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Warwick Park Care Home Requires improvement

The provider of this service changed - see old profile

Reports


Inspection carried out on 20 August 2019

During a routine inspection

About the service

Warwick Park Care Home is registered to provide accommodation and personal care for up to 50 older people. At the time of our inspection, 39 people were living at the service.

People’s experience of using this service

People told us they felt safe, supported and were happy living at Warwick Park Care Home. Staff were kind, caring and treated people with dignity and respect.

At our last inspection we found the provider was failing to ensure they were doing all that is reasonably practicable to manage and mitigate risks. At this inspection we found improvements were still required as people were not always protected from risks associated with their health needs, life style choices, medicines and the environment.

Medicines managed by the service were stored and administered safely and appropriately by staff who had been trained and assessed as competent to do so. However, we found some aspects of medicines recording could be improved and have recommended the provider update their practice in some areas of medicines management to incorporate current best practice.

People were supported to have maximum choice and control of their lives; however, we have recommended that the registered manager reviews all documentation and guidance relating to how staff record best interests’ decisions.

Quality assurance and governance systems were in place to assess, monitor, and improve the quality and safety of the services provided. However, we found the systems in place had not been undertaken robustly, therefore had not identified that some records were not complete or up to date. We have recommended the provider undertakes a review of the effectiveness of the systems and processes in place.

People had confidence in the registered manager and told us the home was well managed. There was an open culture where people, relatives and staff were encouraged to provide feedback. Staff felt they received a good level of support and could contribute to the running of the home.

People's privacy and dignity was respected, their independence promoted, they had access to healthcare professionals when required and were supported to maintain a balanced healthy diet.

People were protected from potential abuse by staff who had received training and were confident in raising concerns. There was a thorough recruitment process in place that checked potential staff were safe to work with people who may be vulnerable by their circumstances.

Other risks were well managed. Risks had been identified, in relation to people’s care needs such as mobility and skin care, and action had been taken to minimise these.

Warwick Park Care Home was clean, and people were protected from the risk and/or spread of infection as staff had access to personal protective equipment (PPE).

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 on 21 August 2018). 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 improvement had been made and the provider was still in breach of regulations.

The service remains rated requires improvement. This was the second consecutive inspection where the service has been rated as 'requires improvement'. Prior to this the service was rated inadequate.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified a breach of regulation in relation to safe care and treatment. We have also made recommendations in relation to medicines and the recording of best interests decisions.

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

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 goo

Inspection carried out on 16 July 2018

During a routine inspection

The inspection took place on 16 and 18 July 2018 and was unannounced.

Following an unannounced comprehensive inspection on 24 and 25 May 2017 we told the provider to make improvements to how people's medicines were managed and to how people's care needs, and risks associated with their care were recorded and known to staff. We told them to ensure people's call bells were answered promptly, and to document people's mental capacity. In addition, we told the provider to improve their quality monitoring processes, to help identify when improvements were required. Following our inspection, we met with the provider to ask them how they would improve the service for people. They told us they would strengthen their governance processes.

The Commission considered its enforcement policy, and took enforcement action, which was to impose a condition on the provider's registration. This meant on a monthly basis, the provider was requested to carry out an audit of people's medicines and of care records; submit a summary of their findings to the Commission, and demonstrate what action was being taken to improve the service and to meet regulation. Since July 2017 the Commission had been receiving and reviewing the provider's monthly returns, which had demonstrated ongoing improvement at the service.

We carried out an unannounced comprehensive inspection on 14 and 15 November 2017. Our inspection was brought forward because we received information of concern about people's care. The findings of that inspection found that the information submitted by the provider to the commission about improvements they were making, had not always been fully accurate and did not always reflect the current regulatory position within the service. Following our inspection, the registered manager submitted a detailed action plan to the commission. The action plan set out how they intended to make urgent changes regarding the safe management of people's nutritional needs. As a result of the inspection the provider also decided not to provide nursing care in the future.

