Archived: Upsall House Residential Home Limited

Upsall House Residential Home Limited is a care home providing personal care for up to 30 people aged 65 and over. At the time of the inspection there were 22 people living at the service. The service accommodated people in one adapted building over two floors.

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

People’s care remained unsafe. Although people said they received good care from staff who knew them well, we found risks were not always anticipated or responded to. Staff were not supported with supervision, appraisal and training. Recruitment procedures remained unsafe. There were always enough staff on duty. Infection prevention and control measures had significantly improved.

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 did not always support this practice.

Little improvement had been made since the last inspection. Leaders did not have the necessary skills and knowledge to deliver a safe service. Quality assurance measures continued to be ineffective and did not support the service to make continued improvements. The quality of the environment had started to impact upon people’s dignity.

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 inadequate (published 7 January 2022). At this inspection we found the provider remained in breach of regulations.

Why we inspected

We carried out an unannounced focused inspection of this service on 15, 18 and 23 November 2021. Breaches of legal requirements were found. We served a warning notice. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, fit and proper persons employed and good governance.

We undertook this focused inspection to check they had met the requirements of the warning notice and 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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service remains inadequate. 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 Upsall House on our website at www.cqc.org.uk.

Enforcement and Recommendations

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 will take further action if needed.

We have identified breaches in relation to recruitment and quality assurance procedures at this inspection. Whilst enforcement action was proposed and being processed, the provider submitted a Voluntary Cancellation of their registration and therefore our enforcement action did not proceed.

Follow up

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures.’ The provider has submitted a Voluntary Cancellation of their registration.

Upsall House Residential Home Limited is a care home providing personal care for up to 30 people aged 65 and over. At the time of the inspection there were 27 people living at the service. The service accommodated people in one adapted building over two floors.

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

The procedures in place to assure fire safety were very unsafe. The oversight of risk needed to be further improved. Repeated incidents had taken place; lessons had not been learned. Recruitment practices were inadequate. There were enough staff on duty who knew people’s needs well. People received their medicines when they needed them. People were very happy with their care.

A lack of robust oversight had led to deterioration in the service. Quality assurance systems were ineffective. Notifications had not been submitted to the Commission when needed. Leadership needed to be strengthened. The staff team worked well together. The service had good relationships with relatives and professionals.

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 requires improvement (published 11 May 2021). At this inspection, we found improvements needed to be made. The service has deteriorated to inadequate.

Why we inspected

We received concerns in relation to recruitment, staff practices, leadership and 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 have found evidence that the provider needs to make improvement.

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 is inadequate. 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 Upsall House Residential Care Home Limited on our website at www.cqc.org.uk.

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 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 safe care and treatment, recruitment and the governance of the service.

Please see the action we have told the provider to take at the end of this report. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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 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.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures.’ This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Upsall House Residential Home Limited is a care home providing accommodation and personal care for up to 30 people. At the time of our inspection there were 20 people using the service, some of whom were living with a dementia type illness. The home accommodates people in one adapted building over two floors.

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

Some improvements had been made to people’s care plans and individual risk assessments. Further information was required to record how people’s health conditions could impact upon their lives. We have made a recommendation about improving the quality of information contained in care records.

Infection prevention and control measures had improved. Visitors were robustly screened and improvements had been made to the environment. We were assured staff were wearing appropriate PPE. Further improvements were required to support good hand hygiene. We have made a recommendation about staff being bare below the elbow.

Medicines were stored safely and people received their medicines as prescribed. Further information was required to record the effectiveness of ‘as and when required’ medicines and where on the body creams were to be applied. We have made a recommendation about the recording of some medicines.

Increased auditing and monitoring checks were in place. Further actions were required to address the issues found at inspection. The provider's quality monitoring of the service had not been effective in identifying these issues. We have made a recommendation about quality monitoring.

People told us they felt safe. Staff understood their safeguarding responsibilities. Leadership and oversight had improved. Action plans had been put in place following the previous inspection. The service sought and encouraged feedback from people, staff, relatives and 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 inadequate (published 22 December 2020) and there were multiple breaches of regulation. This service has been in Special Measures since October 2020. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, safeguarding people from abuse, staffing, and good governance.

During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. This service is no longer in breach of regulations or in Special Measures.

Why we inspected

We undertook this focused inspection to check they had followed their action plan and to check whether the warning notices we previously served in relation to regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. This report only covers our findings in relation to the key questions safe and well-led which contain those requirements.

