Archived: Warren Park

At the time of this inspection, 33 people were living at Warren Park. We observed the care those people received and spoke with seven relatives. We also spoke with the senior manager of the operating company, a health care professional and seven members of staff, as well as reviewing relevant documentation.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask: Is the service safe, effective, caring, responsive and well led?

Below is a summary of what we found.

Is the service safe?

There were risk assessments in place where required for people using the service in relation to their support and care provision. Whilst risk assessments were in place, some people were placed at unnecessary risk, because risk assessments were not always updated as required, which meant further action to minimise risks were not being considered, for example, falls.

Staff were not always using safe moving and handling practices, to make sure people were safe when they were transferred.

The home had policies and procedures in relation to the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). The home were aware of the need to submit applications for people to assess and authorise that any restrictions in place were in the best interests of the person, in response to a recent ruling about DoLS legislation, but hadn't yet done so. This meant that appropriate safeguards would be followed in the next two months in order that people's rights were protected in line with current legislation.

People were not always given their medication at the right time, when they needed them and in a safe way.

People were not being cared for in premises that were safe and well maintained to support their health and welfare. For example, despite a cleaning schedule we found unpleasant odours throughout the home, making it an unpleasant area for people to live. During the inspection the operating company's director received confirmation from the administrators and landlord for refurbishment of the home.

Is the service effective?

People's health and care needs were assessed and care plans formulated. However, people's needs were not always being met in accordance with those plans.

Risk assessments were being carried out, but they were not always updated as required, which meant they were not being effective in identifying further action that may be taken to minimise further risk, for example, falls and malnutrition.

Although an activity worker was employed we saw little activity to stimulate people and enhance their wellbeing. On the day of the inspection this included bits of conversation with individuals. Most interactions with people took place while staff were providing personal care.

Is the service caring?

We saw staff used a friendly and kind approach when speaking with people.

The majority of relatives we spoke with had concerns about the level of care provided. Their comments included: 'on one occasion when I visited [my relative] was not washed or changed from their night pad until the afternoon. Their pull cord was not in reach and he had been shouting staff but nobody had come', 'the staff seem to put the laundry and meals before personal care', 'it can be twelve to fourteen days before they bath him, the explanation is they have to bath him when they have a slot', '[my relative] has a high risk of falls and has had about six falls in about four months. There is no sensor mat by the side of his bed; it's a plastic mattress (crash mat)', 'there is an odour about him, which indicates his pads aren't being changed. I have asked staff to change him because of the smell. You can see that his pad is bulging', 'he [family member} has been losing weight. It's being monitored, but the staff don't actually tell you what is happening, whether it is getting lower or higher. I am informed about the falls but not the everyday care', 'he smells bad of urine, his room smells and his clothes smell'.

We saw that care workers showed patience and gave encouragement when supporting people. They spoke with people in a courteous and respectful manner during our visit. We heard staff treat people with kindness and compassion when providing their day to day care. Our observations of when staff spoke with people were that staff had a clear knowledge of people's individual likes and preferences.

Is the service responsive?

People maintained relationships with family members, but all the relatives we spoke with felt there were insufficient staff for them to be responsive to their relative's needs. Their comments included, 'the staff are fine but there just isn't enough staff, they are rushed off their feet. You have got to find somebody if [relative] wants to go to the toilet. On two occasions, in the last two months he has wet himself before they have been available to support him, 'I have no concerns about the staff, it's like having a second family, but there isn't enough staff to cover if someone is sick and you can see the strain on the staff, 'when staff are off, there doesn't seem to be anybody to fill in', 'staff have told me they cannot stop [my relative] from walking about, but there isn't enough staff to support him when he gets up and tries to walk. The last fall was in the lounge area in the door way. None of the staff witnessed it', 'staff treat him with dignity and respect, but the staffing levels are not high enough to meet his needs', 'I rang the call buzzer and had to wait thirty minutes for someone to come. It has happened before and I have to go down and look for staff. I've also seen other people needing help and rang for assistance. On that occasion I also had to find staff and there were three staff in the kitchenette' and 'staff are overworked and the staffing levels are not high enough to meet the needs of the residents'.

Relative comments were also supported by comments from staff and our observations.

Is the service well-led?

This organisation is currently in administration and being operated by the company Roseberry Health Care Management. There had also been a recent change in manager and the current manager was not registered with the Commission.

Relatives we spoke with commented, 'we've seen definite improvements since the takeover of the company such as charts about what [relative] has eaten and the introduction of relative meetings', 'the new manager has introduced herself, she is very approachable', 'there are resident and relative meetings and they say there is enough staff. You can raise concerns but nothing seems to happen' and 'I attend resident meetings once a month. The last two meetings have been with Roseberry. They talked about refurnishing the home'.

The service's own audits and our findings during the inspection identified there were still gaps, but progress was being made. However, changes to the care provided as a result of an analysis of incidents that had the potential to result in harm to people were being ineffective in practice, for example, falls and malnutrition.

The service were not learning from complaints to improve the level of care provided and minimise the potential risk of harm to people and minimise future concerns being raised. This was because we found repeated concerns alleging poor standards of care and we also found concerns with some care that people received during the inspection.

We found people had received appropriate care, treatment and support which had met their personal needs. We found the provision of activities had improved since our last inspection.

We found people had their health and welfare needs met by safe and competent staff.

We found accurate and appropriate records had been maintained.

We talked with five relatives of people who used the service. The relatives explained that their family members were well cared for, happy with the care given and liked the majority of staff. Some comments captured included 'good friendly staff', 'much improved here with the new manager' and 'the atmosphere [within the home] feels much better'. We talked with two people who used the service. One person who used the service thought staff took 'good care of them'. Both people who used the service felt staff did not sit down and talk with them.

During our inspection we found people looked reasonably clean, tidy and we saw their basic care needs had been met. We could not determine what activities were undertaken at the home which meant that people did not have sufficient stimulation to ensure their psychological and emotional needs were being met.

We found the home had systems and processes in place to ensure the safe administration of medications.

Staff had not been supported adequately over the last 12 months because they had not received regular supervision, training or an annual appraisal.

Care records for people who used the service were not always reviewed adequately.