Upton House is a privately owned residential care home for up to 20 older people living with dementia. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. At the time of our inspection 16 people were provided with accommodation and personal care. The house is a large, Georgian style, listed building set in its own private well-maintained grounds near to the village of Worth. Accommodation is provided on two floors with stair lifts to enable people to access both floors. There are communal lounges on the ground floor, a large dining room and conservatory.

Our last inspection on 20 December 2016 was a focused inspection to check the home was meeting the legal requirements following a breach from the previous comprehensive inspection on 10 and 11 March 2016. The breach was in relation to insufficient staff guidance for risk management and medicines not being managed safely. At the focused inspection we found improvements had been made and the provider had met the legal requirements with regards to risk management and the management of medicines. However, there was a recommendation for the provider to ensure all risk assessments were personalised and contained full guidance to reduce and mitigate risks to people. We therefore rated the home as Requires Improvement in the safe domain and it remained Good in all other domains and overall.

At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the home has not changed since our last inspection.

At this inspection we found the service remained Good.

The provider had acted on our recommendation. Risks to people were assessed on an individual basis and there was comprehensive guidance for staff. People were kept safe from avoidable harm and could raise any concerns with the registered manager. There was enough suitably trained and safely recruited staff to meet people’s needs. Medicines were administered safely and there was clear guidance for staff on how to support people to take their medicines. People were protected from any environmental risks in a clean and well-maintained home. Lessons were learnt from accidents and incidents.

People’s needs and rights to equality had been assessed and care plans had been kept up to date when people’s needs changed. Relatives we spoke to told us their loved one’s general health and wellbeing had improved since living at the home. Staff had the right induction, training and on-going support to do their job. People were supported to eat and drink enough to maintain a balanced diet and were given choice with their meals. People accessed the healthcare they needed and staff worked closely with other organisations to meet individual’s needs. People’s needs were met by the homes facilities and attention was paid to make the home ‘dementia friendly’. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the home supported this practice.

People and relatives we spoke with told us that staff were caring and the management team ensured there was a culture which promoted treating people with kindness, respect and compassion. Staff were attentive to people and everyone was clean and well dressed. The home had received positive feedback and people were involved in their care as much as possible. Staff protected people’s privacy and dignity and people were encouraged to be as independent as possible. Visitors were made welcome.

People received personalised care which met their needs and care plans were person centred and up to date. Wher

Care service description.

Upton House can provide accommodation and personal care for 20 people living with dementia. The property is a large, Georgian style, listed building set in its own private well maintained

grounds. It is near to the village of Worth, on the main road between Deal and Sandwich. Accommodation is provided on two floors with stair lifts to enable people to access all areas of the service. There are two communal lounges on the ground floor, together with a large conservatory.

Rating at last inspection.

At the last inspection, the service was rated Good overall and Requires Improvement in the ‘Safe’ domain.

Why we inspected.

We previously carried out an unannounced comprehensive inspection of this service on 10 and 11 March 2016. A breach of legal requirements was found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach of Regulation 12 of the Health and Social Care Act Regulated Activities Regulations 2014, Safe care and treatment.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Upton House on our website at www.cqc.org.uk

At this inspection we found the service had improved but there were still shortfalls in the safe domain. There was not a breach in the regulations but we have made a recommendation for the provider to improve. Therefore, the rating remained Requires Improvement in the Safe domain.

Why the service is rated Requires Improvement in the safe domain.

People told us they felt safe living at Upton House. Relatives were confident that their relatives were safe at Upton House and received the care and support that they needed.

At the last inspection the registered persons provider did not have sufficient guidance for staff to follow to show how risks were mitigated and managed. There had been some improvements and the service was now compliant with the regulations, but further improvements were needed for people living with diabetes as the guidance was generic and did not contain personalised information. When people were at risk of falling and needed support to mobilise, risk assessments did not include what action staff should take if people did fall.

The shortfalls in the risk assessments had not had a direct impact on people because staff knew people well. However, there was a risk that staff would not take the appropriate action to keep risks to a minimum as there was insufficient guidance.

Other risk assessments contained sufficient guidance on how to care and support people and keep risks to a minimum. People were positively supported with their behaviour. There was guidance in place about what action the staff needed to take to make sure the person and everyone else was safe. People’s risk assessments regarding the use of bed rails had been reviewed and measures were in place to reduce the risks of people falling out of bed.

Accident and incident records and monthly fall audits were reviewed. Any concerns were investigated and action taken to prevent the risk, however further analysis was required to look for patterns and trends to reduce the risk of re-occurrence. This was an area for improvement.

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At the last inspection the provider did not have safe systems in place to ensure that medicines were being stored and administered in line with current guidance. At this inspection improvements had been made and medicines were handled safely and appropriately by staff.

Staff knew how to recognise and respond to abuse. They had received training on how to keep people safe. Regular checks were made on the premises and equipment to ensure it was safe.

There were sufficient numbers of staff on duty at all times to e

The inspection took place on 10 and 11 March 2016, and was an unannounced inspection.

