Warberries Nursing Home

Warberries Nursing Home provides personal and nursing care to a maximum of 49 people. The service provides support to people who are living with dementia, and/or have nursing or residential care needs. At the time of our inspection there were 35 people using the service.

People’s experience of the service and what we found:

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there was 1 person using the service who had a learning disability.

Risks to people were not always monitored and managed in a safe way, particularly risks associated with people’s particular health needs. People’s records did not always contain accurate, complete and contemporaneous information. Systems in place to safeguard people from abuse and avoidable harm, and to learn lessons from previous events, were not always effective. Although there had been improvements since our last inspection, the provider’s systems did not always effectively monitor the quality of care provided to identify risks and drive improvements. This continued to put people at risk of harm.

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.

There were enough staff who had been trained, and during inspection we observed warm interactions between people and staff. Staff knew people well and could describe them and their care needs to us. People told us they felt safe, and relatives felt their family member was safely cared for. There were no restrictions on people having visitors.

People were well supported, and their privacy, dignity and independence was promoted. People were supported to express their views and be involved in making decision about their care. People told us “They are caring, they don’t boss me around”, “They are respectful, no hesitation”.

There was a positive and open culture at the home. One person told us how they felt about the service, “I don’t think you could improve on it, if you ask for anything they get it for you. They inform me of any issues.” One family member told us they were, “kept up to date and the home call straight away if there are any concerns.” The provider worked in partnership with others.

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 26 September 2022.

At this inspection, we found that although some improvements had been made, and they were no longer in breach of regulation 10 or 18, the provider remained in breach of regulations 12 and 17.

At our last inspection, we recommended the provider reviewed a certain element of staff training. At this inspection, we found the provider had taken action to review and amend staff training.

This service has been in Special Measures since 12 April 2022. During this inspection, the provider demonstrated that improvements had been made and is no longer rated Inadequate. However, the service remains in Special Measures due to persistent breaches.

Why we inspected

We inspected due to receiving concerns about an alleged incident of abuse. A decision was made for us to inspect and examine those risks. During our inspection, we found the registered manager had taken swift and appropriate action in response to discovering the abuse.

Enforcement

We have identified continued breaches in relation to regulation 12 safe care and treatment, and regulation 17 good governance.

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

Follow Up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Special Measures

The overall rating for this service is ‘Requires improvement’. However, the service is remaining in 'special measures' due to the persistent breaches. 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 time frame and there is 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 not rated as inadequate for any of the five key questions, it will no longer be in special measures.

Warberries Nursing Home provides nursing care and support for older people. The service is registered to accommodate 49 people in one adapted building. The service supports people who are living with dementia, nursing or residential care needs. At the time of our inspection there were 31 people living at the service.

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

The provider had made some improvements in the service. However, the provider had also failed to act upon known areas of concern, non-compliance and risk to improve the quality of care for people at Warberries Nursing Home. This had exposed people to on-going poor care and risk of avoidable harm.

There were ineffective systems in place to assess, monitor and improve the quality and safety of the service. Not all accidents and incidents were recorded. There was no system in place to help identify themes and trends in order to make changes within the service to help keep people safe

People and relatives told us they received safe care from skilled and knowledgeable staff. However, the training in place to support staff who provided care for people who may demonstrate behaviours that challenge was not effective.

Not all risks to staff and people's safety were being well managed. Medicines were not always managed safely. The providers did not have regard for The Care Quality Commissions guidance on Diabetes and insulin use.

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 knew how to identify and report any concerns. There were sufficient staff deployed to meet people's needs and staff recruitment was on-going. Staff were confident in the new manager and leadership of the service.

People told us staff were caring. Staff did all they could to promote independence and we saw examples of this taking place. People had access to a wide range of activities and were supported to avoid social isolation.

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 inadequate (published 12 April 2022).

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 improvements had been made however we found the provider remained in breach of regulations.

At our last inspection we recommended the provider reviewed how the Accessible Information Standard (AIS) is being implemented within the service. At this inspection we found the provider had acted on this recommendation and had made improvements.

