Warwick Park Care Home

Warwick Park Care Home is a care home providing personal care with nursing for up to 32 older people, some with a diagnosis of dementia. At the time of the inspection there were 26 people using the service.

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

People and their relatives were happy with the care and support they received. They told us the home was a safe environment and they felt reassured. There were enough staff employed to meet people’s needs. There were safe medicines and infection control procedures in place. Incidents and accidents were recorded and there was evidence where things went wrong, the provider used these as an opportunity for learning and to make improvements.

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.

People received appropriate support in relation to their diet and their ongoing health needs, from staff who were adequately trained to do so. Where needed, the provider worked with healthcare professionals to provide joined up care. People’s needs were assessed prior to them moving in which meant their needs could be met. The home was suitably adapted to meet their needs.

The service was caring. This was reflected in the feedback we received on the day of the inspection and from our observations of how staff interacted with people. People were offered a choice in relation to their care and treatment and their wishes were respected. People were provided with dignified care that was sensitive and maintained their privacy.

There was a good activities programme within the home, including group and one to one activities delivered by both an in-house activities co-ordinator and external visitors. People’s needs were reflected in care plans which were reviewed on a regular basis. Staff supported people with communication support needs. End of life care plans were in place and the provider worked with a local hospice to ensure people received good end of life care.

Feedback from people, relatives and staff in relation to the management of the home was positive. The provider engaged with stakeholders and acted upon any feedback received. There were quality assurance checks in place and the provider had given consideration to how these could be improved to enable them to continue to provide a good service.

Rating at last inspection

The last rating for this service was Good (published 20 September 2017).

Why we inspected

This was a planned inspection based on the previous rating.

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.

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

There was a registered manager in post. 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.

At our last inspection, we found the provider was in breach of the Regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because people’s mental capacity in regard to specific decisions had not been accurately assessed; Meetings to make decisions on people’s behalf and in their best interests had not been held when appropriate; Staff had not received effective training in mental capacity to enable them to follow the processes required by the Mental Capacity Act 2005. At this inspection, we found that compliance with the regulation has been achieved.

The CQC is required by law to monitor the operation of Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Appropriate applications to restrict people’s freedom had been submitted and the least restrictive options had been considered.

Staff sought and obtained people’s consent before they helped them. Staff knew how to recognise signs of abuse and how to raise an alert if they had any concerns. Risk assessments were centred on the needs of the individual. Each risk assessment included clear measures to reduce identified risks and guidance for staff to follow or make sure people were protected from harm. Accidents and incidents were recorded and monitored to identify how the risks of recurrence could be reduced.

There was a sufficient number of staff deployed to meet people’s needs. Thorough recruitment procedures were in place which included the checking of references. Staff received regular one to one supervision sessions and all essential training for their role. Staff knew each person well and understood how to meet their support and communication needs. Staff communicated effectively with people and treated them with kindness and respect.

A new electronic system ensured that medicines were stored, administered, recorded and disposed of safely and correctly. Staff were trained in the safe administration of medicines and kept relevant records that were accurate.

The staff provided meals that were in sufficient quantity and met people’s needs and choices. Staff knew about and provided for people’s dietary preferences and restrictions.

People were promptly referred to health care professionals when needed. Personal records included people’s individual plans of care, life history, likes and dislikes and preferred activities. People’s individual assessments and care plans were reviewed monthly or when their needs changed. The staff promoted people’s independence and encouraged people to do as much as possible for themselves.

Activities were provided that were suitable for people living with dementia or memory loss. People’s feedback was actively sought at relatives and residents meetings.

Staff told us they felt valued by the registered manager and they had confidence in her leadership. The manager was open and transparent in their approach. They placed emphasis on continuous improvement of the service.

There was a system of monitoring checks and audits to identify any improvements that needed to be made. A new electronic system provided the registered manager with a clear oversight of the service. The management team acted on the results of checks and audits to improve the quality of the service and care.

There was a manager in post who was in process of being registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the 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.

Staff knew how to recognise signs of abuse and how to raise an alert if they had any concerns. Risk assessments were centred on the needs of the individual. Each risk assessment included clear measures to reduce identified risks and guidance for staff to follow or make sure people were protected from harm. Accidents and incidents were recorded and monitored to identify how the risks of recurrence could be reduced.

There was a sufficient number of staff deployed to meet people’s needs. Thorough recruitment procedures were in place which included the checking of references.

Medicines were stored, administered, recorded and disposed of safely and correctly. Staff were trained in the safe administration of medicines and kept relevant records that were accurate.

