Warmere Court

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

At the last inspection, we found the provider in breach of Regulation 12 (Safe care and treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Two people requiring modified diets had been given high risk foods. A person at risk of malnutrition and who was to be weighed weekly, was not cared for in line with the provider’s guidance. One person living with Parkinson’s disease did not receive a medicine within the prescribed timeframe. At this assessment, improvements had been made and the provider was no longer in breach of Regulation 12. The requirements of the Warning Notice issued had been met. People on modified diets were supported safely and we observed some people having their lunchtime meal. People were given food that mitigated their identified risks such as swallowing, aspiration or choking. Audits provided good oversight and management of the home and were used to drive improvements. Medicines were managed safely. People living with Parkinson’s disease received their medicines within the recommended timeframes. People’s concerns were listened to and acted upon and events relating to their safety were investigated and remedied. People received continuity of care from staff who knew them well, understood their risks and how to support them safely. Staff understood how to protect people from the risk of abuse or harm and had received safeguarding training. People were supported with positive risk taking and understood any issues that posed a risk to their health and wellbeing. The home provided a safe environment for people. Staffing levels were sufficient to ensure people’s needs were met, and staff were recruited safely. The home was very clean with no unpleasant smells.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Accidents and incidents were recorded and analysed, so actions could be taken and improvements made. Accidents and incidents were recorded in ‘live time’ and flagged to regional managers and the provider’s compliance team. These were viewed at the start of each day in case some had come in overnight or at the weekend. On the provider’s system for recording accidents and incidents, there was a ‘lessons learned’ tab which had to be completed before the incident could be signed-off by the registered manager or regional manager. This ensured that every accident or incident had been considered individually, and improvements were made to mitigate the risk of similar events reoccurring.

People were encouraged to share any concerns they might have, so actions could be taken and lessons learned. One person said, “Staff are very kind and I have no reason to complain.” Another person had complained about their wheelchair needing a repair, and a new wheelchair had been ordered as parts were not available to complete a safe repair. A third person, when asked if they felt listened to, said, “Absolutely, they don’t have a choice with me!” and laughed.

Lessons were learned if things went wrong. One staff member provided an example. If a person had a fall, they would look at what had caused it and how this could be prevented from reoccurring. Physical health of the person would be considered, such as infections, mobility, trip hazards, equipment and environmental factors. All this information was used to update risk assessments and care plans. The registered manager explained how safeguarding notifications were completed for the local authority and used as reflective practice with staff every month. They provided an example of a person with Parkinson’s disease, their heightened risk of falls and this was discussed with staff. With regard to people developing pressure areas or moisture lesions, what staff should look for was discussed, including reporting and preventative measures. Staff endeavoured to be proactive and preventative in their approach. The registered manager demonstrated a good understanding of duty of candour, and the need to be honest and open when something went wrong.

People received continuity of care from staff who knew them well. When agency staff were used, these tended to be the same staff. We observed an agency carer supporting a person to eat their lunch. The carer explained the person could become quite anxious and distressed when presented with their meal. We observed this carer supported the person to eat their lunch in a sensitive way, providing the person with a range of food choices which appealed to them. Staff felt listened to by the management team. One staff member said, “I would have no hesitation in raising any concerns. They are a good company and I feel my views are respected.” Nurses and team leaders wrote up care plans and risk assessments. Care staff were involved in reviewing these with people and also informing staff of any changes to a person that might need to be reflected within their care plan. Staff demonstrated their understanding of people’s individual risks. For example, potential risks relating to choking and measures put in place to mitigate this. A carer was able to describe the signs of someone choking or aspirating and what to do. (Aspiration is when food or fluid is taken into the airway and lungs accidentally.)

The service worked with a range of health and social care professionals. For example, advice had been sought from speech and language therapists for people who had difficulties with swallowing. Modified diets were prepared as recommended, and fluids thickened in line with professional advice, to mitigate the risk of people choking or aspirating food or fluids. The service had a contract with West Sussex County Council and the majority of beds were commissioned by this authority. Assessments were completed for people who were referred to the service, either from hospital or care home setting. These assessments identified people’s care needs, so staff were prepared in advance, through information and training, to support them safely.

