Warren Heath Residential Home Limited 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. This service does not provide nursing care. Warren Heath Residential Home Limited accommodates up to 18 older people in one adapted building. There were 16 people living in the service when we inspected on 31 January 2018. This was an unannounced comprehensive inspection.

There was a registered manager in place. 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.

Following our last inspection of 2 February 2018, we rated the service as requiring improvement overall. We identified one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the systems in place to monitor the service were not robust enough to independently identify shortfalls to ensure people who use the service were provided with good quality care at all times. For this reason we rated the key question of well-led as requiring improvement.

In the key questions for safe we rated the service as requires improvement. This was because improvements were needed in the infection control processes in the service and how people were provided with safe care at all times. In the key question for responsive we rated the service as requires improvement because there were inconsistencies in people’s care plans. The key questions of effective and care were rated good.

At this inspection of 31 January 2019, we noted there had been improvements and there were no breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We rated the service good in all key questions and therefore the overall rating of the service has improved to good.

The registered manager since our last inspection, had sought advice and invested in a quality assurance tool to assist with the planning, monitoring and delivery of the service. The staff had worked with the local authority and had developed people’s care plans so that there were no inconsistencies. Staff had undertaken training to increase and enhance their knowledge of infection control. These helped staff deliver safe and good quality care to people.

There were sufficient members of care staff to meet people’s identified needs.

Staff received training in safeguarding and were aware of what actions they should take to safeguard people from abuse and knew what actions to take to promote people’s safety and well-being.

There was a policy and procedure in place designed for the safe recruitment of staff. Staff were supported by an induction process, regular supervision, training and a yearly appraisal.

There were suitable arrangements in place for the safe storage, management and disposal of medicines and people received their medicines when they needed them.

Care and support was delivered in line with the assessed needs and choices of the people living at the service. People had their nutrition and hydration needs met through the delivery of nutritious menus which took into account people’s dietary preferences and requirements.

The service had built up an effective and supportive relationship with other professionals supporting people at the service.

People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice. Staff were knowledgeable with regard to Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

People’s privacy and dignity was resp

Warren Heath Residential Home Limited 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. This service does not provide nursing care. Warren Heath Residential Home Limited accommodates up to 18 older people in one adapted building. There were 15 people living in the service when we inspected on 2 February 2018. This was an unannounced comprehensive inspection.

There was a registered manager in place, who was also one of the providers. 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.

At our last comprehensive inspection of 20 November 2015, this service was rated good. The service had not sustained the rating of good and the overall rating for this service was requires improvement. The key questions for Effective and Caring are rated as good. The key questions Safe, Responsive and Well-led are now rated as requires improvement. This was because the systems in place for infection control were not robust, there were inconsistencies in how people’s needs were planned for and met and the systems for monitoring the service were not robust enough to independently identify shortfalls. We identified a breach of Regulation 17: Good governance of the Health and Social care Act 2008 (Regulated Activities) Regulations 2014.

The service had accepted the support from the local authority to improve their care plans. However, we identified discrepancies in the reviewed care plans, which did not provide clear guidance for staff on how people’s needs were to be met. This included people’s conditions and how these affected their daily life. Staff were not always responsive to people’s needs.

There were systems in place designed to keep people safe from avoidable harm and abuse. Staffing levels in the service were organised to provide people with assistance when they needed it. Recruitment of staff was done safely and checks were undertaken on staff to ensure they were fit to care for the people using the service.

People were supported to see, when needed, health and social care professionals. People’s nutritional needs were assessed and met. People were provided with their medicines as prescribed. The environment was appropriate for people using the service. Staff were provided with training and support.

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.

People were treated with respect and compassion by the staff working in the service. People had positive relationships with the staff who supported them. People were provided with the opportunity to participate in activities that interested them. People’s views were valued and used to plan and deliver their care. People’s views were listened to and acted upon relating to their end of life care. There was a system in place to manage complaints.

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

The inspection took place on 20 November 2015, the inspection was unannounced.

The service is a residential home for 17 older people, some of whom may live with dementia. The service is privately owned and both of the providers are actively involved in the running of the service, one of the providers is the registered 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.

During our last inspection on 31 January 2015 we found that this service was not compliant in some areas. There were concerns about the level of heating and lighting within the home, staffing levels and their training, how the medication was managed, the quality of people’s care plans, monitoring the quality of the service and listening to people and dealing with complaints.

During this inspection we found that the providers had taken action and were offering a good service.

There were enough staff to support people safely and they were clear about their roles. Recruitment practices were robust in contributing to protecting people from staff who were unsuitable to work in care in the home care section of the service.

Staff knew what to do if they suspected someone may be at risk of abuse or harm and medicines were managed and stored safely so that people received them as the prescriber intended.

Staff had received the training they needed to understand how to meet people’s needs. They understood the importance of gaining consent from people before delivering their care or treatment. Where people were not able to give informed consent, staff and the manager ensured their rights were protected.

People have enough to eat and drink to meet their needs and staff assisted or prompted people with meals and fluids if they needed support.

Staff treated people with warmth and compassion. They were respectful of people’s privacy and dignity. Staff made sure that people who became unwell were referred promptly to healthcare professionals for treatment and advice about their health and welfare.