The Commission considered its enforcement policy, and took enforcement action, which was to impose further conditions on the provider's registration and place the service into special measures. This meant on a monthly basis, the provider was requested to carry out an audit of how they were monitoring the quality of the service and how they were keeping people safe; submit a summary of their findings to the Commission, and demonstrate what action was being taken to improve the service and to meet regulation. Since the inspection, the Commission had been receiving and reviewing the provider's monthly returns, which had demonstrated ongoing improvement at the service.

Services in special measures are kept under review and, if we have not taken immediate action to

propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This inspection was to check whether sufficient improvements had been made.

Warwick Park Care Home is registered to provide accommodation and personal care for up to 50 older people. 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.

Accommodation and facilities are spread over two floors, with access to the lower and

Inspection carried out on 14 November 2017

During a routine inspection

The overall rating for this service is ‘Inadequate’ and the service is therefore been placed into ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

We carried out an unannounced comprehensive inspection on 24 and 25 May 2017. The overall rating improved from inadequate to requires improvement, therefore the service came out of ‘special measures’.

We told the provider to make improvements to how people’s medicines were managed and to how people’s care needs, and risks associated with their care were recorded and known to staff. To ensure people’s call bells were answered promptly, and to document people’s mental capacity. In addition, we told the provider to improve their quality monitoring processes, to help identify when improvements were required.

Following our inspection, we met with the provider to ask them how they would improve the service for people. They told us they would strengthen their governance processes.

The Commission considered its enforcement policy, and took enforcement action, which was to impose a condition on the provider’s registration. This meant on a monthly basis, the provider was requested to carry out an audit of people’s medicines and of care records. Submit a summary of their findings to the Commission, and demonstrate what action was being taken to improve the service and to meet regulation. Since July 2017 the Commission had been receiving and reviewing the provider’s monthly returns, which had demonstrated ongoing improvement at the service. However, the findings of this inspection determined the information which had been provided had not always been fully accurate and did not always reflect of the current regulatory position within the service.

We carried out an unannounced comprehensive inspection on 14 and 15 November 2017. Our inspection was brought forward because we received information of concern about how people’s medicines were managed, how people were being supported with their mobility and that there was a delay in staff responding to people’s call bells. We were also told, people were not always effectively supported with their nutrition and continence needs, and staff did not always know how to support people, or have access to their care records. In addition, repairs were not always carried out promptly and the environment was not always clean and tidy. During this inspection we looked at the concerns which had been raised, and found some improvements were required.

Warwick Park Care Ho

Inspection carried out on 24 May 2017

During a routine inspection

This comprehensive inspection was undertaken on 24 and 25 May 2017. The first day of the inspection was unannounced. Warwick Park Care Home Care Home provides nursing and residential care for up to 50 older and younger adults, some of whom are living with dementia or who may have physical or sensory health needs.

On the first two days of the inspection 39 people were living at the service, two people were in hospital. The service also provides assessment and rehabilitation to some people when they are discharged from hospital. This would normally be for a period of up to four weeks and is known as ‘Discharge to Assess’ (DTA). At the time of the inspection the service had four DTA beds, and three were occupied. The assessment and rehabilitation of people staying in a DTA bed is overseen by a DTA team, which includes external community physiotherapists and occupational therapists.

Accommodation and facilities at Warwick Park Care Home Care Home are over two floors, with access to the lower and upper floors via stairs or a passenger lift. There are some shared bathrooms, shower facilities and toilets. Communal areas include two lounges, a dining area, a conservatory, a patio seating area and a garden.

The service had a new 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.

The service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make sure that significant improvements have been made within this timeframe.

The overall rating for this service is ‘Requires improvement’.

At the previous three inspections (December 2014, March 2016 and September 2016) we asked the provider to take action and make improvements. This was because care was not always safe, personalised and consistent; and the systems in place to monitor the quality of the service were ineffective. People were not protected from risks associated with their care. People were also at risk of not receiving their medicines as prescribed. People’s records were not completed accurately to reflect care given and people’s mental capacity was not always assessed.

