs and how to communicate with them effectively. These shortfalls placed people at risk of inappropriate and ineffective care that did not promote positive outcomes. People’s legal right to consent to their care was not always respected in accordance with the Mental Capacity Act. Some people’s care files contained contradictory information about their ability to consent which increased the risk of inappropriate decision making on the person’s behalf.

A service improvement plan was in place to ensure improvements to care planning, risk assessment and the application of the mental capacity act were made. These improvements were still in progress at the time of our assessment.

People told us they were given a choice in how they lived their life and staff respected their wishes. Staff told us team working across the service was good and people we spoke with confirmed this. One person told us, “ They are very efficient”. People told us they got enough to eat and drink and there was always a choice of what to have. Referrals to other health and social care professionals in respect of people’s needs were made as and when required. People told us medical attention was sought quickly if they felt unwell and that staff were attentive and responsive to any signs of ill-health. People’s day to day progress such as their weight, nutritional intake, pressure sore progress and continence care was monitored daily.

There was a breach of legal regulation in relation to good governance. The Local Authority visited the service in March 2024 due to a number of safeguarding concerns reported about the quality and safety of the service. At this visit, the Local Authority identified improvements across the service needed to be made. Following this visit, the provider put a service improvement plan in place to drive up improvements. At the time of our assessment, the service improvement plan was still in progress. During our visit, we found similar shortfalls in care planning, risk assessment, the implementation of the mental capacity act, staffing and good governance, as that identified by the Local Authority. We were concerned that improvements were not being made with any urgency. Record keeping was not always accurate or contemporaneous, which meant it was impossible to monitor the provision of people’s care with any certainty. Daily walkaround checks by the management team had failed to identify that some people’s pressure mattress settings were incorrect or that people had personal confidential information accessible in bedroom areas.

Staff told us that the management team were approachable and felt supported in their job role. The culture of the service was open and transparent, and the service had a warm homely atmosphere. Both staff and people living in the home felt comfortable raising any concerns about the service and felt confident they would be acted upon. The service worked in partnership with other health and social care professionals to support people’s needs. There were systems in place to ensure that professional advice from other professionals was followed.