At our last inspection we recommended that systems within the service were strengthened to ensure clinical observations were carried out to confirm compliance with infection control procedures. At this inspection we found the provider had acted on this recommendation and had made improvements.

The last rating for this service was inadequate. The service is now rated requires improvement. This service has not achieved a rating of good for the last three consecutive inspections.

This service has been in Special Measures since 12 April 2022. During this inspection the provider demonstrated some improvements have been made. However the service is still rated as inadequate in the well-led key question. Therefore, this service is still in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last 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 COVID-19 and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement and Recommendations

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 monitor the service and will take further action if needed.

We have identified breaches in relation to medicines, accident and incidents, governance and the providers statutory requirements.

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 continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is ‘Requires improvement’. However the service is still rated as inadequate in the well-led key question therefore remains 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 rating, 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 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.

Warberries Nursing Home provides nursing care and support for older people. The service is registered to accommodate 49 people.

The service supports people who are living with dementia, nursing or residential care needs. At the time of our inspection there were 34 people living at the service.

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

The service was based on the values and ethos of: “Individuality and equality, kindness and compassion, dignity and respect, honesty, safety, and empowerment”. However, we did not find that these values were embedded into the culture of the service.

People and staff were not fully confident in the management and leadership of the service. There were ineffective systems in place to assess, monitor and improve the quality and safety of the service, and people and staff’s feedback was not sought and acted on for the purposes of continually evaluating and improving the service.

People were not always treated with dignity and respect and there was a shortage of clinically skilled staff within the service, to ensure people’s needs were met safely and/or in line with their care plans. The Accessible Information Standard (AIS) was not being fully considered to ensure those living with visual impairments received information in a format that met their individual needs.

People were not always supported by staff who had the knowledge to meet their needs because required training had not always been completed.

People, family and friends were not being accurately informed of current guidance relating to visiting, which meant some visits were being delayed. People were not always empowered to live an enhanced life and/or the best life possible; social activities were not always available.

Following our inspection, the provider submitted an urgent action plan to The Commission which set out how they would mitigate immediate risks to people. They also told the Commission they would suspend admissions to enable them to focus on making the necessary changes.

In addition, they told us they were committed to improving the safety and quality of the service for people, and in doing so confirmed they would positively engage with local authority health and social care quality teams for support.

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 the service was requires improvement published on 16 April 2021. At this inspection we found improvements had not been made.

Why we inspected

We received information from the Coroner regarding the death of a person at the service. We had also received whistleblowing concerns in relation to staffing levels, nursing competence, training, medicines management, skin, continence, nutrition, and diabetic care. As well as infection prevention and control, safety of equipment and the management, leadership and culture of the service.

As a result, we undertook a focused inspection to review the key questions of Safe and Well-led. During the inspection, because of concerns found, we widened the scope of the inspection to also include the key questions of Caring and Responsive.

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 COVID-19 and other infection outbreaks effectively.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We have found evidence the provider needs to make improvement.

The overall rating for the service has changed from requires improvement to inadequate. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Warberries Nursing Home on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to safe care and treatment, staffing, dignity and respect, and good governance.

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.

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.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore 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 rating, 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.

Warberries Nursing Home (“Warberries”) was a residential care home providing personal and nursing care to 30 people aged 65 and over at the time of the inspection. The service can support up to 49 people.

Warberries is an adapted older building with a newer extension. People live across three floors. One section, referred to as “the unit”, specialises in providing care to people living with dementia.

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

This inspection highlighted the service carried out some tasks well, but there were also concerns about people’s safety and how the service was being governed. People were positive about the care they received however, feedback from families and staff was mixed.

The registered manager and provider had ensured some systems of oversight were in place to review the service, identify issues and ensure these were addressed. However, some additional audits were needed for example in relation to falls and disposal of some waste. Staff told us they had identified concerns and made suggestions to improve the service and people’s care, these were not always responded to.

