Warren Lodge Care Home

Warren Lodge Care Home is a residential care home providing accommodation with personal and / or nursing care to up to 64 people. The service provides care and support to older people, people with complex nursing needs and people living with dementia. The service is arranged across 2 levels with lift access. At the time of our inspection there were 61 people using the service.

People’s experience of using this service and what we found

People told us they felt safe and were happy living at Warren Lodge. One person said, “I am happy. I always have a good sleep and I go to the dining room.” A relative told us, “They keep [relative] safe and the staff are lovely.” Another relative said, “[Relative] is safe and they’re good at caring for them. The staff are nice to them, and they like it here. They are good at phoning me if there’s a problem.”

Warren Lodge followed safe and robust recruitment practices and there were enough staff deployed to provide safe care. People and relatives were complimentary about the staff and described them as kind, friendly, knowledgeable and respectful. One person said, “The carers are very good. If I need anything I just walk to the office.” Relatives told us their loved ones were treated with dignity and respect.

Risk assessments were up to date and people received care and support from staff who knew them well. Medicines were managed safely, and lessons were learned when things went wrong. There were effective infection control procedures in place and people and relatives told us rooms were always kept clean and tidy.

People were encouraged to join in with group activities where this was possible, and staff engaged regularly with people who were cared for in their rooms. Any concerns or complaints raised had been investigated and resolved.

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.

Effective quality assurance processes were in place to monitor the service and regular audits were undertaken. A new manager had been appointed since our last inspection and staff told us they found them approachable and supportive with an open-door policy. Relatives also spoke very positively about the new manager.

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 good (published 29 July 2021).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

The overall rating for the service remains good based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Warren Lodge on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Warren Lodge Care Home is a residential care home with nursing for older people, people who are living with dementia and people who need support to maintain their mental health. The accommodation is arranged over two floors. The service can accommodate 64 people; at the time of the inspection there were 62 people living in the service.

People’s experience of using this service and what we found

People felt safe living in the service. People and relatives told us they felt safe in the service. One person said, “I feel very safe. I have no worries at all.” A relative said, “I do think she feels safe there, definitely.” People were safeguarded from the risk of abuse and received safe care and treatment.

People were involved in the development and review of their care plans. Most relatives said they had been involved in assessments and support planning when people first moved into Warren Lodge, but many had not been involved in any regular reviews. However, all relatives we spoke to were confident they would be informed if there were any changes. Most people and relatives thought there were enough staff to provide safe care.

Medicines were managed safely in line with guidance and people were protected from the risk of infection through good infection control practices. Lessons were learned when things went wrong.

Interim management arrangements were in place in the service. The registered manager had an open-door policy and staff had confidence in and were positive about the interim management team. Most people and relatives had positive comments about the management of the home. One relative said, “It is well managed. The staff seem happy and don’t seem disgruntled.” The service had robust quality assurance processes in place to monitor all aspects of the service.

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.

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 Good (published 3 May 2019).

Why we inspected

This inspection was prompted by our data insight that assesses potential risks at services, concerns in relation to aspects of care provision and previous ratings. As a result, we undertook a focused inspection to review the key questions of safe and well-led. This enabled us to look at the concerns raised and review the previous ratings.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

The overall rating for the service remains good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Warren Lodge Care Home 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.

Warren Lodge Care Home is a residential care home with nursing for older people, people who are living with dementia and people who need support to maintain their mental health. The service can accommodate 64 people on two floors. At the time of this inspection, there were 64 people living in the service.

People’s experience of using this service and what we found

People and relatives were involved in the decisions made about their care. An exception to this was, one relative who said they had not been contacted when the staff were reviewing their relative’s care. They had contacted the home several times but were rarely called back. We have made a recommendation about the culture of the service in the well-led section of this report.

Quality assurance processes were in place to monitor the service and lessons were learned when things went wrong.

People in the service felt safe and were happy living there. Relatives said they thought their loved ones were safe in the service. One person said that their relative could be challenging but that the staff were “amazing” with him.

People were safeguarded from the risk of abuse and received safe care and treatment. One person said, “I can’t fault the care, the care is unbelievable and the staff are incredibly patient”. Another relative said, “I congratulate them. She is always clean, well looked after and well fed. They have the patience of Job.”

