Inspection on 16/04/07 for Uplands Nursing Home

This inspection was carried out on 16th April 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Uplands Nursing Home 30/06/09

Uplands Nursing Home 07/01/09

Uplands Nursing Home 02/04/08

Uplands Nursing Home 09/10/06

Uplands Nursing Home 14/01/06

Uplands Nursing Home 20/06/05

Uplands Nursing Home 13/01/05

Uplands Nursing Home 27/07/04

Uplands Nursing Home 11/02/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Uplands Nursing Home Church Road Maisemore Gloucester Glos GL2 8HB Lead Inspector Mrs Ruth Wilcox Unannounced Inspection 16th April 2007 08:45 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Uplands Nursing Home DS0000016643.V332746.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Uplands Nursing Home DS0000016643.V332746.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Uplands Nursing Home Address Church Road Maisemore Gloucester Glos GL2 8HB 01452 505629 01452 307399 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Graham James Rigby To be Appointed Care Home 50 Category(ies) of Dementia - over 65 years of age (29), Old age, registration, with number not falling within any other category (21) of places Uplands Nursing Home DS0000016643.V332746.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. To accommodate three (3) service users under the age of 65 years but a minimum of 55 years in either category OP or DE(E) To accommodate an additional named service user under 55 years. When this service user reaches the age of 55 years or leaves the home, the condition will revert to the original category with the above condition. 9th October 2006 Date of last inspection Brief Description of the Service: The care home is an extended house within the village of Maisemore, near to the River Severn. It sits back directly off the main road and has car parking to the side. There is a small-enclosed garden within the centre of the building and gardens to the front. A church and public house are nearby. The home is also on a main bus route from Gloucester City. A number of care needs for those aged sixty-five years and over are catered for in this home; these include general personal and nursing care, and care of those with dementia within a designated unit. Three places are allocated to the care of those under the age of 65 years whose health and care needs fall within the skills of the home. The current fees at Uplands at the time of writing this report range from the Local Authority funded rate of £357.90, to the higher nursing rate funded by Continuing Health Care of £700.00. Information about the home is available in the Service User Guide, which is issued to all prospective residents. The home does not display its previous CSCI inspection report, although does display a notice confirming it is available, and inviting people to request a copy to read if they wish. Uplands Nursing Home DS0000016643.V332746.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. One inspector carried out this inspection over two days in April 2007, with a second inspector assisting for most of the first day. A check was made against the requirements that were issued following the last inspection, in order to establish whether the home had ensured compliance in the relevant areas. The quality of pre-admission and contractual information issued to residents was inspected. Care records were inspected, with the care of six residents being closely looked at in particular. The management of residents’ medications was inspected. A number of residents and relatives were either surveyed or spoken to directly in order to gauge their views and experiences of the services and care provided at Uplands. Some of the staff also responded to surveys, with some interviewed during the course of this inspection. The quality and choice of meals was inspected, and the opportunities for residents to exercise choice and to maintain social contacts were considered. The systems for addressing complaints, monitoring the quality of the service and the policies for protecting the rights of vulnerable residents were inspected. The arrangements for the recruitment, training, supervision and provision of staff were inspected, as was the overall management of the home. A tour of the premises took place, with particular attention to health and safety issues, the maintenance and the cleanliness of the premises. Uplands Nursing Home DS0000016643.V332746.R01.S.doc Version 5.2 Page 6 What the service does well: Uplands Provides a satisfactorily maintained, clean and safe environment for the residents. The home has a welcoming, homely and relaxed atmosphere, about which visitors have commented favourably. The dementia care unit has been designed with the needs of the residents in mind, allowing those accommodated there to wander freely as they may wish, however the unit would benefit from some pictorial signage for the residents. The home provides a good information brochure for residents and interested parties, but to date has not included the most recent CSCI inspection report in it; the Proprietor agreed to place an insert in each brochure, so that the reader is aware they can have a copy of the latest report to read if they wish. To accompany this brochure, the home provides new residents with a good amount of information in relation to terms and conditions and fee arrangements. Residents and visitors generally spoke or wrote very positively about the staff here, saying they were hardworking and caring. Some also commented that staff show a good level of respect and understanding. A designated social activities coordinator is employed in this home on a part time basis, and efforts are made to provide residents with opportunities to become socially engaged and occupied to some degree. Although some group activities take place, some residents evidently benefit from social contact on a more one-to-one basis, particularly in the dementia care unit. Some staff appeared particularly aware and sensitive of this, and were taking steps to ensure it happened. Whereas staff at the home do try to offer choice to people, it is important that they remain mindful of those residents who are more frail, and who may be less able to make a clear expression of choice. The home offers an ‘open-house’ for visitors, and the new manager, the Proprietor and the Care Services Manager all endeavour to remain accessible to visitors and residents; they consider this an essential part of the ways in which they monitor the quality of their services. It is reassuring to hear that the new manager has every intention of re-starting the resident and relative meetings. There is a satisfactory standard of food served here, and residents and visitors all indicated that there was a good choice, quality and quantity of food available. Uplands Nursing Home DS0000016643.V332746.R01.S.doc Version 5.2 Page 7 The home has a written procedure for dealing with complaints, which is made accessible to all. It is important that the home consistently responds promptly and fully to any complaint that is raised. In most regards the