Warberries Nursing Home is a 'care home'. 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.

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.

Warberries Nursing Home provides nursing, care and accommodation to up to 49 older people who may also be living with dementia. On the day of inspection there were 30 people living at the service.

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

We visited Warberries Nursing Home to follow up on an inspection we had carried out on the 8th October 2013. At that time we had found that the home was not compliant with standards regarding supporting workers. The homes training matrix had indicated that many staff required training updates in areas such as manual handling, safeguarding adults, infection control and fire awareness.

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

On the day of our inspection 29 people were living at the home and receiving care from the service. We, the Care Quality Commission (CQC), spoke with five people, the manager, a registered nurse, three care workers and two ancillary staff. We also spoke to a visiting social worker. One person described the home as a "lovely".

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.

We carried out this review as part of our scheduled programme of inspection. We also wanted to follow up on some information of concern received from the service and from the local safeguarding team.

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.

Everyone we spoke with was very happy with the care that they received and they confirmed that they were able to carry on with their chosen lifestyles since moving to the Warberries. Comments included "It lovely here, I can ring the bell if I need anything," "We are all very well looked after" and "I'm very well looked after."

People told us that they were able to make decisions about all aspects of their day to day lives. Everyone asked said that they were able to choose what time they got up, when they

went to bed and how they spent their day. One person said "We are well looked after but we

can please ourselves about what we want to do." Another person said "They help me when I need help but I decide how and when I want help."

Many of the people spoken with commented positively on the range of activities available

at the home. People told us that they were told in advance of what activities were taking place each week so they could plan their time. People said that they were able to choose the activities that interested them and were not pressured to join in with activities they were not interested in.

Throughout our visit we saw that staff interacted with people in a respectful and kind manner. People living at the home appeared comfortable and relaxed with all staff.Everyone said that staff were always kind and approachable. One person told us "I have nothing to worry about and feel very safe here."

Summary of our findings

During the inspection there were numerous positive comments about the staff. These comments included; "They are all lovely," "All the staff are very, approachable" and "Staff are all very nice and helpful."

People said that they were asked their opinions about the care that they received and were able to make suggestions about the day to day running of the home.

We saw comments made by relatives including one thanking the provider for “Giving me so much of his time”. Comments included “To all our very good friends at the Warberries, you really have excelled yourselves in all the care and kindness and consideration that you have shown to us over the past”.

We spoke with people using the service who told us they were happy with the quality of service provided since the Margaret Rose Care Limited has taken over the service. We spoke with staff who told us that they are confident in the management of the home and that the standard of care is monitored, although this is not currently recorded consistently. They told us they had “been through some very unsettling times recently but now things are settled and calm, things are a lot better. Staff are happier and that makes people living here happier”. They also confirmed they felt that when concerns are raised, these are addressed and appropriate action taken.

The provider told us that they operate a system which provides regular reviews on the Quality of Care in the other services they own and this will be introduced at Warberries. People at the home, their relatives and professionals will be provided with questionnaires to get their views and concerns.

The Inspection took place on 19 and 20 November 2014 and was unannounced.

Warberries Nursing Home provides nursing care and residential care and accommodation for up to 49 people, including individuals living with dementia or mental health needs. On the day of the inspection 38 people lived at the home. 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 registered manager was in the process of relinquishing the post. Another manager had been appointed and was in charge of the home. This manager had applied to become the new registered manager.

During the inspection people and staff were relaxed, there was a calm and pleasant atmosphere. Comments included; “It’s wonderful here” and “The staff are lovely, kind nice people and provide a positive service.” People told us they had the freedom to move around freely as they chose and enjoyed living in the home.

People were not consistently involved in identifying their needs and how they would like to be supported. People’s preferences were not actively encouraged or sought. The manager had taken steps to address this and plans had been put in place to ensure people received personalised care and support.

People’s risks were managed and monitored. People were not consistently promoted to live full and active lives or supported to go out in the community. Activities did not meaningfully reflect people’s interests or individual hobbies. The service had employed an activities co-ordinator to address this issue.

There were sufficient numbers of suitable staff to meet people’s needs. Safe recruitment practices were followed. The service had implemented plans to help ensure all staff were appropriately trained and had the correct skills to carry out their roles effectively. One staff member said: “I’m fully up to date with all my training.” Another staff member told us; “I haven’t had all my training, but I am booked on to a course to have it.”

People were treated with kindness and respect. Staff supported people in a way that promoted and protected their privacy and dignity. Comments included, “Staff are excellent, they are lovely, kind nice people” and “My dignity is always respected, the staff are marvellous.” Staff felt the quality of care people received was the best thing about the service.

People were supported to maintain a healthy balanced diet. Dietary and nutritional specialists’ advice was sought so that people with complex needs in their eating and drinking were supported effectively. People told us they enjoyed their meals and did not feel rushed. One person said, “The food here is very nice.”

People had their medicines managed safely. People received their medicines as prescribed, received them on time and understood what they were for. People, when required, were supported to maintain good health through access to healthcare professionals, such as GPs, community psychiatric nurses, occupational therapists and physiotherapists.

People told us they felt safe. The manager had sought and acted on advice where they thought people’s freedom was being restricted. This helped to ensure people’s rights were protected. Staff displayed good knowledge on how to report any concerns and described what action they would take to protect people against harm. Staff told us they felt confident any incidents or allegations would be fully investigated.

Staff described the management as supportive and approachable. Staff talked positively about their jobs. Comments included: “The management listen and care.” And “I really enjoy my job, the management are good and listen to you.”

There were quality assurance systems in place. Incidents were appropriately recorded and analysed. Learning from incidents and concerns raised were used to help drive improvements and ensure positive progress was made in the delivery of care and support provided by the staff.