Risk assessments provided detailed information about people’s identified risks. These included risks of choking, malnourishment, weight loss, skin integrity, and falls. We reviewed several risk assessments and checked staff understanding of particular risks that people experienced. For example, people at risk of developing pressure areas had risk assessments using Waterlow. Waterlow is a tool that calculates the risk of people developing pressure ulcers through a points-based system. Where people were at risk of developing pressure ulcers, they were supported in a variety of ways, such as the use of pressure-relieving mattresses, and being repositioned in bed. Monitoring charts to record people’s weight enabled effective oversight to identify when people might need extra calories to fortify their diets. One person had received input from the hospital dietician and also been assessed by a speech and language therapist. As a result, they were prescribed calorific supplements and weighed weekly, with their consent. A review of their weight records for the last 3 months demonstrated their weight remained stable and risk of weight loss was mitigated.

Safe systems of care had been established to promote people’s safety. As much as possible, care and support were planned and organised with people. One person explained they had lived at Warmere Court for a long time, although they could not remember if staff had spoken with them about their care. However, they told us that staff did a good job. Another person had limited movement and mobility. They were able to use their call bell which had been placed directly under one hand by staff, so they could press down on the call bell to summon staff. Although they were unable to reach their drink on a table next to their bed, they were able to use their call ball if they felt thirsty. Bed rails and pillows placed appropriately, supported their posture and comfort. Every person cared for in bed had call bells. There were no signs of restrictive practices.

Processes were sufficiently robust to monitor any safeguarding concerns and to ensure these were reported to the local authority as well as to CQC. Where people lacked capacity to make specific decisions, the service adhered to the requirements of the Mental Capacity Act 2005, (Deprivation of Liberty Safeguards) and decisions were taken in people’s best interests. This ensured people’s freedom was protected and they were supported in the least restrictive way possible.

Staff had completed training in safeguarding and understood the different types of abuse they might encounter, and what actions to take. One staff member explained how they kept people safe and was very knowledgeable on this topic. They knew how to recognise signs of potential abuse or harm and how to report this, including to the police, local authority and CQC. This staff member told us they had no concerns about the way people were treated or the conduct of staff. They were very clear they would report any concerns to the management team. Staff could raise any concerns anonymously if they preferred. A staff member knew how to do this through the provider’s whistleblowing policy. They told us they had access to this policy and there were posters on display on how to whistleblow too. Staff completed safeguarding training annually. A staff member said, “This is through e-learning, although we are just going back to face-to-face training. I’ve never had to report anything of a safeguarding nature, but we did raise a safeguarding concern recently regarding the hospital. I wouldn’t hesitate to report any concerns if I witnessed something.” They added that generally staff worked in pairs when delivering personal care to people. This was a safety factor to prevent abuse and also because people had high support needs which required 2 staff to care for them.

People were safe living at Warmere Court. One person said, “I feel very safe. I have no worries and staff are very kind and gentle. I am look after well. Most staff know me well, although there are a few new faces now and again.” Another person told us, “I have no concerns about my safety. The care is good and staff are generally very kind and helpful. I would tell my family if I had any concerns as I have daily contact with them and I would also tell care staff.” People were protected from the risk of abuse or harm and knew how to raise any concerns they might have. We observed staff treated people courteously and with dignity and respect.

Processes were effective in monitoring and managing risks. For example, a person’s risk of falls was exacerbated because of arthritis. A GP was brought in, a scan and ECG was undertaken to see whether there were any contributing factors to the falls, and actions were taken to minimise any further risk of falls.

Staff were well-informed on how to manage people’s risks safely, whilst promoting their independence. For example, a staff member explained the risks people would face who had diabetes. Their knowledge on this topic was good and they demonstrated their understanding of signs of unstable blood sugars and actions to be taken. They told us about a person who was a diabetic and had capacity to choose what they ate. They chose not to eat a diet that would support good health, and the staff member advised the person and pointed out the risks and consequences of not eating a healthy diet. The chef spoke knowledgeably about diets for older people, and the need to ensure people had enough protein to maintain their muscle mass, whilst reducing their salt and sugar intake. The chef knew people’s individual dietary needs, including fortified diets to support people at risk of weight loss. They told us they prepared protein milkshakes for people with small appetites who were at risk of losing weight.

