This inspection took place on 5 September 2018 and was unannounced. A second day of inspection took place on 11 September 2018 which was announced.

Warrior Park 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.

Warrior Park is registered to accommodate 52 people in one adapted building across two floors. At the time of the inspection 46 people were resident. The first floor specialises in providing care to people living with a dementia who may, at times, be anxious and distressed. The service provided nursing care to people on both floors of the home.

When we completed our previous comprehensive inspection in April 2016 the service was rated good. At this inspection we found the service was no longer meeting all the required standards to retain this rating.

This is the first time the service has been rated Requires Improvement.

There had been a registered manager in post but they had resigned the day before we started the inspection. 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 the absence of the registered manager the provider's Resident Experience team were providing management support.

There was insufficient management support in place and staff morale was low. The service had experienced four different managers in less than two years and this lack of stability meant staff and relatives felt unsupported. Audits and quality checks were not identifying the concerns we found during the inspection.

We found records relating to people's safety such as falls had not always been recorded meaning measures may not always be in place to keep people safe.

We looked at the systems in place for medicines management and found they did not always keep people safe.

Some staff were not aware of the fire drill procedure relating to evacuating people from the rear of the building. We found some environmental risks such as loose radiator covers and trip hazards on our first visit. These had been repaired and flooring was being reviewed by the second day of our inspection.

Staff members and relatives we spoke with told us there was not enough staff. Although basic care needs were met staff appeared rushed. We discussed with the regional management team who stated they would review the staffing levels and deployment of staff as some feedback from relatives included staff going for breaks together which is not good practice.

There were limited activities taking place. People were left sitting in lounge areas or in their bedrooms with no stimulation for most of the day. We saw staff would sing with people but this was not an activity tailored to individual needs.

Staff had completed all training the provider had identified as essential and although supervisions had lapsed from August 2018. The regional manager had put a plan in place to address this.

The environment had some adaptations and design to ensure people living with dementia were supported. Practice around mealtimes to ensure people had meaningful choice and were supported appropriately could be improved.

We saw complaints were investigated in line with the provider’s complaint’s policy.

Checks were carried out around the service to ensure the premises and equipment were safe to use but these did not pick up issues we found on the day of our visit

Safe recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work.

Staff had knowledge of safeguarding and were aware of the action to take if they had concerns.

Appropriate authorisati

This focused inspection of Warrior Park Care Home took place on 24 October 2017. It was an unannounced inspection which meant that the staff and provider did not know that we would be visiting.

We last inspected the service on 2 and 3 February 2016 and found the provider was meeting the fundamental standards of relevant regulations. At that time we rated Warrior Park as ‘Good’ overall and ‘Good’ in all five domains. We carried out this inspection in response to a recent safeguarding incident, where a person using the service had sustained a serious injury and also because prior to this, concerns had been raised around staff moving and handling practices. Therefore, we completed this focused inspection to review risk management practices and to establish whether lessons were learned from previous incidents and changes implemented where needed. During our inspection we found risks were being managed by the provider and registered manager.

Warrior Park is registered to provide care for up to 56 people, but there are only 48 bedrooms in use following the reduction of shared rooms and conversion of some bedrooms for storage. It is a two storey, purpose-built home with secure gardens. The ground floor provides accommodation for people needing personal or nursing care whilst the first floor provides accommodation for people living with dementia who require personal or nursing care. There were 45 people in receipt of care from the service at the time of this inspection.

The home has had a registered manager in post since 4 January 2016. 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 they felt “safe” and “well cared for”. People were seen to be relaxed and engaged with the staff. Relatives told us they felt confident in the safety of the service and in the staff. All staff had completed updated training in safeguarding adults and they knew how to report any concerns.

People and relatives we spoke with felt staff were competent to provide the right support. Staff told us they felt well trained and supported in their roles. We found the registered manager regularly checked that staff implemented the learning from training and would request that staff completed additional training if gaps in practice were noted. We found that during 2017 all of the staff had received moving and handling training on two occasions, completed workbooks on this topic and undergone competency assessments.

All of the people, staff and visitors we spoke with said the registered manager was open and supportive. Staff told us the registered manager routinely reviewed people’s care and looked at how any risks could be more closely managed. The registered manager closely scrutinised any incidents and made sure lessons were learnt and all staff were aware of the actions that could be taken to reduce the potential that an accident or incident would reoccur. For instance following a person sustaining an injury in their bedroom the registered manager had reviewed the furniture and determined that the armchair design might increase risk of injury. They had started to replace all of the armchairs with ones that had padded arms. Whilst this programme of renewal was being undertaken the registered manager had ensured those people who were at highest risk of falls got the new armchairs first.

At the last inspection of this in August 2015, we asked the provider to make improvements. This was because safeguarding concerns had not always been investigated. Risk assessments about people’s individual needs were either inaccurate or not in place and fire safety shortfalls had not been addressed. Recruitment checks of new staff had not always been carried out so the provider had not made sure staff were suitable to work with the people who lived there. Staff had not understood people’s rights about their mental capacity to make their own decisions. People’s individual care records were not accurate so people might not have received the right care. Also, the provider’s quality monitoring processes were not effective in addressing these shortfalls.

After the inspection the provider wrote to us to say what they would do to meet the legal requirements. We carried out this comprehensive inspection to check whether the provider had addressed these breaches and to provide a new rating for the home. We found there had been improvements in all these areas.

