The Uplands at Oxon

The Uplands at Oxon is a care home providing nursing care to a maximum of 81 people. At the time of the inspection, 75 people were using the service. Accommodation is provided in one purpose-built building consisting of four units over two floors.

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

People felt safe living at the home and with the staff who supported them. The provider’s staff recruitment procedures helped to protect people from harm. Staff had been trained and knew how and when to report any concerns about people’s well-being. Risks to people were assessed and there were plans in place to mitigate risks. People received their medicines when they needed them from staff who were trained and competent. The provider followed best practice in relation to infection control and prevention and management of risks relating to COVID-19.

People were assessed to ensure their needs and aspirations could be met. People were provided with enough food and drink to meet their needs and preferences. People were positive about the quality and quantity of the food they received. People were supported to have maximum choice and control of their lives. Staff supported them in the least restrictive way possible and in their best interests; the provider's policies and procedures supported this practice. People lived in a home which was well-maintained and adapted to meet their needs. People saw healthcare professionals when they needed. People were supported by staff who were trained and competent to carry out their role.

People told us they were supported by kind and caring staff who respected their wishes and treated them with respect. People were supported to live their lives as they chose and were regularly consulted about the care they received. People’s privacy was respected, and they could spend time alone in their bedroom when they wanted. People were supported to be as independent as they could be.

People told us staff knew them well and what was important to them. People were supported to maintain contact with those who were important to them and were provided with opportunities for social stimulation. People’s communication needs were assessed and responded to. People did not raise any concerns about the care they received but felt confident action would be taken to address any concerns they may have. There were systems in place to ensure people’s needs and preferences would be understood and met during their final days.

Staff morale was good and staff told us they felt well supported. Staff received the supervision and support needed to carry out their role effectively. The views of people were sought and valued. Systems to monitor and improve the quality of the service provided had improved. The provider worked in partnership with other professionals to ensure good outcomes for people. The provider was aware of legal requirements and of their responsibility to be open and honest when things go wrong.

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 23 July 2020) and there were breaches of regulation. 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

This inspection was carried out to follow up on action we told the provider to take at the last 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.

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

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

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

The provider had well established infection control and prevention policies, procedures and safe systems of practice in place. These were well embedded throughout the home.

Staff followed safe infection prevention control policies and wore personal protective equipment (PPE) as required. Staff were knowledgeable about the IPC and PPE practices they needed to follow to minimise the risk of and potential spread of infection.

Staff had adequate supplies of PPE and hand hygiene products. Handwashing facilities were available throughout the premises for staff and visitors.

The provider had ensured their COVID-19 testing regimes, visiting arrangements and vaccination requirements all met current Government guidance.

Enhanced cleaning took place and there was frequent cleaning of regularly touched surfaces so that the cleanliness of the home was maintained.

The Uplands at Oxon is a care home providing nursing care to a maximum of 81 people. At the time of the inspection, 79 people were using the service. Accommodation is provided in one purpose built building consisting of four units over two floors.

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

Some risks to people were not always considered. Some items, which could cause significant harm if ingested, were not securely stored. People’s medicines were not always managed or administered in a safe way. Good infection control procedures were followed by the majority of staff.

People felt safe living at the home and with the staff who supported them. The provider’s procedures for staff recruitment and training helped protect people from the risk of abuse. There were sufficient numbers of staff to meet people’s needs in a safe way. Regular health and safety checks were carried out on the environment and equipment used by people to ensure they remained well-maintained.

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. People said staff always asked for their consent before helping them.

People’s nutritional needs were assessed, and care plans were in place to manage risks however these were not always followed by staff. People who were living with dementia did not experience a positive meal-time experience.

People were able to personalise their bedrooms. Systems were in place to ensure staff received the training they needed. Staff monitored people’s health and well-being and worked with other professionals to make sure they received the care and treatment they needed.

People were supported by kind and caring staff. People were treated with respect and their right to privacy was understood and respected by staff. People were supported to remain as independent as possible. Staff understood and respected people’s right to confidentiality.

There were opportunities for social stimulation and people could see their friends and family whenever they wanted. People were treated as individuals and chose how they spent their time. People and their relatives felt confident and comfortable to discuss any concerns with staff. People could be confident that their wishes for end of life care would be respected by staff.

There were systems to monitor safety and the quality of the service people received however these were not always effective. Staff felt well supported and motivated. The service worked in partnership with other professionals and the local community to achieve good outcomes for people.

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. (Report published July 2017).

Why we inspected

This was a planned inspection based on the previous rating.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well-led sections of this full report.

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

Enforcement

We have identified breaches in relation to safe care and treatment, person-centred care and good governance at this inspection.

Follow up

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. We will

return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

At the last inspection, the service was rated Good.

At this inspection, we found the service remained Good.

People felt safe living at the home. Staff had been trained in how to protect people from harm and abuse, and understood how to respond to and report any concerns of this nature. The risks to people had been assessed, kept under review and plans implemented to manage these. Appropriate staffing levels enabled people's needs to be met safely. People's medicines were handled and administered safely by trained, competent staff.

Staff had appropriate training, guidance and support to enable them to perform their job roles effectively. The management team and staff understood and protected people's rights under the Mental Capacity Act 2005. People had enough to eat and drink, and any associated risks or complex needs were assessed, reviewed and managed. Staff liaised with, and supported people to access, a range of healthcare services, and responded promptly to any deterioration in people’s health.

