Archived: Warrior Park Care Home

Warrior Park Care Home is a care home which can provide nursing and personal care for up to 52 people. The care home accommodates people in one adapted building across two floors. One of the floors specialises in providing care to people living with a dementia type illness. At the time of this inspection there were 36 people living at the service.

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

People told us they were happy with their care. Medicines were administered safely however some staff were not following best practice guidance. We made a recommendation about this. Effective recruitment procedures were in place and people received care in a timely way. The environment and equipment were safe and well maintained. Staff understood how to keep people safe. People were protected from the risks associated with the spread of infection.

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. People were assisted to eat and drink enough to maintain their health and welfare. Staff received appropriate training and supervision. People's health was well managed. Staff worked closely with professionals to provide effective care.

Staff had developed caring relationships with people and respected their privacy and dignity. People’s independence was promoted. Staff ensured people maintained links with their friends and family.

People’s care was based on detailed assessments and person-centred care plans. A range of activities were available. People felt confident raising concerns and complaints had been dealt with effectively. Staff were aware of good practice and guidance in end of life care. People’s religious beliefs and preferences were respected.

Management systems were in place to monitor the quality of the care provided and feedback was used to make continuous improvements to the service.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 17 October 2018) and there were two breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulation.

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.

Warrior Park is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Warrior Park is registered to accommodate 52 people in one adapted building across two floors. At the time of the inspection 46 people were resident. The first floor specialises in providing care to people living with a dementia who may, at times, be anxious and distressed. The service provided nursing care to people on both floors of the home.

When we completed our previous comprehensive inspection in April 2016 the service was rated good. At this inspection we found the service was no longer meeting all the required standards to retain this rating.

This is the first time the service has been rated Requires Improvement.

There had been a registered manager in post but they had resigned the day before we started the inspection. 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. In the absence of the registered manager the provider's Resident Experience team were providing management support.

There was insufficient management support in place and staff morale was low. The service had experienced four different managers in less than two years and this lack of stability meant staff and relatives felt unsupported. Audits and quality checks were not identifying the concerns we found during the inspection.

We found records relating to people's safety such as falls had not always been recorded meaning measures may not always be in place to keep people safe.

We looked at the systems in place for medicines management and found they did not always keep people safe.

Some staff were not aware of the fire drill procedure relating to evacuating people from the rear of the building. We found some environmental risks such as loose radiator covers and trip hazards on our first visit. These had been repaired and flooring was being reviewed by the second day of our inspection.

Staff members and relatives we spoke with told us there was not enough staff. Although basic care needs were met staff appeared rushed. We discussed with the regional management team who stated they would review the staffing levels and deployment of staff as some feedback from relatives included staff going for breaks together which is not good practice.

There were limited activities taking place. People were left sitting in lounge areas or in their bedrooms with no stimulation for most of the day. We saw staff would sing with people but this was not an activity tailored to individual needs.

Staff had completed all training the provider had identified as essential and although supervisions had lapsed from August 2018. The regional manager had put a plan in place to address this.

The environment had some adaptations and design to ensure people living with dementia were supported. Practice around mealtimes to ensure people had meaningful choice and were supported appropriately could be improved.

We saw complaints were investigated in line with the provider’s complaint’s policy.

Checks were carried out around the service to ensure the premises and equipment were safe to use but these did not pick up issues we found on the day of our visit

Safe recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work.

Staff had knowledge of safeguarding and were aware of the action to take if they had concerns.

Appropriate authorisation was requested to ensure people were protected against unlawful deprivation of liberty and staff supported people in the least restrictive way possible.

We saw evidence in care plans to show the service worked with external healthcare professionals to maintain people’s health.

During this inspection we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to Safe Care and Treatment and Good Governance. You can see what action we told the provider to take at the back of the full version of the report.

We last inspected the service on 2 and 3 February 2016 and found the provider was meeting the fundamental standards of relevant regulations. At that time we rated Warrior Park as ‘Good’ overall and ‘Good’ in all five domains. We carried out this inspection in response to a recent safeguarding incident, where a person using the service had sustained a serious injury and also because prior to this, concerns had been raised around staff moving and handling practices. Therefore, we completed this focused inspection to review risk management practices and to establish whether lessons were learned from previous incidents and changes implemented where needed. During our inspection we found risks were being managed by the provider and registered manager.

Warrior Park is registered to provide care for up to 56 people, but there are only 48 bedrooms in use following the reduction of shared rooms and conversion of some bedrooms for storage. It is a two storey, purpose-built home with secure gardens. The ground floor provides accommodation for people needing personal or nursing care whilst the first floor provides accommodation for people living with dementia who require personal or nursing care. There were 45 people in receipt of care from the service at the time of this inspection.

