Archived: The Warren

Updated 21 May 2016

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

The inspection took place on 7 April 2016. It was undertaken by one inspector. This was an announced inspection. We provided 24 hours’ notice, because the service is small and we wanted to ensure that people we needed to speak to were available.

We reviewed the information we held about the home, including previous inspection reports. We contacted the local authority to obtain their views about the care provided. We considered the information which had been shared with us by the local authority and other people, looked at safeguarding alerts which had been made and notifications which had been submitted. A notification is information about important events which the provider is required to tell us about by law.

During the inspection we reviewed the records at the home. These included staff files which contained staff recruitment, training and supervision records. Also, medicine records complaints, accidents and incidents, quality audits and policies and procedures along with information in regards to the upkeep of the premises.

We also looked at two care plans and risk assessments along with other relevant documentation to support our findings. We also ‘pathway tracked’ people living at the home. This is when we looked at their care documentation in depth and obtained their care and treatment at the home. It is an important part of our inspection, as it allowed us to capture information about a sample of people receiving care.

We looked at all areas of the service, people’s bedrooms, bathrooms, lounge and dining area. During the inspection we spoke with one person and two relatives to seek their views and experiences of the services provided at The Warren. We also spoke with the registered manager, and three care staff.

Updated 21 May 2016

We carried out an announced comprehensive inspection at The Warren on the 17, 18 and 22 June 2015. Breaches of Regulation were found and the service was placed in special measures. As a result we undertook an inspection on 7 April 2016 to follow up on whether the required actions had been taken to address the previous breaches identified. Although we found significant improvements had been made there remained some areas that required improvement.

The Warren provides accommodation and support for up to three people. Accommodation is provided in two semi-detached houses at the end of a residential cul-de-sac. There were two people living at the service during our inspection, each had their own defined living space. There were also areas which were communal, such as a lounge, kitchen and garden. The age range of people living at the service was 29 – 39.

The service provides care and support for people living with autism and other learning disabilities.

People presented behaviours that could challenge along with self-harming behaviour. Both people had been living at the service for over six years. The provider leased the properties from a third party and had not renewed this arrangement. Therefore the service was scheduled to close at the end of June 2016. There were transition plans in place for the two remaining people to move to other services the provider ran locally.

A registered manager was 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 and associated Regulations about how the service is run.

Records identified an occasion when guidance put in place to keep a person safe had not been followed by a staff member; this failing had resulted in the person presenting behaviours that challenged which may have been avoided.

Not all hazards associated with fire had been considered in the providers risk assessment in regard to an emergency exit.

People’s mental capacity had been assessed for a range of daily living requirements, however not all restrictive practice had been considered in accordance with the principles of the Mental Capacity Act (MCA).

Although there were a range of quality assurance processes designed to assess and improve the effectiveness of the service these had not consistently identified shortfalls in administration. For example in regard to historic information in care plans not being updated or removed.

Risk assessment had been completed for a broad range of areas. These provided clear descriptions and guidance for staff to deal with perceived and apparent risks. Appropriate checks and routine servicing to the building and equipment were undertaken to keep people safe.

There were sufficient numbers of suitably qualified, competent staff deployed to meet people’s needs. These staff had the skills and experience to support people effectively.

Medicines were managed safely in accordance with current regulations and guidance. Medicines had been stored, administered and reviewed appropriately.

People had access to healthcare professionals when required. This included GP’s, dentists, opticians and chiropodists. Staff were aware of their responsibilities to monitor people’s changing health care needs.

Care was responsive and met people’s individual care needs. There was clear guidance and strategies in place for staff to support and manage people’s behaviours that challenged.

People were provided with opportunities to take part in their chosen activities ‘in-house’ and to regularly access the local and wider community. People were supported to take an active role in decision making regarding their own routines and those of the home. Staff offered clear explanations to people in ways they understood. Staff were seen to be kind and caring to people.

Relatives and staff spoke positively of the leadership of the service. Staff had regular supervision and told us the registered manager listened and responded to their concerns and they felt supported.