Archived: Warneford House

After the last comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches. We carried out this comprehensive inspection to check that they had followed their plan and to confirm that they were meeting all of the legal requirements.

Warneford House provides accommodation, nursing and residential care for up to 40 older people including those who are living with dementia. At the time of our inspection the home was providing support to 30 people. The home had 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.

There were systems in place to protect people from abuse, staff had received appropriate support and training which enabled them to identify the possibility of abuse and take appropriate actions to report and escalate concerns. Risks were assessed and managed appropriately through the appropriate use of risk assessments.

There were systems in place to monitor the safety of the environment and equipment used within the home minimising risks to people. There were arrangements in place to deal with emergencies.

There were safe staff recruitment practices in place and appropriate checks were conducted before staff started work ensuring people were supported by staff that were suitable for their role. There was enough staff on duty to meet the needs of the people living at the home.

Medicines were managed, stored and administered safely by trained and competent staff.

There were processes in place to ensure new staff were trained appropriately and staff received regular training, supervision and annual appraisals. Staff gained consent for the support they offered people. The registered manager and staff were able to demonstrate their understanding of the Mental Capacity Act 2005

and Deprivation of Liberty Safeguards legislation.

Staff had a good understanding of the needs of the people and how they liked to be supported. Staff spoke with and treated people in a respectful and caring manner and interactions between people, their relatives and staff were relaxed and friendly. Staff respected people's privacy and dignity. People and their relatives told us they were made welcome in the home.

People received care and treatment in accordance with their identified needs and wishes. Care plans documented information about people's personal history, choices and preferences and preferred activities.

There was information on how to make a complaint displayed on the notice board for people living at the home. People knew how to complain and felt that when they did that their concern was taken seriously.

There were systems and processes in place to monitor and evaluate the quality of the service provided.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, speaking with the staff supporting them and looking at records.

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

Is the service safe?

People were treated with respect and dignity by the staff, and staff were given support and guidance to ensure that they cared for people safely. People were protected from the risk of abuse because staff had appropriate training and guidance had been followed. People were asked for their consent before care tasks were undertaken. Systems were in place for managers to monitor the quality of the service and make sure it was run safely. One person who used the service told us: 'I am always asked my permission before they (staff) do anything.'

Is the service effective?

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. Care plans contained assessments of people's care and support needs. These assessments described the steps staff should take to ensure each person's needs were met. Staff received appropriate support to meet the needs of people living at the home. Audits and reviews took place to ensure that care was delivered in a way that met people's needs.

Is the service caring?

We observed that staff were caring and respectful towards people. Each care task we observed took place in a patient and kind manner. People spoke positively about their experience of receiving care at the home. One person who used the service told us: "It's smashing, all the people are lovely.'

Is the service responsive?

Staff acted on people's needs and in accordance with their wishes. Where people needed specific support or care, we saw evidence that this was delivered in accordance with people's needs.

Is the service well-led?

There was a quality assurance system in place, where staff internal and external to the home carried out a quality monitoring programme. This was detailed, frequent and thorough. Staff we spoke with believed they were well led and had confidence in the

management team.

The provider sent us an action plan saying they would be compliant by the end of September 2013.

During this inspection we spoke with the families of people who used the service who told us told their relatives were treated with dignity, and their privacy was respected. They also told us that staff promoted their independence. We found that people's privacy, dignity and independence was respected.

The relatives of people who used the service told us they were satisfied with the care provided. One person told us; 'The staff know my relative very well and they understand. I can see that my relative has trust in the staff.' We found that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare.

People expressed satisfaction with the care they received. However, the majority of people we spoke with told us they were not aware of their care plans, and had no input into their continuing care. We also found that care was not delivered in line with people's individual care plans.

Relatives told us that staff did not always act in a professional manner when managing inappropriate behaviour by people who used the service. We found there was a policy on safeguarding and care workers we spoke with understood how to report any suspicions of abuse.

People told us they felt there were not always sufficient staff on duty. We found that the home did not use a tool to assess people's dependency levels when working out how many staff should be on duty.

Whilst some people told us they had attended a meeting about the service, or undertaken a satisfaction survey, other people told us they had not. We found there was an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who used services.

People told us they were happy with the food and refreshments provided. We saw evidence of people being given choices as to what they wished to eat. A nutritious and balanced diet was made available.

A person who used the service told us they had not been given all the medicines which had been prescribed to them. We found that people were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage them safely.

People told us they thought care workers knew what they were doing. We found that care workers got appropriate training, supervision and development.

People who used the service told us they knew how to make a complaint and who to complain to. There was a complaints procedure in place and staff were aware of their responsibilities to report verbal complaints so they could be formally investigated.