home adopts some satisfactory infection control practices, and provides suitable protective equipment for the staff. What has improved since the last inspection? It would appear that the most positive improvement to have happened at Uplands since the last inspection is the recruitment of a new manager. The quality of assessment as part of the pre-admission process for new residents has improved for more recent admissions to the home; it now remains for the home just to confirm the offer of placements at Uplands in writing as is required. The service of the main lunchtime meal is very much more organised than existed previously, with a good level of supervision from staff for those residents needing it, and with an altogether calmer atmosphere. Essential training for staff in relation to the protection of vulnerable adults has been reviewed and made more comprehensive of late, so as to include more topics that will better equip staff to cope with a wider range of needs. An improved induction-training package has been introduced for new staff, although it is recommended that this be further reviewed in order that it can fully reflect the recommended national induction training standards for care workers. Although the staff supervision policy has still not been strictly adhered to, there are now quite clear plans to address this properly, with a basis for a more structured approach to this just commencing. A new boiler has been installed, and the Care Services Manager and the new manager are commencing a regular fire safety audit of the premises, as approved by the Fire Safety Officer. Uplands Nursing Home DS0000016643.V332746.R01.S.doc Version 5.2 Page 8 What they could do better: The standard of documented care planning has been of a poor standard at Uplands for some time now, and this has been fully accepted and appreciated by the new manager. Although work has commenced to address this, with a more thorough assessment of needs taking place for each resident, this will remain an area that requires an urgent emphasis to make it better. This work will have to incorporate documented risk assessments for all areas where residents might be at risk, such as falling and nutritionally, as examples. Despite many good comments from residents and visitors, it is imperative for staff to ensure that all residents’ needs in respect of their dignity are addressed, such as assisting gentlemen with their shave in a more thorough and timely way, if this is what they need. Generally the system for managing medications is satisfactory, however there are some areas that require some improvement, mostly in relation to recording. As previously reported, there have been significant improvements in the way lunch is served to the residents. However Uplands has very limited designated dining space, and a large number of residents have to sit in arm chairs with small wheeled tables in front of them for their meals. The communal lounge in the nursing section of the home is also quite small for the number of occupants residing in there. In the kitchen there were isolated foodstuffs stored incorrectly; there were certain aspects of the catering records that seemed either to be poorly kept, or were confusing at the very least; the room was open to the front car park, allowing for the possibility of pests, such as flies, to invade the food preparation area. Some of the baths and one of the showers are inaccessible to residents due to design, which imposes a limit on options for use of bathing facilities for the residents. There was one particular bath that was ‘out of action’, although had been identified as needing replacement by the Proprietor. The disinfecting machine in one of the sluices was not being used by the staff to clean toilet equipment, with them opting to clean things manually, and the home does not have a proper agreement to dispose of wound dressing waste under its existing clinical waste contract. Uplands Nursing Home DS0000016643.V332746.R01.S.doc Version 5.2 Page 9 Uplands has many very capable and hard working staff, but due to working at minimum numbers, should have a laundry assistant at weekends, so as to avoid taking staff away from the care of the residents. It was commented upon by some visitors and staff that there are some language difficulties among the diverse staff team, which could sometimes impact on the needs of the residents. Progress to get some care staff qualified to a National Vocation Qualification standard is very slow, with only one carer so qualified. However with three carers now on a course, there is a degree of progress in this area, with more focus needed in the future. There is a satisfactory recruitment procedure here, but there must be evidence of tighter controls in just a few areas, so as to ensure that each and every one of the required pre-employment checks is undertaken in full. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Uplands Nursing Home DS0000016643.V332746.R01.S.doc Version 5.2 Page 10 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Uplands Nursing Home DS0000016643.V332746.R01.S.doc Version 5.2 Page 11 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 & 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. An improved assessment process, the provision of an information brochure and financial information about the home, enables prospective residents to make an informed decision regarding their admission and gives them assurances that their needs will be met. EVIDENCE: All prospective residents and their representatives are provided with information about Uplands, in the home’s Service User Guide, referred to as the Home Brochure. The brochure does not contain the most recent CSCI report as it should do, and neither was there an insert explaining to the reader that this was available in the home should they wish to read it. However, a notice is displayed in the home advising people that a report is available if they wish to read it, and following this inspection the Proprietor agreed that a similar insert would be placed in each brochure in the future, in order to comply with the requirement. Uplands Nursing Home DS0000016643.V332746.R01.S.doc Version 5.2 Page 12 Copies of the home’s written terms and conditions and contracts were seen. A good amount of contractual and fee information was contained in each. Contracts made clear any additional charges, the fee payable, including information about different fee structures depending on individual circumstances and funding arrangements. The home issues a one-month written notice of any changes to any arrangements, such as a rise in fees, and the Proprietor was advised of the revised requirement to now include the reason for the changes in the letters issued. Copies of pre-admission assessments carried out on more recently admitted residents were inspected. Each had been conducted and recorded in full before their admission to the home was agreed. The home had confirmed being able to accommodate the person’s needs, but only verbally, and agreed to adopt the practice of providing written confirmation of placement