Warren Park Nursing Home

We found the following examples of good practice.

The provider had safe visiting arrangements which included all visitors taking a COVID-19 Lateral flow Test, having their temperature checked and wearing personal protective equipment (PPE) when entering the home.

The service supported people and their relatives to understand the isolation processes and how the service could help to alleviate them from feeling lonely during an outbreak of COVID-19. This included calls with friends and relatives and dedicated staff spending time with people and supporting them with activities.

Specific staff were allocated to support people’s needs, and staff were consistently working in the same area of the home to avoid cross contamination. During an outbreak, people were supported by staff to isolate in their own rooms and areas near their rooms as much as possible.

PPE was well stocked and organised, and cleaning products were stored and used appropriately. The home was clean.

Staff and people living at the home were partaking in regular COVID-19 testing. All staff and people living at the home had received COVID-19 vaccinations.

Warren Park Care Home is a residential care home providing nursing and personal care to 34 people at the time of the inspection. The service is registered to support up to 40 people in one adapted building.

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

Improvements had been made since the last inspection. However, some concerns remained regarding the recording of people’s medicines and the support they had been given by staff. Due to these recording issues we could not always be fully assured people had had their needs met. The provider and manager were aware of most of the concerns before our inspection and had put new processes in place to address these. These processes needed more time to embed.

Risks relating to people’s health and wellbeing were appropriately assessed and managed. New care records were much improved from the last inspection, but older care records needed a full review to ensure they were accurate and contained enough information to guide staff to support people safely.

Recruitment systems were robust and safe and there were enough staff to support people’s needs. People were supported by caring and well-trained staff. Feedback from people showed they liked living at Warren Park and they felt safe.

The environment of the home was pleasant and clean throughout. Staff followed appropriate infection and prevention control measures and COVID-19 related guidance. Some parts of the home had been adapted to support people living with dementia.

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.

A new manager had started since the last inspection. Feedback from staff was positive and they felt improvements had been made in the home. Staff reported the atmosphere and culture of the home was more positive and felt there was more engagement with the new manager.

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 8 April 2020) and there were three 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 some, but not enough improvement had not been made and the provider was still in breach of regulation.

This service has been in Special Measures since 07 April 2020. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

Whilst we found some improvements have taken place, we have identified continued breaches in relation to medicines management and good governance.

Please see the action we have told the provider to take at the end of this report.

Why we inspected

This was a planned inspection based on the previous rating.

We carried out an unannounced comprehensive inspection of this service on 18 and 19 February 2020. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, consent and good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has remained requires improvement. This is based on the findings at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Warren Park Nursing Home on our website at http www.cqc.org.uk.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Warren Park Care Home is a residential care home providing personal and nursing care to up to 40 older people, some of whom are living with dementia. There were 40 people living at the home at the time of inspection.

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

Systems in the home to check the quality and safety of the service were not robust or effective. The provider was in breach of regulation at three previous inspections and has demonstrated a failure to make and sustain improvements. After the inspection the provider told us they were looking to recruit an appropriately qualified person to support the registered manager with making improvements in the home.

At this inspection we found that improvements were still needed regarding medication administration as well as reporting and recording with regards to risks to people and their care needs. As these issues were raised at the last inspection report there remains significant concern about poor governance and safety of the service.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. Mental capacity assessments had not always been completed, and best interest meetings had not always taken place in order to make ongoing decisions regarding peoples care.

Recruitment systems were robust and safe and there were enough staff to support people’s needs. People were supported by caring and well-trained staff who treated people as individuals and with dignity and

respect. However, people were at risk of not receiving care and support they needed because of poor recording and planning. Feedback from people showed they liked living at Warren Park and they felt safe.

Care plans did not always contain enough information to ensure people received care that was personalised to them and met their needs. However, there was a consistent staff team who knew people well and involved people in making choices about their day to day care. Activities were widely available and tailored to meet people’s cultural needs.

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 21 August 2019) 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 not enough improvements had been made and the provider was still in breach of regulations.

Enforcement

At this inspection we have identified breaches in relation to safe care and treatment, governance and consent.

Please see the action we have told the provider to take at the end of this report.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

The overall rating for this service is ‘Requires improvement’. However, we are placing the service in 'special measures'. We do this when services have been rated as 'Inadequate' in any Key Question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services in special measures. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Warren Park Nursing Home is a residential 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 in one adapted building. The home is situated over three floors, with access to an administrative office located on a fourth floor.

