We carried out a review of the data available to us about Warrengate Nursing Home on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Warrengate Nursing Home, you can give feedback on this service.
We found the following examples of good practice.
The provider had arranged for an external infection prevention and control lead to work across the group of four services including Warrengate. This involved establishing infection control champions at each service and working to improve the knowledge and skills of all staff in relation to infection prevention and control. There was an area ready to be used as an isolation zone for any people who may test positive for Covid-19. A plan was in place to enlarge this area depending on the number of cases.
There were individual risk assessments in place for staff who may be at an increased risk from Covid-19. When Covid-19 cases were high in the area staff had been offered accommodation by the provider near to the service to avoid them needing to use public transport.
Further information is in the detailed findings below.
Warrengate Nursing Home is a ‘care home’ providing personal and nursing care to 39 people aged 65 and over at the time of the inspection. The service can support up to 40 people.
Warrengate Nursing Home accommodates people in one adapted building over two floors.
People’s experience of using this service and what we found
People continued to be protected against the risk of abuse as staff could identify, respond to and escalate suspected abuse. Robust risk management plans in place, protected people against avoidable harm. The manager deployed sufficient numbers of staff to keep people safe. People’s medicines was managed safely. People were protected against the risk of cross contamination as there were clear infection control measures in place. The provider was keen to learn lessons when things went wrong.
People continued to receive support from staff that reflected on their working practices and undertook regular training to enhance their skills and knowledge. People were supported to access sufficient food and drink that met their dietary needs and preferences. People had access to healthcare professional services to monitor and maintain their health and well-being. People’s spiritual and cultural needs were respected and catered for.
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 confirmed they were treated with respect and had their dignity promoted. People were encouraged to maintain their independence where safe to do so. Staff were observed being respectful of people’s decisions and encouraged them to share their views.
Care plans were person-centred and regularly reviewed to reflect people’s changing needs. People continued to be encouraged to participate in both in-house and external activities. People were supported to access information in a way they understood in line with the provider’s accessible information standard. Complaints were managed swiftly to reach a positive outcome. People’s end of life wishes were documented.
People spoke positively about the manager and confirmed the service was well-led. The acting manager carried out regular audits to drive improvements. Partnership working was important to the acting manager in order to ensure people received good care and support.
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 23 December 2016).
Why we inspected
This was a planned inspection based on the previous rating.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Warrengate Nursing 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.
The home is arranged on three levels, with the care being given on the ground and first floor at the time of our inspection. Communal areas include a large dining area, lounge and secure gardens.
There was a registered manager in post. 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.
The inspection took place on 01 November 2016 and was unannounced. At our last inspection in February 2015 we identified five breaches in the regulations, and areas of the home that required improvement. The registered manager and provider gave us an action plan on how they would address these issues. At this inspection we found that all the areas of concern had been addressed, and people had a positive experience living at Warrengate.
Staff managed the medicines in a safe way and were trained in the safe administration of medicines. However guidelines for ‘As required’ medicines needed to be further developed, to minimise the risk of these medicines being given incorrectly. People received their medicines when they needed them.
There was positive feedback about the home and caring nature of staff from people who live here. A relative said, ““The staff are kind and caring here.”
People were safe at Warrengate because there were sufficient numbers of staff who were appropriately trained to meet the needs of the people. The registered manager regularly reviewed staffing levels to ensure they matched with the needs of people. Staff understood their duty should they suspect abuse was taking place, including the agencies that needed to be notified, such as the local authority safeguarding team or the police.
Risks of harm to people had been identified and clear plans and guidelines were in place to minimise these risks. In the event of an emergency people were protected because there were clear procedures in place to evacuate the building. Each person had a plan which detailed the support they needed to get safely out of the building in an emergency.
The provider had carried out appropriate recruitment checks before staff commenced employment, to ensure they were safe to work with people who may be at risk.
Staff received a comprehensive induction and ongoing training, to ensure they could meet and understand the care needs of the people they supported. Staff received regular support in the form of annual appraisals and formal supervision to ensure they gave a good standard of safe care and support.
Where people did not have the capacity to understand or consent to a decision the provider had followed the requirements of the Mental Capacity Act (2005). An appropriate assessment of people’s ability to make decisions for themselves had been completed. Where people’s liberty may be restricted to keep them safe, the provider had followed the requirements of the Deprivation of Liberty Safeguards (DoLS) to ensure the person’s rights were protected.
People had enough to eat and drink, and received support from staff where a need had been identified. People’s individual dietary requirements where met.
People were supported to maintain good health as they had access to relevant healthcare professionals when they needed them. Positive feedback was given by a visiting healthcare professional about the knowledge and skills of the nursing and care staff. People’s health was seen to improve due to the care and support staff gave.
The staff were kind and caring and treated people with dignity and respect. The staff knew the people they cared for as individuals, and were attentive to people’s needs.
People received the care and support as detailed in their care plans. Care plans were based around the individual preferences of people as well as their medical needs. People and relatives were involved in reviews of care to ensure it was of a good standard and meeting the person’s needs.
People had access to a wide range of activities that met their needs. Activities were varied and based on people’s interests and life history.
People knew how to make a complaint. When complaints had been received these had been dealt with quickly and to the satisfaction of the person who made the complaint. Staff knew how to respond to a complaint should one be received.
The provider had effective systems in place to monitor the quality of care and support that people received. Quality assurance records were kept up to date to show that the provider had checked on important aspects of the management of the home. People and relatives were encouraged to give feedback about the home, via surveys and regular meetings. The registered manager and provider listened and took action where required. The registered manager had ensured that accurate records relating to the care and treatment of people and the overall management of the service were maintained.
