This inspection took place on the 10 and 11 of August 2017 and the first day of the inspection was unannounced. The registered manager, staff and people at the service were aware of our visit on the 11 August 2017. The Warrington Lodge provides accommodation and personal care for up to 21 people with a diagnosis of dementia and at the time of the inspection there were 20 people living at the service.
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.
Where wedges were used to prevent people from falling our of bed capacity assessments were not carried out before making best interest decisions. Some documentation included references to making best interest decision to deliver personal care to people who resisted and were at risk of skin breakdown. However, the framework needed to make these decisions were not in place. The registered manager agreed to complete capacity assessments where appropriate.
The staff we spoke with were knowledgeable about enabling people to make day to day decisions. We saw staff gain consent before any task or activity took place. The people at the service were subject to continuous supervision and applications to deprive people of their liberty were made. to the appropriate supervisory authority. Records were clear where Lasting Power of Attorney were in place and copies of activated orders were kept in care records.
People told us they liked living at the care home. They said the staff were kind and that their privacy and dignity was respected. Relatives said their family members were safe living at the service and had no “concerns”.
Members of staff said they had attended safeguarding of vulnerable adults training. Their comments indicated their understanding of the safeguarding of adults from abuse procedures. Staff knew the types of abuse and how to identify abuse. Staff were knowledgeable about the actions they needed to take where their concerns were not taken seriously by the registered manager.
People received care that was individual to their needs. Care plans were detailed and included people’s preferences. People and where appropriate their relatives were involved in the reviewing process of their care needs. There was a programme of group activities and some one to one activities were taking place for people who preferred not to join group activities.
Risks were assessed and appropriate action was taken to meet the identified risk. Staff were knowledgeable about the people at risk and the actions needed to minimise the risks.
The rotas in place showed there was sufficient staff on duty to meet people needs. Catering and housekeeping staff as well as an activities coordinator was employed. Staff said the staffing levels were adequate to meet people’s needs. People told us their care was not rushed and staff took time to listen to them.
Safe systems of medicine management systems were in place. People were supported with their ongoing healthcare needs. The health and social healthcare professionals told us their advice was followed and requests for visits were made at the appropriate times.
Staff were supported with the roles and responsibility. New staff had an induction to prepare them for the role they were employed to undertake. Staff attended training to meet the needs of people which included dementia awareness. There was an expectation that staff completed recognised vocational training for working with vulnerable adults which included Care Certificate and Quality Credit Framework (QCF). There were opportunities for staff’s professional development which included one to one supervision with the in house trainer and annual appraisals with the registered manager.
Quality assurance systems were in place. The views of people and their relatives were gathered and action was taken from the feedback received. Social and healthcare professionals were positive about the care and treatment people receive.
The staff said they had good support they felt they had a voice. The staff were commended by relatives for the care they delivered to their family members living at the home. Staff meetings were the forums used to share information about changes in policy and to discuss issues relating to joint working. Staff said the team worked well together and felt valued by the organisation.
The home was designed for people living with dementia. There were signs to help people find their way around. We saw there were seating areas and points of interest for people that liked to walk around the home. Memory boxes on bedroom which contained objects of interest specific to the person helped people find their way to their bedrooms.