offers following assessment, as is required. Appropriate care assessments and health information from other health and social care professionals involved in each case were also on file where applicable. Uplands does not provide intermediate care. Uplands Nursing Home DS0000016643.V332746.R01.S.doc Version 5.2 Page 13 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 &10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The care planning documentation needs much improvement if it is to adequately provide staff with the written information they need to meet residents’ health and personal needs. Despite this shortfall there is knowledge and understanding among many of the staff in relation to individuals’ needs. The systems for the administration of medications are generally good, however isolated failures by staff to observe them consistently could pose a small risk to the safety of residents. In most regards efforts are made to promote the privacy and dignity of the individual. EVIDENCE: Each resident has their own individual care records. It is accepted by the new manager of Uplands that the standard of documented care planning here has been of poor quality and in need of major improvement; it is of some Uplands Nursing Home DS0000016643.V332746.R01.S.doc Version 5.2 Page 14 reassurance that she has identified this area as one requiring immediate priority; it will be important that residents and/or their representative can participate in this work, and that plans are subject to regular review as an ongoing feature. A new and improved assessment is being carried out on each resident, using an ‘Activities of Daily Living’ model. Assessments in relation to pressure sore vulnerability and moving and handling are in place, and are being reviewed. The progress to draft complete and full plans of care on the basis of each of these assessments has begun, but really does warrant more urgent attention from the manager and staff. Six care plans were identified for closer scrutiny as part of the case tracking exercise. Admission Forms were only partially completed in most cases. In at least two of these cases the residents were obviously at risk of falling, and were a nutritional risk. Although certain steps had been taken to address these issues, indeed there had been excellent progress towards a recovery in one case, there were no documented risk assessments or associated care plans to address these particular issues. Residents are weighed, although recording some in Metric measurement with subsequent ones recorded in Imperial measurements made it problematic to identify trends for individuals. In cases where a risk of developing a pressure sore had been identified appropriate healthcare intervention and support equipment had been introduced. Although not currently in use, the home now has a wound-mapping tool available for their use when managing wounds of any description. Records and direct observation confirmed that the residents are afforded medical reviews and consultations, and access to a range of health care services, either in the community or in the home. In one particular case, about which there has been particular scrutiny due to the risks posed by the resident to themselves and to others, some work had been done to provide a relevant plan of care more suitable to identified needs and risks, but further advice was needed in this regard, in order to effect a more detailed and robustly written plan. Significant progress had been made in this case however, in relation to reducing the risks that have existed, and staff themselves were able to demonstrate their improved understanding of this person’s care and particular needs. Despite the concerns in this area, it was reassuring to find staff who demonstrated awareness and sensitivity towards residents’ needs. Some staff were able to speak knowledgeably about issues relating to residents, both in the nursing and personal care part of the home, and in the dementia care unit. Uplands Nursing Home DS0000016643.V332746.R01.S.doc Version 5.2 Page 15 There were many observed examples of skills among the care staff that demonstrated a good understanding of the needs of the residents; it must be said however, that some appeared stronger in this regard than others. Resident and visitor surveys confirmed a good level of satisfaction about the care and attention offered at Uplands. People spoke of a relaxed and happy atmosphere, with staff showing respect and understanding and being caring and hardworking. One visitor said that they had to ‘ask’ if they required information about their relative, whilst others said that information was forthcoming. Whilst the majority of people surveyed felt that the home gave good care, one said that prompts were needed sometimes. Indeed, it was noted that one gentleman appeared unkempt and had not been shaved until much later in the day when his visitor arrived. Residents are able to self-medicate if they wish and are able, and this is done on the basis of a risk assessment; just one person was currently doing this. There are clearly printed Medication Administration Records from the supplying pharmacist; a small number of hand written entries on charts had not been signed in full by the author, and there was no second signatory as a witness. In some cases there were clear instructions for the use of external preparations, but in the main this was not the case; there were no plans of care to direct usage either, except in one case. Administration of medications had been signed for consistently, and the exact amount of variable dosages had been recorded when administered. Storage of medications is safe, with appropriately detailed records for receiving, disposal and management of all types of medication. Two prescribed items were discovered which had come adrift from their packaging, and consequently did not have an attached pharmacy label, which all prescribed items must have. Boxed and bottled items were dated on opening as a precaution against using the item beyond its expiry date, and also provided a good means of conducting audits. Random audits were carried out on three specific boxed medications, and a slight discrepancy was identified in one case. There were a small number of dosages in excess of what there should have been at that particular point in time. It was not possible to explain this discrepancy at the time, and the manager is advised to carry out her own investigation of this matter. Nursing staff responsible for dealing with medications have attended specific training with the pharmacy supplier, and good liaison and support from the Uplands Nursing Home DS0000016643.V332746.R01.S.doc Version 5.2 Page 16 pharmacist was described. Information for prescribed medications was available, although it was noted that one particular drug reference book was now out of date and should be replaced. Care was delivered to residents in the privacy of their own rooms or in bathrooms. Attention from staff was generally very discreet, and interactions between them and the residents were seen as being respectful. There was one