We carried out a review of the data available to us about The Warren on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about The Warren, you can give feedback on this service.
We found the following examples of good practice:
•The service was booking visitors in at a specific time that suited people. There were designated visiting times and named visitors for each person.
•Visiting took place within the entrance foyer of the building and this had been made safe within current guidelines.
•Before visitors entered the main building, they had their temperature taken and were asked a series of questions to ensure they had no symptoms of Covid-19.
•Visitors to the home were asked if they would like to undergo immediate testing for Covid-19. The service had recently purchased test kits to facilitate this. These gave a positive or negative result in approximately 10 minutes.
•People who were at the end of their lives could have their visitors enter their rooms directly from the outside to avoid entering other areas of the home.
•The service facilitated people to keep in touch with their relatives and friends. A variety of electronic applications were used to support this.
•The service had emergency contingency plans in place to support people within three separate areas of the home if necessary. This had been tested recently; staff were asked for their feedback on how the process had gone and if it could be more efficient.
•The service had a dedicated infection control champion who kept updated on infection control practices and procedures.
The Warren is a nursing home providing personal and nursing care to 25 people aged 65 and over at the time of the inspection. The service can support up to 27 people.
People’s experience of using this service and what we found
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.
Since our last inspection improvements had been made. Extensive and detailed personalised care plans and risk assessments were in place. Staffing levels had been increased and protective care time overlap shifts were in place to enable meaningful time with people. An extensive activities programme had been implemented which provided people with physical and emotional stimulation.
Robust audits had been implemented in consultation with Local Authority Quality Assurance Improvement Team (QAIT), at the request of the registered manager. The QAIT team offers advice and support to providers to meet the quality standards and requirements of regulators and local authority. Audits reviewed people’s care plans and risk assessments, incidents and accidents, staffing needs, infection control and health and safety. This enabled any trends to be spotted to ensure the service was meeting the requirements and needs of people being supported. Where actions were needed, these had been followed up. For example, care plans and risk assessments had extensively been updated, an activities programme implemented, and new policies and procedures put in place to guide staff.
Staff spoke positively about communication as a staff team. Several voiced difficulties adjusting to all the changes which had been implemented by the registered manager. Staff did however recognise that changes had to be made in order for the service to meet health and social care regulations.
The service provided safe care to people. People felt safe and supported by staff. One person commented, “The staff are brilliant. I feel safe here and well cared for." A relative commented, “My husband is very safe here.” Medicines were safely managed on people’s behalf.
People were supported to maintain a balanced diet. Health and social care professionals were regularly involved in people’s care to ensure they received the care and treatment which was right for them.
Staff relationships with people were caring and supportive. Staff treated people with dignity and respect when helping them with daily living tasks. The service ensured people led meaningful and fulfilled lives.
Some improvements were needed with the recruitment and selection process in place. There were certain issues with three staff members recruitment procedure, with regards to start dates and receipt of paperwork prior to starting. We fed this back to the registered manager and established there appeared to be some communication issues. The registered manager immediately agreed to carry out an audit of all staff files. The second day of our inspection found that the registered manager had already started auditing the staff files of all new starters and these had followed the recruitment procedure correctly. People received effective care and support from staff who were well trained and competent.
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 requires improvement (published 22 January 2019) and there were four breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.
Why we inspected
This was a planned inspection based on the previous rating.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Warren on our website at www.cqc.org.uk.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
The Warren accommodates a maximum of 27 people in one adapted building. People were receiving either nursing or residential care. There were 25 people using the service at the time of this inspection.
Lycette Care Ltd took ownership of The Warren 8 December 2017 since when there have been two registered managers. 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. The current registered manager has left the service and is the process of deregistering. A new manager started at The Warren the week following this inspection. At the time of the inspection the provider was managing the service on a day to day basis. They assisted with this inspection.
This was the first inspection since Lycette Care Ltd. took ownership. This means there was no previous rating.
Quality monitoring arrangements had not ensured people received a safe service which met their individual needs. This included omitting to assess where there was a high risk to a person’s health. Not all care plans provided staff with the information they required to provide person centred care. Some information was contradictory, some missing and some no longer used, as it was out of date. This had the potential to increase risk.
There were not always enough staff available to meet the needs and wishes of people using the service. Staffing was a concern mentioned by most staff, who said they were sometimes unable to provide care to the standard they themselves expected. People also spoke of having to wait for care but “didn’t want to make a fuss”.
Meaningful, individual activities were not always promoted. Some people had not continued following their interests, on a misinformed belief this would not be possible. The provider said they would follow this up robustly. Some people enjoyed group activities.
Medicines were managed in people’s best interest but best practice was not always followed. Securing oxygen cylinders and not double checking hand written entries, for example. We have made a recommendation in relation to medicines.
Staff considered the standard of training to be satisfactory but said they could not always attend it, as they were needed to provide care when it was taking place. The provider said this was now being addressed. There had been a trial of one to one supervision meetings, but this was not found to be satisfactory and so staff were not currently receiving this. There were plans to reintroduce supervision using a different approach. Staff received a yearly appraisal of their work.
People were protected through the recruitment arrangements.
Staff had a good understanding of the types of abuse and what steps to take if they believed a person was at risk. People were protected from discrimination.
The premises was kept in a safe state. Improvements had been made to better meet people’s diverse needs and the provider had further improvements planned, once they had asked people’s views about this.
The premises was very clean and fresh. Equipment to promote hygiene was properly maintained. Staff had the protective equipment they needed. Some had not yet received training in infection control, but his was being arranged.
People’s legal rights were understood and protected. Where people lacked capacity to make informed decisions these were made in their best interest.
People’s health was closely monitored. Where external advice and expertise were required, this was arranged. Letters of compliment indicated that end of life care had been delivered to a high standard, and promoted people’s dignity.
Staff were proud of the work they did and spoke frequently of the high standards they aspired to. People and their family members said that staff were kind, caring and friendly. Privacy and dignity were promoted.
A complaints procedure provide a formal way for people to complain. The provider said they considered any complaint to be a way to improve the service. People’s views were sought through day to day contact, two formal family meetings and an audit which was held to look at ‘the dining experience’. The provider was aware of the requirement to make information available in accessible formats and had plans to progress this, using tablets, for example.
The provider was aware that they had not yet achieved the required standards, or the standards which they aspired to, and they were keen to improve.
We found four breaches of Regulations in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.You can see what action we told the provider to take at the back of the full version of the report.