People were encouraged to be involved in planning and reviewing their care. One person told us they could become depressed and anxious at times. Their care plan reflected this and showed they had received support from medical professionals, and opportunities to be reassured by staff. This was confirmed by our observations between this person and staff on the day of inspection. Staff were person-centred in their approach and were empathic when providing support. People told us they were encouraged to take positive risks, and bespoke equipment promoted their independence. For example, one person liked to manage their drink independently, but had been assessed as at risk of scalding. A risk measure was implemented to mitigate this risk and enable their independence. They drank using a straw and beaker, and their hot drinks were mixed with 2-parts cold water. No unnecessary restrictions were placed on people, and they were free to move around the home freely. Staff were kind and reassuring in their approach when supporting people. One person did not like having to use the hoist as they felt this impacted on their independence. However, they told us that staff provided reassurance when the hoist was used and they had never had any incident whilst using the hoist. Staff tried to allay their anxieties and worries that they might fall. This person’s care plan provided clear guidance for staff on supporting safe transfers.

People were supported by staff to understand and manage identified risks and received care that met their needs. We observed a person had refused their lunchtime meal because they wanted an alternative which put them at risk of choking. The food they were offered was pureed and presented nicely with each food item presented separately on the plate. A Deprivation of Liberty Safeguards was in place due to the person’s high risk of choking and refusal to limit their risk by accepting a modified diet. Although the person had chosen what they would like to eat, they did not accept their lunchtime choice. They refused their main course, but did eat some dessert and were offered three different types of pudding; they ate a mouthful of each. Throughout the inspection, we saw people were supported by staff who understood any risks associated with their care. Staff followed information contained within people’s care plans. For example, a person at high risk of choking due to a stroke could hold food in their mouth. Staff needed to give verbal prompts to remind the person to swallow, followed by checks that this had been done after each mouthful. The person’s risk of aspiration had been identified and was mitigated through a modified diet and thickened fluids, as advised by healthcare professionals.

Potential risks in the environment had been assessed to enable staff to deliver care safely. The home was well maintained and equipment was serviced regularly, for example, hoists were safe for staff to use when transferring people and were fit for purpose. The home accommodated pet guineapigs and a friendly parrot. Staff cleaned and fed the animals and encouraged people to engage with them. A notice on the parrot’s cage provided a history of the bird and warned people about the risk of putting their fingers through the bars.

Various sensory experiences around the home provided people with visual and tactile opportunities. Pictures of Hollywood stars on one corridor encouraged conversation about films people had seen. Close Circuit Television (CCTV) was operational at the entrance of the home, with views of the car park, and provided security when any visitors tried to gain access. This was especially important at night and provided peace of mind to people and staff.

The provider had implemented a system of audits to monitor the safety of the environment including risk assessments, cleaning schedules, health and safety audits and fire safety. A handyperson was employed to undertake repairs and maintenance of the environment.

The environment provided a safe setting for people. People confirmed they felt safe. One said, “Staff seem to know what they’re doing. I receive help when I need it. Access to doctors is good and the nurses change my dressings.” Another person had used their electric wheelchair to move safely around the home, although this was due to be replaced with a new model. Attention had been paid to people’s surroundings, with doors at the top of stairs to prevent accidents and falls. Spacious communal areas and corridors enabled people to move freely and safely. Bathrooms were furnished with hoists and aids to support people when they had a bath or shower. Handrails could be used to aid people’s mobility and promote their independence. Equipment such as pressure relieving mattresses, mitigated people’s risks of developing pressure areas. Sensor mats in bedrooms were used so staff could provide immediate assistance when people were moving around.

Staffing levels were sufficient to meet people’s needs. Generally people felt there were enough staff on duty. One person said, “Staff pop in and out and that is why I like my door open. Staff are busy, but they come in to check on me, but don’t always have time to sit and talk.” When asked about staff responding to their call bell, another person told us, “Sometimes it’s better than others. It depends on the urgency and time of day.” They added they felt reassured they would receive a response when they used their call bell and there always seemed to be enough staff around.

Our observations confirmed the number of staff on duty correlated with staffing rota records. Call bells were responded to promptly by staff and people’s needs were attended to by staff in communal areas such as the dining room and lounge areas. There was flexibility for staff to work overtime if they wished and rotas were planned over 4 – 8 weeks so staff could sign up for any overtime through the provider’s portal.

Staffing levels were calculated based on people’s care and support needs. Assessments were completed before people came to live at the home, including any impact on overall residency and existing residents. Staff were recruited safely. We reviewed 2 staff files and these showed application forms had been completed fully, with identity checks and references. Staff suitability to work in a care setting had also been determined with Disclosure and Barring Service (DBS) checks. DBS checks provide information including details about convictions and cautions held on the Police National Computer. The information helps employers make safer recruitment decisions. Records showed staff received supervision and support from their line managers. New staff completed an induction programme, including the training they needed to carry out their role safely and effectively.