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

There were systems in place to monitor the quality of the service. We found these remained ineffective at identifying all the concerns raised during the inspection. The registered provider has recently employed a quality manager to support the governance processes.

Medicines were still not safely managed. We found at times people were left without medication due to no stock being in the home, people did not always receive their medication on time, some medication was stored unsecured in people’s rooms and people were not reviewed appropriately when they had refused medication for a number of days. There have been concerns regarding the management of medicines at the previous two inspections.

The registered manager engaged with support from other professionals in relation to concerns in the home. There have been changes to practice to try and improve the safety of medicines in the home. However, we found these had not been effective and concerns were still evident.

Some risk assessments were not always updated with information after incidents occurred, and they hadn’t always been completed correctly. However, people told us they felt safe living at the home. People said the staff treated them with respect and kindness and we observed this.

During the inspection we found concerns with rooms being left unsecured. These rooms contained hazardous substances that were potentially harmful to people. These doors often had locks but these had been left open by staff. There was a door that was to remain locked at all times, however the lock was broken and unable to be secured. After the inspection the registered manager told us doors within the home have had new locks fitted.

Some people living in the home were on modified diets or thickened fluids. Thickened fluids support people to maintain hydration when they have swallowing difficulties. We found not all care plans contained the correct information regarding people’s needs. We checked with staff who knew people’s needs. However, this had not always been recorded. We saw people’s fluid charts did not record the use of thickener, and people’s food charts did not record the type of diet they had. We did not receive any complaints from people regarding their fluids and food and although we saw no evidence people had been negatively affected by the lack of recording, there was no clear oversight of people’s needs being met safely.

Care plans did not always contain enough detail regarding people’s needs, although we did see staff knew people well and had good relationships with them. We asked the registered manager to review care plans to ensure they were detailed with people’s needs.

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.

Staff understood their role and had confidence in the manager. Staff told us they worked well together as a team, and there was good morale amongst them. We received positive feedback from other health professionals working with the registered manager.

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 19 July 2018). The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

At the last inspection there were multiple 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 enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to the management of medicines and ineffective governance processes at this inspection.

Please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

At the last inspection on the 9 February 2016, the service was rated Good however we identified a breach of Regulation 12 (Safe care and treatment) due to concerns regarding the safety and storage of medication. Following the last inspection, the registered provider completed an action plan dated 15 April 2016 to tell us what they would do and by when to improve the safety of medicines. At this inspection, we found that registered provider remained in breach of Regulation 12 because medicines were not managed safely at the service and we identified a breach of Regulation 17 (Good Governance).

A registered manager was in post at the service, however, they were not present on the day of our unannounced 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. During our inspection, we were assisted by a nurse and two directors at the service. We discussed how the contingency arrangements in the registered manager’s absence could be developed to ensure records were more easily accessible by other members of the management team because we found that some records were not available during our inspection site visit.

At the last inspection on 9 February 2016, we found that the registered provider was in breach of Regulation because medicines were not stored safely and securely at all times. The registered provider assured us they would audit the storage of medication and introduce regular spot checks during the medicine rounds to ensure that they were compliant with policies and procedures. At this inspection, we found that medication was still not stored securely and the recording of medication was not always accurate. Furthermore, we identified that audit processes were not sufficiently robust to identify errors and quality assurance procedures had not picked up on the issues we identified during our inspection. The registered provider remained in breach of the Regulations.

People told us they felt safe and secure living at the service. We received positive feedback from people and their relatives regarding the atmosphere in the home. Comments included; “There’s a feeling of security. There’s a feeling of contentment and a lot of fun” and said “It’s always nice and clean and visitors are always made welcome.”

Staff were recruited safely and pre-employment checks were carried out before they started work at the organisation to ensure they were suitable to work with vulnerable people. Staff were aware of how to protect people from avoidable harm and were aware of local safeguarding procedures to ensure that any allegations of abuse were reported and referred to the appropriate authority.

Our review of staff rotas showed there were appropriate numbers of staff employed to meet people's needs in accordance with the registered manager's dependency tool. Nevertheless, we received some mixed feedback from people and their relatives regarding the staffing levels at the service. We raised this with the registered provider’s representatives at the time of our inspection who agreed to review the deployment of staff within the home.

Risks to people's health, safety and well-being were assessed and information was available to guide staff on how to mitigate risks. Support plans had been completed for everyone who was receiving care to help ensure their needs were met and to protect them from the risk of harm. Accidents, incidents and ‘near misses’ events were documented and the registered manager maintained oversight of these for future learning and prevention.