At the unannounced comprehensive inspection of this service on 1, 6 and 28 September 2016, continued breaches of legal requirements were found. We rated the service as inadequate overall. In line with our enforcement policy we made the decision to place conditions on the provider’s registration. We told the provider they must send us monthly reports to tell us about their progress to address the concerns raised. This condition would remain in place until we are satisfied sufficient improvements have been made. At this inspection we found many improvements had been made but we had on-going concerns related to medicine management, risk management and the governance systems in place.

Medicine management was not always safe. We found the systems in place to check medicines were administered as prescribed had improved but there were still multiple issues. We found one person had not received their prescribed antibiotics and another had not received their medicine due to poor stock control. There were ongoing issues with gaps on medicine charts and we found medicine equipment which had expired. However, recording of creams on body maps had improved, fridge temperatures were being recorded, there were policies relating to medicine management in place and thorough audits identifying issues which were being followed up and action taken. Following the inspection the registered manager sent us information detailing the improvements which had been made to ensure medicine management would be safer.

Risk asses

Inspection carried out on 1 September 2016

During a routine inspection

This comprehensive inspection was undertaken on 1, 6 and 28 September 2016. The first day of the inspection was unannounced. Warwick Park Care Home Care Home provides nursing and residential care for up to 50 older and younger adults, some of whom are living with dementia or who may have physical or sensory health needs.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

On the first two days of the inspection 45 people were living at the service. At the time of the inspection the provider was involved in a pilot project with the NHS and local hospital, to help facilitate faster hospital discharges. Thirteen of the 50 beds at the time of the inspection were contracted by commissioners for this purpose. During the inspection, due to our concerns, admission to these beds was stopped by the provider.

Accommodation and facilities at Warwick Park Care Home Care Home are over two floors, with access to the lower and upper floors via stairs or a passenger lift. There are some shared bathrooms, shower facilities and toilets. Communal areas include two lounges, a dining area, a conservatory, a patio seating area and a garden.

The service 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. The manager was also the registered provider.

At the previous two inspections (December 2014 and March 2015) we asked the provider to take action and make improvements. This was because care was not always safe, personalised and consistent; there were not sufficient staff to meet people’s needs in a timely way and, the systems in place to monitor the quality of the service were ineffective. People were not protected from risks associated with their care. People were also at risk of not receiving their medicines as prescribed. People’s records were not completed accurately to reflect care given.

At the unannounced comprehensive inspection of this service on 22 and 23 March 2016, breaches of legal requirements were found. We served Warning Notices on the registered provider. Warning notices are part of our enforcement policy and tell the provider where they were not

Inspection carried out on 22 March 2016

During a routine inspection

This was an unannounced inspection on 22 and 23 March 2016. Warwick Park Care Home provides nursing and residential care for up to 50 older people who require support in their later life or are living with dementia. There were 47 people living at the home at the time of our inspection. At the time of our inspection the provider was involved in a pilot project with the NHS and local hospital, to help rehabilitate people to return home following hospital treatment.

The home is on two floors, with access to the upper floors via stairs or a passenger lift. Some bedrooms have en-suite facilities, whilst other bedrooms have shared toilets, bathroom or shower facilities. There are two lounge/dining rooms, two conservatories, a patio seating area and garden.

There was a registered manager in place. 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.

At the last inspection on 4 December 2014 we asked the provider to take action to make improvements to how they respected and involved people, social activities, and how records relating to people’s care were documented. Improvements were also required to help ensure the management of medicines was safe, and there were enough staff to meet people’s needs.

The provider sent us an action plan on 7 April 2015 confirming how improvements were going to be made and advising us these improvements would be completed by June 2015. During this inspection we looked to see if these improvements had been made. We found they had not all been completed.

People told us they felt safe living at the service, with one person telling us, “They check on me about every hour, so I know I’m safe enough”. People were protected from abuse and harm because staff and the registered manager understood their safeguarding responsibilities. People were not always protected from risks associated with their care because staff did not always have guidance and direction about how to minimise risks relating to people’s care.

People lived in an environment which had not always been assessed for risks which could cause people harm. For example, doors which should have been locked to prevent injury, for example a cleaning store was not. Overall, the environment was clean and free from odour; however there were some bedrooms which had a smell of urine.