exception to this however, when a non-care member of staff was heard to be disrespectful towards a resident, being less than mindful of the person’s dignity at the very least. This matter was addressed at the time, although will require monitoring in the future. Uplands Nursing Home DS0000016643.V332746.R01.S.doc Version 5.2 Page 17 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home does make an effort to ensure that residents can exercise choice in their daily lives, and that the opportunity to engage in social activities is usually offered. Visiting arrangements are such that residents can keep close contact with their families and friends. Despite only limited designated dining space, the dietary needs of residents are adequately catered for, with a selection of food available that meets their tastes and choices. EVIDENCE: Residents were spending their time in a variety of ways. Some were enjoying television, radio or a daily newspaper, whilst there were some who also appeared to have a degree of social contact with other residents, with some remaining more solitary. There was some evidence that staff, particularly in the dementia care unit, had ascertained past interests of some, and were endeavouring to promote the continuance of this as far as possible, although this was really only in a Uplands Nursing Home DS0000016643.V332746.R01.S.doc Version 5.2 Page 18 minority of cases; the senior carer said that staff try to build on any kind of expression of interest from a resident. Good social contacts were seen between the staff in the dementia care unit and the residents living there. Social activities and contact provided on a oneto-one basis was described by a staff member as being more beneficial in some cases. It was also good to hear that there was recognition that relationship building played a very important part in the area of social activity. Residents not accommodated in the dementia care unit are able to go into the large communal lounge for organised social activity, and indeed some were doing so to participate in the entertainments on offer during this visit; this particular lounge offers more space for larger numbers of people. A social activities coordinator visits the home on two days each week, organising group or one-to-one social opportunities for residents. Different types of activity are advertised in fairly large print on notice boards, which show that residents have the opportunity to join in games, musical activities and cooking, as some examples. Apart from this indication, it has not been the home’s practice to keep records in relation to social activities and particular interests. It is strongly recommended that such records are now maintained, in order to reflect consultation with the residents themselves, and to provide clear evidence of events and activities organised in accordance. Outings are very occasionally planned. A couple of the residents go out to attend local clubs. Local ministers of different denominations visit certain residents to provide pastoral and religious support, where an interest or wish has been expressed. Residents themselves, and most visitors surveyed, felt that there was plenty of social activity and stimulation for people, with just one expressing a reservation that there was enough. There were occasions when residents were observed sitting quietly in their rooms or in lounges with no-one in attendance. One resident, with very particular needs, actually received only minimal support from staff; this person was very independent, and chose to pursue his personal interests avidly, apparently not requiring interventions from staff in this regard. Residents receive their visitors according to their choice, and there are no restrictions placed on visitors here. Residents’ relatives were evidently welcomed, and there were examples of relatives being able to join in the social life of the home with their loved one, and could have a meal also if they wished. Visitor surveys indicated the fact that they felt welcome here and that they felt ‘included’. Uplands Nursing Home DS0000016643.V332746.R01.S.doc Version 5.2 Page 19 In consideration of this evidence so far, plus the fact that residents have a choice of food and can choose to have personal effects and treasured possessions in their own rooms shows that individual choices are respected. Visitors surveyed each confirmed that residents’ wishes are respected in the home, and indicated that individual lifestyle choices are supported by the staff. Due to the environmental layout of the dementia care unit residents were freely able to wander in safety and without restriction, according to their choice. Some residents were clearly more vulnerable and reliant on the staff to assist them, and staff should remain particularly vigilant in these cases where it could be more difficult for residents to make a clear expression of choice. Although an increase in the numbers of dining tables and chairs was reported by staff, these are still not sufficient to allow all residents sit at a dining table for their meal if they so wished; a large number ate in armchairs with small wheeled tables placed in front of them. The service of breakfast and lunchtime meals was seen. Mealtimes appeared relaxed, unrushed and calm; this was evidently a big improvement on the previously reported chaotic and sometimes unsupervised mealtime. Staff were present throughout the meal with the residents. The home has done well to review this and implement a much more conducive atmosphere at residents’ mealtimes. Residents’ choices of meals had been ascertained and recorded in advance, and could be served accordingly. Two choices of hot meal were served at lunch, although another option was available if wanted. A variety of breakfasts were served, with a small number opting for a cooked meal. Breakfast times appeared quite staggered, with the whole affair being very relaxed and flexible; those who wanted more to eat after the meal were given it. This was particularly relevant and reassuring in the case of a resident, who was at risk nutritionally, but whose appetite was improving; the carer involved said that the residents are never denied anything that they might like. The lunch choices looked wholesome and appetising. Staff were providing discreet assistance where needed, with just one exception to this when a carer did not sit down to feed a resident, as is the expectation. Adapted cutlery was in use and residents were provided with aprons and napkins to protect their clothes where needed. Each resident had a drink with their meal, which was replenished if wanted. There were no condiments on the tables, although they were available close by if wanted. Residents themselves all spoke of good food, and of being well fed. Visitors too spoke of seeing good food served here. Uplands Nursing Home DS0000016643.V332746.R01.S.doc Version 5.2 Page 20 The kitchen was seen after the lunchtime preparations. It was reasonably clean, although certain units appeared old and well used. Storage of food was satisfactory in the main, with refrigerated