Uplands House Care Home

Updated 17 January 2023

Uplands Independent Hospital provides treatment for patients who require long stay and rehabilitation services. aged over 18 who may be informal or detained under the Mental Health Act 1983. It offers assessment, treatment and continuing care for up to 24 people. At the time of the inspection there were there were 13 patients, one on section 17 leave, all were detained under the Mental Health Act. The hospital takes referrals from acute and low secure inpatient wards.

Uplands Independent Hospital is registered to provide the following regulated activities:

• Assessment or medical treatment for persons detained under the Mental Health Act 1983.
• Diagnostic and screening procedures.
• Treatment of disease, disorder or injury.

Uplands Independent Hospital is based in a grade 2 listed building on the outskirts of Fareham. It is set within its own grounds. When originally established, the service was set up to provide for patients who had long term mental health issues and was considered a placement for life.

As national guidance and best practice for patients with a long-term mental illness changed to encompass a recovery focus to support patients to live more independently in the community the hospital began to accept patients with more complex mental health issues.

The model of care provided by the hospital is in the process of changing and staff are receiving training to provide care that is recovery focused. However, at the time of the inspection staff had not been trained in the new care model.

There was a hospital director in place who had not yet been registered with the CQC.

The service was last inspected in June 2022.

What people who use the service say

Patients we spoke with felt safe at the service and one explained that staffing, locking their bedroom and their compatibility with other patients gave them a sense of safety.

Patients were able to make day to day decisions such as times to rise and retire, their appearance and activities. They also said they had support from staff with taking some decisions.

Overall patients gave positive feedback about the meals and the service catered for their dietary requirements. For example, the chef could provide vegetarian meals.

Patients knew the conditions of their legal status at the service and said staff read them their section 132 rights.

Patients with unescorted leave went into the local community daily. Some patients said they were bored. Daily activities were limited and not specific for people to develop and maintain their daily living skills.

Patients knew who to approach with complaints, although they were not confident, they would be resolved to their satisfaction.

Patients were positive about the staff and about the improvements since the last inspection. We saw staff engage with patients and the staff knew how to approach individual patients.

Patients knew the managers and said they were regularly seen on the ward

Updated 17 January 2023

Our rating of this location improved. We rated it as requires improvement.

The Care Quality Commission conducted an unannounced inspection of Uplands Independent Hospital on 19 and 20 October 2022 to check that the improvements detailed in the warning notice served following our inspection January 2022 had been made. In January 2022 we rated the hospital inadequate and placed it in special measures.

On 28 and 29 June 2022 we undertook a focussed inspection to check whether improvements had been made. We found that the provider had made some improvements but needed more time for improvements to be fully implemented. The provider gave us assurance that they would continue to improve. We decided to give the provider more time to make the required improvements but to monitor it closely. The hospital remained in special measures and continued to be rated inadequate.

During this inspection we saw that the provider had maintained the improvements we found in June 2022 and had continued to make progress with the areas that required improvement outlined in their action plan. They had started work to improve the environment, installed a new fire alarm system, ensured staff undertook mandatory training and commenced recruitment for a range of clinicians so they could offer a full multidisciplinary team input to patient care. Whilst the provider had developed a comprehensive rehabilitation and recovery care model this had not yet been fully implemented or embedded within the services practice. Staff had involved patients in developing the new model of care and we also saw that staff were more engaged with patients; offering more one to one engagement time. Senior managers were visible across the hospital and staff felt they were approachable, listened to them and acted on their concerns. However, the provider was clear that they still had actions to complete and that they needed to continue embedding the improvements they had already made.

Our rating of this location improved. We rated it as requires improvement because:

At this inspection we found:

• The provider had not yet fully addressed all of the improvements to the environment identified in their action plan. For example, some ligature anchor points remained although these could have been removed and these were not all included in the ligature risk assessment. Not all patients had access to a nurse call system in their bedrooms so would be unable to call for help if they needed to.
• The provider had reduced the number of registered nurses on duty, since our last inspection, as the number of patients admitted to the hospital had reduced. However, the staffing ladder used to identify the number of registered nurses required on the ward focussed more on the number of patients rather than the care they needed.
• Care plans were not as person centred or recovery focused as they could have been. For example, they did not detail how patients could gain the skills needed to live in the community. Staff did not always document how patients had been involved, in care planning, recorded best interest decisions for patients that lacked capacity or if they had understood changes to their treatment.
• Staff told us that they sometimes had to cancel escorted community leave because of staffing numbers.
• We found that one medication record did not have a completed section 62(1) urgent treatment form attached to it. A section 62(1) urgent treatment form is needed to authorise treatment which has not been agreed by the patient when a patient does not or cannot consent and treatment has been agreed by a second opinion appointed doctor.
• The provider did not actively seek feedback from families and carers about the service.
• The female lounge was a long distance from the main areas of the hospital so not easy for female patients to access.
• The provider was in the early stages of implementing a new governance process across all of its services. Managers at Uplands were still introducing this structure so not all governance process were working effectively.
• The provider had identified a new rehabilitation and recovery focused model of care, but this had not been fully implemented at the time of the inspection.

However:

• The ward remained clean and there were maintenance plans in place to improve the environment.
• The hospital had reduced the number of agency staff it used. All staff received an induction before working at the hospital. The service held regular multidisciplinary team (MDT) meetings and was actively recruiting to ensure they had a complete MDT available to the patients.
• The care plans in place met and identified patients’ physical and mental health needs. Staff supported patients to access physical health care. Staff used rating scales to identify and meet patients’ needs. All patients’ records we reviewed had a positive behaviour support plan in place, which staff understood, and a discharge plan.
• Staff ensured that the clinic room was fully equipped and clean and the provider had introduced an electronic prescription system to reduce errors.
• Interactions we witnessed between patients and staff were caring and respectful, patients told us they felt safe in the hospital and knew how to complain. Staff completed a daily risk assessment for each patient and reported incidents appropriately.
• The provider had opened a female lounge and was preparing a room to be used as a gym for the patients.
• There was a new hospital director in post and the provider had agreed a long hand over period with the interim hospital director to ensure consistency.

As a result of the improvements, we will remove the hospital from special measures.

Updated 17 January 2023