There was not always enough staff deployed to meet people’s needs. Some people did not receive the care they required because their call bells were not answered promptly. People who were unable to use their call bell had to wait for staff to hear them calling out, which meant they may not always receive support quickly. Staff told us staffing levels could vary at times, impacting on the quality of care people received. However, people did not complain to us about staffing levels with one person telling us, “There is always plenty of staff around if I need anything”.

People were complimentary of the food and of the recently employed chef, telling us, “Today it is meatballs, since that chef came we’ve had marvellous meals, everything is lovely and tasty. I look forward to everything he brings up. In fact if you want extra things he gets them”. A member of staff explained, “We went through a few different chefs but the new one he’s fantastic. Now he’s here the kitchen is finally sorted. He’s very approachable, nothing is too much trouble and he gives a lot of variety as well. He will go and chat with people and ask them what they would like if. He’s jolly and boosts morale as well”.

People’s care plans did not always provide detail about how to meet their individual nutritional needs, so staff may not always know how to correctly support people. Documentation which was being compl

Inspection carried out on 4th December 2014

During a routine inspection

We inspected Warwick Park on 04 December 2014. Warwick Park is a care home for older people who require nursing or personal care. It provides accommodation over two floors for up to 50 people. At the time of the inspection there were 40 people living at Warwick Park.

There was a registered manager in post at Warwick Park. 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.

We saw people were well cared for, but some people did not always have their needs met in a timely way. Staff and people living at the home told us there were not always enough staff to meet their needs. People told us they had to wait for care to be provided at times; “Wait to go to bed, in toilet ages waiting” and “They could always do with a few more pairs of hands” and “Sometimes there are delays answering bells.” Following the inspection we received anonymous information of concern, from one person, stating that some staff were not always respectful to people at the home. We heard some staff using inappropriate disrespectful language during the inspection.

The provider did not have an effective way of monitoring and assessing the service it provided to people. Some maintenance of the premises had not been regularly monitored. Although a lot of training and support had been offered to staff, the training, supervision and appraisal records were not held effectively so the provider could monitor when such support was next due for individual staff. We found records relating to people’s medicines were not always accurate or completed by staff appropriately.

Accidents and incidents were not audited so that any patterns could be addressed to help reduce the risk of re-occurrence. Food and fluids charts were kept by staff for each person at the home. It was not clear why all people at the home required this monitoring and was institutional practice. These charts did not show they had been monitored to ensure each person had sufficient to meet their individual needs. Care plan reviews were not always held in a timely way to reflect any changes that may have taken place in the needs of a person. This meant staff were not provided with accurate information to support them to meet people’s needs effectively. People were not always involved in their own care plan reviews or given the opportunity to sign in agreement with the contents. We have required the service to always keep the records of peoples care adequately. Activities were provided, however, people told us they did not always find them to their choice and preferred to spend time in their rooms. You can see what action we told the provider to take at the back of the full version of the report. The provider told us they were keen to address the shortfalls found at this inspection and that they were committed to improving this service.

People were supported to live their lives in the way they chose. People’s preferences and wishes were recorded and well known by the staff who cared for them. People were asked what they thought of their service at residents meetings. People told us they saw the registered manager most days, who they could speak with if they wished. People had requested activity to be provided to them in their rooms and this was being discussed with the registered manager.

Staff reported being supported by the registered manager and although stated they were stressed and under pressure due to staff shortages, they felt they worked well together as a team. They told us; “I really love working here, if there are any problems the manager is more than happy to sort them out” and “We are a good team if we see someone is down, the team try to bring them up.”

During our inspection there was building work going on around the home as part of the re-furbishment programme started by the provider. The service was in the process of making rooms bigger and adding en-suite facilities. New carpets were due to be laid the week after the inspection. Disruption was kept to a minimum for people who lived at the home. There were comfortable areas for people to spend time with visitors or time on their own away from their bedrooms.

People were happy living at Warwick Park. The atmosphere was friendly and relaxed and we observed staff and people living at the service were happy in each others company. People told us; "Lovely, only one word, I’m well looked after, couldn’t be better” “I like it here, the girls are lovely” and “the food is not brilliant, the veg are always mashed.” We saw visitors come and go throughout our visit, people told us visitors were welcome at any time.

