Archived: Warren Park

Updated 23 March 2017

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 22 September and 28 September 2016 and was unannounced. The inspection was carried out by two adult social care inspectors and an expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service. On the 28 September 2016 the inspection continued with one adult social care inspector who had commenced the inspection on 22 September 2016.

The inspection included reviewing information we held about the service. This included correspondence we had received about the service and notifications required to be submitted by the service. A notification is the action that a registered provider is legally bound to take to tell us about any changes to their regulated services or incidents that have taken place.

We also gathered information from the local authority. This information was used to assist with the planning of our inspection and inform our judgements about the service.

We used a number of different methods to help us understand the experiences of people who used the service. We spent time observing the daily life in the home including the care and support being delivered. We spoke with five people who used the service, four relatives or friends, two healthcare professionals and five staff. We also spoke with the covering manager, the deputy manager and the service manager. We looked around different areas of the home such as the communal areas and with their permission, some people’s rooms. We reviewed a range of records including three people’s care records, four people’s medication administration records, five people’s personal financial transaction records, four staff files, maintenance records, complaints record and quality assurance records such as audits related to the management of the regulated activity.

Updated 23 March 2017

This inspection was carried out on the 22 and 28 September 2016. Both days were unannounced, which meant no-one at the service knew we would be visiting.

This service was registered under this registered provider on 10 April 2015.

Warren Park is a care home registered to provide accommodation with nursing and/or personal care for up to 60 older people, including people living with dementia. At the time of our inspection 25 people were living at the home.

The service did not have a registered manager at the time of the inspection. The covering manager had submitted an application for registration to the CQC in August 2016 and they were awaiting the outcome of the application. 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 and associated Regulations about how the service is run. This registered manager was not managing the service at the time of our inspection. The service was being covered by another manager who is referred to in the report as the covering manager. The service manager is the member of staff who has line manager responsibility for the manager of the care home.

At the last inspection on 11 and 20 April September 2016 the service was rated inadequate. During the inspection we found the covering manager was keen to improve the service and we saw that improvements had been made already. Care plans had been revised, staff had been assessed and measures taken if performance was below standard, and an auditing system had been put in place. However there continued to be fundamental errors in the delivery of care and support. However there continued to be four breaches in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were breaches in, Regulation 12; Safe care and treatment, Regulation 9; Person centred care, Regulation 17; Good governance and Regulation 18; Staffing.

We checked that improvements had been made in the safe handling of medicines. We saw that insufficient action had been taken to achieve compliance.We found the service continued not have appropriate arrangements in place to manage medicines to ensure people were protected from the risks associated with medicines.

During our inspection we observed people had to wait at times for assistance. Staff and relatives told us at certain times they could do with more staff to ensure people needs were met in a timely way and maintain their safety.

People were not always supported to eat and drink sufficient amounts to maintain a balanced diet.

At the last inspection we found some staff had not received all the appropriate training relevant for their role and responsibilities and staff had not received an appraisal. We found that the service had policies on supervision and appraisal. Supervision is an accountable, two-way process, which supports, motivates and enables the development of good practice for individual staff members. The covering manager and staff told us flash supervisions was provided regularly . We looked at supervision records of four staff and found evidence of discussion about development and well-being. The registered manager showed us records of group supervisions and ten minute catch up meetings where they provided support and supervision to staff. However, supervisions in two staff files stated that people would receive supervision on a weekly basis and there was no record of this taking place.

Appraisal is a process involving the review of a staff member’s performance and improvement over a period of time, usually annually. Records seen showed that although staff had been provided with supervision none of the staff had received a yearly appraisal. The covering manager had taken action to address these issues, but they still required embedding in practice. The covering manager told us that all staff were still awaiting an appraisal. The example of staff not having had an annual appraisal was a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities)

We checked whether the service was working within the principles of the MCA, and whether any conditions on authorisations to deprive a person of their liberty were being met. Whilst authorisations to deprive a person of their liberty were in place when they lacked capacity, the care and treatment provided was not always appropriate to meet their needs.

All the staff we observed were kind and considerate and assisted people to meet their needs. We always heard staff ask people before they assisted them with care needs.

People told us they were well cared for by staff and felt safe. This was supported by people’s relatives and friends.

People had access to a range of health care professionals to help maintain their health.

The covering manager had informed CQC of significant events in a timely way by submitting the required notifications. This meant we could check that appropriate action had been taken.

There was an inadequate system in place to monitor and improve the quality of the service provided, because checks and audits in place had not been effective in ensuring compliance with regulations.

At the last comprehensive inspection this provider was placed into special measures by CQC. This inspection found that there continued to be multiple breaches .This was not enough improvement to take the provider out of special measures. CQC is now considering the appropriate regulatory response to resolve the problems we found.

Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.