items dated and covered. However, two items were discovered in a cupboard, which should have been refrigerated on opening and were not; these had to be discarded because of this. The back door from the kitchen was wide open to the front car park area; there was no fly screen fitted to prevent any possible entry of flies into the food preparation area, which could pose a significant health risk. The Proprietor should give consideration to the provision of fly screens if doors and/or windows are to be left open in the kitchen; an ‘Insectocutor’ pest control device was in operation. There was a recorded cleaning schedule, although this did not appear to have been consistently completed in writing. Temperature monitoring forms were also in use, although there were gaps in recording with these also. These records also appeared confusing, with temperature checks carried out but recording not in accordance with what would be expected for cold storage. The Proprietor agreed to look into this with the cook. Uplands Nursing Home DS0000016643.V332746.R01.S.doc Version 5.2 Page 21 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A satisfactory complaints system, when consistently observed, enables residents and their families to feel assured that their views would be listened to and acted upon. Although the home’s aims are to ensure residents are offered protection against abuse, some additional work in this area, particularly around more comprehensive and in depth training, will make such policies more robust. EVIDENCE: The home has a clearly written procedure for dealing with any complaints or concerns that are raised, a copy of which is displayed in the entrance hall of the home, and is provided to each resident and their representatives in the home’s information brochure. Although the home endeavours to acknowledge complaints within twenty-eight days, there has recently been a complainant who did not receive such a timely response; however this was reported to be due to a particular break down in communication when correspondence went missing. These issues were eventually addressed to the satisfaction of the complainant. There is a system for recording any complaints, with specifically designated records; the manager must ensure that these are utilised fully in the future so Uplands Nursing Home DS0000016643.V332746.R01.S.doc Version 5.2 Page 22 as to maintain a clear record of complaints, subsequent actions, correspondence and eventual outcomes as is required. Residents and visitors confirmed that each knew how to raise concerns if they had to, and that in their experience staff had always responded most positively and appropriately to any concerns raised. The home has written policies and procedures in relation to the protection of vulnerable adults, although these currently need reviewing. It was recommended that contact with CSCI be incorporated into the policies for when concerns arise, along with the Police and the Local Authority, which are already included; it was further recommended that wording be more specific, and include contact details regarding the Adult Protection Unit within the Local Authority. The Care Services Manager provides adult protection training to the staff, as she has done the Enhanced learning course herself, and partially completed the ‘trainer’s course’. The training for staff has consisted of video and facilitator led instruction in the recognition of different types of abuse, and whistleblowing procedures; the course provides an assessment questionnaire at the conclusion for each candidate to assess their knowledge and understanding. All staff spoken to or surveyed confirmed their training and awareness of these issues, with one exception, who said she had not attended training for some time; the Care Services Manager gave assurances that this person would be part of the forthcoming course immediately following this visit. At this point in time, the home does not have a policy of exercising methods of restraint techniques, only one which states that such action would only be considered as a very last resort. Staff themselves said that they do not use restraint methods at all. It is important for this home to provide training for staff in this regard, if any restraint techniques are ever to be used, as they were in one case in recent months. In relation to the one case about which there has been particular scrutiny as part of a multi-agency approach, three staff are about to receive extra training in the ‘Management of Wandering and Aggression’, as part of the management strategy in this case. This will then be cascaded to all staff, who coincidentally said that they had not yet received such training so far. Furthermore, the external training provider to this home for ‘The Care of Residents with Dementia’ is being requested to include elements in her course relating to distraction techniques and dealing with challenging behaviour. Feedback in relation to this case will be delivered back to the next multiagency meeting, as part of the protection strategy. Uplands Nursing Home DS0000016643.V332746.R01.S.doc Version 5.2 Page 23 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22 & 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Despite some areas of concern requiring attention, Uplands provides a reasonably maintained, clean and safe environment for the residents. EVIDENCE: The residents’ accommodation is divided into two areas, one of which is known as ‘the house’, and accommodates those residents requiring nursing and personal care. The other part of the home is the ‘dementia care unit’, and provides accommodation to those residents requiring this specific type of care. There is limited space in the nursing unit, with one quite small, but cosy and comfortable lounge; this room has a pleasant aspect, with patio doors leading to an enclosed front garden. Lighting in some of these corridors was not overly bright, and infact seemed quite dim in places. Uplands Nursing Home DS0000016643.V332746.R01.S.doc Version 5.2 Page 24 By contrast, the dementia care unit appeared bright and more spacious. Communal rooms could open out onto a safely enclosed courtyard garden. Consideration has been given to the layout and décor in relation to the needs of the residents in this area, although some of the residents’ rooms were decorated with very ‘busy’ wallpaper; the Proprietor said this was being gradually addressed overtime, in order to provide more restful and harmonious décor. Although toilets were identified with words and directional arrows, there were no pictorial signs anywhere, which may be more helpful for some of the residents here, and only an isolated few had a familiar and recognisable photograph on their door. Rooms were fitted with locks for those wishing to use one, which were of a safe design that could be accessed from the outside if ever necessary. Some of the baths were inaccessible to residents, being of a more low level domestic style; the manager said that the fixed base hoist for one of these would be better re-sited to the other end of the bath for better