Staff knew each person well and understood how to meet their support and communication needs. Staff communicated effectively with people and treated them with kindness and respect. People were not able to spend private time in quiet areas when they chose to due to lack of such space, however the building of a quiet lounge was included in the building works that were in progress.

The CQC is required by law to monitor the operation of Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Appropriate applications to restrict people’s freedom had been submitted and the least restrictive options had been considered. Staff sought and obtained people’s consent before they helped them. Staff received regular one to one supervision sessions and all essential training for their role. However, their training in mental capacity and DoLS was not effective. Staff were not able to identify how people were subject to DoLS. People’s mental capacity was not appropriately assessed about particular decisions. When necessary, appropriate meetings were not held to make decisions in people’s best interest, as per the requirements of the Mental Capacity Act 2005. We have asked the provider to take action and will check that remedial action has been taken at our next inspection.

The staff provided meals that were in sufficient quantity and met people’s needs and choices. Staff knew about and provided for people’s dietary preferences and restrictions. However, two people told us the food was often ‘bland’ and this was confirmed by our observations. There was no attention paid to food presentation to encourage people living with dementia to eat. We have made a recommendation about this.

Although information was provided about menus, activities and how to complain, there were no pictorial elements that may help people living with dementia understand this information. There was no pictorial signage throughout the home to help people living with dementia help orientate themselves. Although there was a plan to include pictorial signage when the building works were completed, people needed to be currently oriented in the home. We have made a recommendation about this.

People were promptly referred to health care professionals when needed. Personal records included people’s individual plans of care, life history, likes and dislikes and preferred activities. People’s individual assessments and care plans were reviewed monthly or when their needs changed. The staff promoted people’s independence and encouraged people to do as much as possible for themselves.

People were involved in the planning of activities and an enhanced activities programme was in progress. People’s feedback was actively sought at relatives and residents meetings.

Staff told us they felt valued by the registered manager and they had confidence in her leadership. The manager was open and transparent in their approach. They placed emphasis on continuous improvement of the service.

There was a system of monitoring checks and audits to identify any improvements that needed to be made. The management team acted on the results of these checks to improve the quality of the service and care. The audit system had not identified shortfalls in regard to mental capacity processes.

During this follow-up inspection, we found that action had been taken and the provider had achieved compliance with Regulation 12 of the Health and Social Care Act 2008.

Our report is based on our observations during the inspection, looking at records, speaking with people who lived in the care home and with the staff supporting them. We spoke with two people, one visitor, two carers, one chef, one kitchen assistant and the manager.

During this inspection, the inspector focused on answering our five key questions; is the service safe, effective, caring, responsive and well-led? Below is a summary of what we found. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

There were effective systems in place, which reduced the risk to people from the spread of infection. The procedures in place for washing people's bedding and clothing reduced the risk from cross-contamination.

Is the service effective?

Staff were clear about their responsibilities and showed a good knowledge and understanding about how to protect people. Staff were trained in how to reduce the risks to people from the spread of infection and cross-contamination

Is the service caring?

People benefitted from living in a clean and hygienic environment.

One person told us 'It's clean everywhere. The sheets and my room are always clean. They come in to do the room every day and the bathroom is always clean.'

Is the service responsive?

Any necessary repairs were done promptly, which made cleaning more effective. Staff described how areas were cleaned regularly, but also immediately if necessary. This made sure that people's needs for a hygienic environment were met.

Is the service well-led?

The registered manager was the person responsible for giving staff guidance about how to control the spread of infection. They were knowledgeable about where to seek professional advice. The care home had systems in place to monitor the risk of infection. Cleanliness and infection control audits had been carried out by the registered manager.

People had their needs assessed, and specialist help was sort when necessary. There was a programme of individual and group activities.

The service has systems in place for managing infection control, but these were not always fully implemented which may put people at risk.

Medication was managed and administered safely and securely.

Care was provided in a safe environment.

The people we spoke with and their relatives were positive about the staff. We were told the 'staff are lovely' and that the staff working in the service were 'very nice people'. There were usually enough staff working in the service.

One person told us that it was a 'very homely place' and that the 'girls and matron are very friendly and approachable.' One person said that they liked the staff, and could speak with them, and would feel safe to go to them if they had any complaints. They told us that staff get the doctor out to see them when necessary.

Two people told us that they didn't like living in the home. One person raised some concerns with us which we discussed with the manager, who took immediate action.

The provider had risk assessed the building and taken steps to provide care in a safe and suitable environment. However, there were some areas where inadequate maintenance may present a risk to people using the service such as a bath hoist that was dirty and rusty.