People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service supported this practice. Consent was sought in line with the principles of the Mental Capacity Act 2005 and applications for authorisations to deprive people of their liberty had been made appropriately. A registered mental health nurse was employed by the service and undertook assessments of people’s capacity.

Staff told us they felt well supported. The registered provider’s records showed staff had received adequate training to ensure they had the skills and knowledge to support people effectively.

Most people told us they enjoyed the food served at the home. One person commented, “It’s quite good, there’s a variety. We all get a newsletter and it has the weekly menu in it”. We sampled the food available and found it to be of good quality. Staff knew, and catered to, people's individual dietary needs and preferences. People were supported with their nutrition and hydration intake when required and a coloured cup system was in place to facilitate this.

People's overall health and well-being needs were being safely and effectively supported. Staff monitored people's health and welfare needs and acted on any concerns promptly. The service maintained good links with community health partners to ensure people's outcomes were met. One visiting health professional told us, “The care is great.”

People were complimentary about the staff and the service in general. Comments included; “Everyone gets treated very well here” and “They’re [staff are] all very nice and kind.” We observed good quality interactions from staff towards people living in the home. Everyone we spoke with told us their privacy and dignity was maintained.

People had access to a range of activities to promote their social inclusion and stimulation. The activities co-ordinator employed by the service organised a range of events, including trips out in the local community.

People and their relatives had access to a complaints procedure and they were aware of how raise a concern. The service had not received any recent formal complaints but people’s ‘niggles’ and low-level concerns were documented and responded to.

Opportunities were provided for people and their relatives to comment on their experiences and the quality of service provided through the circulation of surveys and resident meetings. People told us that residents meetings were effective because they received feedback and issues raised were acted upon. People were kept informed about any changes at the service through weekly newsletters.

A variety of quality assurance procedures were in place to monitor and assess standards within the home and included regular audits in respect of care plans, weights, infection control and falls. However, we found the governance processes in respect of medication to be ineffective.

The registered manager had notified the Care Quality Commission (CQC) of events and incidents that occurred in the home in accordance with our statutory requirements. This meant that CQC could monitor risks and information regarding Warren Park.

The ratings awarded at the last inspection were displayed in the communal area of the home.

Situated in a residential area of Blundellsands, Liverpool, the home is registered to provide nursing care for up to 40 people with general nursing needs. The home has four floors with lift access to three flours and stair access to the administrative office on the fourth floor. There are large accessible gardens to the rear of the building and car parking to the front. The home is accessible to people with limited mobility and wheelchair users.

There were 39 people living at the home when we carried out the inspection.

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 2008 and associated Regulations about how the service is run.

People said they felt safe living at the home and were supported in a safe way by staff. Staff understood what abuse was and the action they should take to ensure actual or potential abuse was reported. Staff understood and adhered to the principles of the Mental Capacity Act (2005).

Staff had been appropriately recruited to ensure they were suitable to work with vulnerable adults. People and their families told us there was sufficient numbers of staff on duty at all times.

Our review of a selection of care records informed us that a range of risk assessments had been undertaken depending on people’s individual needs. These included a falls risk assessment, lifting and handling assessment, nutritional and a skin integrity assessment. Care plans had been developed based on the outcome of risk assessments and they provided good detailed guidance for staff on how to support each person thus minimising the risks.

People told us they received their medication at a time when they needed it. We found that the medicines were not always stored in a safe way. You can see what action we told the provider to take at the back of the full version of this report.

The building was clean, well-lit and clutter free. Measures were in place to monitor the safety of the environment.

Families we spoke with told us the manager and staff communicated well and kept them informed of any changes to their relative’s health care needs. People said their individual needs and preferences were respected by staff. They were supported to maintain optimum health and could access a range of external health care professionals when they needed to.

People spoke highly of the meals and the general meal time experience. They told us the food was very good and they got plenty to eat and drink.

People and families described management and staff as caring, considerate and respectful. Staff had a good understanding of people’s needs and their preferred routines. We observed positive and warm engagement between people living there and staff throughout the inspection.

Although staff said there was a need for formal supervision, they told us they were well supported on a day-to-day basis and through the induction and appraisal processes. They said they were up-to-date with the training they were required by the organisation to undertake for the job.

The culture within the service was open and transparent. Staff, people living there and families said the registered manager was approachable and inclusive. They said they felt listened to and involved in the running of the home.