There was sufficient experienced and skilled staff working at the home to meet people’s needs. Staffing levels were determined using a dependency tool which estimated the number of hours’ support people required from staff based on their specific care needs. We received mixed feedback from staff with regard to staffing levels. One staff member did not feel there were sufficient staff on the nursing floor, particularly since the majority of people had high support needs and many required 2 staff to deliver care. Other staff did feel there were enough staff on duty and both felt they had enough time to provide support and spend time with people. Any gaps within staffing rotas were filled by agency staff, and the same agency staff were used consistently. A carer told us they did not have to use agency staff so often as there had been a big recruitment drive. Some staff had dual roles, for example, housekeeping staff were also trained to deliver care. Staff received supervision from their line managers. One staff member said, “I haven’t been here long, but the support system is massive. There’s always someone around to guide you. They organise training and address any shortfalls. They’re all helpful.”

The home provided a clean and comfortable environment for people. One person said, “They are always cleaning my room. The person who cleans is very nice and very chatty; we have a laugh.” Another person, when asked about their safety, felt, “All is good. Staff wear personal protective equipment (PPE) and they are good and caring”. They added the staff were trained and knew what they were doing.

Staff had been trained in infection prevention and control and in the use of PPE. We were advised by the registered manager that 1 person was in isolation due to testing positive for Clostridium difficile (C-Diff). C-Diff is a type of bacteria that can cause diarrhoea and often affects people who have been on a course of antibiotics; it is extremely contagious. Steps had been taken to prevent the infection from spreading, with the person being barrier nursed in their room. We spoke with a laundry assistant who explained their understanding of infection control and the use of red bags for contaminated items that were laundered separately in a dedicated washing machine.

Processes included annual training for staff on infection prevention and control, donning and doffing of PPE, and risk assessments as needed. For the person in isolation, their care plan provided guidance on good infection control and hygiene practices for staff, as well as ensuring the person’s fluid intake was increased to prevent the risk of dehydration. There were notices around the home reminding staff on the use of PPE, and stations equipped with PPE for staff to use.

People’s bedrooms were clean and tidy, and there were no malodours. En-suite bathrooms were clean with sufficient stocks of PPE available for staff to use. Communal areas were clean and windows had been opened to let in fresh air. We observed staff donning PPE before entering the person’s room who had contracted C-Diff. Staff disposed of the PPE before leaving the room and the bedroom door was kept closed. There was very clear signage on the bedroom door indicating the person was in isolation and the risk of infection. A dedicated PPE station had been placed outside this person’s bedroom door.

Processes were effective in ensuring the safe management of medicines. Medication records were kept electronically and checked by senior staff to ensure people received their medicines as needed. Medicines requiring extra secure storage were managed safely and recorded appropriately. Medicines were ordered for people in a timely way to ensure they did not run out. Any medicines no longer needed were disposed of safely. Protocols for medicines to be taken as needed (PRN) were on display for staff in the medicines room. Medicines requiring refrigeration, such as insulin, were kept safely and within recommended temperature ranges. No medication was used to control people’s behaviour.

Only staff who were qualified, or received appropriate training, were allowed to administer medicines. Registered nurses and team leaders gave people their medicines. If people were admitted to hospital, a print-off of their medication record went with them, as well as a summary of their care needs and prescribed medicines. We discussed how medicines were managed with a registered nurse on duty. They told us they had completed medicines training and this had been signed off before they were allowed to administer any medicines on their own. All medicines people received had been prescribed by their GP or healthcare professional.

People received their medicines as prescribed from trained staff. We observed people having their medicines at lunchtime. A registered nurse administered medicines to people from a special trolley which stored medicines securely. The registered nurse washed their hands thoroughly in the medicines room before beginning the medicines round. As each person received their medicine, the registered nurse waited with them to ensure there were no mishaps. For example, 1 person required paracetamol in an effervescent form which required dissolving with water. This took a few minutes to dissolve and the nurse waited patiently with the person whilst they drank the liquid, ensuring any bits left at the bottom were finished. Each person was offered pain-relief as appropriate and the nurse gained people’s consent before giving them their medicine. No-one at the home administered their own medicines; everyone received their prescribed medicines from trained staff.