The home has had a registered manager in post since 4 January 2016. 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.

People told us they felt “safe” and “well cared for”. People were seen to be relaxed and engaged with the staff. Relatives told us they felt confident in the safety of the service and in the staff. All staff had completed updated training in safeguarding adults and they knew how to report any concerns.

People and relatives we spoke with felt staff were competent to provide the right support. Staff told us they felt well trained and supported in their roles. We found the registered manager regularly checked that staff implemented the learning from training and would request that staff completed additional training if gaps in practice were noted. We found that during 2017 all of the staff had received moving and handling training on two occasions, completed workbooks on this topic and undergone competency assessments.

All of the people, staff and visitors we spoke with said the registered manager was open and supportive. Staff told us the registered manager routinely reviewed people’s care and looked at how any risks could be more closely managed. The registered manager closely scrutinised any incidents and made sure lessons were learnt and all staff were aware of the actions that could be taken to reduce the potential that an accident or incident would reoccur. For instance following a person sustaining an injury in their bedroom the registered manager had reviewed the furniture and determined that the armchair design might increase risk of injury. They had started to replace all of the armchairs with ones that had padded arms. Whilst this programme of renewal was being undertaken the registered manager had ensured those people who were at highest risk of falls got the new armchairs first.

After the inspection the provider wrote to us to say what they would do to meet the legal requirements. We carried out this comprehensive inspection to check whether the provider had addressed these breaches and to provide a new rating for the home. We found there had been improvements in all these areas.

Warrior Park is registered to provide care for up to 56 people, but there are only 48 bedrooms in use following the reduction of shared rooms and conversion of some bedrooms for storage. It is a two storey, purpose-built home with secure gardens. The ground floor provides accommodation for people needing personal or nursing care whilst the first floor provides accommodation for people living with dementia who require personal or nursing care. There were 31 people living at the home at the time of this inspection.

Last year there had been several different temporary managers at the home. However in October 2015 a new manager was appointed who has since registered with the Care Quality Commission (CQC). 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.

People told us they felt “safe” and “well cared for”. People were seen to be relaxed and engaged with the staff. Relatives told us they felt confident in the safety of the service and in the staff. All staff had completed updated training in safeguarding adults and they knew how to report any concerns.

There were enough staff on duty to support the people who lived there. The staffing levels and skill mix throughout the day and night was suitable to meet people’s needs. The provider carried out checks to make sure only suitable staff were employed.

People and relatives we spoke with felt staff were competent to provide the right support. Staff felt well trained and supported in their roles. People were supported to eat and drink enough and they had choices about their meals. Staff were knowledgeable about individual people and were able to spot any changes in their wellbeing. They liaised with other health agencies to meet people’s healthcare needs.

People said they were happy living at the home and felt the care and support they received was very good. When asked if they felt well cared for, one person said, “Oh yes absolutely, some of the girls in here are excellent.” Another person said the care they received was “exceptional” and “in all aspects they are very good indeed”.

Relatives said they were “very happy” with the way their family members were cared for. One relative said, “Staff are brilliant, I have no concerns over them at all, they really do care.” Relatives told us they felt their family members were treated with dignity and respect.

People received personalised care. Their individual needs had been assessed and their care plans had been rewritten and updated to make sure they got the right support to meet their specific needs. Staff were knowledgeable about people’s history as well as their likes and dislikes.

All the people, staff and visitors we spoke with said there had been significant improvements to the running of the home since the last inspection. They said the registered manager was open and supportive. People, relatives and staff now had more opportunities to comment on how the home was run.

All the staff we spoke with were very positive about the improvements that had already been made and about the future development of the service. One member told us, “We’ve come a million miles since the last inspection. We’re on the right road now. We’ve made so many improvements – we’ll always be trying harder but I feel we’re on the way.”

During this inspection we found the provider had made improvements to the cleanliness of the home. Some areas had been redecorated to make them easier to keep clean and cleaning staff were on duty for longer hours. New cleaning equipment and furnishings had been provided. Regular checks were now in place to monitor the cleanliness of all rooms. One visitor told us, 'It's much better. They've got new furniture and the cleaners have changed.'

We found the provider had made some improvement to keeping care records complete and up to date. However we found some care records were inconsistent and some were still incomplete. The provider had carried out audits of all care records and identified the gaps in care records. This work was still on-going. Staff were to receive individual training in care recording and this was still on-going. This meant the provider was still addressing this area.