Staff were aware of the whistle blowing policy and said they would not hesitate to use it. Opportunities were in place to address lessons learnt from the outcome of incidents, complaints and other investigations.

A procedure was established for managing complaints and people living there and their families were aware of what to do should they have a concern or complaint. We found that a complaint last year had been managed in accordance with the complaints procedure.

Audits or checks to monitor the quality of care provided were in place and these were used to identify developments for the service. Processes were in place for people living at the home and their families to provide feedback on the service. We were provided with examples of improvements made to the service as a result of feedback.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

Below is a summary of what we found '

Is the service safe?

Arrangements were in place to protect people living at the home against the risks associated with the unsafe use and management of medicines.

We spoke with two people who lived at the home. Both told us they received their medication when they needed it. One person told us, 'They are pretty good at giving me my tablets on time. I know what the medication is for. The nurse told me.' The other person said, 'I get my medication at the same times every day. It's like clockwork.'

Is the service effective?

This was a follow-up inspection to check if the provider had made improvements to an area of non-compliance identified at the previous inspection. We did not look specifically at this area.

Is the service caring?

This was a follow-up inspection to check if the provider had made improvements to an area of non-compliance identified at the previous inspection. We did not look specifically at this area.

Is the service responsive?

This was a follow-up inspection to check if the provider had made improvements to an area of non-compliance identified at the previous inspection. We did not look specifically at this area.

Is the service well led?

This was a follow-up inspection to check if the provider had made improvements to an area of non-compliance identified at the previous inspection. We did not look specifically at this area.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people who lived at the home, their relatives, staff providing support and looking at records.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

The people we spoke with told us staff were caring and treated them with kindness and respect.

Systems were in place to ensure staff were informed about, and learnt from, events such as incidents, complaints and the outcome of audits (checks).

The home was clean, hygienic and odour free. Measures were in place to ensure the environment was safe and suitable for the people who were living there.

Although a busy home, both people who were living there and staff told us there was enough staff on duty to ensure people's safety.

The daily checks of the medication fridge temperatures showed the fridge frequently recorded a minimum temperature of 1', which is outside of the acceptable range of 2-8' advised by the pharmacy providing medication to the home. This meant the advice provided by the pharmacy had not been taken into account in the routine monitoring of the fridge temperatures. In addition, there is a risk that medication requiring refrigeration may lose its effectiveness if stored at the incorrect temperature. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to the management of medicines.

Is the service effective?

People's health and care needs were assessed with them and/or with a family member. People and family members told us staff communicated well about care needs and any changes were discussed with them. Specialist dietary, mobility and equipment needs had been identified in care plans where required. People's care plans reflected their current needs.

Is the service caring?

People told us they were supported by kind and attentive staff. We observed staff supporting people in a caring, friendly and respectful way. A person living there said, 'Sometimes I feel overwhelmed by their [staff] kindness.' Another person told us, 'I can only praise the staff. They are busy but also patient and give you the time you need.'

Staff were knowledgeable about people's preferences, interests and diverse needs so care and support was provided in accordance with people's wishes.

People who lived at the home and their relatives had the opportunity to participate in an annual satisfaction survey and could also provide feedback via the resident's and relative's forum. Where shortfalls or concerns were identified these were addressed through an action plan developed by the provider.

Is the service responsive?

People knew how to make a complaint or raise a concern if they were dissatisfied with something. A family member told us the manager listened and responded promptly to concerns raised.

From our discussions with people and family members and through observation of care records, we could see that the approach to care and support was revised as people's needs changed. This was particularly evident with changing medical and nursing care needs.

Following our last inspection in August 2013 we made a compliance action (requirement to improve) that the service needed to respond to and address. We found that this had been addressed and the improvements made.

Is the service well-led?

The home had systems in place to regularly monitor the quality and safety of the service provided. Records we looked at demonstrated that action plans were developed to address identified shortfalls in a timely way.

Staff we spoke with said they received good quality training, had an annual appraisal and received regular supervision. This helped to ensure that people received a good quality service at all times.

We spent time with people in the dining room while lunch was being served. We observed staff supporting people to eat their meals. One person showed little interest in their meal and they were offered an alternative, which they accepted. The food looked appetising and people told us they were offered a choice of what they would like to eat each day.

We found that staff had received training and were supported appropriately, which enabled them to deliver care and support effectively. Staffing levels were adequate at the time of the inspection. At our last inspection in July 2012 we had concerns that care plans and risk assessments were not being updated consistently. At this inspection we found these concerns had not been addressed.