Warren Park Nursing Home is registered to provide nursing care for up to 40 people. It is situated in the Blundellsands area of Liverpool. The home has four floors with lift access to three flours and stair access to the administrative office on the fourth floor. The home is accessible to people who use a wheelchair. At the time of our inspection, there were 37 people living in the home.At the last inspection on the 9 February 2016, the service was rated Good however we identified a breach of Regulation 12 (Safe care and treatment) due to concerns regarding the safety and storage of medication. Following the last inspection, the registered provider completed an action plan dated 15 April 2016 to tell us what they would do and by when to improve the safety of medicines. At this inspection, we found that registered provider remained in breach of Regulation 12 because medicines were not managed safely at the service and we identified a breach of Regulation 17 (Good Governance).
A registered manager was in post at the service, however, they were not present on the day of our unannounced inspection. 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. During our inspection, we were assisted by a nurse and two directors at the service. We discussed how the contingency arrangements in the registered manager’s absence could be developed to ensure records were more easily accessible by other members of the management team because we found that some records were not available during our inspection site visit.
At the last inspection on 9 February 2016, we found that the registered provider was in breach of Regulation because medicines were not stored safely and securely at all times. The registered provider assured us they would audit the storage of medication and introduce regular spot checks during the medicine rounds to ensure that they were compliant with policies and procedures. At this inspection, we found that medication was still not stored securely and the recording of medication was not always accurate. Furthermore, we identified that audit processes were not sufficiently robust to identify errors and quality assurance procedures had not picked up on the issues we identified during our inspection. The registered provider remained in breach of the Regulations.
People told us they felt safe and secure living at the service. We received positive feedback from people and their relatives regarding the atmosphere in the home. Comments included; “There’s a feeling of security. There’s a feeling of contentment and a lot of fun” and said “It’s always nice and clean and visitors are always made welcome.”
Staff were recruited safely and pre-employment checks were carried out before they started work at the organisation to ensure they were suitable to work with vulnerable people. Staff were aware of how to protect people from avoidable harm and were aware of local safeguarding procedures to ensure that any allegations of abuse were reported and referred to the appropriate authority.
Our review of staff rotas showed there were appropriate numbers of staff employed to meet people's needs in accordance with the registered manager's dependency tool. Nevertheless, we received some mixed feedback from people and their relatives regarding the staffing levels at the service. We raised this with the registered provider’s representatives at the time of our inspection who agreed to review the deployment of staff within the home.
Risks to people's health, safety and well-being were assessed and information was available to guide staff on how to mitigate risks. Support plans had been completed for everyone who was receiving care to help ensure their needs were met and to protect them from the risk of harm. Accidents, incidents and ‘near misses’ events were documented and the registered manager maintained oversight of these for future learning and prevention.
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 supported this practice. Consent was sought in line with the principles of the Mental Capacity Act 2005 and applications for authorisations to deprive people of their liberty had been made appropriately. A registered mental health nurse was employed by the service and undertook assessments of people’s capacity.
Staff told us they felt well supported. The registered provider’s records showed staff had received adequate training to ensure they had the skills and knowledge to support people effectively.
Most people told us they enjoyed the food served at the home. One person commented, “It’s quite good, there’s a variety. We all get a newsletter and it has the weekly menu in it”. We sampled the food available and found it to be of good quality. Staff knew, and catered to, people's individual dietary needs and preferences. People were supported with their nutrition and hydration intake when required and a coloured cup system was in place to facilitate this.
People's overall health and well-being needs were being safely and effectively supported. Staff monitored people's health and welfare needs and acted on any concerns promptly. The service maintained good links with community health partners to ensure people's outcomes were met. One visiting health professional told us, “The care is great.”
People were complimentary about the staff and the service in general. Comments included; “Everyone gets treated very well here” and “They’re [staff are] all very nice and kind.” We observed good quality interactions from staff towards people living in the home. Everyone we spoke with told us their privacy and dignity was maintained.
People had access to a range of activities to promote their social inclusion and stimulation. The activities co-ordinator employed by the service organised a range of events, including trips out in the local community.
People and their relatives had access to a complaints procedure and they were aware of how raise a concern. The service had not received any recent formal complaints but people’s ‘niggles’ and low-level concerns were documented and responded to.
Opportunities were provided for people and their relatives to comment on their experiences and the quality of service provided through the circulation of surveys and resident meetings. People told us that residents meetings were effective because they received feedback and issues raised were acted upon. People were kept informed about any changes at the service through weekly newsletters.
A variety of quality assurance procedures were in place to monitor and assess standards within the home and included regular audits in respect of care plans, weights, infection control and falls. However, we found the governance processes in respect of medication to be ineffective.
The registered manager had notified the Care Quality Commission (CQC) of events and incidents that occurred in the home in accordance with our statutory requirements. This meant that CQC could monitor risks and information regarding Warren Park.
The ratings awarded at the last inspection were displayed in the communal area of the home.