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 Good (published 3 May 2019).

Why we inspected

We undertook this targeted inspection to follow up on specific concerns we had received about the service. The inspection was prompted in response to a high number of safeguarding concerns. A decision was made for us to inspect and examine those risks. The overall rating for the service has not changed following this targeted inspection and remains good.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

We found no evidence during this inspection that people were at risk of harm from these concerns.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Warren Lodge Care Home 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.

Warren Lodge Care Home is a residential care home with nursing for 64 older people, people who live with dementia and people who need support to maintain their mental health. At the time of this inspection 53 people were living in the service.

For more details, please read the full report which is on the CQC website at www.cwc.org.uk

People's experience of using the service:

• All of the people living in the service and most of the relatives were positive about the service. A person said, "I’m okay here as the staff are kind and I have pretty much everything I need.” A relative summarised the views of most relatives when they said, “The care here is first class and the staff are excellent.” However, one relative said, “Sometimes I need to ask for things to be done and it shouldn’t be up to me to point out what care my family member needs.”

• People received safe care and treatment from nurses and care staff who had the knowledge and skills they needed.

• People were safeguarded from the risk of abuse, received person-centred care and were supported to safely take medicines.

• People and their relatives were consulted about the care provided and their consent had been obtained.

• There were robust arrangements to manage complaints and quality checks had been completed.

• Good team work was promoted and regulatory requirements had been met.

Rating at last inspection:

The service was rated as ‘Requires Improvement' at the inspection on 13 March 2018 (the inspection report was published on 24 April 2018). At the inspection in March 2018 there was a breach of regulations. This was because the registered provider was not operating a safe recruitment and selection procedure. At this inspection in April 2019 the recruitment and selection procedure had been strengthened and the breach of regulations had been resolved. At this inspection in April 2019 the overall rating of the service has improved to ‘Good’.

Why we inspected:

This was a planned inspection based on the rating we gave the service at the inspection in March 2018.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit in line with our re-inspection programme. If any concerning information is received we may inspect sooner.

Warren Lodge is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Warren Lodge is registered to provide nursing and personal care for up to 64 people .There were 55 people using the service during our inspection; who were living with a range of health and support needs. These included; diabetes, catheter care, dementia and people who needed support to be mobile. Warren Lodge is a purpose built premises situated in Ashford, Kent. The service had very large communal lounges/dining rooms available on each floor; with armchairs and TVs for people and a separate, quieter lounge, where people could entertain their visitors.

At the last Care Quality Commission (CQC) inspection on 23 and 24 February 2017, the service was rated Required Improvement in Safe, Effective, Caring, Responsive and Well Led domains with an overall Required Improvement rating. We found breaches of Regulations 9, 12, 13 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We issued a warning notice for the breach of Regulation 17 because there remained shortfalls in diabetes management and quality assurance. We found that there were no assessments about choking for people who were known to be at risk, and no guidance for staff about actions to take in the event of a choking incident. Staff did not raise the alarm appropriately when a person fell; delaying nurse input. Staff had not always followed the provider's processes for reporting incidents to the registered manager, which meant some had not been discussed with the local safeguarding authority. Some aspects of people's healthcare required improvement to ensure people received consistent care and treatment, but other areas were well-managed. People's individual needs were not always met because care plans contained confusing information. Quality assurance processes had not picked up and addressed the issues we found during this inspection. We also recommended that the provider obtains training for staff from a reputable source for diabetes, epilepsy and end of life care. That the provider carries out a full review of PEEPS to ensure they are completely legible and that the provider ensures that people's hopes and wishes for the end of their life are individually discussed and documented wherever possible.

We asked the provider to take action to meet the regulations. We received action plans on 18 April 2017, which stated that the provider will be meeting the regulations by 14 April 2017.

We carried out a focused inspection on 20 July 2017 to check that the provider had met Regulation 17. We found they had met the warning notice for Regulation 17. Improvements had been made in relation to meeting Regulation 17. The provider had taken action to address some of the concerns raised at the previous inspection. However, further work was required to ensure safeguarding incidents were robustly monitored and reported and behaviour which could challenge others was managed positively. Quality assurance processes had not been wholly effective in identifying risks to people in these areas.

