We inspected the service on 20 March 2018. The inspection was unannounced. Warren Drive is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Warren Drive is registered to provide accommodation and personal care for 29 older people. There were 21people living in the service at the time of our inspection visit.

The service was run by a company who was the registered provider. There was 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. In this report when we speak about both the company and the registered manager we refer to them as being, ‘the registered persons’.

At the last comprehensive inspection on 17 October 2016 the overall rating of the service was, ‘Requires Improvement’. We found that there were two breaches of the regulations. This was because there were shortfalls in the arrangements that had been made to provide people with safe care and treatment. We also found that robust arrangements had not been made to ensure that people were fully supported to give their consent to the care they received.

We told the registered persons to take action to make improvements to address both of our concerns. After the inspection the registered persons told us that they had made the necessary improvements.

At the present inspection we found that suitable provision had been made to provide safe care and treatment. This included there being safe arrangements for the management of medicines and for promoting people's health and safety. Also, suitable provision had been made to promote good standards of hygiene in order to prevent and control the risk of people acquiring infections. We also found that people’s consent to their care had been obtained in the right way.

Our other findings were as follows. People had been safeguarded from situations in which they might experience abuse. There were enough care staff on duty and background checks had been completed before new care staff were appointed. Also, lessons had been learned when things had gone wrong.

Suitable arrangements were in place to assess people’s needs and choices so that care was provided to achieve effective outcomes. This included providing people with the reassurance they needed if they became distressed. Care staff knew how to care for people in the right way and had received training and guidance. People were helped to eat and drink enough to maintain a balanced diet. Suitable arrangements had been made to help people receive coordinated care when they moved between different services. Also, people had been supported to access any healthcare resources they needed. Furthermore, the accommodation was adapted, designed and decorated to meet people’s needs and expectations.

People were treated with kindness and compassion in a way that respected people’s dignity. People were given emotional support when it was needed. Also, they had been supported to express their views and be actively involved in making decisions about their care as far as possible. This included them having access to lay advocates if necessary. Confidential information was kept private.

People received responsive care that met their needs for assistance. Also, care staff supported them to have access to written information that was relevant to them. People had been offered sufficient opportunities to pursue their hobbies and interests and to engage in social activities. Furthermore, suitable arrangements had been made to promote equality and diversity. There were suitable arrangements for

The inspection took place on 17 October 2016. Warren Drive is a residential care home that provides accommodation and personal care for a maximum of 29 older people. There were 26 people living in the service at the time of our inspection, some of whom lived with dementia.

There was a manager in post who was registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC 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.

Staff knew how to recognise signs of abuse and how to raise an alert if they had any concerns. Risk assessments were centred on the needs of the individual. Each risk assessment included clear measures to reduce identified risks and guidance for staff to follow or make sure people were protected from harm.

Accidents and incidents were recorded and monitored to identify how the risks of recurrence could be reduced. However, the provider had not ensured that all environmental risks and fire risks had been assessed, identified and mitigated.

There was a sufficient number of staff deployed to meet people’s needs. Recruitment procedures were in place which included criminal records checks and the checking of references.

Medicines were stored, administered, recorded and disposed of safely and correctly. Staff were trained in the safe administration of medicines and kept relevant records that were accurate.

Staff knew each person well and understood how to meet their support and communication needs. Staff communicated effectively with people and treated them with utmost kindness and respect. Staff received essential training, additional training relevant to people’s individual needs, and regular one to one supervision sessions.

People’s mental capacity was not assessed when necessary about particular decisions and meetings were not held to make decisions in people’s best interests, as per the requirements of the Mental Capacity Act 2005 code of practice.

The staff provided meals that were in sufficient quantity and met people’s needs and choices. People told us they enjoyed the food and their meal times. Staff knew about and provided for people’s dietary preferences and restrictions. People’s individual assessments and care plans were person-centred, reviewed monthly or when their needs changed. Clear information about the service, the facilities, and how to complain was provided to people and visitors.

People were promptly referred to health care professionals when needed. Personal records included people’s individual plans of care, life history, likes and dislikes and preferred activities. The staff promoted people’s independence and encouraged people to do as much as possible for themselves.

A range of meaningful activities and outings were provided that was suitable in meeting people’s social needs. People were consulted in the planning of activities and their suggestions were taken into account.

Staff told us they felt valued and supported by the manager, the management team and the provider. The manager was open and transparent in their approach. They placed emphasis on continuous improvement of the service and promoted links with the community. There was a system of monitoring checks and audits in place to identify any improvements that needed to be made. However, the quality assurance system had not been consistently effective as not all the shortfalls that needed to be remedied had been identified.

You can see what action we told the provider to take at the back of the full version of this report.

Our inspection team was made up of one inspector. The purpose of this inspection was to follow-up on the shortfalls that we previously identified in respect of the way the home monitored infection control and recorded staff support.

Below is a summary of what we found. If you want to see the evidence supporting our summary please read the full report.

Since our last inspection we found that the home had reviewed its infection control policies and procedures. A new infection control lead had been appointed and the manager had re-evaluated their previous annual statement. Housekeeping staff showed us that new daily and weekly cleaning schedules had been introduced. This ensured the home could evidence that all parts of the home were cleaned on a regular basis. The home was clean and tidy at the time of our inspection. Staff were confident about their roles and responsibilities, including which personal protective equipment (PPE) should be worn. This meant that people were protected because the home had taken appropriate steps to identify and minimise the risk of infection.

