Archived: Upper Mead

Upper Mead is a residential care home and provides personal and nursing care for up to 48 people. At the time of inspection, 32 people were living at the service. People were aged 60 and over and lived with a range of mental health and physical health needs including age related frailty, diabetes and degenerative conditions such as dementia and Parkinson’s disease.

The building was purpose built over two floors. The building and courtyard garden were fully accessible, and the first floor was accessed by a lift. One wing specialised in providing care to people living with dementia.

Upper Mead is owned and operated by the provider Sussex Healthcare. Services operated by the provider had been subject to a period of increased monitoring and support by local authority commissioners. As a result of concerns raised, the provider is currently subject to a police investigation in relation to incidents that occurred between 2016 and 2018. The investigation is on-going, and no conclusions have yet been reached. The investigation does not include Upper Mead specifically.

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

People were happy with the care they received and felt safe with the staff that were supporting them. People were safeguarded from situations in which they may experience harm. Risks to people's safety had been assessed, and people were supported to stay safe. Staff knew how to identify potential harm and report concerns. People received their medicines safely from registered nurses. Checks were carried out prior to staff starting work to ensure their suitability to work with people who used the service.

The culture of the service was positive, and people and staff were complementary of the management and provider. Improvements had been made to systems and process that monitored the quality of the service being delivered and accuracy of records. These improvements need to be sustained and become fully embedded into practice.

Care was personalised to meet people’s individual needs and preferences. Care plans provided information and guidance for staff. Staff knew people well and provided support in line with people’s preferences. People’s diverse needs were catered for and they were treated with dignity and respect.

People described the staff as caring and thoughtful and said they were treated with care and kindness. Feedback about the service from people and those close to them was positive. People and relatives told us they received good care and could not praise the service highly enough. People repeatedly told us that staff had made a positive difference in their lives during the past year and had kept them safe and well during the global COVID-19 pandemic.

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. There was a flexible approach to risk management which promoted people’s independence and provided opportunities for new experiences.

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 11 May 2020) and there were two breaches of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 20 and 21 February 2020. Two breaches of legal requirements were found in relation to Regulation 12, safe care and treatment and Regulation 17, Good Governance. The provider completed an action plan after the last inspection to show what they would do and by when, to improve their governance processes. However, positive changes made at Upper Mead will need to be embedded and sustained in practice and we will check on progress with this.

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 remained as requires improvement. This is based on the findings at this inspection. This is the third consecutive inspection where the service has been rated requires improvement.

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

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.

Upper Mead is a residential and nursing care home providing care and support to 37 people aged 65 and over at the time of the inspection. The service can support up to 48 people living with dementia and physical care needs.

Upper Mead is a large, purpose-built premises and is split across two floors. People live on both the ground and the first floor of the service. There is a self-contained area on the ground floor of the service where people with dementia support needs live called 'Chestnut Lodge'.

Upper Mead is owned and operated by the provider Sussex Healthcare. Services operated by the provider had been subject to a period of increased monitoring and support by local authority commissioners. As a result of concerns raised, the provider is currently subject to a police investigation in relation to incidents that occurred between 2016 and 2018. The investigation is on-going, and no conclusions have yet been reached.

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

People told us they felt safe at the service. However, people were not always protected from risks. Risks associated with suicidal thoughts, constipation management and behaviours of concern were not consistently assessed and mitigated. Staff practice and reporting systems to safeguard people from abuse were not always effective. We have made a recommendation for improvement.

Lessons were not always learnt, and actions taken to investigate safety incidents and prevent them re-occurring. Protocols for the use of ‘as required’ medicines lacked detailed and failed to provide sufficient guidance to staff.

The care and treatment of people was not always appropriate and did not always meet their specific needs. Care plans did not evidence that people were being involved to the maximum extent possible in their care or that their preferences were always being taken into consideration. Best practice guidance was not always considered when assessing people’s care needs. Care plans were not consistently holistic, and people were not routinely supported with their mental health needs. The risks associated with social isolation had not always been assessed or mitigated. We have made a recommendation for improvement.

Quality assurance frameworks were in place; these were not consistently effective in driving improvement or identifying shortfalls. Care plans were reviewed on a monthly basis; however, these reviews were not effective in identifying shortfalls with the poor provision of concern or how improvements could be made.

