Archived: Warren Heath Residential Home Limited

Updated 29 July 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection, we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was undertaken by an inspector.

Inspection activity started 8 March 2022 and ended on 24 March 2023. We visited the service on 8 March 2023.

Service and service type

Warren Heath Residential Home Limited is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Warren Heath Residential Home Limited is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post, who was also a director and the provider’s nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider.

Notice of inspection

This inspection was unannounced.

What we did before inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

During our visit we spoke with 5 people who used the service. We spoke with the registered manager and a director; we spoke briefly to 2 care staff members.

We undertook a tour of the service and observed the interactions between staff and people using the service to help us understand the experience of people who could not talk with us. We reviewed four staff personnel files, and records relating to governance and health and safety, including fire safety checks and audits.

We also reviewed records remotely, away from the service, including 4 people’s care plans, risk assessments and medicine administration records, training records and records relating to the governance of the service. We spoke with 3 care staff members and the relatives of 6 people who used the service on the telephone.

We fed back our findings of the inspection electronically on 24 March 2023 to the registered manager, a director and 2 of their family members.

Updated 29 July 2023

About the service

Warren Heath Residential Home Limited is a residential care home providing accommodation and personal care to up to 18 people. The service provides support to older people. At the time of our inspection there were 14 people using the service, some people were living with dementia. The service is two neighbouring buildings which have been adapted into one care home.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

People’s experience of using this service and what we found

At this inspection we found there had been some improvements made in the service in areas such as infection control, replacing equipment, decoration, and staff training. However, shortfalls remained, and we were concerned that the provider and registered manager had not implemented enough improvements at this inspection.

The provider had employed the support of a consultant and was receiving support and guidance from health and social care professionals to make improvements in the service. We were concerned that whilst the provider was making attempts to improve following guidance, their governance systems were not robust enough to support them to independently identify shortfalls and take action to address them.

Right Support:

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Records relating to people’s capacity to make decisions were poor and did not demonstrate people’s choice and consent was sought in all areas of their care. Contradictions were in care records relating to people’s independence and how this was being promoted.

Right Care:

Some attempts had been made to improve people’s care records, including care plans and risk assessments. However, we found the records were poor, they were contradictory and not person centred. This could lead to people receiving inappropriate and unsafe care, and at times care which could cause people distress. There were outdated terms used in people’s care plans and sometimes the language used did not demonstrate an understanding of respectful and dignified ways of referring to people.

Right Culture:

We had received feedback that the provider and registered manager were caring in their approach, which we observed. We were concerned the systems in place did not demonstrate a caring service was always provided, which went over and above caring interactions.

There was not a proactive approach in place to assess and mitigate risks in the service. Where shortfalls were identified by other professionals, the provider was responding in part. However, we were concerned the registered manager and provider, had not independently identified risks.

People told us there were enough staff to support them. However, the staffing tool used to assist the provider to calculate the numbers of staff required to meet people’s needs, did not take account of the additional duties staff undertook including cooking. Staff were recruited safely.

The registered manager told us they were making improvements in the menu, due to the current menu not demonstrating people always received nutritional and well-balanced meals. People’s weight was monitored, and referrals made to health professionals where required. However, the outcomes and guidance provided was not always recorded in records to ensure people’s needs were consistently met.

Since our last inspection improvements had been made in the training provided to staff, this included training in learning disabilities and updated safeguarding training. Staff were made aware of how to report concerns of safeguarding and people’s wellbeing.

The home was clean and actions had been undertaken to improve the cleaning of the service and equipment and broken items had been replaced. There was a programme of refurbishment and redecoration ongoing.

People were supported to have visitors in the service, in line with current government guidance.

People received their medicines when they were needed. Staff had received training and had their competency checked when they were responsible for assisting people with their medicines.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was inadequate (published 5 January 2023) and there were breaches of regulation relating to safe care and treatment, staff training and governance. The provider completed an action plan after the last inspection to show what they would do and by when to improve. We also served a warning notice relating to safe care and treatment and governance. We gave the provider a date for when we expected improvements to be made.

At this inspection, improvements had been made relating to staff training and support and the provider was no longer in breach of this regulation. We found the provider remained in breach of regulations relating to safe care and treatment and governance. In addition, a further breach relating to consent was identified.

The last rating for this service was inadequate (published 5 January 2023). The service remains rated inadequate. This service has been rated inadequate for the last two consecutive inspections. This service has been in Special Measures since 30 November 2022. During this inspection improvements have not been fully implemented. The service is still rated as inadequate. Therefore, this service remains in Special Measures.

Why we inspected

We carried out an unannounced focused inspection of this service on 26 October 2022. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve in relation to staffing. We had recommended the provider maintains up to date records of people's best interest decisions and consent for their care and treatment.

We undertook this focused inspection to check whether the Warning Notice we previously served in relation to Regulation 12: Safe care and treatment and 17: Good governance of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. This inspection was carried out to follow up on action we told the provider to take at the last inspection. We also checked the provider had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions safe, effective, and well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last comprehensive inspection to calculate the overall rating. The overall rating for the service has not changed following this focused inspection and remains inadequate. This is based on the findings at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We have found the provider had not fully met the requirements of the Warning Notice and found evidence that the provider needs to make improvements. Please see the safe, effective and well-led sections of this full report.

You can read the report from our last comprehensive and focused inspection, by selecting the ‘all reports’ link for Warren Heath Residential Home Limited on our website at www.cqc.org.uk.

Enforcement

We have identified repeated breaches in relation to safe care and treatment and governance and a breach of regulation in relation to consent at this inspection.

Please see the action we have told the provider to take at the end of this report. We have imposed conditions to the provider's registration, which requires them to send us information which demonstrates improvement.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Special Measures:

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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