People living with dementia were not always safe from the actions of other people living alongside them. Some people found it difficult to communicate their needs and concerns. The provider had arranged some training for staff, but this had not been delivered due to the pandemic. Staff would benefit from training around different ways of communicating with people. In the months following the inspection, the registered manager has provided evidence to show what actions, alongside other professionals, has been taken to support people be safer in each other’s company.

People were at risk of harm from poor medicines systems and processes.

People’s health needs and associated risks were not always identified, assessed and mitigated. Where records of risks were in place, some of these had not been updated in line with the provider’s required programme or when adverse events, such as a fall, took place.

In general, good practice was being followed in respect of infection control and the home had not experienced an outbreak of Covid 19. Further improvements would enhance the good practice observed.

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 Good (the last report was published 12 December 2018). This has now deteriorated to Requires improvement. This is based on the findings at this inspection.

Why we inspected

We received concerns in relation to the management of medicines, the safety of people living with dementia, falls and the clinical management in the service.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

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

Enforcement

We have identified breaches in relation to safe care and treatment and, in respect of leadership and governance.

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.

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 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.

Warberries Nursing Home provides nursing care and accommodation for up to 49 older people who may also be living with dementia. At the time of this inspection, 31 people were living at the home.

At the last inspection, the service was rated Good.

At this inspection we found the service remained Good.

People received person-centred care which was responsive to their specific needs and wishes. Each person had an up to date, personalised care plan, which set out how their care and support needs should be met by staff. Assessments were regularly undertaken to review people's needs and any changes in the support they required.

People had access to a wide range of group and individual activities and events they could choose to participate in, which were tailored to meet their specific social needs and interests. This enabled people to live an active and fulfilling life.

People who preferred or needed to stay in their bedroom were also protected from social isolation. People regularly participated in outings and activities in the local community. The service also had strong links with local community groups and institutions.

When people were nearing the end of their life, they received compassionate and supportive care. People's end of life wishes were sensitively discussed and recorded.

Staff were aware of people's communication methods and provided them with any support they required to communicate in order to ensure their wishes were identified and they were enabled to make informed decisions and choices about the care and support they received.

The service had appropriate arrangements in place for dealing with people's complaints if they were unhappy with any aspect of the support provided at the home. People and their relatives said they were confident any concerns they might have about the home would be appropriately dealt with by the managers.

People were kept safe at the home, cared for by staff that were appropriately recruited and knew how to highlight any potential safeguarding concerns. Risks to people were clearly identified, and ongoing action taken to ensure that risks were managed well.

People's medicines were managed safely and the provider ensured that incidents and accidents were fully investigated. The home was well kept and hygienic.

Staff were well supported through training, supervision and appraisal. Staff worked effectively together to ensure people's needs were communicated and supported them to access healthcare professionals when they needed them.

People enjoyed the meals available to them and were appropriately supported with eating and drinking. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

The home was dementia friendly and met the needs of the people living there. Staff could demonstrate how well they knew people and people and their relatives were positive about the care provided.

People were treated with privacy and dignity and supported to be as independent as possible whilst any differences or cultural needs were respected.

The service had a robust management structure in place, and quality assurance systems were effective in driving improvements across the home. Regular feedback was sought from people and their relatives to ensure they were involved in the development of the service.

Further information is in the detailed findings below.

This unannounced inspection took place on 29, 30 March and 28 April 2016. The service was last inspected on 19 and 20 November 2014 when it was rated overall as ‘Requires improvement’. This was because people were not involved in identifying their needs and how they wanted to be supported. People’s preferences were not sought and activities did not reflect people’s interests and hobbies. Also, although there were good quality assurance systems in place, not enough time had passed for some of these changes to be fully embedded into practice. At this inspection in March and April 2016 we found that improvements had been made.

There were two managers registered in respect of the service. However, the registered provider had notified us that neither now works at the service. A new manager had been appointed and had submitted an application to register as manager. 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’s needs were met in a safe and timely way as there were enough staff available. There was a relaxed and unhurried atmosphere in the home which indicated there were enough staff on duty.

Staff ensured people received care and support that was responsive to their needs. People’s care plans contained details of how people’s needs were to be met and were reviewed regularly.