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 felt supported in their role and spoke highly of the registered manager. Relatives and people were complimentary about the caring nature of the service. People had access to a wide range of communal activities.

People received a balanced diet which met their individual needs and took into consideration their preferences. People spoke highly of the food provided. Staff were skilled and had received training on dementia care. Staff had spent time getting to know people and were knowledgeable about their likes, interests and hobbies.

Staff were respectful and warm when they spoke about people. We observed kind and caring interactions. People were supported to be independent in their personal care and mobility. Safe recruitment practice was operated, and people received their medicines in a dignified manner.

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 (report published 22 February 2019). The provider was found to be in breach of two regulations. Regulation 9 – Person Centred Care and Regulation 17 – Good Governance. Requirement notices were served, and the provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection, some improvements had been made but the provider remained in breach of Regulation 17 - Good Governance and was also found to be in breach of Regulation 12 – Safe Care and Treatment.

The last rating for this service was Requires Improvement (published 22 February 2019). The service remains rated Requires Improvement. This service has been rated Requires Improvement for the last two consecutive inspections.

Why we inspected:

This was a planned inspection based on the previous rating. You can see what action we have asked the provider to take at the end of this full report.

Enforcement:

We have identified two breaches of regulation in relation to safe care and treatment and good governance.

We had previously imposed conditions on the provider's registration. The conditions are therefore imposed at each service operated by the provider. CQC imposed the conditions due to repeated and significant concerns about the quality and safety of care at a number of services operated by the provider. The conditions mean that the provider must send to the CQC, monthly information about incidents and accidents, unplanned hospital admissions and staffing. We will use this information to help us review and monitor the provider's services and actions to improve, and to inform our inspections.

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.

Upper Mead is a care home. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Upper Mead is registered to provide accommodation for people requiring nursing and personal care for up to 48 older people and people with dementia support needs.

Upper Mead is a large, purpose-built premises and is split across two floors. People live on both the ground and the first floors. There is a self-contained area on the ground floor of the service where people with dementia support needs live called ‘Chestnut Unit’. At the time of the inspection there were 39 people living in Upper Mead, nine of whom lived in ‘Chestnut Unit’.

The service was last inspected in May 2017 and was rated ‘Good’ overall and ‘Good’ in all domains.

The service had 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.

Upper Mead is owned and operated by the provider Sussex Healthcare. Services operated by the provider had been subject to a period of increased monitoring and support by local authority commissioners. As a result of concerns raised, the provider is currently subject to a police investigation. The investigation is on-going and no conclusions have yet been reached.

Between May 2017 and November 2018, we inspected a number of Sussex Health Care locations in relation to concerns about variation in quality and safety across their services and reported on what we found. We used the information of concern raised by partner agencies to inform our planning regarding certain areas we would inspect and to judge the safety and quality of the service at the time of the inspection.

We imposed conditions on the provider’s registration. The conditions are therefore imposed at each service operated by the provider. CQC imposed the conditions due to repeated and significant concerns about the quality and safety of care at a number of services operated by the provider. The conditions mean that the provider must send to the CQC, monthly information about incidents and accidents, unplanned hospital admissions and staffing. We will use this information to help us review and monitor the provider’s services and actions to improve, and to inform our inspections.

At the last inspection, we identified that people’s care plans contained varying levels of detail and that plans regarding people’s ‘stimulation’ and ‘activity’ lacked person-centred information and that this was an area for development. At this inspection we checked to see if improvements had been made to address these issues.

People and relatives told us that staff knew them well and understood who they were as individuals and that their care reflected this. However, there remained a lack of person-centred detail in some care plans, care plans had not always been reviewed and there was a reliance of some staff on verbal handover information instead of reading care plans. This presented a risk that staff might not always know or understand how to provide personalised care that was responsive to people’s needs.

There were recently revised quality assurance systems in operation. However, these were not yet embedded and operating effectively. The provider’s governance framework had not been able to ensure that staff at all levels understood and had carried out their responsibilities successfully. Quality and safety risks were not always acted on in a timely manner or monitored and managed effectively.

For example, issues found during this inspection regarding risk assessments and staff training and knowledge had not been identified or acted on in a timely manner. Issues in some areas of practice, such as updating care plans to include more person-centred detail, required additional work; despite being noted for development at the last CQC inspection and noted for action in successive internal provider audits.

