We carried out an unannounced comprehensive inspection on 3 and 8 September 2015.
We last inspected the home in September 2013 and found no breaches in the regulations we looked at.
The Warren Care Home provides nursing and accommodation for up to 28 older people, many receiving end of life care. There were 26 people using the service the first day of this inspection.
The service had a registered manager. 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.
Staff had not acted to gain authorisation to deprive people of their liberty where a person was subject to continuous supervision and control, such as the use of bed sides and monitoring people’s movements. This was because the Registered Manager was not aware of a Supreme Court judgement which had widened and clarified the definition of deprivation of liberty.
Whilst staff said they felt supported by the registered manager, and their work was under continual assessment by more senior staff, they did not receive a formalised supervision of appraisal of their role. Some felt this would be a benefit to them.
People received their medicines as prescribed. Nursing staff were trained and competent in managing pain relief and optimising people’s health.
People were fully involved in decisions and staff ensured they were involved at every stage of their care, from assessment to care planning and regular reviews of their needs.
People said they felt safe at The Warren. People’s safety was promoted through checking staff’s suitability to work in a care home setting, ensuring sufficient staff to meet people’s individual needs and assessing and managing any risks to peoples’ welfare.
Staff had a good understanding of what constitutes abuse and how to respond to protect people.
People received a nutritious diet, which they enjoyed. Where there were concerns about a person’s weight or diet this was monitored and followed up in their best interest.
Care staff said they were very satisfied with their induction and training, and that these equipped them for their caring role. Nursing staff said they were supported to maintain their training and so protect their nursing registration. Support staff also received the training they needed for their work.
People had all necessary access to health care professionals, who were consulted to promote people’s health and welfare. This included such specialists as the tissue viability team, where wound care was complex, and hospice services. A GP said the care provided at The Warren was “excellent.”
People, and their families, received a service from kind and caring staff and management. One person’s family said, “You can’t fault them. It’s a lovely relaxed atmosphere and very homely.” Staff took considerable time to ensure a person got the individual care they needed, and took nothing for granted. Staff were competent and a hospice nurse said the end of life care at The Warren was “very, very good.” People were treated with respect and dignity throughout their involvement with The Warren.
People’s individual needs and wishes were assessed in detail and then planned with their involvement. Care was centred on the person as a whole. In particular, where people were anxious or needing reassurance this was provided. Staff regularly checked people still agreed with their plan of care, sometimes on a daily basis.
The Warren was well-led by a provider and registered manager whose culture of care was to put people first. They led by example and their staff team was professional and it was a well organised service. People’s opinion was regularly sought and there were effective arrangements in place to check the home was run in a safe and effective way, with improvements made as and when necessary.
There was one breach of regulation, relating to depriving people of their liberty without lawful authority. You can see what action we told the provider to take at the back of this report.