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.

The ratings from the previous comprehensive inspection (published 16 May 2019) 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 inadequate to requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection and our last focused inspection, by selecting the ‘all reports’ link for Upsall House Residential Home Limited on our website at www.cqc.org.uk.

Follow up

We have asked the provider for an action plan. 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.

Upsall House Residential Home Limited is a care home providing personal care for up to 30 people aged 65 and over. At the time of the inspection 20 people were living at the home. The care home is an adapted building and houses people over two floors.

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

Since March 2020 the service has had two outbreaks of Covid-19. We found people were not protected from the risk of harm. Staff failed to wear PPE appropriately. Infection control procedures needed to be significantly improved. Some medicines were not given as prescribed. People said they felt safe living at the home and received good care.

Leaders did not have the right skills to minimise the risk of harm to people. Managerial oversight of the home was limited. Quality monitoring systems failed to identify staff were not adhering to relevant guidance and best practice when working in the home. They did not identify areas where improvements needed to be made.

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 16 May 2019).

Why we inspected

As part of CQC’s response to the coronavirus pandemic we are conducting a review of infection control and prevention measures in care homes.

We undertook this inspection to look at the infection control and prevention measures the provider has in place. We widened the scope of the inspection to include the key questions of safe and well-led because we identified concerns in those key areas.

Enforcement

We have identified breaches in relation to safe care and treatment, safeguarding people from abuse, staffing and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

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 alongside the provider and 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.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions of their registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions, it will no longer be in special measures.

People’s experience of using this service: People and their relatives were happy with the care and support they received from the provider.

The management team and staff developed good relationships with people and their relatives to ensure they received the right support to improve their quality of life.

People told us they felt safe whilst being supported by staff. Relatives were confident family members were well cared for. There was a proactive approach to assessing and managing risk which allowed people to remain as independent as possible.

The provider promoted person-centred care which was delivered through the assessment and planning of people's individual and specific needs. Care plans were detailed and informative. They identified the specific care that people required.

Staff were skilled and knowledgeable in the care and support people required. They provided flexible care and support in line with a person's needs and wishes. The staff team was consistent with some staff working at the service for many years. Staff worked with family members and a range of professionals to ensure people were provided with the care and support they required.

Medicines systems were organised, and people were receiving their medicines when they should. The provider was following national guidance for the receipt, storage, administration and disposal of medicines.

People were involved in decisions about the care they received. People had maximum 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 was open and approachable which allowed people to share their views and raise concerns. People told us if they were worried about anything they would be comfortable to talk with staff or the management team.

The management structure in the service ensured people and staff had access to, and support from, a competent management team. The registered manager and provider monitored quality, sought people's views and had plans in place for improvements to the service environment.

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

Rating at last inspection: Good (Report published 29 November 2016)

Why we inspected: We inspected the service as part of our inspection schedule for ‘Good’ rated services.

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

The service was previously inspected in April 2016 and was not meeting two of the regulations we inspected. These related to medicine management, risk assessments, quality assurance audits and staff training records. We took enforcement action and issued warning notices requiring the registered provider to be compliant with our regulations by 29 July 2016. We also found that the service was not displaying the rating awarded at an inspection we carried out in October 2015. We also issued a fixed penalty notice in relation to failure to display the October 2015 inspection rating. When we returned for this inspection we found the issues identified had been addressed.

Upsall House Residential Home provides care and accommodation to a maximum of 30 people, some of whom may be living with a dementia. The home is a two storey converted private dwelling situated near Middlesbrough. There are 30 single bedrooms, 24 of which have en-suite facility which consist of a toilet and hand wash basin. There are two communal lounges and a dining room. At the time of our inspection 26 people were using the service.

The service had a manager but they were not 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 2008 and associated Regulations about how the service is run.

People’s medicines were managed safely. Risks to people were assessed and plans put in place to reduce the chances of them occurring. Regular checks of the premises and equipment were undertaken to ensure they were safe for people to use. Plans were in place to help keep people safe in emergency situations.

Policies and procedures were in place to protect people from abuse. The manager monitored staffing levels to ensure sufficient staff were employed to support people safely and recruitment procedures minimised the risk of unsuitable staff being employed.

Staff received the training they needed to support people effectively, and felt confident to request more. Training was clearly recorded, which helped the manager to monitor it. Staff were supported through supervisions and appraisals.