Staff understood and responded to people’s preferences and needs so that they could engage meaningfully with people. The service offered people a chance to take part in activities and pastimes that were tailored to their individual preferences and wishes. Outings and outside entertainment was offered to people, and staff offered people activities and supported them on a daily basis.

Staff understood the importance of responding to and resolving concerns quickly if they were able to do so. Staff also ensured that more serious complaints were passed on to the management team for investigation. People and their representatives told us that they were confident that any complaints they made would be addressed by the manager.

The service had good leadership; the providers both worked closely with the staff and monitored the quality of care. There were effective quality assurance systems in place.

The inspection took place on 31 January 2015, the inspection was unannounced.

The service is a residential home for 17 older people, some of whom may have dementia. The service is privately owned and both of the providers are active in the service, one of the providers is the registered 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 told us that they are happy and feel safe in the home, but we found some examples in the way the home was working that meant that they may not be well cared for or safe all of the time.

Some people had not had their needs assessed before they moved in to the home and did not have a care plan, others care plans had not been fully updated and did not show present needs.

Risk assessments around making sure people did not develop bed sores and remained healthy were in place and were reviewed regularly, but we found that other risks around moving and handling people had not been assessed.

People’s day to day health care was looked after and the doctor, or other medical advice, was sought when it was needed.

The provider did not make sure people were warm enough. We noted and people told us that they were cold at times. Some people told us that their families had brought in extra bedding so they were warm at night. We also noted that the corridor lights were kept off with the expectation that people could turn the lights on if they wanted to move about independently, but this put them at risk of falling over objects they could not see.

The staffing levels are not always sufficient to keep people safe. There are times on the rota that showed only one staff on duty. We also saw that the rota did not reflect the actual number of staff on duty.

We saw that medicines were not managed well and that best practice was not followed in giving people their medicine.

People told us that they felt well cared for and during our inspection staff interacted well with people and listened to what they had to say. The staff are friendly and helpful to people. The staff and the registered manager know what action to take if they think anyone living in the home is being harmed in any way.

People’s privacy and dignity is not always protected by the service. People’s care plans and other written information are not kept in a safe place to stop others seeing it.

Staff receive an induction when they start working at the home and are trained and supported in their work by the registered manager, although their competency in some areas is not always effectively assessed and they are not given the opportunity to attend staff meetings to discuss and plan people’s support needs.

People told us that they get enough to eat, are given a choice and that the food is well cooked, but they always eat their meals in their armchair. They are not given the choice to eat at the table with others to enjoy some social interaction. Some people told us that the days are long and boring and that sometimes they only leave their chair to go to the toilet and bed. There are some activities on offer. A staff member is employed to offer people company, read to them and to play board games with them, and entertainers are brought into the home regularly.

The provider does not effectively consult people on their views about the quality of service they receive, and the registered manager does not properly assess, monitor and improve the quality and safety of the service provided.

People told us that the staff would listen to their complaints, and relatives we spoke with said they were confident their complaints would be dealt with. However, the complaints people told us about are not recorded. The registered manager makes themselves available to people who want to talk to them and is involved in the day to day running of the home. Some improvement is needed in the way they audit the quality of the service, staff performance and the way that records are updated and stored.

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

We spoke with seven of the 12 people who used the service. They told us that they were happy with the service they were provided with. One person said, "It could not be any better." Another person said, "I have nothing but praise for them, they do a good job, I have not had a fall since I moved here." Another person said, "It is perfect."

We looked at the care records of three people who used the service. We found that people experienced care, treatment and support that met their needs and protected their rights. People were provided with their medication at the prescribed times. People were protected from the risks of inadequate nutrition and dehydration.

We looked at the personnel records of four staff members which showed that the appropriate checks were carried out before they started working in the service to ensure that they were able to work with vulnerable people.

The provider had systems in place to monitor and assess the service that people were provided with. Checks were made on equipment, including lifting equipment, to ensure that they were safe and fit for use.

The majority of the people staying in Warren Heath Residential Home Limited were living with dementia and were unable to tell us about the quality of care they received. To enable us to be able to access people’s wellbeing we spent time sitting with them observing the care they received and the level of staff interaction with the people.

During our inspection we observed that the staff were attentive to people’s needs. Staff interacted with people using the service in a friendly, respectful and professional manner. We saw that staff sought their agreement before providing any support or assistance.

We saw that staffing was at a level that would safeguard the health, safety and welfare of the people living in the service.

We were able to speak with two people, they said that they were comfortable living in the service and also told us that they had not needed to make a complaint. One person said that, “I like it here.” Indicating towards two staff members, they also said, “I get on with them OK”

We saw that appropriate measures were taken to ensure that the people living in the service their visitors and the staff were protected against the spread of health care associated infections.

People were encouraged and supported to make complaints. The manager told us that they tried to ensure that complaints were dealt with informally, which resulted in very few formal complaints made in the last few years.

During our visit to The Warren people told us that they were happy living at the home, they felt supported by staff and enabled to make choices about what activities they took part and how to spend their days. One person told us that it was a very “homely” place to live and another person told us that the care is “excellent”.

We observed people engaging with their surroundings, talking to staff and being part of every day activities.