CQC report explained · a nursing home
What the CQC found at Upton Dene Residential and Nursing Home
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
What inspectors found, June 2018
Rated Good; inspectors found safe, kind and responsive care, with improvements made after earlier medicine and oversight problems.
Inspectors visited on 21 and 24 May 2018 without notice. They reviewed care plans, medicines, staff recruitment and training records, audits and policies. They spoke with people living there, relatives and staff, and observed care.
All five areas were rated Good: Safe, Effective, Caring, Responsive and Well-led. Inspectors found medicines were now ordered, stored and given safely. Risks were assessed, the home was clean, and staff recruitment and training were suitable.
People were treated with patience, kindness and dignity. Care plans reflected people's needs and preferences. Activities, complaints handling and family involvement were in place.
The home had improved since the February 2017 inspection, when it was rated Requires Improvement and breached two regulations. Those breaches had been addressed. Inspectors recommended reviewing the way lunchtime meals were delivered because people were sometimes served 10 to 15 minutes apart.
Medicines were safer
The previous problems with ordering and administering medicines had been addressed. Clear ordering processes, stock checks and PRN care plans were in place.
“A medication ordering system had been put into place.” from the report
Kind and dignified care
People described staff as caring and patient. Inspectors saw support being given in an unhurried and respectful way.
“Interactions between staff and people who used the service were patient and kind.” from the report
Person-centred care
Care plans included people's preferences, social history, spiritual needs and support needs. They were reviewed regularly.
“Care plans were person centred and included personal preferences for each person and the way they wanted to be supported.” from the report
Activities and communication
The home offered group and one-to-one activities. Information was provided verbally or with pictures to meet people's communication needs.
“A programme of activities was in place and people were encouraged to join in with social activities and groups.” from the report
Improved oversight
Audits and a new clinical lead role helped the home monitor medicines, pressure care, weight loss and falls.
“A range of audits were implemented by the registered manager so that the quality of care could be monitored.” from the report
Lunchtime meal delivery
needs fixingMeals were delivered at different times, sometimes 10 to 15 minutes apart. Inspectors recommended that the home review this process.
“We observed that the delivery of meals did appear to be staggered meaning that people were provided with their meals at different times, sometimes 10 to 15 minutes apart.” from the report
Two doors were unlocked
needs fixingInspectors found two doors that should have been locked were unlocked. The manager corrected this immediately, but families should ask how these safety checks are now monitored.
“During a tour of the home we found two doors that required to be locked at all times or when not in use; were unlocked.” from the report
Mixed views about food
minorPeople had different opinions about the food. The manager had sent questionnaires to find out how meals could be improved.
“People had mixed views of the food they were provided with.” from the report
More trips out
minorOne person said there should be more trips to places of interest. The manager was aware and was considering how to develop this.
“One person did comment that they felt that there needed to be more trips out to places of interest.” from the report
- 01What changes have been made to the lunchtime meal delivery since inspectors found that meals could arrive 10 to 15 minutes apart?
- 02How do you now check that doors which should be locked remain secure?
- 03How have you acted on people's mixed views about the food?
- 04How much agency staff do you currently use, and how do you maintain continuity for residents?
- 05What improvements have been made to trips and activities outside the home?
This inspection checked improvements after the February 2017 inspection and assessed all five CQC areas, including care, medicines, staffing, records, audits and the premises. This explanation was written from the published report of 27 June 2018 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, April 2017
Rated Requires Improvement; inspectors found kind, personalised care, but medicines and quality records were not consistently safe or complete.
Inspectors visited on 15 February, 13, and 14 March 2017. The first day was unannounced. They spoke with people living there, relatives, staff, managers, and health professionals. They also reviewed care records and medicines records.
The home had improved since the previous inspection in September 2016. Care plans were more personalised and staff were trained. People said they felt safe and were treated with kindness, dignity, and respect. Staff supported people's health, choices, meals, activities, and complaints well.