usage. Another bath was out of use, with a broken integral hoist; the Proprietor said that this bath was scheduled for replacement, with new flooring also. There are two walk-in showers that allow for an assisted showering facility, however the third communal shower is not used, as it does not allow for this. Most areas of the home are satisfactorily maintained, and the home employs a full time maintenance person; records of cyclical and other maintenance issues are kept. A missing light bulb and shade was identified to the Proprietor, who took swift action to address it. The home was reasonably clean, with occasional odours detected in certain locations. Residents and visitors said that they felt the home was ‘kept clean and bright’. The laundry room was fairly well organised, and washing cycles in use were sluicing and disinfecting linen where needed, in accordance with good infection control measures. One visitor survey told of experiencing occasional laundry problems in the home, with instances of laundered clothing being delivered back to the wrong rooms. Hand washing facilities for staff, with liquid soaps, sanitising hand gels and paper towels were sited around the home, and plentiful personal protective clothing was provided. The home has two small sluice rooms, one of which contains a sluicing disinfector machine, as would be required in a home providing nursing care. However, this machine was not in use by staff, with staff apparently opting to Uplands Nursing Home DS0000016643.V332746.R01.S.doc Version 5.2 Page 25 use the other sluice room, and disinfect commode pans by hand using chemicals. The Proprietor established that the machine was operational, and could not explain why it was not fully utilised. Chemicals were being stored in the sluice room in readiness to clean commodes; this room was not locked and was accessible to residents. If chemicals are to be stored in this way, then this room will now have to be secured; the Proprietor agreed to address this. The home has a contract for the disposal of most grades of clinical waste, but does not have a contract for the disposal of soiled wound dressings. Consideration must be given to this in the event this type of waste is produced. Uplands Nursing Home DS0000016643.V332746.R01.S.doc Version 5.2 Page 26 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staffing provision is only just adequate to meet the needs of the residents currently living in the home. Although staff are afforded some training opportunities to enable them to understand their roles, progress to get care staff to undertake a care qualification is so far slow. Robust recruitment procedures would ensure that suitable staff are employed for the protection of residents, however any failure to observe these consistently could pose a degree of risk. EVIDENCE: Recorded staff rotas show that there is one qualified nurse on duty at all times, with eight care staff during the morning, six during the afternoon and evening, and three overnight. The care staff are deployed in each area of the home during the morning, four working in the dementia care unit and three in the nursing area; one senior carer works between each area. Given that there is only one nurse on duty, during the morning in particular, and that this home is registered to provide care to 50 residents, these staffing numbers are considered to be the minimum. Uplands Nursing Home DS0000016643.V332746.R01.S.doc Version 5.2 Page 27 An ancillary team of catering, cleaning, laundry, maintenance and administrative staff ably supports the care and nursing team. However, there is no designated laundry worker at the weekends, meaning that care staff have to carry out these non-care tasks. It is the Inspector’s view that this arrangement is not ideal, and it is essential that it remains under review by the manager, in order to monitor its impact on the ability of the staff to meet the needs of the residents. Surveys from residents and visitors showed that in their opinion the home could do with more staff, particularly at weekends. Staff themselves felt that they sometimes worked short staffed, and that laundry duties could impact on their work. Reports were heard that communication problems have existed among the staff team, with some language problems for the diverse staff group that could impact on the needs of the residents. Some staff spoke favourably about the group, saying that foreign members of the staff team worked very hard in the main, and were understanding of the needs of the residents; however they also did acknowledge that there were some language problems that were to be overcome. Residents and visitors, without exception, spoke very positively about the ‘hard working and caring staff team’. Progress to get at least half of the care team qualified to National Vocational Qualification (NVQ) level 2 or equivalent is slow. Despite the home’s policy being to achieve this there is still only one carer so qualified. However, the Care Services Manager and the home’s manager are considering further options to address this more satisfactorily, particularly in relation to a reliable training provider, and there are currently three care staff on a training course to achieve their qualification. The home manager has very little involvement in the recruitment of new staff, the responsibility for which lies primarily in the first instance with the adjacent company main office. It is strongly recommended that the manager be permitted involvement in the selection and recruitment of staff to her home. The random selection of two new staff recruitment files showed that in the main they had been recruited in accordance with appropriately robust procedures, with the required pre-employment checks carried out. However, each case could have been improved by the proper written recording of the interview process, which could then be used to show clearly that any gaps in a person’s employment history had been fully explored, as is required. Uplands Nursing Home DS0000016643.V332746.R01.S.doc Version 5.2 Page 28 In cases where the worker’s last position involved the care of vulnerable adults, the home’s standard reference request form asks for the referee to disclose the reason why the person left their employ. One applicant had failed to complete the criminal convictions declaration section of the application form, and the interviewer must remain mindful of the requirement for applicants to do this. Each worker had been commenced on the basis of a POVA First check (Protection of Vulnerable Adults), whilst awaiting the receipt of a full CRB (Criminal Records Bureau) disclosure. The manager was mindful of the requirement for workers commenced under these circumstances to work only under direct supervision at all times, until such time as a full CRB disclosure has been received. It was recommended that the identity of the worker’s supervisor be recorded, on their induction records as an example, and on the rota should this change for whatever reason. To date the Proprietor has remained unaware of the General Social Care Council (GSCC), and