Warberries Nursing Home

Updated 14 February 2024

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.

Inspection team

The inspection team consisted of 4 inspectors, an assistant inspector 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.

Service and service type

Warberries Nursing Home 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. Warberries Nursing Home is a care home with 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 were 2 registered managers in post. One of them is known in the service as the registered manager, and is the person referred to in this report as the registered manager. The other registered manager is known in the service as the Clinical Lead.

Notice of inspection

The first day of inspection, on 21 November 2023, was unannounced. Our second day of inspection, on 23 November 2023, was announced. The inspection ended on 5 December 2023.

What we did before the inspection

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

We spoke with 10 people living at the service, 4 relatives and 8 staff including the 2 registered managers. We used the Short Observational Framework for Inspection (SOFI), in the dementia unit and the main home. SOFI is a way of observing care to help us understand the experience of people who could not talk with us. We also reviewed a number of records about the governance of the service. This included quality assurance information, care plans and risk assessments for 13 people, medicine records, training and recruitment records and staff rotas. We made 3 referrals to the local authority safeguarding team, and we asked the registered manager to make 4 referrals as the result of our inspection.

After the inspection

We spoke with 5 more relatives on the telephone, and continued to review care plans and documents related to governance of the service. We spoke with 2 health professionals about the service.

Updated 14 February 2024

About the service

Warberries Nursing Home provides personal and nursing care to a maximum of 49 people. The service provides support to people who are living with dementia, and/or have nursing or residential care needs. At the time of our inspection there were 35 people using the service.

People’s experience of the 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 was 1 person using the service who had a learning disability.

Risks to people were not always monitored and managed in a safe way, particularly risks associated with people’s particular health needs. People’s records did not always contain accurate, complete and contemporaneous information. Systems in place to safeguard people from abuse and avoidable harm, and to learn lessons from previous events, were not always effective. Although there had been improvements since our last inspection, the provider’s systems did not always effectively monitor the quality of care provided to identify risks and drive improvements. This continued to put people at risk of harm.

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

There were enough staff who had been trained, and during inspection we observed warm interactions between people and staff. Staff knew people well and could describe them and their care needs to us. People told us they felt safe, and relatives felt their family member was safely cared for. There were no restrictions on people having visitors.

People were well supported, and their privacy, dignity and independence was promoted. People were supported to express their views and be involved in making decision about their care. People told us “They are caring, they don’t boss me around”, “They are respectful, no hesitation”.

There was a positive and open culture at the home. One person told us how they felt about the service, “I don’t think you could improve on it, if you ask for anything they get it for you. They inform me of any issues.” One family member told us they were, “kept up to date and the home call straight away if there are any concerns.” The provider worked in partnership with others.

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 Requires Improvement 26 September 2022.

At this inspection, we found that although some improvements had been made, and they were no longer in breach of regulation 10 or 18, the provider remained in breach of regulations 12 and 17.

At our last inspection, we recommended the provider reviewed a certain element of staff training. At this inspection, we found the provider had taken action to review and amend staff training.

This service has been in Special Measures since 12 April 2022. During this inspection, the provider demonstrated that improvements had been made and is no longer rated Inadequate. However, the service remains in Special Measures due to persistent breaches.

Why we inspected

We inspected due to receiving concerns about an alleged incident of abuse. A decision was made for us to inspect and examine those risks. During our inspection, we found the registered manager had taken swift and appropriate action in response to discovering the abuse.

Enforcement

We have identified continued breaches in relation to regulation 12 safe care and treatment, and regulation 17 good governance.

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

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.

Special Measures

The overall rating for this service is ‘Requires improvement’. However, the service is remaining in 'special measures' due to the persistent breaches. 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 time frame and there is a rating of inadequate for any key question or overall, 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 not rated as inadequate for any of the five key questions, it will no longer be in special measures.