We asked the provider to take action to meet the regulations. We received action plans on 21 September 2017, which stated that the provider will be meeting the regulations by 31 October 2017.

At this inspection we found the service remained Requires Improvement.

The service has a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 provider did not follow safe recruitment practice. Gaps in employment history had not been explored to check staff suitability for their role.

There were activities located around the service for people to engage with independently and each dining room table was set up for people to be engaged in different activity. However, not everyone was engaged in activities during our inspection. We made a recommendation about this.

Staff received regular training. Clinical staff got the support they needed to remain up to date with current practice. However, supervision and appraisals were irregular and not up to date, which would have further helped staff to meet people's needs effectively. We made a recommendation about this.

Although effective systems were in place to enable the provider to assess, monitor and improve the quality and safety of the service, these had not been rigorously followed. We made a recommendation about this.

The registered manager provided good leadership. They checked staff were focussed on people experiencing good quality care and support.

People and staff were encouraged to provide feedback about how the service could be improved. This was used to make changes and improvements that people wanted.

People were safe at Warren Lodge. Staff knew what their responsibilities were in relation to keeping people safe from the risk of abuse. Staff recognised the signs of abuse and what to look out for. There were systems in place to support staff and people to stay safe.

Medicines were managed safely and people received them as prescribed.

There were appropriate numbers of trained staff to meet people’s needs and keep people safe.

Each person had an up to date, personalised support plan, which set out how their care and support needs should be met by staff. These were reviewed regularly.

People were supported to eat and drink enough to meet their needs. They also received the support they needed to stay healthy and to access healthcare services.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The provider and staff understood their responsibilities under the Mental Capacity Act 2005.

Staff showed they were caring. They treated people with dignity and respect and ensured people's privacy was maintained particularly when being supported with their personal care needs.

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

The registered manager ensured the complaints procedure was made available if people wished to make a complaint. Regular checks and reviews of the service continued to be made to ensure people experienced good quality safe care and support.

We found a breach of 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 this report.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach. We undertook a focused inspection on the 20 July 2017 to check that they had followed their plan and to confirm that they now met the legal requirements.

This report only covers our findings in relation to the well-led domain and the warning notice we served. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Warren Lodge Care Home’ on our website at www.cqc.org.uk’

Warren Lodge is registered to provide nursing and personal care for up to 64 people .There were 60 people using the service during our inspection; who were living with a range of health and support needs. These included; diabetes, catheter care, dementia; and people who needed support to be mobile.

Warren Lodge is a purpose built premises situated in Ashford, Kent. The service had very large communal lounges/dining rooms available on each floor; with armchairs and TVs for people and a separate, quieter lounge, where people could entertain their visitors.

A registered manager was not in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. 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. A new manager had been appointed in May 2017 and had started the process for applying with The Commission for their registration; they were present throughout the inspection.

At the previous inspection in February 2017 there were shortfalls in diabetes management and quality assurance processes. We also found other issues which needed to be addressed to protect people's health, safety and well-being.

The provider had taken action to address some of the concerns raised at the previous inspection. However, further work was required to ensure safeguarding incidents were robustly monitored and reported and behaviour which could challenge others was managed positively. Quality assurance processes had not been wholly effective in identifying risks to people in these areas.

People that were at risk of choking benefited from risk assessments which identified the steps staff should take to prevent choking and staff understood how to respond appropriately.

People’s diabetes and catheter care was managed well and staff knew how to support people with their individual needs. Management of health conditions such as epilepsy were well monitored and responded to. Care plans were person centred and provided individualised information on how to care for and support people.

Staff said they had received more training and felt supported by the manager. The views of people and other individuals were sought so the service could improve.

We found a continued breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Warren Lodge is registered to provide nursing and personal care for up to 64 people .There were 63 people using the service during our inspection; who were living with a range of health and support needs. These included; diabetes, catheter care, dementia; and people who needed support to be mobile.

Warren Lodge is a purpose built premises situated in Ashford, Kent. The service had very large communal lounges/dining rooms available on each floor; with armchairs and TVs for people and a separate, quieter lounge, where people could entertain their visitors.

A registered manager was in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. 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.