consequently has not been issuing the Council’s Code of Conduct to workers. The contact details of the GSCC were given to the Care Services Manager and the Proprietor after this inspection, so that they research this, and make the necessary arrangements to obtain the Social Care Worker’s Code of Conduct for their care staff. Induction records were seen for two members of staff, with assessed competencies signed off by their mentor when appropriate. The induction training programme has recently been reviewed, and although quite comprehensive and a good learning tool for new staff, would be best subjected to further review, in order that induction training can be delivered to new staff in line with the National Common Induction Standards. Details of how to access this information from the Skills for Care was given to the Care Services Manager and the Proprietor after this inspection. Each member of staff has a record of their training in their file. Recent training has included Fire Safety, Manual Handling, Adult Protection, End of Life Care, and Dementia Awareness. The Dementia Care course has incorporated elements in relation to the signs and symptoms, the types and causes of it, how to respond using positive and effective communication and how behaviours are related to feelings and needs. Following advice, the training provider is to be asked to also include restraint and distraction techniques, and dealing with challenging behaviour. Uplands Nursing Home DS0000016643.V332746.R01.S.doc Version 5.2 Page 29 Qualified nurses are about to have updated First Aid training, and have attended medication training, supplied by the pharmacist. Staff are issued with certificates of their learning and development, and should now be encouraged to maintain their own professional portfolios. Some staff spoke positively about the training opportunities they had, whilst others felt that more could be done, particularly in relation to dementia care for some newer workers. Uplands Nursing Home DS0000016643.V332746.R01.S.doc Version 5.2 Page 30 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 & 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. It is anticipated that after a period of upheaval, the permanent management arrangements and the planned improvements for implementation now in place here, that better leadership will be provided, with greater consistency and continuity for all in this home. EVIDENCE: It is of some reassurance that a new manager has taken over the day-to-day management of this home since the last inspection, at which time a number of serious concerns were identified. The new manager is a first level nurse, who has a lot of experience in caring for older people in a similar setting, and who has previous managerial Uplands Nursing Home DS0000016643.V332746.R01.S.doc Version 5.2 Page 31 experience. She has achieved the Registered Manager’s Award, and her application to become registered with CSCI is currently under consideration. Given that she will be managing the diverse needs of residents that include those with dementia, it will be necessary for her to undertake some specific training in this area. She has already addressed this to some degree, with a possible option to start a University course later this year in Person Centred Care for People with Dementia. She has focussed in these early days on getting to know the residents and their needs, and on making herself as accessible as possible to them, staff and visitors. Staff said that they found the introduction of a new manager a very positive thing, that she was very approachable, and was prepared to listen to people. Her particular interest in dementia care was also commented upon favourably. There would seem to be a slight restriction on her ability to progress certain issues in the most timely of ways, as it is the adopted practice at this home for the manager to only have approximately half of her working week when she is supernumerary to the care and nursing team, to attend to managerial issues. There are very clear lines of accountability to the Proprietor, through the Care Services Manager. As well as the manager remaining accessible to residents and visitors, it was clear that the Proprietor and the main office staff are also very accessible to them, with visitors able to pop into the main office just to say hello, or discuss any issues they may have. The Proprietor and Care Services manager are regularly in the home among staff and residents. This has been an essential part of the company’s strategy to monitor the quality of their service to people, with the ethos being to learn of concerns quickly so as to address and improve things quickly. Resident and visitor survey forms were issued last year, so that people could give their views on their experiences of the home. Results of these surveys had been collated, and although it is recommended that a written action plan be devised on the basis of results, the Proprietor said that results are always shared and discussed with relevant staff, in order to implement change and/or improvement. The practice of holding resident and relatives’ meetings as part of this quality monitoring process has been allowed to lapse, but it is strongly recommended, and it is the manager’s intention, to re-start these meetings as soon as possible. It is also her intention to share the outcomes of this CSCI report with the staff, so that all can understand areas that they address well, and areas where improvement is required. Uplands Nursing Home DS0000016643.V332746.R01.S.doc Version 5.2 Page 32 Regular internal inspections are carried out in the home, by the Care Services Manager, with reports produced on this basis. Some residents have placed personal money with the home for safekeeping. Staff in the home are not involved in the management of this system however, with responsibility for this remaining within the company main office, adjacent to the home. Clear and transparent records for each person, which include transaction details, running totals, and receipts are kept. Residents or their representative are able to sign to acknowledge their transactions, but where this has not taken place or been possible in the majority of cases, it is strongly recommended that two staff members sign the record to witness on behalf of the resident. Despite this recommendation however, it is generally the same two people within head office who complete these records, so events could be easily tracked if necessary. A regular audit has been carried out on these arrangements, confirmation of which is signed on each record. Since starting in the home, another area of priority for the manager is the supervision of staff. To date, progress to address this has been slow, with staff only having received supervisory instruction informally or at a meeting. The manager has endeavoured to work alongside her staff team, whilst they carry out their caring and nursing duties, as part of the monitoring process of their practice. The manager is in the process of devising designated staff supervision forms, which can be used as a