We found that the home had introduced a new system for formally supervising staff on a quarterly basis. Staff told us previously that they felt well supported by the management team at Warren Drive. Records of formal staff supervision demonstrated there were clear learning and development plans for all staff.

Our inspection team was made up of one inspector. We answered our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary describes what people who used the service and the staff told us, what we observed and the records we looked at. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

We found that the home had undertaken a lot of work since our last inspection to improve the way medicines were stored and managed at the home. We saw that the home now had good systems in place to support people to receive the right medication at the right time.

We found the home to be clean and tidy at the time of our visit. The home had designated domestic and housekeeping staff who worked in the home each day to ensure that people received care in an environment that was hygienic and free from odour. Staff demonstrated a good understanding of the systems in place by the provider to reduce the risk of the spread of infection. Staff had access to personal protective equipment, such as gloves and aprons to ensure that they protected themselves and others. There were reminders and facilities around the home to promote good hand hygiene which meant that the risk of cross infection was minimised. We found that the home had a system for auditing its standards of infection control, but that the actions these checks had identified had not been monitored. We have asked that the home look into improving the documentation it keeps about this.

We found evidence that the home had taken steps to ensure that it was compliant with the Mental Capacity Act and Deprivation of Liberty Safeguards. Through staff training and ongoing care plan reviews we found that the home had taken appropriate action to ensure that people received support that protected their legal rights and balanced safety with choice.

Is the service effective?

We saw that people had good relationships with the staff who supported them and observed positive relationships between them. People described staff as "Kind" and "Fun" and "Caring". The home had mechanisms in place to ensure that staff received training and line management support to deliver their roles effectively. Staff told us that the management team operated an "Open door policy" and were "Always approachable." We found that staff support was automatic at Warren Drive and as such was effective. We did however notice, that the support provided to staff was not always formally recorded. This meant that the home could not demonstrate that each staff member had a clear learning and development plan in place and we have asked them to address this.

Is the service caring?

We observed that people received sensitive and discreet care at all times. We saw that people’s choices were respected and that staff involved them in their care. We found that people had care plans which provided detailed information about how they should be supported. This meant that the provider had taken steps to ensure people received the care they needed in a way that made them feel comfortable.

Is the service responsive?

People’s needs were continually assessed. Records confirmed people’s preferences, interests, aspirations and diverse needs had been recorded and support had been provided in accordance with people’s wishes. Staff had a good understanding of people’s needs and demonstrated that they recognised and responded when these changed. We found that as individual staff were responsible for updating people's needs assessments and care records, these were not always being completed with the same frequency. The provider may wish to look at how this can be checked.

Is the service well-led?

The provider had good systems in place to monitor and improve the services provided. The management team had a strong presence in the home and demonstrated a sound commitment to listening to the people who lived there.

We spoke individually with eight people who used the service and one relative during the course of our inspection. People told us that they were "Very happy to be here" and described the staff who supported them as "Helpful", "Kind", "Friendly" and "Jolly".

We found that the home had appropriate systems in place to assess and manage people's needs and that people received care that was individual and appropriate to them. There was a programme of activities which enabled people to participate in things on a daily basis.

People said that the food at Warren Drive was "Fantastic" and "Lovely" and confirmed that they always had choice over the meals provided. We met with the chef who showed us evidence that meals were homemade according to a menu that had been drawn up in consultation with the people who used the service.

People told us that they were appropriately supported with their medicines, but we identified some concerns about the way medicines were being recorded and stored in the home and have required the home to make improvements in this area.

People told us that they "Could not fault" the care they received and said that if there was ever anything that they were unhappy about, that they would feel confident to discuss this with staff on the manager. We saw evidence that where people had raised issues or concerns, that these had been dealt with efficiently to people's satisfaction.

We spoke privately with ten of the eighteen people who were living at the home and met the other eight in communal areas. Our observations and discussions with people indicated that they were happy and had positive relationships with the staff who supported them. People told us that they liked their bedrooms and had been able to furnish them with their own personal belongings. People talked to us about how they liked to spend their time and said that they had freedom and control over their lives. We observed people participating in meaningful activities and noticed that they were consulted with throughout the day.

The home employed dedicated maintenance and housekeeping staff and the home was found to be clean and well maintained at the time of our inspection.

We spoke with five members of staff including the registered manager. We found staff to be knowledgeable about the needs of the people they supported and committed to their roles. Staff told us that they felt well supported by both the manager and the provider and said that Warren Drive was a nice place to work. We found that the home had effective systems in place to recruit appropriate staff.

We looked at a range of records maintained by the home, including the care plans for two people. We found that all records viewed were well maintained with evidence of having been regularly updated.

Concerns were raised to us, anonymously, about staffing levels at the service. The manager provided us with information on 22 December 2011 that we requested about staffing levels including duty rotas and how staffing levels were worked out and maintained.

We then visited the service on 4 January 2012 and spoke to people about the staffing levels. People who use the service told us that they felt there were enough staff on duty to meet their needs. We found that the staffing levels were sufficient to meet peoples' needs.

They said that staff were kind and helpful and were there when they needed them. A visitor told us that they saw staff around the home and that staff were there when they were needed. We found that the staffing levels were sufficient to meet peoples' health and welfare needs.

One person said “They (staff) come promptly when I use the call bell. Yes, there are staff around when I need them. The staff are very good”.

Another person said “Yes. The staff are around when I need them”.

People told us that the food was very good and that the home was always clean. People said that there was enough to do during the day and that they were happy with their rooms.

One person said “I can assure you that we are very well looked after. The staff are most helpful and kind. The home is scrupulously clean”.