People’s privacy and dignity was respected and all personal care was provided in private. People’s needs were met by kind and caring staff. People told us how kind and caring staff were to them and how much they enjoyed living at Warberries. One person said “I love it, utterly adore it”. Staff asked people for their consent before they provided personal care. Staff spoke about people in a respectful, confidential and friendly manner. People were assisted with care tasks in gentle and caring ways.

People and their relatives could be involved in making decisions about their care if they chose. Care plans were reviewed regularly and updated as people’s needs and wishes changed. Daily records showed that people’s needs were being met. For example there were details of when specific health care needs were attended to.

Staff received training that helped them meet people’s needs. Training included topics such as moving and transferring, safeguarding people, infection control and dementia care. One staff member told us all the training had ‘boosted’ the way they felt about their job.

People were supported to maintain a healthy balanced diet. People told us the food was good and one person told us they were fed too well and always seemed to be going to a meal.

There were effective systems in place to manage people's medicines. People’s rooms had been fitted with lockable medicine storage cupboards and their individual medicines were stored in these. People had access to healthcare professionals such as GPs as and when required.

People who were able to, told us they felt safe at the home. People were protected from the risks of abuse as staff knew how to recognise and report abuse. Thorough recruitment procedures ensured the risks of employing unsuitable staff were minimised.

People’s human rights were upheld because staff displayed a good understanding of the principles of the Mental Capacity Act 2005 and the associated Deprivation of Liberty Safeguards (DoLS).

The manager was very open and approachable. Staff told us “[the manager] is lovely, you can go to them at any time”. People were confident that if they raised concerns they would be dealt with efficiently. There were effective quality assurance systems in place. An external person had independently audited the service to support its future development and improvement. The service had recently signed up to the Social Care Commitment. This is a Department of Health initiative to provide high quality care throughout the adult social care sector.

The provider had also been made aware that there wasn't a system in place to ensure all staff met formally with their line manager to discuss their development. This meant that staff did not have the opportunity to formally discuss their training needs or work issues with their line manager.

Following the inspection the provider sent us an action plan telling us what they were going to do to improve.

At this inspection we saw that improvements had been made. We saw that the home had put in place a training program. The majority of staff had undertaken the training updates required and other staff were booked to attend training before the end of March 2014.

The home now had an ongoing supervision program in place. We saw that staff had met with their line manager and had discussed their learning development needs and any work concerns they needed to discuss

Risks to people's health and welfare were identified and their needs were met in a way that was personalised to each person. Health promotion was encouraged through referrals to specialists. People told us they felt safe and well cared for.

We saw people had a choice of suitable and nutritious food and drink available in sufficient quantities. People said the food was good.

People received their medicines as they were prescribed although not always in a timely way.

Staff were familiar with how to safeguard vulnerable adults. They were supported to make known any concerns they might have had, through internal mechanisms and by "whistle blowing" if needed.

Whilst there were enough staff on duty, care workers and nurses had not received the training they needed to support them to carry out their roles and responsibilities. Some had not had training in moving and handling, medicines management, safeguarding, mental capacity and deprivation of liberty. Not all staff had received formal supervision.

Systems were in place to support the ongoing development of the quality of services provided and to identify and manage risk.

The home was undergoing major refurbishment. This included rebuilding a part of the home, refurbishing the kitchen and replacing roofs. Electrical, heating, water systems and flooring had been replaced. The garden was being redesigned and landscaped. During this process the home had remained open. People said the refurbishment was not affecting them, although they would be pleased when they could see the results. There was no evidence that the refurbishment was affecting people's health, welfare or safety.

A recent training and skills audit undertaken by the provider had demonstrated that robust systems were not in place to ensure that staff had the training, skills and supervision needed to meet people's needs. People told us that care workers and nurses were 'always patient and helpful' and were 'good girls'. The management team had found that some staff had poor attitudes. Measures had been taken to address this, and progress was being made. However, these measures were in the early stages of implementation. During our inspection two care workers declined to answer call balls because they were having their break. The provider explained that this was the type of staff attitude they were determined to change.