The registered manager acknowledged that the original timescale of 1 August 2014 to address this requirement had not been achieved, but showed us there were clear action plans in place to meet this within the next month. As a result of the work being carried out we have made a further compliance action about records and will follow this up in the near future.

This inspection visit was carried over two days. We spoke with nine people who used the service, four visiting relatives, and two care professionals. Some people who were using the service had dementia care needs which meant they were unable to tell us their views. We used a number of different methods to help us understand their experiences.

We considered all the evidence we gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

' Is the service caring?

' Is the service responsive?

' Is the service safe?

' Is the service effective?

' Is the service well led?

Below is a summary of what we found. If you want to see the evidence that supports our summary please read the full report.

Is the service caring?

People were supported by calm and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. We saw people were assisted at their own pace. Staff working in the unit for people with dementia care needs spent time chatting with people about their interests in a warm and engaging manner.

One relative said, 'We visit my relative all the time and we find all the staff on the first floor are kind and they are always interacting with them.' A visitor to the ground floor unit commented, 'Some staff seem more caring than others but they all do their jobs well enough.'

People who were able to express a view told us they were 'well looked after' and 'happy with it'.

In discussions staff were knowledgeable about people's individual needs and preferences and were respectful of their diverse needs. Our observations of the care provided and discussions with people showed us that individual wishes for care and support were taken into account.

Is the service responsive?

People told us they were able to participate in a range of activities both in the home and in the local community. The daily activities included group events and others that met people's individual interests.

The home had an enthusiastic activities co-ordinator who arranged weekly lunch trips out to local venues which helped to keep people involved with their local community.

People and visitors told us they could approach the manager at any time if they wanted to discuss anything and felt they were listened to. One visitor told us, 'The manager listens if I have any comments or grumbles, so I feel I can talk to her at any time.'

Is the service safe?

People told us they felt 'safe' at the home. One person said, 'I'm well looked after here.' Relatives commented, 'Staff are kind' and 'I don't think it's unsafe.'

Equipment was well maintained and regularly serviced and the health and safety records were up to date. These checks meant that people were not placed at unnecessary risk.

Some areas of the premises were not kept clean. Although this had been identified in checks by the regional manager, action had not been taken yet to address this. This compromised the control of infection as well as the dignity of people who lived there. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

We inspected the staff rotas which showed that there was sufficient care staff on duty to meet people's needs throughout the day. There was a visible staff presence so that staff could support and supervise people when needed. The call alarms were responded to promptly so people got support in a timely way.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. The manager understood the home's responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). An urgent deprivation of liberty application had been submitted to the local authority regarding one person. Following a recent court ruling regarding DoLS in care settings, the provider may wish to review people's living arrangements to check whether their circumstances may amount to a deprivation of liberty, according to the revised definition.

Is the service effective?

The home's dementia care unit had achieved an award for the dementia care services it provided. This meant the unit had been assessed for staff training in dementia care, the environment and activities.

One person told us, 'I've been here for a while and they've helped me gain weight. I'm well fed and well looked after.'

People all had an individual care plan which set out their care needs. Some people's care records were not always complete or updated to show recent changes. This meant some records did not accurately reflect people's new needs. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

Is the service well-led?

The home had a registered manager.

The provider had a system to assure the quality service they provided. The way the service was run had been regularly reviewed. When shortfalls were identified, the action to put things right was not always timely. The home had recently appointed an experienced deputy manager who showed us plans for improved checks and corrective actions that were to be put in place.

People who used the service who we spoke with told us they were happy with the care and treatment being delivered by the service. They felt their needs were met and there were enough staff on duty to meet others' needs. They told us: 'The staff take their time with me, I never feel rushed and I feel safe in their hands. If I don't feel well, I can tell them and they will call the nurse or doctor for me, what more can I ask for?', 'I get well looked after here. The staff are friendly, they'll do anything I ask and they know what I need to make sure I stay safe and well' and 'It's fine here, yes I like it.' People also felt that they were given opportunities to be involved in decisions about their care.

We found there were arrangements in place to seek people's consent for treatment. Staff were clear about the legal arrangement in place for people when they lacked the capacity to make complex decisions such as who had lasting power of attorney in place and whether this was for people's finances or care and welfare.

We found there were sufficient staff in place to meet the needs of the people who used the service.

There were effective systems in place to monitor the quality of care people received. People and their relatives were given the opportunity to give feedback about the care and treatment delivered by the service.

Records were accurate, fit for purpose and protected people who used the service from the risks of receiving unsafe or inappropriate care and treatment.