People felt safe at the home. One person told us; “I feel safe and respected, there is nothing wrong with that.” Staff were aware of how to report any concerns of abuse they may have to the registered manager and were confident any necessary action would be taken to protect people. We found the service was meeting the requirements of the Deprivation of Liberty Safeguards. People’s human rights were properly recognised and promoted.

Staff understood the needs of people and we saw that support and assistance was provided in a caring manner. People and their families told us; “Staff are wonderful couldn’t have better staff,” “Its alright, been here seven years, they [staff] are respectful, no harm.” Visitors told us; “My Mum would not be alive today if she hadn’t come here, it is a lifeline. I can’t fault anything not one thing and my brother feels the same he has lunch there, he spends hours he loves it.”

The provider took steps to ensure staff were skilled. Staff were actively encouraged to attend training in areas specific to the needs of people living at the home, for example, phlebotomy [blood taking] and catheter care. Specific care guidelines were provided to staff to help ensure best practice was followed by the staff in the home. This helped ensure the care provided to people was safe and effective to meet their needs. New staff received a thorough induction when they joined the home and all staff fully understood their roles and responsibilities.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of the report.

Inspection carried out on 29 July 2013

During an inspection in response to concerns

On the day of our inspection we found people were cared for well. People told us "It's quite good here" and "They look after me." We found the people had their needs assessed prior to coming to live at Warwick Park and they had individual care plans which reflected their needs. Many people told us that there were sometimes long delays in receiving help with personal care. A new call bell monitoring system was being introduced to monitor this. We found that staff knew people well and worked in partnership with other agencies to meet people's needs.

We found that people at the home felt safe. Staff had a good knowledge and understanding of safeguarding and they knew how to raise any concerns they may have about a vulnerable person. The staff we met felt supported by the registered manager and able to discuss and share concerns they may have with her.

We found the home had a complaints policy and followed this to manage complaints which people had made. The registered manager was keen to learn from complaints that had been made and we saw that this had occurred with a complaint the provider had recently received.

Inspection carried out on 25 January 2013

During an inspection in response to concerns

We carried out this visit after concerns were identified at a local safeguarding meeting attended by the Care Quality Commission.

We met ten of the people who used services, talked with the staff on duty and checked the provider's records. We also met and spoke to seven relatives, two visiting professionals and the registered manager also provided information. We also observed staff interaction with people as they went about their daily routines.

We saw people�s privacy and dignity being respected and we saw and heard staff speak to people in a way that demonstrated a good understanding by staff of people�s choices and preferences. People said, �I am looked after well�.

We saw that four people�s care records described their needs and how those needs were met. We saw that best interest meeting were held to determine the best way to support someone who was unable to make that decision.

Some people were able to say that if they had any concerns that they would speak to staff or the management and felt confident that appropriate action would be taken.

We saw that the staff had a good understanding of people's individual needs and that they were kind and respectful. They took time to work at people's own pace.

Inspection carried out on 28 September 2012

During a routine inspection

We carried out an unannounced inspection on 28 September 2012. On the day of our visit we were told that there were 34 people living at Warwick Park Care Home. We spoke with 15 people living at the home, two relatives, eight staff members, the registered manager and looked at four people�s care files.

We saw that staff treated people with consideration and respect. For example, we saw that staff responded to people�s care needs to ensure that they were kept comfortable and informed about what was happening, such as discreetly assisting someone to the toilet and informing them about when lunch would be.

Care plans that we saw reflected people�s health and social care needs and demonstrated that other health and social care professionals were involved.

We spoke with staff about their understanding of what constituted abuse and how to raise concerns. They demonstrated a good understanding of what kinds of things might constitute abuse, and knew where they should go to report any suspicions they may have.

We had received concerning information about people�s needs not being met in a timely way possibly due to low staffing levels. During our visit we saw that the registered manager was aware of and dealing with this issue, by restructuring the staff team and recruiting additional staff.