Staff were offered training and had spot checks, supervisions and appraisals from the registered manager, nurses and senior carers. Most staff we spoke with said training and supervisions occurred regularly and helped give them the knowledge they needed to be able to support people effectively. However, one staff member we spoke with said they felt they required more training and support to be able to improve their skills in some areas of practice. We saw that some other staff member’s training records showed their training required updating or was outstanding.

There were systems and processes in place to keep people safe from abuse. All staff we spoke with understood how to recognise signs of abuse and their responsibilities to report any concerns to the registered manager or other senior staff. Some staff were not confident during our discussions about who they could speak with outside of the provider’s organisation if they were concerned about people suffering from abuse.

People had assessments that identified potential risks to their safety and how to support them to manage these in the least restrictive way. Staff we spoke with displayed a good knowledge and understanding of how to safely manage risks to people. Some people’s risk assessments were lacking detail compared to others that we sampled or were requiring review. The registered manager was aware of this and work was currently underway at the service to review and add more detail where this was the case.

People had assessments of their physical, emotional and social support needs, including any specific care and support decisions that related to protected characteristics under the Equality Act 2010. Some assessments contained only high-level detail about people’s social needs and personal backgrounds. This is an area for development.

The service was operating within the principles of the Mental Capacity Act (MCA) 2005 and adhering to the correct processes regarding authorisations for any necessary Deprivation of Liberty Safeguards (DoLS). People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

The service had sufficient numbers of staff to meet people’s needs safely and there were safe recruitment practices. Medicines were managed safely. The premises were clean and hygienic. Infection control and risks associated with the safety of the environment and equipment were identified and managed appropriately.

People told us they had a good quality of life and their support helped them to achieve good outcomes. Relatives told us they thought the service was effective. One relative said, “We have had other family members live here and we have always been happy with the care.”

People’s healthcare and eating and drinking needs were being effectively met. Adaptations had been made to the physical environment in the main service and within Chestnut Unit to help meet the needs of people living there.

People told us staff were kind and caring and respected their privacy and dignity. Staff supported people with compassion, involving them in decisions about their care and promoting their choice and independence wherever possible.

People had support to access group activities at the service. People told us they enjoyed these and the activities that were offered were relevant to them and reflected their social and cultural interests. People were encouraged and supported to maintain social and personal relationships with important people in their lives. Visitors were welcome at any time and relatives told us that they saw their family members regularly.

The registered manager told us that it was important that the service was integrated into the local community, to help avoid people becoming socially isolated once they had moved in. Neighbours and community groups were regularly invited to help provide and take part in activities for people at the service. This had helped the service build strong relationship links with people and organisations in the local area.

The service supported people to have effective support with planning, managing and making decisions about their end of life care, according to their express wishes. Complaints were managed appropriately and used to see how to improve the service in future.

There was a positive, inclusive and open team culture. Staff and management were committed to providing high quality care to people and creating a homely and supportive atmosphere at the service. People and staff spoke highly of the registered manager’s leadership and felt involved in developing the service.

During this inspection we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take, alongside the imposed provider level conditions, at the back of this report.

Upper Mead provides nursing care and accommodation for a maximum of 48 older people. The home has a dedicated unit called Chestnut for people living with dementia. Accommodation is provided over two floors. Most rooms have ensuite facilities. There is a lounge on both floors of the home along with a quiet room that can be used by visitors and a large communal dining room. There is an enclosed courtyard garden area. At the time of this inspection there were 39 people living at the home (one of whom was in hospital when we visited).

During our inspection the registered manager was present. 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.

Upper Mead was last inspected on 8 March 2016 when it was given an overall rating of ‘Requires Improvement’. Breaches of regulations were identified and requirement actions made. In response to these, the registered manager submitted an action plan that detailed the steps that would be taken to address the requirement actions. At this inspection we found that the requirement actions had been met and that the contents of the registered manager’s action plan complied with.

People said that they were treated with kindness and respect. The atmosphere in the home was calm, relaxed and friendly. People’s privacy was respected. Information was displayed in the home to help people understand choices about their care. Relatives were welcomed at the home.

Staff were skilled and experienced to care and support people to have a good quality of life. A training programme was in place that helped to ensure staff knowledge was current. Staff were confident about their role in keeping people safe from avoidable harm and abuse. They demonstrated that they knew what to do if they thought someone was at risk of abuse.