Upton House is a privately owned care home for people living with dementia. It provides care for up to 20 older people. The property is a large, Georgian style, listed building set in its own private well maintained grounds. It is near to the village of Worth, on the main road between Deal and Sandwich. Accommodation is provided on 2 floors with stair lifts to enable people to access all areas of the service. There are two communal lounges on the ground floor, together with a large conservatory. At the time of this inspection there were 19 people receiving a service.

The service has a general manager and an established registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Potential risks to people were identified in all aspects of people’s care. However, there was not always full guidance for staff to follow to move people safely to show how the associated risks were being managed safely.

Medicines were administered safely. However, people did not always receive their medicines in line with safe infection control procedures because of the way some staff handled the medicines. The storage of the medicines was not in line with current legislation to ensure it was safe and secure at all times.

People and relatives told us they felt safe in the service. Although staff had received safeguarding training, and had an understanding of what constituted abuse, they were not all sure of the process to report any such concerns in order to keep people safe.

Records of accidents and incidents showed that action was promptly taken to investigate and implement measures to prevent re-occurrence. Health and safety audits of the environment and equipment were carried out regularly to make sure people were safe in the service. Fire tests and drills were held regularly but staff names had not been recorded to ensure that all staff had attended a drill. Environmental risk assessments were in place and each person had a personal plan to be actioned in the event of an emergency.

Some refurbishment of the premises had been carried out and plans were in place to further improve the environment. People’s rooms were personalised to their individual preferences.

Relatives and staff told us that there was always sufficient numbers of qualified, skilled and experienced staff to meet people’s care and support needs. Staff received ongoing training to ensure they had the skills and competencies to carry out their role. There was a programme of staff supervision and appraisal to discuss and identify any further training and development needs. There were systems in place to ensure that staff were recruited safely and ensure they were suitable to work at the service.

Staff were kind, compassionate and caring. They treated people with respect and ensured they received the care and support they needed. Staff encouraged people with their daily routines and encouraged them to remain as independent as possible. People and relatives told us that staff were respectful and their privacy and dignity were maintained.

People were supported to make their own decisions and choices, and these were respected by staff. Where people lacked the mental capacity to make decisions the registered manager was guided by the principles of the Mental Capacity Act 2005 to ensure any decisions taken were made in the person’s best interests. Staff understood the importance of supporting people to make decisions, however not all staff had an understanding of the process. The registered manager told us that Mental Capacity and DoLs training had been booked for all staff in March 2016

We used a number of different methods to help us understand the experiences of people who used the service, because some of the people using the service had complex needs and communication difficulties, which meant they were not all able to tell us their experiences in detail. These included observing the care and interactions between the people who used the service and staff.

People we were able to talk with told us that the service responded to their health needs quickly and that staff talked to them regularly about their plan of care and any changes that may be needed. All staff spoken with demonstrated an appropriate level of experience and knowledge that enabled them to support people who lived at the service with their needs effectively.

We saw that the people who used the service were making choices about their lives and were part of the decision making process. People had their own individual routines which were respected. One person who used the service said "Staff are very good. I have no concerns". Another person said “They look after me well here”. A relative said "The staff are very friendly they do a good job".Another relative said " The manager is doing a good job I have no concerns".

The service was clean and free from offensive odours. The medication was being handled appropriately and systems were in place to monitor the service that people received to ensure that the service was satisfactory and safe.

We used a number of different methods to help us understand the experiences of people using the service, because the people using the service had complex needs which meant they were not all able to tell us their experiences.

During our visit we spoke to two people who used the service and four members of staff including the manager. We looked at the views of relatives of people who used the service.

We saw care plans and health files in place for all people and these were regularly reviewed and changes made as necessary. We found that people were encouraged to be as independent as possible and to make their own decisions. Where this was not possible we found that best interest meetings and mental capacity assessments had taken place.

Staff were observed interacting with people in a relaxed and friendly way. They listened to people’s requests and responded quickly.

We saw that people were treated with dignity and respect and had choice, and their views and needs were taken into account. We found that there were enough staff on duty to meet people’s needs and that safeguarding issues were understood and addressed.

Records showed that staff had been properly recruited, trained and supervised. We found that the service monitored quality of care regularly and acted on any issues that had arisen.

People that we spoke to said that they liked living at the home. Relatives and visiting professionals commented on how good the care was. People and their relatives told us they were involved in decisions about their care and support and that their privacy and dignity was respected.

Care plans had been reviewed and developed with individuals to inform staff how people wished to be supported. People told us they were happy with the care and support they received. Menus reflected a varied and balanced diet. People confirmed the food was good and there was always a choice.

People had access to health care such as dentists, doctors and specialist teams.

All medication was managed by the staff and people got their medication safely and on time.

People told us they felt safe living at Upton House. They said that Upton House felt like their own home.

The home was clean and tidy and people said this was always the case.

People we spoke to told us that the staff were very good and caring. They said there was enough staff on duty to meet the needs of the people in a timely manner.

Staff had received the training they required. This means they had the skills and knowledge they needed to look after people in a way that suited them best.

Relatives and visitors told us that they did not have any complaints but felt confident to raise any issues or concerns with the manager. Records were stored appropriately and safely.