The Care Quality Commission
  • Care Home
  • Care home

Archived: The Warren

Overall: Requires improvement read more about inspection ratings

23-25 The Warren, Ticehurst, East Sussex, TN5 7QY (01580) 201448

Provided and run by:
Autism Sussex Limited

All Inspections

7 April 2016

During a routine inspection

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.

17, 18 and 22 June 2015

During a routine inspection

We inspected The Warren on 17, 18 and 22 June 2015. 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 three people living at the service during our inspection. Two people were living in one of the houses and one person lived on their own on the other side of the house. There was a small shared garden at the rear of the properties. The age range of people living at the service was 23 – 37. People either had limited or no verbal communication. They communicated by vocalisation or the use of body language and picture/flash cards.

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. Two people had been living at the service for over five years and one person had lived there for twelve months. Records and staff identified that the day after our inspection finished one person was scheduled to move out of the service to another service provider and this vacancy would not be filled. The provider leased the properties from a third party and the lease was scheduled to end in December 2015. The provider informed us the lease was not being renewed. There were transition plans in place for the two remaining people to move to other services the provider ran locally.

A registered manager was not 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. However the service did have an acting manager in post who over saw the day to day running of the service and was currently going through the CQC Registration process.

The provider had not protected people’s safety by ensuring there were sufficient numbers of suitably qualified, competent, skilled and experienced staff deployed.

We found incidences where previous accidents and incidents had not been reported in line with the providers own policies and procedures. However, the acting manager had taken steps to ensure these were now being followed and relevant external agencies informed where appropriate.

Mental capacity assessments had not consistently recorded the steps taken to reach a decision about a person’s capacity for decisions. Not all staff had completed MCA training however were able to confirm how they sought consent.

The provider had not taken steps to ensure people’s privacy or dignity was respected. The premises did not provide people with the opportunity for personal space or a suitable communal area. One person’s sleep routines had negatively impacted on other people living at the service, the provider had not taken steps to respond in a timely manner to prevent this.

The provider had not ensured the service met people’s individual care needs. Care for one person was not responsive to their needs. There were not clear strategies in place to manage behaviour that challenged and care management for this person was not planned but reactive.

The Warren did not have a Registered Manager with the CQC however an acting manager was in day to day control of the home and was undertaking the registration process. However they were not clear on all functions of their role such as notifying the Care Quality Commission of incidents where injury, harm or abuse had occurred to people.

There were limited quality assurance processes in place and these had not effectively identified the shortfalls in quality of care being provided.

Risk assessments had been completed for a broad range of areas. They provided clear descriptions and guidance for staff to deal with perceived and apparent risks.

The provider had taken steps to ensure appropriate checks and routine servicing to the building and equipment were undertaken to keep people safe.

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

Checks were undertaken to ensure staff were safe to work within the care sector. Staff had completed training on safeguarding and knew what action they should take if they suspected abuse was taking place.

People told us they liked the food and relatives spoke highly of the meals and snacks provided. Systems were in place to ensure there were sufficient quantities of fresh food available that catered for people’s preferences.

Staff were having regular supervision and told us the acting manager listened and responded to their concerns and they felt supported.

People were supported to access health care professionals routinely and as required as a result of changes in health. Staff were aware of the processes they needed to follow to raise concerns about people’s health.

We heard staff offering clear explanations to people in ways they understood. Staff were seen to be kind and caring to people.

Some people were supported to have clear structured involvement in activities that were appropriate and engaged them effectively.

Care plans provided clear guidance for staff on supporting people with routine living needs.

People’s family were made welcome and relatives spoke positively about the welcome they received. One told us, “I can pop in anytime and know I will be made welcome.”

Staff meetings were used as a forum to share key operational information about the running of the service and provide updates on individual people.

People spoke positively of the acting manager and told us they had made a positive contribution to staff morale and identifying where things needed to improve.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve.

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

Services placed in special measures will be inspected again within six months. The service will be kept under review and if needed could be escalated to urgent enforcement action.

We found breaches in Regulations. You can see what action we told the provider to take at the back of the full version of this report.

29 August 2013

During a routine inspection

At the time of our inspection, two residents were living in The Warren. We spoke to the manager, the senior social care worker, two relatives and one person who used the service. We looked at records of people's care plans, staff files, the service's policies, procedures and food management. We also inspected the premises.

We found that people's needs were assessed and met according to their care plans. A member of staff told us, "The whole team is totally devoted to our residents' welfare". A relative said, "I could not ask for better care for my daughter, she has a great quality of life and the staff are so caring". Another relative told us, "Our daughter gets all the attention she needs, the staff are always available and patient".

People who lived in the service were provided with a choice of suitable and nutritious food and drink; they were supported to eat and drink sufficient amounts to meet their needs. A relative told us, "The food is always wonderful".

We found the premises were clean, welcoming and well maintained.

The service had a recruitment procedure that ensured people who used the service were cared for, or supported by, suitably qualified, skilled and experienced staff.

We saw that records were accurate, up to date, maintained, stored and archived appropriately.

30 January 2013

During a routine inspection

During our inspection we spoke to two people who used the service, two members of staff and the manager. Following our inspection we spoke with two relatives, to obtain their feedback on the service. We found that people were treated with respect. We spoke to a service user who said 'I like it here, my key worker is so nice, I like my room and my lounge, the staff give me different food to try because I do not like to eat many things'. We found that people and relatives participated in their care and that their views and wishes were considered. One relative stated how she was always welcomed by staff and regularly invited to participate with her daughter's care planning, she told us 'I am always kept informed and can put my views across with confidence as they always listen and follow things through'. We found that people were encouraged to develop independent living skills while being supported, and that their care plans reflected their individual needs. Two relatives told us 'I am delighted with the service that is provided for my daughter, the staff could not do more, they understand her needs and are giving her a good quality of life, they really care'; 'People with autism need autism-specific care, they need to be understood. My daughter is doing things she could not do before she came to The Warren, I am so pleased with her progress'. We found that staff were being supported to carry out their role. We saw that a clear safeguarding policy was in place and implemented.