Staff treated people with kindness and compassion, showing concern for their comfort and wellbeing. People's involvement in care planning and decision-making was encouraged by staff. People's rights to privacy and dignity were understood and promoted by staff.

People received care and support shaped around their individual needs and requirements. People’s relatives contributed to care planning and felt listened to by staff and the provider. People and their relatives knew how to raise complaints and concerns with the provider, and felt comfortable doing so.

The management team promoted an open and inclusive culture within the home. People and their relatives had confidence in the management of the service. Their views were actively sought out and acted upon. Staff felt well supported, valued and able to challenge practices and decisions if they needed to. The provider maintained strong links with the local community and worked with key organisations to support and develop service provision. They placed a strong emphasis upon continuous improvement, which had led to a number of improvements in the service people received.

Further information is in the detailed findings below.

Two inspectors carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

As part of this inspection we spoke with people who used the service, relatives, staff, the registered manager and the managing director.

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.

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

This is a summary of what we found:

Is the service safe?

Prior to this inspection we had received concerns about the care, support and treatment of people who lacked mental capacity and the manner in which they were supported to manage their behaviour.

The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The care records we looked at showed that some people's liberty had been restricted to manage their behaviour. The registered manager confirmed that DoLS were in place for these people. However, we found that two DoLS had expired. The registered manager said that action would be taken to address this.

Is the service effective?

One person told us that staff always explained what they were going to do and asked for their consent before providing them with care and support. Discussions with one care staff demonstrated that they had a good understanding of obtaining people's consent before assisting them with their personal care needs. The care staff said, 'If the person refused assistance I would respect this and return later and encourage them if needed.'

A number of people who used the service lacked mental capacity to consent to their care and treatment. There was no evidence of the undertaking of best interest meetings. These meetings would ensure that any decisions made in relation to the person's care and treatment would be in their best interest. However, we saw that other healthcare professionals were actively involved in people's care and treatment.

One person who used the service told us, 'The staff are alright, their heart is in the right place.' One care staff told us that they had access to care plans that provided information about the individual's care and support needs. We spoke with two care staff who demonstrated a good understanding of people's support needs. This meant that people could be confident that staff would know how to care for them appropriately.

Is the service caring?

One person who used the service said, 'I am alright in myself and the staff are kind.' We saw that staff were attentive to people's needs and approached them in a calm and reassuring manner. We saw that where people required assistance with their meal this was carried out by care staff in a dignified manner. We saw that where people had limited verbal communication, staff were patient and enabled the person to express their wishes.

Discussions with two relatives confirmed that they were satisfied with the care and support provided to their relative. They told us they were actively involved their relative's care planning and they were informed about any changes in their relative's care and treatment.

Is the service responsive?

A number of people who used the service lacked mental capacity to give consent to their care and treatment. The registered manager said that staff had received Mental Capacity Act (MCA) and DoLS training and this was confirmed by the care staff we spoke with. We found that staff had a good understanding about MCA and DoLS.

People had access to relevant healthcare services when required and this was confirmed by one person who used the service and two relatives. This meant people could be confident that their physical and mental health needs would be met.

Staff confirmed that they had access to care plans that provided them with information about the person's diagnosis and support needs. However, we found that one person's care needs had changed. We spoke with staff who understood the person's needs had changed. They knew what support the person required. We found that the person's care record had not been up dated to reflect the support they required. The registered manager assured us that this care plan would be reviewed.

Is the service well-led?

The registered manager was supported by a team of qualified nurses and care staff to assist people with their care and treatment needs.

We found that not all care plans had been reviewed to reflect people's current support needs and the registered manager acknowledged this. This could place people at risk of inadequate care and support. The registered manager assured us that these care records would be reviewed and up dated.

The registered provider did not have an effective monitoring system in place to review DoLS and where necessary request an extension. This meant that restrictions imposed on people's liberty were unlawful. The appropriate review of DoLS would ensure that care practices were in the person's best interest and was lawful.

People at the home were supported with medication and health care needs by nursing and care staff. They received consultations from their general practitioner and other health professionals as required. The five staff we spoke with were knowledgeable about the care needs of the people living at the home. We also spoke with the provider and registered manager.

People living at The Uplands told us that there were nutritious food and drinks available. One person said: 'There is an excellent choice of meals'.

The five staff we spoke with said they were provided with training appropriate to their role.

There was a policy in place to enable people living at the home and their family to formally raise any concerns or complaints. This process ensured that all complaints were recorded, investigated and responded to.

People were satisfied with the care they received from staff. People spoke positively about the staff that looked after them. Comments made by relatives included that they were, "More than happy with the staff" and, "Any suggestions made are taken on board immediately ".

People were treated with respect and courtesy by staff.

People who were able to were involved and consulted with the way that care and support was given and reviewed. People were supported to retain their independence as much as possible.

Care plans contained guidance for staff on people's needs and how these should be met. This was done in a way that tried to reflect people's individuality and preferences.

People were protected from the risk of abuse because staff were trained to recognise and report any concerns.

Checks were made before staff started working at the home to make sure they were suitable.

There were systems in place to monitor and review the quality of the service The Uplands at Oxon provided. The registered manager told us about their plans to improve these systems to make sure prompt remedial action would be taken to maintain standards at the home.