Warren Lodge was last inspected in October 2015. At that inspection it was found to require improvement. We issued requirement actions about the storage of medicines, recruitment checks, fire drills, diabetes management and quality assurance processes. At this inspection some of these areas had improved, but there remained shortfalls in diabetes management and quality assurance. We also found other issues which needed to be addressed to protect people’s health, safety and well-being.

There were no assessments about choking for people who were known to be at risk, and no guidance for staff about actions to take in the event of a choking incident. Staff did not raise the alarm appropriately when a person fell; delaying nurse input. Assessments about other types of risk however were detailed and offered staff advice about reducing the likelihood of them happening.

Staff had not always followed the provider’s processes for reporting incidents to the registered manager, which meant some had not been discussed with the local safeguarding authority. Most safeguarding concerns however were referred appropriately.

There were enough staff on duty to meet people’s needs, but staff training could be improved in some areas.

Some aspects of people’s healthcare required improvement to ensure people received consistent care and treatment, but other areas were well-managed. People enjoyed nutritious meals and were offered plenty to drink. Referrals were made in a timely way to dieticians when necessary but people’s individual needs were not always considered to ensure they received a reasonable level of intake.

There were scant records about people’s hopes and wishes for the end of their life; although the provider introduced new paperwork relating to this during the inspection. People’s individual needs were not always met because care plans contained confusing information.

Quality assurance processes had not picked up and addressed the issues we found during this inspection.

We recommend that the provider obtains from a reputable source: diabetes, epilepsy and end of life care training for staff.

We recommend the provider carries out a full review of PEEPS to ensure they are completely legible.

We recommend that the provider ensures that people’s hopes and wishes for the end of their life are individually discussed and documented wherever possible.

Medicines were well-managed and safely administered by staff. The service was maintained to a good standard and all equipment was routinely safety checked. People had individual emergency evacuation plans and staff knew the location of fire exits and assembly points.

Staff received regular supervision and completed the Care Certificate induction programme. There was a robust recruitment system in operation and all necessary checks had been made prior to taking on new staff. Staff were kind and considerate and treated people with dignity and respect.

People’s consent had been sought formally and verbally for day-to-day care tasks. Staff were knowledgeable about the Mental Capacity Act (MCA) 2005 and worked within its principles. The registered manager had made applications for deprivation of liberty safeguards (DoLS) and received authorisations for some of these.

There was a wide and varied range of activities available to people, delivered by knowledgeable activities staff who were passionate about supporting people to be seen as individuals rather than people living with dementia.

Complaints had been properly recorded and managed and people and relatives knew how to raise concerns. Feedback was sought through a variety of sources and was acted upon.

The registered manager was well-respected by staff, people and relatives and staff described an open culture where they could safely raise concerns or make suggestions for improvement.

We found a number of breaches 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 this report.

During this inspection we spoke with 10 people who used the service, 5 relatives and friends, the registered manager and 12 members of staff. Some people who were living at the service were unable to talk to us directly about their experiences due to their complex needs, so we used other methods to help us understand their experiences.

People told us their privacy and dignity was respected and that the staff 'are all nice' and 'kind'. We saw that generally people were treated with dignity and respect. People felt they were able to express their views and were involved in decisions about their care and support.

People were satisfied with the care and support they received. One relative said, 'This is by far the best (service). The care is excellent, beyond normal caring - they really know and love her (family member)'.

People and most relatives felt there was sufficient staff on duty to assist people when they needed help. People were complimentary about the staff team and felt staff had the right skills and experience in order to meet their needs.

People had opportunities to give feedback about the service provided. There were effective systems in place to regularly assess and monitor the quality of service people received.

Most of the people and their relatives were happy with the care and support provided. However, people and their relatives were not always involved in the planning of their care. People and their relatives that we spoke to were not aware of people's care plans. One person said, they (the staff) 'Don't sit down with relatives and go through (people's) care plan.

The service had policies and procedures in place to promote people's safety and welfare. Most people felt safe in the service and that their personal property was respected.

People and relatives consistently told us how "hard the staff worked'. However, one relative expressed their concern that when they visited their relative most days they have not been assisted to get up and said that they had been told that it was because "there was not enough staff'.

Staff told us they had not had regular supervision or appraisals. One staff member said 'Carer's don't feel supported nor do the nurses'.

The provider did not have effective systems in place to regularly assess and monitor the quality of service people received.