However, medicines were still not managed consistently safely. Some people missed prescribed medicines, and records did not always show when medicines were given. Quality checks and pressure mattress records were also not always completed fully or on time. The home did not have a manager registered with the CQC at the time.
Kind and respectful care
People and relatives spoke positively about staff. Inspectors saw calm, attentive care, with privacy and dignity protected.
“People were supported by staff that were kind, caring and friendly.” from the report
Personalised care plans
Care plans included people's backgrounds, preferences, health needs, and how they wanted support. They were reviewed when needs changed.
“Care plans across the residential, dementia and nursing units contained personalised information about people, such as their background and family history, health, emotional, cultural and spiritual needs.” from the report
Enough trained staff
Inspectors found enough staff to meet people's needs. Recruitment checks had been completed and staff received relevant training.
“There were sufficient numbers of suitably skilled and experienced staff to keep people safe.” from the report
Good health and nutrition support
Staff contacted health professionals when needed and supported people with eating and drinking. People had choices and were not rushed at mealtimes.
“People were supported to eat and drink what they liked.” from the report
Activities and complaints
People could take part in activities they enjoyed or choose not to join in. Complaints were investigated and people were updated about the outcome.
“A complaints procedure was in place which explained what people or their family members could do if they were unhappy about any aspect of the service.” from the report
Missed and poorly recorded medicines
seriousSome people missed prescribed medicines for between one and five days. Records did not always show the exact time medicines were given, and some records were not signed immediately.
“Missing doses of prescribed medicines places people's health at unnecessary risk of harm.” from the report
Medicine guidance was incomplete
seriousOn the first day, six people did not have PRN, or as-needed, medicine care plans. These were put in place by the second day, but the report found that medicine management remained a breach.
“This was a continued breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 as the management of medicines and associated records was not consistently safe.” from the report
Quality checks and records were not reliable
seriousAudits did not always record who would take action or when. Pressure mattress checks had not been completed for 18 days in January, and some other records were incomplete or late.
“This was a continued breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 as records were not always completed in full detail or in line with the registered providers own timescales.” from the report
Some dementia monitoring was too vague
needs fixingDementia records used general terms such as unsettled or agitated without enough detail to identify patterns. One person's fluid chart had not been updated since 10am when it was checked at 3pm.
“The use of such terms did not allow for specific trends to be identified with regards to peoples well being.” from the report
- 01What action has been taken to prevent people missing prescribed medicines, especially medicines supplied through the hospital discharge-to-admission service?
- 02How do you now check that medicine administration records show the exact time medicines were given and are signed immediately?
- 03How are PRN medicine care plans kept up to date, including guidance on when a person may need the medicine?
- 04How do you make sure pressure-relieving mattress checks are completed on schedule and recorded?
- 05How are dementia care records and fluid charts checked to ensure changes and risks are recorded clearly and promptly?
This inspection considered all five CQC questions, reviewed care and medicines records, and checked whether improvements required after the September 2016 inspection had been made. This explanation was written from the published report of 28 April 2017 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk. The report was longer than we could read in one go; the later sections may not be reflected.
Every inspection of Upton Dene Residential and Nursing Home
3 rated inspections over 2 years: the service has improved, from Requires improvement to Good.
- June 2018Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
Read what inspectors found at Upton Dene Residential and Nursing Home →
- April 2017Requires improvementstayed Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
Read what inspectors found at Upton Dene Residential and Nursing Home →
- October 2016Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- December 2015
Registered with the Care Quality Commission on 23 December 2015.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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84 live-in carers within about an hour of Cheshire West and Chester
These are self-employed carers on PrimeCarers, the introductory agency that runs this directory. Each has a profile with their own rates and reviews from families, and you choose who to talk to.
Most charge £980 to £1,260 a week. 76 can care for a couple. 10 years' experience on average.
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Every carer has had an enhanced DBS check in the last 18 months, ID and right-to-work checks and an online interview. Their skills and training are for you to check with them. Carers set their own rates, and who is free changes week to week.