The Uplands at Oxon is a nursing home that provides accommodation, nursing and personal care for up to 81 older people, some of whom have dementia. At the time of our inspection, 81 people were living at the home.

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.

This inspection took place on 24 March 2015 and was unannounced.

The Uplands at Oxon provides accommodation, personal and nursing care for older people and people living with dementia for a maximum of 81 and the home was fully occupied when we inspected.

The home had a registered manager in post who was present for our inspection. 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.

People told us that they felt safe living in the home. Staff told us that they had received safeguarding training and knew how to protect people from potential abuse. Staff were aware of their duty to share concerns of abuse with the manager and other agencies. Accidents were monitored and action taken to reduce them happening again. People were supported by staff to take their prescribed medicines.

People told us that they had been involved in their assessment and received care and support from skilled staff. Staff told us that they were supported by the management team and had access to regularly supervision and training. People told us that staff asked for their consent before they received care and treatment. Where people lacked capacity to consent a best interest decision had been made to ensure they received the appropriate care and support. People told us that they were happy with the meals provided and that they had a choice. We saw that people had access to other healthcare professionals when needed.

People told us that staff treated them with kindness. We saw that care was provided in a way that promoted people’s privacy and dignity. People’s involvement in their care planning ensured they received care and treatment the way they like.

People told us about their interests and confirmed that they had access to a variety of social activities in and outside the home. We saw that complaints were recorded and showed what action had been taken to resolve them and people told us that they would be confident to share their concerns with the manager.

Quality assurance surveys were given to people to enable them to tell the provider about their experience of using the service. Audits were carried out to monitor the service provided and staff told us that they had access to regular meetings and that their views were listened to. People and staff were aware of the management team and told us that the home was run well.

We carried out this inspection in response to concerns we had received about The Uplands at Oxon.

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.

During the inspection we spoke with seven people who were living at The Uplands and three visitors. All were complimentary of the staff and the care provided. People told us that staff were helpful and respected their privacy and independence. One person said: “The staff are excellent”. A visitor told us they could not speak highly enough of the staff. They said: “I am happy, I am very involved with my relative’s care and supported by the staff”.

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.

We spoke with over 10 people and two relatives who were visiting the home. We also spoke with seven staff and the registered manager. Some people had complex needs so could not tell us of their experiences. We spent time in two lounges to carry out short periods of observation and visited people in their bedrooms.

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.

People told us that their choices, human rights, dignity and privacy are considered and respected. They felt they are supported to make decisions about their care and how the service is run. Processes are in place to ensure that people are able to give consent to their care and people said that staff ask permission before carrying out any care with them.

People consider that they are involved in assessments of care and are aware that they have a care plan. They told us that the attitude of staff is good and they feel safe and well cared for at the home. Comments about food and drink were favourable and all felt they had enough to eat.

Cleanliness and tidiness was reported to be very good. All people spoken with liked their rooms and said the environment was very nice to live in. They said that staff made them feel very welcome and were skilled at making them feel at home. People said that staff were very kind and certainly seemed to know what they were doing. People had confidence that staff would do the right thing for them. Visitors said that staff try their hardest to sort things out and keep at it until a suitable outcome is achieved. They said they were able to make comments about the service and understood that they could complain formally.