recording tool for each individual. It was recommended that she also devise some sort of matrix in order to establish and monitor the supervision programme throughout the year. The home does have a staff supervision policy, which indicates that staff will receive this at least six times in a twelve-month period, and it is the manager’s expressed intention to adhere to this. Staff themselves indicated their awareness that this programme was about to start, even knowing who was going to be first. The home has a written health and safety policy. Staff have received training in fire safety and have had regular drills. Manual handling training has recently been delivered, and nursing staff are qualified in basic first aid, although this is due for updating; care staff receive basic underpinning knowledge in first aid during their induction. Safety checks and maintenance of all equipment and utilities is undertaken in a timely fashion. A new boiler has been installed. Uplands Nursing Home DS0000016643.V332746.R01.S.doc Version 5.2 Page 33 The fire alarm system is regularly maintained and checked. The Care Services Manager and the manager have devised a new Fire Safety risk assessment form, which has been approved by the visiting fire safety officer, and which will be used to audit the premises in relation to fire safety on a regular basis. Hot water temperatures are regularly checked for safe levels, and the Proprietor confirmed that hot water is stored at appropriate temperatures for the control of Legionella. Accident records are maintained in relation to incidents that have occurred in the home. The environment was generally safe and secure. Uplands Nursing Home DS0000016643.V332746.R01.S.doc Version 5.2 Page 34 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X 3 X X X 2 STAFFING Standard No Score 27 3 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 2 X 3 Uplands Nursing Home DS0000016643.V332746.R01.S.doc Version 5.2 Page 35 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP3 Regulation 14(1.d) Requirement The Registered Person must confirm in writing that the home is able to meet a prospective resident’s needs, once an assessment has been carried out. The Registered Person and the home manager must ensure that each resident has a written care plan demonstrating how his or her individual needs are to be met. These must be devised after consultation with the resident or their representative where possible, and must be kept under regular review. This requirement has been repeated from the last inspection. The Registered Person must ensure that risk to the health and safety of residents is identified, and so far as possible eliminated. The home must ensure that risk assessments are carried out and recorded for those residents who DS0000016643.V332746.R01.S.doc Timescale for action 31/05/07 2 OP7 15 31/05/07 3 OP7 13(4.c) 12(1.a) 31/05/07 Uplands Nursing Home Version 5.2 Page 36 are at risk of falling, or at risk nutritionally. 4 OP9 13(2) The Registered Person must ensure that there are safe systems for the management of medications in the home. The home must ensure that: • Handwritten entries on medication administration chart are signed in full by the author • Medication administration charts contain clear instructions for the use of external preparations • A pharmacy label is attached to each prescribed item in stock. 31/05/07 5 OP18 13(6)(7) 18(1.c.i) The Registered Person must 31/07/07 ensure that there are suitable arrangements to prevent residents being harmed or suffering abuse, in relation to the use of physical restraint. Staff must be trained in the use of restraint techniques. The Registered Person must 31/05/07 ensure that the areas of the home accessible to residents are free from hazards to their safety. Hazardous chemicals must be stored securely. The Registered Person must only employ suitable persons at the home. The home must ensure that: • Any gaps in a prospective worker’s employment history are fully explored, and a satisfactory written explanation of any gaps is DS0000016643.V332746.R01.S.doc 6 OP26 13(4.a) 7 OP29 19(1.b) Schedule 2 (2)(6) 31/05/07 Uplands Nursing Home Version 5.2 Page 37 • obtained A prospective worker provides details of any criminal convictions in a signed criminal convictions declaration. 31/07/07 8 OP29 18(4) The Registered Person must ensure that care workers are provided with information about the Social Care Workers Code of Conduct, as published by the General Social Care Council. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP8 OP9 Good Practice Recommendations The manager should ensure that residents’ weights are recorded in one scale only, for ease of reference. The manager should ensure that: • There is a second signatory as a witness to any handwritten entries on medication administration charts • There is an associated plan of care for the use of external preparations. The manager should ensure that detailed records are kept of consultation with residents, their interests, and their participation in social activities and events. The Registered Person should make arrangements to have fly screens fitted to the external kitchen door. The manager should ensure that pictorial signage is fitted to rooms in use by residents in the dementia care unit. The Registered Person should have made suitable arrangements for the correct disposal of wound dressings DS0000016643.V332746.R01.S.doc Version 5.2 Page 38 3 OP12 4 5 6 OP15 OP22 OP26 Uplands Nursing Home as part of the clinical waste contract. 7 8 OP27 OP28 The Registered Person should provide a designated laundry worker at weekends. The Registered Person should ensure that at least 50 of the care staff are qualified to at least NVQ 2 level or equivalent. The Registered Person should ensure that when recruiting new staff: • A written record is maintained of the interview process • The home manager is involved in the selection and recruitment process for new workers. The manager should ensure that the identity of a new worker’s supervisor is recorded on their induction record, and/or on the rota when changes occur. The Registered Person should ensure that the care workers’ induction training is in line with the national Common Induction Standards for care workers. The Registered person should ensure that a written action plan is drawn up on the basis of collated results of resident and visitor surveys, as part of the quality monitoring process. The Registered Person should ensure that two signatures are recorded on residents’ financial records, where staff carry out transactions on their behalf. The manager should ensure that: • Staff supervision is given at least 6 times each year • A matrix is devised to plan and monitor the progress of the programme. 9 OP29 10 OP30 11 OP30 12 OP33 13 OP35 14 OP36 Uplands Nursing Home DS0000016643.V332746.R01.S.doc Version 5.2 Page 39 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Uplands Nursing Home DS0000016643.V332746.R01.S.doc Version 5.2 Page 40 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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