Warrengate is a nursing home for up to 40 people some of whom have dementia. At the time of our visit 39 people lived here. People who live here are all over the age of 65, and many receive care and support for a physical disability, or a sensory impairment.

The home is arranged on three levels, with the care being given on the ground and first floor at the time of our inspection. Communal areas include a large dining area, lounge and secure gardens.

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.

The inspection took place on 01 November 2016 and was unannounced. At our last inspection in February 2015 we identified five breaches in the regulations, and areas of the home that required improvement. The registered manager and provider gave us an action plan on how they would address these issues. At this inspection we found that all the areas of concern had been addressed, and people had a positive experience living at Warrengate.

Staff managed the medicines in a safe way and were trained in the safe administration of medicines. However guidelines for ‘As required’ medicines needed to be further developed, to minimise the risk of these medicines being given incorrectly. People received their medicines when they needed them.

There was positive feedback about the home and caring nature of staff from people who live here. A relative said, ““The staff are kind and caring here.”

People were safe at Warrengate because there were sufficient numbers of staff who were appropriately trained to meet the needs of the people. The registered manager regularly reviewed staffing levels to ensure they matched with the needs of people. Staff understood their duty should they suspect abuse was taking place, including the agencies that needed to be notified, such as the local authority safeguarding team or the police.

Risks of harm to people had been identified and clear plans and guidelines were in place to minimise these risks. In the event of an emergency people were protected because there were clear procedures in place to evacuate the building. Each person had a plan which detailed the support they needed to get safely out of the building in an emergency.

The provider had carried out appropriate recruitment checks before staff commenced employment, to ensure they were safe to work with people who may be at risk.

Staff received a comprehensive induction and ongoing training, to ensure they could meet and understand the care needs of the people they supported. Staff received regular support in the form of annual appraisals and formal supervision to ensure they gave a good standard of safe care and support.

Where people did not have the capacity to understand or consent to a decision the provider had followed the requirements of the Mental Capacity Act (2005). An appropriate assessment of people’s ability to make decisions for themselves had been completed. Where people’s liberty may be restricted to keep them safe, the provider had followed the requirements of the Deprivation of Liberty Safeguards (DoLS) to ensure the person’s rights were protected.

People had enough to eat and drink, and received support from staff where a need had been identified. People’s individual dietary requirements where met.

People were supported to maintain good health as they had access to relevant healthcare professionals when they needed them. Positive feedback was given by a visiting healthcare professional about the knowledge and skills of the nursing and care staff. People’s health was seen to improve due to the care and support staff gave.

The staff were kind and caring and treated people with dignity and respect

We visited Warrengate Nursing Home to look at the care and welfare of people who used the service. This was a follow up visit to see if the service had made improvements after our visit in July 2013.

It was not necessary on this occasion to speak with people who used the service. During our last inspection people that we spoke with were generally happy with the care they received. We spoke with the registered manager who showed us the changes that had been made that ensured they now met the regulation related to people’s care and welfare and records.

Prior to the inspection we had received an action plan from the registered manager. This confirmed the steps that had been taken by the home to meet these compliance actions.

We found improvements had been made to the service. Documentation had been audited and changes made where necessary. Staff now had handover sheets for each shift that ensured continuity of care for people. Changes had been made to the activity provision at the home.

When we inspected the service we were accompanied by two specialists in dementia care who gave us their advice on how they thought the service was run. During our inspection we spoke with five people who used the service, six relatives, nine members of staff and two health care professionals. We also observed care being given throughout the inspection. We were unable to speak with every person in the service due to their complex needs.

We found that people had choices about what they wanted to eat and what they wanted to wear. We saw that people were treated with dignity and respect.

People and relatives we spoke with felt the staff were caring. A relative told us “I think they (staff) are excellent, better than hoped.” However we found that the care that was provided to people was not always in line with their needs.

The service handled medicines in a safe, secure and appropriate way. The service had systems in place to audit the safe administration of medicines for people.

We found that Warrengate assessed and monitored the quality of the service that they provided. We found that the service had an effective complaints procedure. All of the people and relatives that we spoke with told us that they would speak to the manager if they had any concerns.

The service’s records were not always clear and up to date. This related to daily care notes and care plans.