People benefitted from living in a home with good leadership and a stable staff team, so they knew the people who looked after them. A relative said, “I am very happy with this care home; It’s the human interaction they give.”
This inspection took place on 05 and 12 February 2015 and was unannounced on both days.
Warrengate Nursing Home provides accommodation for up to 40 elderly people who require nursing care, some of whom are living with dementia.
At the time of our visit there was no registered manager in post as they had left the service in September 2014. 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. The newly appointed matron told us they were in the process of sending in their application to the CQC to become the registered manager.
People may not always be protected in the event of an emergency as personal evacuation plans had not been completed for everyone. Some people lived in rooms upstairs. Due to their mobility needs this may not be the best place for them in the event of an emergency. The home had not taken this into account when they assessed the person.
The manager’s time was spent ensuring that day to day care needs were being met, mainly due to the number of agency staff in use. This meant that quality assurance systems were not being used consistently, nor were they effective at checking that people received a good quality of service. Some good interactions were seen between the staff and the people who live here. They were friendly, caring and supportive.
Documents to enable staff to support people and record the care given were not always complete. The provider was switching from a paper system to an electronic one to try to improve the quality of the service. While the switch was taking place care plans and risk assessments had not been updated so peoples care needs were not completely clear to all staff.
The provider and manager did not always deal with peoples complaints effectively. They had not been recorded consistently, and they were unable to show if they had all been dealt with effectively.
We had a mixed response about the staff from people and their relatives. People were generally positive about the permanent staff saying they were kind and caring, but they were concerned about the number of agency staff being used. We have made a recommendation around how the provider calculates the number of staff needed to support people. We have also made a recommendation about staff training in relation to staff whose first language is not English.
People said they were happy with the medicines they received, however we found issues with how staff responded to problems with storage, and the effectiveness of their checks to make sure people were getting the correct medicine. We have made a recommendation about the management of some medicines.
Examples were seen where staff had not fully supported all those that needed it, for example when managing aggressive behaviour from others, or not knowing what individual care needs people may have. Improvements were also identified in how people who stay in their rooms receive support to eat and drink enough, or when staff support with other activities, such as turning people to reduce the risk of pressure sores developing. We have made a recommendation around the support process so people are consistently supported to eat and drink. We have made also made recommendation about activities to meet people’s individual needs and interests.
We have identified five breaches in the regulations. You can see what action we told the provider to take at the back of the full version of this report.
It was not necessary on this occasion to speak with people who used the service. During our last inspection people that we spoke with were generally happy with the care they received. We spoke with the registered manager who showed us the changes that had been made that ensured they now met the regulation related to people's care and welfare and records.
Prior to the inspection we had received an action plan from the registered manager. This confirmed the steps that had been taken by the home to meet these compliance actions.
We found improvements had been made to the service. Documentation had been audited and changes made where necessary. Staff now had handover sheets for each shift that ensured continuity of care for people. Changes had been made to the activity provision at the home.
We found that people had choices about what they wanted to eat and what they wanted to wear. We saw that people were treated with dignity and respect.
People and relatives we spoke with felt the staff were caring. A relative told us 'I think they (staff) are excellent, better than hoped.' However we found that the care that was provided to people was not always in line with their needs.
The service handled medicines in a safe, secure and appropriate way. The service had systems in place to audit the safe administration of medicines for people.
We found that Warrengate assessed and monitored the quality of the service that they provided. We found that the service had an effective complaints procedure. All of the people and relatives that we spoke with told us that they would speak to the manager if they had any concerns.
The service's records were not always clear and up to date. This related to daily care notes and care plans.
We saw during our inspection that staff provided good care. All of the relatives and the people we spoke with said that the staff were kind and considerate. All of the care plans that we looked at were detailed and had accounted for people's needs. However we found that there were not enough meaningful activities for people who used the service.
The service had a safeguarding policy and staff were aware of the types of abuse to look out for. All of the people said that they felt safe there. The relatives we spoke with said that they knew that after they had visited they knew people were safe.
We looked at records to see whether staff had received all of the mandatory training that the manager told us they should have had. We saw that most of the staff had not completed all of their mandatory training however plans were already in place to address this.
The service had systems in place to address weaknesses with the service. They also had regular meetings with relatives and people to gain their views.
During our last visit we observed a person who used to stay in bed for most of the time. Although this person was not able to give their view, we noted that they were sitting in the lounge enjoying the company of other people.
Three people told us that staff knock on their bedroom doors before entering, to respect their right to privacy. One person told us they were able to choose where they spent their time during the day and another person told us of the community activity they go out of the home to enjoy.
When we discussed peoples' care plans, two people using the service told us they were not aware of their care plan and had not been involved in any meetings to discuss their care.
We were told that people had recently completed satisfaction surveys. One person using the service said 'I can talk to the staff if I have any problems' and another person told us 'I am happy to talk the manager if I am not happy about anything'. One person using the service told us that their bedroom would benefit from repainting.
The majority of people using the service who were able, told us they did not know what food was going to be available until each meal was served. On the day of our visit, people said they were not sure if the main meal contained beef or lamb.
We asked people about the arrangements for their healthcare support and three people told us they could see the doctor when they needed to. We asked those using the service if they felt safe and three people told us they did.
We were invited to see five people's bedrooms and four of the people told us they were happy with their bedrooms. One person said they had to move rooms as work was required after the recent small fire, but they were pleased to return to their own room. People seemed satisfied about the number of staff available to help them, and those we spoke to told us that staff were usually available when needed, but they might have to wait a short while when they used their call bells if staff were busy.
No one we spoke to could recall being asked to give their views about the service, but four people told us the manager was available to them if they had comments or concerns.