The service worked within the principles of the Mental Capacity Act 2005 to protect people’s rights to make decisions for themselves. People were supported to maintain a healthy diet and spoke positively about the food they received at the service. People were supported to access external professionals to maintain and promote their health.

People spoke positively about staff at the service, describing them as kind and caring. Throughout the inspection we saw staff treating people with dignity and respect and numerous examples of kind and caring support being provided.

One person was using an advocate at the time of our inspection, and the service worked with them to ensure the person’s voice was heard in planning their care.

Care and support was based on people’s assessed needs and preferences and was person-centred. Care plans were regularly reviewed to ensure they reflected people’s current support needs, and people said they were involved in these reviews.

People were supported to access activities they enjoyed. Procedures were in place to investigate and respond to complaints.

The manager carried out regular quality assurance audits to monitor and improve standards at the service. The registered provider also carried out monthly quality review visits. The manager and registered provider had worked closely with the local authority following our April 2016 inspection to improve quality assurance processes.

Feedback was sought from people at quarterly resident meetings and through regular informal discussions between people and staff.

Staff spoke positively about the culture and values of the service and said they were supported by the manager and were proud of the improvements made at the service.

Upsall House Residential Home provides care and accommodation to a maximum of 30 people, some of whom may be living with a dementia. The home is a two storey converted private dwelling situated near Middlesbrough. There are 30 single bedrooms, 24 of which have en-suite facility which consist of a toilet and hand wash basin. There are two communal lounges and a dining room. At the time of our inspection 27 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 2008 and associated Regulations about how the service is run.

Medicines were not always managed safely. People’s medicine records did not always contain the information needed to support them safely with their medicines. Controlled drugs stock levels were not always accurately recorded.

Risk to people using the service were not always effectively assessed which meant plans were not in place to minimise them. Some of the risk assessments we looked at contained only basic information. Where people’s support needs gave rise to specific risks these had not always been risk assessed.

During our last inspection in October 2015 we identified a breach of regulation in relation to quality assurance processes. At that inspection we found limited infection control audits, remedial action was not taken following health and safety audits and there was limited detail in care plan and medicine audits. During our latest inspection we saw there were still gaps in quality assurance audits being carried out. Quality assurance processes were not carried out when the registered manager was absent, which meant standards were not consistently monitored. Where audits were completed it was not always clear what records meant.

During the inspection we checked to see if the service was displaying the rating awarded at the October 2015 inspection. The rating was not displayed as required by our regulations.

Recruitment procedures had improved since our last inspection in October 2015. Three members of staff had been recruited since then and we saw pre-employment checks were carried out to minimise the risk of unsuitable staff being employed.

People and staff told us staffing levels were sufficient to support people safely. The registered manager did not use any tools to monitor or assess staffing levels, but all housekeeping staff received the same training as care staff so they could assist in covering staff absences.

Staff understood safeguarding issues and were able to describe the types of abuse that can occur in care settings. There was a safeguarding policy in place, and staff had signed this to confirm they had read and understood it.

Risks to people arising out of the premises were monitored, and remedial action taken where necessary. The service was working with the local fire brigade to address issues identified by a fire brigade inspection in April 2016. Plans were in place to support people and provide a continuity of care in emergency situations.

Accidents and incidents were monitored and steps taken to reduce the chances of them occurring. These included staff making a report on accidents and incidents and the registered manager carrying out a falls analysis to see if any trends were emerging.

Staff received the training they needed to support people effectively and felt confident to request additional training. However, it was not clear how overall training was monitored as training records were confusing and unclear. Staff were supported through regular supervisions and appraisals, and competency checks were also carried out.

The service was working with the local authority to make Deprivation of Liberty Safeguards (DoLS) applications. Care plans contained evidence of best interest decisions. Staff had a working knowledge of the principles of the Mental Capacity Act 2005 and how to make decisions in people’s best interests.

People were supported to maintain a healthy diet and spoke positively about the food on offer at the service. People were given a choice of meals, and were free to ask for anything not listed on the daily menu.

People were supported to access external professionals to maintain and promote their health. Care records contained references to visits from GPs, district nurses, community mental health nurses and podiatrists.

People spoke positively about the care they received at the service. Throughout the inspection we saw numerous examples of kind and positive interactions between people and staff. Staff protected people’s dignity and treated them with respect when delivering care and support.

The service supported people to access advocacy services. Procedures were in place to provide people with end of life care.

