The purpose of the inspection was to answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? Below is a summary of what we found. This was a responsive inspection as we had received concerns from relatives and a social worker. This included people not being supported with having baths, lack of support at meal times, staffing levels in respect of supporting people living with dementia and answering call bells.
The inspection was conducted by three inspectors. The inspectors were accompanied by an expert by experience a person who has had experience of using services.
Warmley House was split into 3 areas, a nursing unit, a residential care area called The Coach House and Sunflower which was an area supporting ten people with dementia. Sunflower was situated on the third floor above the Coach House.
The summary is based on our observations, a review of records and discussions with 15 people who used the service, eight relatives, a regional manager, two nurses, six care staff and two domestic staff.
If you wish to see the evidence supporting our summary please read the full report.
Is the service safe?
We found not all aspects of the service were safe.
CQC have a duty to monitor the use of the Mental Capacity Act 2005, which includes the Deprivation of Liberty Safeguards (DoLS). The purpose of DoLS is to make sure that people are looked after in a way that does not inappropriately restrict their freedom. We were told that no person in the home had an authorisation under DoLS to do this. We spoke with staff about their understanding and three care staff we spoke with had no understanding about these safeguards that protect people's human rights.
We spent time on Sunflower, where people living with dementia were supervised by staff and a key pad was place. There had been no applications in respect of these people to ensure they were not being deprived of their liberty and these restrictions on their freedom were the least restrictive. When we asked staff if people could leave the unit they told us only with staff support and often they do not have the staff to support people outside the home.
We had received concerns from relatives and the social workers. These included the home was not clean, bedding was stained and there was often an odour. We found the home was not clean and hygienic. There was an odour in some parts of the home. The staff were not following the appropriate guidance, equipment and facilities was not in place. This meant that people who used the service were not safe or protected from the risks associated with cross infection.
Staffing in the part of the home caring for people living with dementia was not sufficient to meet their needs. This was because the numbers of staff on duty had resulted in restrictions on people so that they did not get opportunities to go out of the building and their personal care needs were not being met consistently.
We were shown around the home we saw that some of the areas of the home were not safe and suitable in relation to the fixture, fittings and furniture. This was because some furniture was broken and unsafe. Light fittings in people's bedrooms had no shades protecting them from the exposed light bulbs.
Is the service effective?
We found not all aspects of the service were effective.
When we spoke with staff they were knowledgeable about the people they cared for and their needs. The majority of the staff we spoke with told us that they tried their best but they rarely had time to spend time with people unless engaged in providing personal care or assisting with meals. One staff member told us, 'It's the attention to detail we are lacking, we only have time to provide the basics, we never seem to have time to spend quality time with people'.
Some care plans only contained brief information and guidance about the care and support people required. They did not show that people had been involved in developing their own care plans so that the staff could provide them with personalised care.
The needs of people living with dementia had not been considered with regards to their environment. There were no signs that would help people move around independently. Equipment was stored in en suites and in communal bathrooms and toilet facilities. This meant that people could not move around freely and safely.
We asked staff about how they support people with dementia with choices about activities and food. They told us 'it was a waste of time as people would not remember'. This did not demonstrate that the staff had an understanding of people with dementia so that they could meet their needs and provide appropriate care. .
Is the service caring?
We spoke with fifteen people who used the service and six relatives. They were complimentary about the staff telling us they were 'caring and hardworking'. However they all told us there was 'either not enough staff or that staff were very busy'.
People were not treated with dignity and respect at mealtimes. We saw people with food left in their laps following mealtimes; clothes were not always protected from spillages from food and drink. People's clothes were left soiled.
It was a warm sunny day on the day of our inspection. Three people were taken out to enjoy the gardens and the fresh air, by their visitors. We asked a member of staff on the nursing unit why people were not sat outside. They told us, 'There are not enough staff to supervise people outside and inside'.
We saw some staff that were attentive to people in the home and they were caring.
Is the service responsive?
We found not all aspects of the service were responsive.
People we spoke with told us there was very little in the way of activities. One person told us 'I am bored; I sleep most of the time and hardly see anyone'. This person had spent all day in their bedroom, sleeping for much of that time with no social stimulation other than when staff provided care. This meant the staff had not been responsive to this person's needs.
We observed call bells being responded to promptly. Where we observed that people required support staff promptly attended to their needs.
There were discrepancies around recording in people's charts staff and people using the service could not be assured that food and drink intake monitoring was accurate. This meant that staff may not be aware when people were at risk of poor nutrition and hydration and take any necessary action.
Is the service well-led?
We found not all aspects of the service were well-led.
People who used the service were not protected from the risks of inappropriate or unsafe care and treatment. This was because the systems to assess and monitor the quality of service were not effective. Risks relating to people's welfare and safety were not assessed effectively.
Evidence of breaches in regulations identified at this inspection demonstrated that there had been a failure to identify and manage risks for people across the home.
The home's environmental audit had failed to identify the serious concerns we found during our inspection regarding the quality and safety of the environment, including problems with the cleanliness of the home. The audits did not identify risks to people who used the service in order to keep them safe from harm.
People could not be assured that there were sufficient staff. This was because there was no management tool to determine how many staff were required to support people in the home, based on their assessed needs taking into consideration the layout of the building.
The home had a registered manager. There was leadership from the registered nurses in the area of the home where nursing care was provided, this was less apparent in the other areas of the home where the majority of the shortfalls were found.