We found during our inspection that all of the people we spoke with felt respected by the staff and felt involved in their care. We spoke with relatives who also felt that the staff involved them and contacted them if there had been any changes in their relative.

We saw during our inspection that staff provided good care. All of the relatives and the people we spoke with said that the staff were kind and considerate. All of the care plans that we looked at were detailed and had accounted for people’s needs. However we found that there were not enough meaningful activities for people who used the service.

The service had a safeguarding policy and staff were aware of the types of abuse to look out for. All of the people said that they felt safe there. The relatives we spoke with said that they knew that after they had visited they knew people were safe.

We looked at records to see whether staff had received all of the mandatory training that the manager told us they should have had. We saw that most of the staff had not completed all of their mandatory training however plans were already in place to address this.

The service had systems in place to address weaknesses with the service. They also had regular meetings with relatives and people to gain their views.

We spoke to three people who told us that they were happy with the care and support provided, and made comments such as “The staff know when I need my medicines, they are very good”, “it’s very nice living here and I am happy” and “the staff especially at night time are very nice”.

During our last visit we observed a person who used to stay in bed for most of the time. Although this person was not able to give their view, we noted that they were sitting in the lounge enjoying the company of other people.

The people using the service that we spoke to seemed happy with the care and support they received and a representative of a person using the service agreed with this. Since the changes had recently been made regarding the food in the home, people said they were happier because they could choose their meal options. A person using the service told us that were pleased that a board had been put in place as they could now see what the menu was.

Three people told us that staff knock on their bedroom doors before entering, to respect their right to privacy. One person told us they were able to choose where they spent their time during the day and another person told us of the community activity they go out of the home to enjoy.

When we discussed peoples’ care plans, two people using the service told us they were not aware of their care plan and had not been involved in any meetings to discuss their care.

We were told that people had recently completed satisfaction surveys. One person using the service said “I can talk to the staff if I have any problems” and another person told us “I am happy to talk the manager if I am not happy about anything”. One person using the service told us that their bedroom would benefit from repainting.

This inspection took place on 05 and 12 February 2015 and was unannounced on both days.

Warrengate Nursing Home provides accommodation for up to 40 elderly people who require nursing care, some of whom are living with dementia.

At the time of our visit there was no registered manager in post as they had left the service in September 2014. 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 newly appointed matron told us they were in the process of sending in their application to the CQC to become the registered manager.

People may not always be protected in the event of an emergency as personal evacuation plans had not been completed for everyone. Some people lived in rooms upstairs. Due to their mobility needs this may not be the best place for them in the event of an emergency. The home had not taken this into account when they assessed the person.

The manager’s time was spent ensuring that day to day care needs were being met, mainly due to the number of agency staff in use. This meant that quality assurance systems were not being used consistently, nor were they effective at checking that people received a good quality of service. Some good interactions were seen between the staff and the people who live here. They were friendly, caring and supportive.

Documents to enable staff to support people and record the care given were not always complete. The provider was switching from a paper system to an electronic one to try to improve the quality of the service. While the switch was taking place care plans and risk assessments had not been updated so peoples care needs were not completely clear to all staff.

The provider and manager did not always deal with peoples complaints effectively. They had not been recorded consistently, and they were unable to show if they had all been dealt with effectively.

We had a mixed response about the staff from people and their relatives. People were generally positive about the permanent staff saying they were kind and caring, but they were concerned about the number of agency staff being used. We have made a recommendation around how the provider calculates the number of staff needed to support people. We have also made a recommendation about staff training in relation to staff whose first language is not English.

People said they were happy with the medicines they received, however we found issues with how staff responded to problems with storage, and the effectiveness of their checks to make sure people were getting the correct medicine. We have made a recommendation about the management of some medicines.

Examples were seen where staff had not fully supported all those that needed it, for example when managing aggressive behaviour from others, or not knowing what individual care needs people may have. Improvements were also identified in how people who stay in their rooms receive support to eat and drink enough, or when staff support with other activities, such as turning people to reduce the risk of pressure sores developing. We have made a recommendation around the support process so people are consistently supported to eat and drink. We have made also made recommendation about activities to meet people’s individual needs and interests.

We have identified five breaches in the regulations. You can see what action we told the provider to take at the back of the full version of this report.