People told us they were given a choice over how their care and support was delivered. Care plans contained details of people’s preferences, which helped staff to deliver person-centred care and support to people. We saw that people with particular support needs sometimes had care plans for these, but that was not always the case.

People were supported to access activities, and spoke positively about these. During the afternoon of our inspection we saw staff helping people with jigsaws and walking around the service’s garden with them.

There was a complaints policy in place, which was publically advertised in the reception area of the service. Records confirmed that two complaints logged since our last inspection had been investigated and the outcome communicated to the people involved.

Staff felt supported by the registered manager, and included in how the service was run. They described the service as friendly and homely.

The deputy manager told us feedback was sought from people using the service by way of an annual questionnaire. Records from the 2016 survey were not available to us to look at, but positive feedback was received in the 2015 survey.

The local authority had helped to arrange support for the service from a nearby care provider and the deputy manager spoke positively about this. This support included help improving policies and procedures at the service.

We found three breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014, in relation to medicines management and risk assessments, quality assurances processes and training records and displaying the rating from our previous inspection. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

As part of this inspection we spoke with 14 people who use the service, eight visitors, the registered manager, the deputy manager and six care staff. We also reviewed records relating to the management of the home which included seven people's care records, staff rotas, communication books, medication records, staff files and staff training records. We spent time in home observing how people's care was delivered during the early hours of the morning through to the afternoon.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

Is the service safe?

People were treated with respect and dignity by the staff. People told us they felt safe. People were cared for in an environment that was safe, clean and hygienic. There were enough staff on duty during the day to meet the needs of the people living at the home but not at night.

We saw from records that from April 2014 to date of the inspection that on numerous occasions only two staff had been on duty during the night. During this time occupancy levels were between 23 to 28 people using the service. At least a quarter of these people needed two staff to assist them we found that the staffing levels were insufficient. People told us, 'The staffing numbers seem a bit low overnight but otherwise I cannot complain', 'I need two staff to assist me and when there are only two night staff on duty I worry about how much time staff have to take with me, as it leaves everyone else with no one at hand.' A compliance action has been set for this and the provider must tell us how they plan to improve.

Although senior care staff on night duty were qualified to give medication due to the low staffing levels day staff gave out night medication before 8pm. This meant that some people were administered four lots of medication in a 12 hour period. No discussion had been held with GPs or the pharmacists about the safety of condensing administration times into a 12 hour period. A compliance action has been set for this and the provider must tell us how they plan to improve.

Staff personnel records did not contain all the information required by the Health and Social Care Act 2008. This meant the provider could not demonstrate that the staff employed to work at the home were suitable and had the skills and experience needed to support the people living in the home. 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 which applies to care homes. Whilst the majority of people had the capacity to make decisions staff needed to give consideration to what actions they needed to take to meet the needs of those who did lack capacity. No reviews had taken place to determine if the couple of people who experienced some confusion had a dementia and whether this compromised their ability to make decisions or if actions staff took constituted a deprivation of liberty.

Is the service effective?

People told us that they were happy with the care they received and felt their needs had been met. It was clear from what we saw and from speaking with staff that they understood people's care and support needs and that they knew them well. One person told us. 'I find it a first class service. The staff are so kind and considerate.' Staff had received training to meet the needs of the people living at the home.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers were patient and gave encouragement when supporting people. People told us they were able to do things at their own pace and were not rushed. Our observations confirmed this. One person told us

Is the service responsive?

People's needs had been assessed before they moved into the home. People told us they met with their key workers once a week to discuss what was important to them. Records confirmed people's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided that met their wishes. People had access to activities that were important to them and had been supported to maintain relationships with their friends and relatives.

Is the service well-led?

Staff had a good understanding of the ethos of the home and we saw that the manager had put quality assurance processes in place. People told us they were asked for their feedback on the service they received. Staff told us they were clear about their roles and responsibilities. They said the management had consulted with them before implementing changes to the management of the home and their views had been taken into consideration. However the provider may wish to note that the manager's understanding of setting staffing levels, safe administration of medication, record keeping inhibited the effectiveness of the monitoring systems.

We were able to observe the experiences of people who used the service. We saw that staff treated people with dignity and respect. Staff were attentive and interacted well with people. We saw that people had their needs assessed and that care plans were in place.

We saw that people lived in safe, accessible surroundings that promoted their wellbeing.

We saw that the service had appropriate equipment. We saw that regular checks and servicing of equipment was undertaken to ensure that it was in safe working order.

We found there was an effective complaints system in place at the home.