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Warren Lodge Care Centre Inadequate

We are carrying out a review of quality at Warren Lodge Care Centre. We will publish a report when our review is complete. Find out more about our inspection reports.

Inspection Summary


Overall summary & rating

Inadequate

Updated 22 November 2018

This inspection took place on 3, 4, 5, 10 and 11 September 2018 and it was unannounced. We undertook this inspection due to a number of concerns raised.

Warren Lodge Care Centre is a care home without nursing. People in care homes receive accommodation and personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

The service supports people requiring care for reasons of age or frailty, some of whom are living with dementia. The service is registered to accommodate up to 55 people, during the inspection there were 42 people living at the service. The service is divided into two units known as the Main House and the Courtyard. The Courtyard is designed specifically to meet the needs of people living with dementia.

The service did not have a registered manager as required. At the last inspection the registered person had taken immediate action following the resignation of the registered manager to appoint a new manager. However, during this inspection the home manager was still in the process of applying to 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. The home manager, four operations managers and the nominated individual assisted us with our inspection.

The registered person did not ensure their safeguarding systems were operated effectively to investigate and follow the provider's procedure after becoming aware of an allegation of abuse. Not all staff were up-to-date with their safeguarding training.

The registered person did not ensure staff kept clear and consistent records when people's care and treatment needs changed. In some cases, this put people at risk. They were not having their individual health and care needs met on time. There was inconsistent and ineffective support for people who became distressed or who were unable to make their needs known. When we raised queries or issues with support or records at our inspection, the evidence was not always available. We gave the provider the opportunity to provide the evidence needed but they were not able to.

We did not receive information to evidence the provider operated safe recruitment and selection processes to ensure suitable staff were employed. Staff training records indicated which training was considered mandatory by the provider. Not all staff were up to date with, or had received, their mandatory training. We saw evidence that learning was not always put into practice when staff supported people. Staff felt some training was missing to help them care for people more effectively. The provider could not be sure staff had the appropriate knowledge and qualifications to meet people's needs. Staff did not have regular support and supervision sessions to review their work and performance. However, staff felt supported to do their job and could ask for help when needed.

People had access to health care professionals. However, staff did not always record and act upon health issues promptly. Therefore, appropriate care and treatment was delayed and did not help people stay as healthy as possible. People had sufficient to eat and drink to meet their nutrition and hydration needs, however support from staff at meal times was not always available.

People's safety was compromised in the service as the premises were not well maintained. People received their prescribed medicine safely and on time. Storage and handling of medicine was managed appropriately. We found some errors with recording and storage which was not picked up by the provider's audit system. There were no specific plans for people receiving medicine covertly and anticoagulants as the prov

Inspection areas

Safe

Inadequate

Updated 22 November 2018

The service was not safe and has deteriorated to Inadequate for this key question.

There were enough staff on duty. However, the deployment of the staff did not always allow them to spend time engaging with people and meet all people's needs.

The service did not always identify and manage potential risks to people. The registered person did not ensure premises were managed well to keep people safe.

Medicines management was not always safe. The provider's recruitment processes were not robust.

The provider had not always notified the relevant authorities of allegations of harm or abuse.

Cleanliness and hygiene standards had been maintained to prevent cross infection and illnesses.

Effective

Inadequate

Updated 22 November 2018

The service was not effective and has deteriorated to Requires Improvement for this key question.

People's needs were not always met because staff did not always follow the care plans. Care plans did not contain detailed guidance.

Staff did not always receive the required training that would enable them to meet people's needs effectively. Staff did not always have the knowledge they needed to support people in stressful situations.

Staff did not receive regular supervision but felt they were supported to carry out their jobs.

The provider did not keep accurate records or take swift action when people's health deteriorated.

Although some Deprivation of Liberty applications were made to local authority, we did not receive sufficient information to ensure people were deprived of their liberty in a lawful way.

Most staff understood people's rights to consent to their care and showed respect to people making their own decisions. However, not all staff were aware of the importance of following the principles of the Mental Capacity Act and help make best interest decisions for people that would reduce the risk of harm.

People had sufficient to eat and drink and gave us mostly positive comments about the food and mealtime experience.

Caring

Requires improvement

Updated 22 November 2018

The service was not always caring and has deteriorated to Requires Improvement for this key question.

People were not always supported with care and respect. Relatives and most people were positive about the staff and the care they received. However, this view was not always supported by our observations.

We also observed when people were treated with kindness and respect. Staff were caring when attending to people's physical, emotional and spiritual needs.

People's privacy and dignity was respected. People were encouraged and supported to be as independent as possible.

People's right to confidentiality was protected.

Responsive

Requires improvement

Updated 22 November 2018

The service was not always responsive to people's needs. It has deteriorated to Requires Improvement for this key question.

Care plans did not always show the most up-to-date and important information on people's needs, care and welfare. Therefore, people's individual and complex needs were not always supported.

Staff did not always interact with people or respond appropriately to them if they needed help or support.

There was an activities program. However, there were not enough meaningful activities for all people to participate in as groups or individuals to meet their social needs. Visitors were welcomed and people could maintain relationships important to them.

The service managed complaints that had been raised. However, they did not always record all verbal or informal concerns raised.

Well-led

Inadequate

Updated 22 November 2018

The service was not well-led and it has deteriorated to Inadequate for this key question.

The registered person did not ensure notifications were submitted in time to the CQC to inform us about events in the service. There was no registered manager for over nine months. These circumstances limit the rating for well-led to no better than requires improvement.

People were put at risk because systems for monitoring the quality of the service and risks were not effective.

The registered person did not organise and lead the service successfully so that concerns were addressed swiftly. The management team did not carry out regular audits to have an overview of the service and issues.

Problems with the service and necessary improvements were not always identified and this had an impact on people. We did not always see evidence of action plans or action taken where concerns had been highlighted.

Staff felt they were supported by the management team. However, their suggestions were not always taken on board. They felt at times not all staff members worked as a team.