Risks to people’s safety were managed. Some people had been assessed as being at risk of developing pressure wounds and they had skin integrity assessments in place. We saw these people had the correct profile bed in place and pressure relieving equipment to prevent their skin becoming sore. Regular checks on equipment took place to ensure it was safe to use and there was a system to report if equipment was faulty. The registered manager had a good oversight over accidents and incidents within the home and reported events appropriately to the relevant agencies including CQC.

People said that they were happy with the medical care and attention they received and we found that people’s health and care needs were managed effectively. The medicine management in the home was safe. People said that they were happy with the choice of activities on offer. Trips out into the wider community took place and enhanced people’s wellbeing.

The registered manager had taken appropriate steps to manage restrictions on people’s freedom. DoLS applications had been submitted to the authorising authority for people who lacked capacity and were unable to leave the home freely. Mental capacity assessments were completed for people and their capacity to make decisions had been assumed by staff unless there was a professional assessment to show otherwise.

People said that the food at the home was good. People had choice over their meals and were effectively supported to maintain a healthy and balanced diet.

Everyone spoke highly of the registered manager. People said she was approachable and staff said they felt fully supported. There was a positive culture at the home that was supported by a registered manager who took steps to ensure this was inclusive and empowering. She was passionate about providing a quality service to people. People said they felt confident that issues and concerns would be acted upon when raised. Quality assurance systems were in place that helped ensure quality standards were maintained and legislation complied with.

Upper Mead provides accommodation, care and nursing support for up to 48 older people. 11 of the rooms are within the Chestnut Unit, which cares for people living with dementia. There were 43 people in residence at the time of our visit, including nine in Chestnut Unit.

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.

At our last inspection, in February 2015, we asked the provider to take action to improve the way that topical creams were administered and recorded. The registered manager took prompt action to address these concerns. At this visit, we found that improvements had been sustained and that people received their medicines safely. The new deputy manager, a registered nurse, was making improvements to how information about people’s medicine was recorded to ensure that details on their individual needs and preferences were accurate.

The provider was unable to demonstrate that they were working within the principles of the Mental Capacity Act 2005 and respecting people’s rights. The recommendation made at our previous inspection had not been addressed.

We found that people were at risk of harm because risks had not been minimised effectively through appropriate support and regular monitoring.

Staff and the registered manager were able to speak knowledgeably about safeguarding people from abuse but the registered manager had failed to notify the local authority safeguarding team about an incident of possible neglect.

The provider had failed to display the rating received following our last inspection, which meant that people using the service and relatives may not have been informed of our findings. The provider had also failed to notify the Commission of specified incidents as required by law.

The registered manager and provider used a series of checks and audits to monitor and improve the quality and safety of the service. There was evidence that this system of quality assurance had delivered improvements but it had failed to identify the issues we found during this inspection. We have made a recommendation to the provider that they review their quality assurance system to ensure that all aspects of the regulations are monitored.

The atmosphere in the main part of the service was warm and lively with people able to participate in a range of activities. We found, however, that people who lived in the Chestnut unit lacked social stimulation and that few opportunities to engage in activities were recorded. The registered manager had arranged for further staff training and support to help staff meet the needs of people living with dementia. We have made a recommendation about improving activities and social stimulation for people who are unable to access the main activities in the home.

The premises were well-equipped. Improvements were being made in the Chestnut unit to better adapt the décor and information to meet the needs of people living with dementia.

People were referred to healthcare professionals to promote good health and visiting professionals told us that staff made appropriate referrals.

People and their relatives spoke highly of service and told us that the staff team were marvellous. Staff had developed positive relationships with people and treated them with dignity and respect. Although there were no records of people being involved in planning their care, we saw that people were involved in day to day decisions and that staff knew them well.

People enjoyed the food and were involved in planning the menus. There were regular meetings for residents and relatives to share ideas or concerns and contribute to how the service was run. Everyone told us that the registered manager was approachable and that she responded promptly to any issues they had raised.

There were enough staff with the skills and experience to support people safely. Pre-employment checks were completed before new staff began work. All of the staff that we spoke with told us they enjoyed their work and felt well-supported by the registered manager.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of the full version of the report.