Archived: Warren Park

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.

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 had a registered manager. 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. On the second day of the inspection a new manager had commenced at the service, as had a new service manager.

At the last inspection on 21 and 25 September 2015 the service was rated inadequate and placed into special measures. We took enforcement action against the registered provider and the then registered manager telling them they needed to improve. During this inspection we found the service had made some improvements, but these were insufficient to fully meet regulations.

People and relatives felt staff were visible and we found staff available to respond to people’s needs, but staffing levels at times, did fall below that identified as being required by the service. Nursing staff were not always able to give people their morning medicines at the right time.

We found some staff had not received all the appropriate training relevant for their role and responsibilities, nursing staff had not received supervision and staff had not received an appraisal.

Records of risks presented by people were carried out, but there were gaps in addressing some of those risks to ensure the safe care and treatment of people, including the proper and safe management of topical medicines.

People, relatives and staff reported the covering manager demonstrated good management and leadership of the home saying they felt she listened to worries or concerns they had, providing an appropriate response or taking action where needed. However, we found that some complaints did not have a full and accurate record of the investigation that supported the findings and that the full complaint had been addressed.

We also found omissions in the reporting of some incidents to CQC as required by regulations.

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

People and relatives we spoke with told us staff were caring and compassionate in their approach. We observed this for most staff when they were interacting with people.

The service were working within the principles of the Mental Capacity Act, but were not meeting the conditions of one of the authorisations, which meant the person was not receiving appropriate care to meet their needs. They had told the authorising body about this.

People received a varied and nutritious diet that took into account their dietary needs and preferences, so that their health was promoted and choices could be respected. The changes in the layout and furnishings of the dining area, made the dining experience a much better experience for people.

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

Some activities were provided for people, but this needed improvement to ensure all people had the opportunity to partake in hobbies and interests they enjoyed.

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.

The overall rating for this service remained inadequate and the service therefore remained in special measures.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, the service will be inspected again in six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated up to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

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.