Archived: Warren Heath Residential Home Limited

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

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 16 people using the service, some people were living with dementia. The service is two neighbouring buildings which have been adapted in to one care home.

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

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.

The registered manager told us they were aware of Right support, right care and right culture.

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.

People’s care records did identify how people made choices in their daily living. However, where people lacked capacity, there was limited information in their care records relating to how best interest decisions were made and who was involved.

Right Care: People’s care records were inconsistent, not always complete and did not always show how their individual needs were met or how risks were assessed and mitigated. We were not assured that people’s dignity was always considered and respected.

Right Culture: People were included in decisions about their care in regular meetings. We observed staff were caring and interacted with people in a respectful way.

We were concerned that the provider and registered manager’s monitoring system were not robust enough to independently identify shortfalls and address them. The systems for governance and audits were poor. This had been picked up in previous inspections and the provider had made improvements, but not sustained them. The provider had not maintained standards to ensure consistent ratings of good were sustained.

The service did not have effective infection, prevention and control measures to keep people safe in a clean and hygienic environment. The environment and equipment required updating and some replacing, such as commodes which could not be or were not effectively cleaned.

The systems to measure the numbers of staff required to meet people’s needs were not robust. We were not assured that staff were always receiving training and were competent, this was because the systems for recording staff training, included training for staff on dates they had not been working in the service.

People had access to their medicines when needed. We had received concerns about how the service reported and responded to safeguarding prior to our inspection. This had been addressed by the registered manager.

People had access to health professionals, however, this was not always consistently recorded and gave a clear picture of for example, who required support from a dietician. People had enough to eat and drink.

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

Rating at last inspection

The last rating for this service was good (published 8 March 2019).

Why we inspected

The inspection was prompted in part due to concerns received about safe care and treatment. A decision was made for us to inspect and examine those risks.

We received concerns in relation to how incidents had been managed relating to the safety of people using the service. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to inadequate based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well-led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

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.

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

Enforcement and Recommendations

We have identified breaches in relation to safe care and treatment, staff training and governance at this inspection. We have made a recommendation in relation how the provider maintains records relating to people's capacity to make decisions.

Please see the action we have told the provider to take at the end of this report relating to staff training.

We have served a warning notice for the breaches of regulation relating to safe care and treatment and governance. The notice identifies the date that the improvements must be made by the provider.

Follow up

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 alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is ‘Inadequate’ and the service is therefore 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 questions it will no longer be in special measures.

There was a registered manager in place. 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 2008 and associated Regulations about how the service is run.

Following our last inspection of 2 February 2018, we rated the service as requiring improvement overall. We identified one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the systems in place to monitor the service were not robust enough to independently identify shortfalls to ensure people who use the service were provided with good quality care at all times. For this reason we rated the key question of well-led as requiring improvement.

In the key questions for safe we rated the service as requires improvement. This was because improvements were needed in the infection control processes in the service and how people were provided with safe care at all times. In the key question for responsive we rated the service as requires improvement because there were inconsistencies in people’s care plans. The key questions of effective and care were rated good.

At this inspection of 31 January 2019, we noted there had been improvements and there were no breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We rated the service good in all key questions and therefore the overall rating of the service has improved to good.

The registered manager since our last inspection, had sought advice and invested in a quality assurance tool to assist with the planning, monitoring and delivery of the service. The staff had worked with the local authority and had developed people’s care plans so that there were no inconsistencies. Staff had undertaken training to increase and enhance their knowledge of infection control. These helped staff deliver safe and good quality care to people.

There were sufficient members of care staff to meet people’s identified needs.

Staff received training in safeguarding and were aware of what actions they should take to safeguard people from abuse and knew what actions to take to promote people’s safety and well-being.

There was a policy and procedure in place designed for the safe recruitment of staff. Staff were supported by an induction process, regular supervision, training and a yearly appraisal.

There were suitable arrangements in place for the safe storage, management and disposal of medicines and people received their medicines when they needed them.

Care and support was delivered in line with the assessed needs and choices of the people living at the service. People had their nutrition and hydration needs met through the delivery of nutritious menus which took into account people’s dietary preferences and requirements.

The service had built up an effective and supportive relationship with other professionals supporting people at the service.

People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice. Staff were knowledgeable with regard to Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

People’s privacy and dignity was respected by the staff who knew the people they cared for well.

Each person had a recorded needs assessment and a care plan which was regularly reviewed in order for the staff to provide personalised care.

There was a complaints procedure and senior staff visited each person everyday to determine if their needs had changed and if they had any concerns. There were a range of activities available to the people for their entertainment and to enhance their wellbeing.

There was a registered manager in place, who was also one of the providers. 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 2008 and associated Regulations about how the service is run.

At our last comprehensive inspection of 20 November 2015, this service was rated good. The service had not sustained the rating of good and the overall rating for this service was requires improvement. The key questions for Effective and Caring are rated as good. The key questions Safe, Responsive and Well-led are now rated as requires improvement. This was because the systems in place for infection control were not robust, there were inconsistencies in how people’s needs were planned for and met and the systems for monitoring the service were not robust enough to independently identify shortfalls. We identified a breach of Regulation 17: Good governance of the Health and Social care Act 2008 (Regulated Activities) Regulations 2014.

The service had accepted the support from the local authority to improve their care plans. However, we identified discrepancies in the reviewed care plans, which did not provide clear guidance for staff on how people’s needs were to be met. This included people’s conditions and how these affected their daily life. Staff were not always responsive to people’s needs.

There were systems in place designed to keep people safe from avoidable harm and abuse. Staffing levels in the service were organised to provide people with assistance when they needed it. Recruitment of staff was done safely and checks were undertaken on staff to ensure they were fit to care for the people using the service.

People were supported to see, when needed, health and social care professionals. People’s nutritional needs were assessed and met. People were provided with their medicines as prescribed. The environment was appropriate for people using the service. Staff were provided with training and support.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People were treated with respect and compassion by the staff working in the service. People had positive relationships with the staff who supported them. People were provided with the opportunity to participate in activities that interested them. People’s views were valued and used to plan and deliver their care. People’s views were listened to and acted upon relating to their end of life care. There was a system in place to manage complaints.

You can see what action we have told the provider to take at the back of the full version of this report.

We looked at the care records of three people who used the service. We found that people experienced care, treatment and support that met their needs and protected their rights. People were provided with their medication at the prescribed times. People were protected from the risks of inadequate nutrition and dehydration.

We looked at the personnel records of four staff members which showed that the appropriate checks were carried out before they started working in the service to ensure that they were able to work with vulnerable people.

The provider had systems in place to monitor and assess the service that people were provided with. Checks were made on equipment, including lifting equipment, to ensure that they were safe and fit for use.

During our inspection we observed that the staff were attentive to people's needs. Staff interacted with people using the service in a friendly, respectful and professional manner. We saw that staff sought their agreement before providing any support or assistance.

We saw that staffing was at a level that would safeguard the health, safety and welfare of the people living in the service.

We were able to speak with two people, they said that they were comfortable living in the service and also told us that they had not needed to make a complaint. One person said that, 'I like it here.' Indicating towards two staff members, they also said, 'I get on with them OK'

We saw that appropriate measures were taken to ensure that the people living in the service their visitors and the staff were protected against the spread of health care associated infections.

People were encouraged and supported to make complaints. The manager told us that they tried to ensure that complaints were dealt with informally, which resulted in very few formal complaints made in the last few years.