Archived: The Warren Residential Lodge

We undertook this unannounced comprehensive inspection on the 14 December 2015 to check the service had made improvements and met legal requirements. The service had taken sufficient steps to be taken out of special measures.

The home provides accommodation and nursing care for up to 31 older people. At the time of our inspection 23 people lived at the home.

The registered provider of this service was an individual provider and therefore was not required to appoint a manager. They had appointed a nominated individual to manage this service on their behalf. This person was not registered for the service and as such did not have the legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The legal responsibility for this service was with the registered provider. Following our inspection in June 2015, the registered provider informed us of their plans to change the registration of the service to a Limited Company and appoint a Registered Manager for the service.

At this inspection we found the registered provider had met all of the requirements of the Regulations to meet the fundamental standards, although further work was required to embed practices in the home.

Risk assessments in place informed plans of care for people to ensure their safety and welfare, and staff had a good awareness of these. Health and social care professionals were involved in the care of people, especially those with enhanced needs; care plans reflected this. Medicines were stored and administered safely.

There were sufficient staff to meet the needs of people who lived at the home and the provider had implemented a system of review to ensure adequate staffing levels would be available if people’s needs changed. Staff had a good understanding of how to keep people safe, identify signs of abuse and report these appropriately. Processes to recruit staff were in place which ensured people were cared for by staff who had the appropriate checks and skills to meet their needs.

People consented to their care and had opportunities to be involved in planning and reviewing their care however further work was required to embed this practice in the home.

People received food and drink in line with their needs; the provider had discussed people’s dietary likes and preferences recently and was planning to introduce a new range of food choices for people. People who required specific dietary requirements for a health need were supported to manage these.

Care plans in place for people reflected their identified needs and the associated risks; a system of review for care plans had been implemented but was in its infancy. Key workers had been identified to support people in ensuring these care plans remained up to date and in line with their needs. Staff were aware of people’s needs and understood their role in supporting these. Staff were caring and compassionate and knew people in the home well.

There was a wide variety of activities available for people, however some people were not aware of these. People were able to move independently around the home and access communal areas where groups of people enjoyed social interactions and activities together.

Complaints had been responded to in line with the registered provider’s policy and this work needed to be sustained. Incidents and accidents had been reported and investigated; there was a robust system in place to monitor and review the incidents of falls in the home and ensure staff learned from these incidents.

A new management structure in the home had greatly improved the support available for staff and staff spoke openly of working together to improve the lives of people who lived at the home. The management team had introduced robust quality assurance systems in the home. Whilst in their infancy, these audits were monitored by the management team to ensure the safety and welfare of people at the home. People, their relatives and staff felt positive in the recent changes in the service; however these needed to be sustained.

The provider sent us an action plan to say the home was compliant by 31 January 2014.

We spoke to the manager and deputy manager at the home during this visit and reviewed the cleanliness of the premises. We reviewed policies and procedures in place to support the management of infection control and we toured the premises.

At this inspection we found that people were protected from the risk of infection because appropriate guidance had been followed and people were cared for in a clean, hygienic environment.

Care was provided over one floor with single occupancy rooms available. People were able to personalise their rooms with their own possessions and could access their rooms whenever they chose. Many people chose to remain in their rooms throughout the day, however there were three communal lounge or dining areas available for people to use.

We saw that the home offered people a wide variety of planned social activities throughout the day; we saw that people were encouraged to participate. The day prior to our visit some people had visited a local zoo.

We saw that clear person-centred care plans were in place to support people and we found that staff had a good awareness of people's needs.

Staff treated people in a kind and gentle manner respecting their dignity at all times. People had their care discussed and agreed with them or their representative.

We found that the provider did not have robust infection control procedures in place to ensure that people were protected from the risk of infection.

People told us they were happy living at this home. One person told us, 'The staff are just the best, nothing is too much trouble.'

Comments included. 'I can't complain about anything here. I am very happy. The girls are very friendly, the home is always clean and I like the food.'

There were care plans in place that included people's individual needs and wishes. The plans also contained clear information regarding staff supporting people's emotional wellbeing.

The home's staff worked with a variety of healthcare professionals including district nurses and mental health teams. We saw that people also had access to specialist care when required.

We spoke to staff and reviewed records which showed us that people were protected from abuse and their care was planned and delivered in a safe manner.

Evidence we saw showed us that people were supported by a caring, experienced staff team. The staff team were well supported and trained.

People had their social needs assessed and had access to a variety of day activities.

There were processes in place for the provider to audit and record the standard of care being provided.

A family member who visited the home regularly told us. 'It's fine here. Staff are very helpful and cheerful and I am always made welcome.'