We carried out a comprehensive inspection of Upper Mead on 21 November 2018.

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.

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This was an unannounced inspection which took place on 22 May 2017.

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 con

The inspection took place on 8 March 2016 and was an unannounced inspection.

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

The inspection took place on 10 February 2015 and was unannounced. We returned on 12 February 2015 for a second day and to complete the visit.

Upper Mead provides accommodation, care and nursing support for up to 48 older people. 11 of the places are within the Chestnut Unit, which cares for people living with dementia. There were 33 people in residence at the time of our visit, including nine in Chestnut Unit.

The service has 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.

We identified issues with the handling of topical creams and found some gaps in the administration records of medicines. We discussed our concerns with the registered manager who had resolved most of the issues before we returned for the second day of our inspection.

Staff knew people well and understood their needs and preferences. Where people may have been deprived of their liberty, proper processes had been followed that met the requirements of the Deprivation of Liberty Safeguards. We found, however, that improvements could be made in the way details about people’s methods of communication were recorded. Where decisions had been made in a person’s best interest, records did not always clearly evidence the process that was followed. We have made a recommendation about how decisions are recorded to demonstrate that people’s rights under the Mental Capacity Act have been respected.

There were sufficient staff on duty to meet people’s needs safely. Staff were clear on what was expected of them and received training and supervision to help them deliver care to an appropriate standard. Risks to people’s safety were assessed and reviewed. Any accidents or incidents were recorded and reviewed in order to minimise the risk in future. Staff understood local safeguarding procedures. They were able to speak about the action they would take if they were concerned that someone was at risk of abuse.

People were treated with kindness and respect. One person told us, “It’s nice here, the staff are very good”. There was a friendly atmosphere at the home. People and staff enjoyed each other’s company and were seen to share a joke and laugh together. People were involved deciding how they wished to spend their time and staff were quick to notice when people required assistance or reassurance. In the visitors’ comment book we read, ‘Wonderful home, great staff, great atmosphere’.

People enjoyed the meals and for many mealtimes were a social occasion. People who required assistance to eat or drink were supported. Care and support needs were reviewed on a regular basis and advice was sought from external healthcare professionals when required.

The service was well organised. The registered manager was well-respected and responded quickly to resolve any issues or to make improvements. A system of audits was in place to monitor and review the quality of care delivered and action plans were used to track the implementation of agreed changes. When we provided feedback after our inspection, the registered manager took immediate action to make improvements in the areas we had identified.

People, their representatives and staff were asked for their views on how the service was run and their feedback was acted upon. In a survey one relative had written, ‘My mother is very happy here. Staff are friendly and aware of resident’s needs and the care is excellent’. Another relative told us, “I’m very happy. I know (my relative) is safe and well cared for”.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which corresponds to regulation 12 (g) 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.