Warrior Park is registered to provide care for up to 56 people, but there are only 48 bedrooms in use following the reduction of shared rooms and conversion of some bedrooms for storage. It is a two storey, purpose-built home with secure gardens. The ground floor provides accommodation for people needing personal or nursing care whilst the first floor provides accommodation for people living with dementia who require personal or nursing care. There were 31 people living at the home at the time of this inspection.

Last year there had been several different temporary managers at the home. However in October 2015 a new manager was appointed who has since registered with the Care Quality Commission (CQC). 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 they felt “safe” and “well cared for”. People were seen to be relaxed and engaged with the staff. Relatives told us they felt confident in the safety of the service and in the staff. All staff had completed updated training in safeguarding adults and they knew how to report any concerns.

There were enough staff on duty to support the people who lived there. The staffing levels and skill mix throughout the day and night was suitable to meet people’s needs. The provider carried out checks to make sure only suitable staff were employed.

People and relatives we spoke with felt staff were competent to provide the right support. Staff felt well trained and supported in their roles. People were supported to eat and drink enough and they had choices about their meals. Staff were knowledgeable about individual people and were able to spot any changes in their wellbeing. They liaised with other health agencies to meet people’s healthcare needs.

People said they were happy living at the home and felt the care and support they received was very good. When asked if they felt well cared for, one person said, “Oh yes absolutely, some of the girls in here are excellent.” Another person said the care they received was “exceptional” and “in all aspects they are very good indeed”.

Relatives said they were “very happy” with the way their family members were cared for. One relative said, “Staff are brilliant, I have no concerns over them at all, they really do care.” Relatives told us they felt their family members were treated with dignity and respect.

People received personalised care. Their individual needs had been assessed and their care plans had been rewritten and updated to make sure they got the right support to meet their specific needs. Staff were knowledgeable about people’s history as well as their likes and dislikes.

All the pe

We carried out this follow up visit to check what progress the service had made to the improvements we suggested at the last inspection in May 2014 about the cleanliness of the building and about the completeness of care records.

During this inspection we found the provider had made improvements to the cleanliness of the home. Some areas had been redecorated to make them easier to keep clean and cleaning staff were on duty for longer hours. New cleaning equipment and furnishings had been provided. Regular checks were now in place to monitor the cleanliness of all rooms. One visitor told us, “It’s much better. They’ve got new furniture and the cleaners have changed.”

We found the provider had made some improvement to keeping care records complete and up to date. However we found some care records were inconsistent and some were still incomplete. The provider had carried out audits of all care records and identified the gaps in care records. This work was still on-going. Staff were to receive individual training in care recording and this was still on-going. This meant the provider was still addressing this area.

The registered manager acknowledged that the original timescale of 1 August 2014 to address this requirement had not been achieved, but showed us there were clear action plans in place to meet this within the next month. As a result of the work being carried out we have made a further compliance action about records and will follow this up in the near future.

In this report the name of a registered manager appears who was not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.

People who used the service who we spoke with told us they were happy with the care and treatment being delivered by the service. They felt their needs were met and there were enough staff on duty to meet others' needs. They told us: “The staff take their time with me, I never feel rushed and I feel safe in their hands. If I don’t feel well, I can tell them and they will call the nurse or doctor for me, what more can I ask for?”, “I get well looked after here. The staff are friendly, they’ll do anything I ask and they know what I need to make sure I stay safe and well” and “It’s fine here, yes I like it.” People also felt that they were given opportunities to be involved in decisions about their care.

We found there were arrangements in place to seek people's consent for treatment. Staff were clear about the legal arrangement in place for people when they lacked the capacity to make complex decisions such as who had lasting power of attorney in place and whether this was for people's finances or care and welfare.

We found there were sufficient staff in place to meet the needs of the people who used the service.

There were effective systems in place to monitor the quality of care people received. People and their relatives were given the opportunity to give feedback about the care and treatment delivered by the service.

Records were accurate, fit for purpose and protected people who used the service from the risks of receiving unsafe or inappropriate care and treatment.

We spoke with four people and two relatives during our inspection. Both relatives told us that they were always kept up to date with information about their family member. One relative also told us that whenever their family member was unwell, they were informed immediately. They also thought that the staff acted quickly in calling other health professionals such as the GP if they were needed. The other relative told us, “Although things here aren’t perfect and there have been some problems in the past, the staff are very good and the manager always makes sure any problems are put right”.

The four people who lived at the service which we spoke with told us; “The staff here are really helpful and cater for my needs”; “The staff never make me feel embarrassed when they are helping me get ready”; “The staff here are great, really lovely”. One person also added that Warrior Park was, “very amenable to my needs”. Two people told us that the food was good and the other said, “mostly the food is good but sometimes you just have to take your pick of what there is”. They also said that the choice of drinks was, “a bit limited”.

We spoke with five people using the service. One person told us "I'm not sure if staff speak to me about my care, but it's all ok". They also told us "the female staff here are all very good" and "I feel safe here."

Another person told us "If I'm not keen on the food being served, they will bring me sandwiches."

One person said "I don't get involved in the activities here, I manage to occupy myself. I get on well with all the staff. I would tell you if there was anything wrong going on here, and there isn't."

The last inspection of this home was carried out on 20 and 21 January 2015. At that time we found the provider had breached a regulation relating to the supervision and development of staff. After the inspection the provider wrote to us to say what they would do to meet legal requirements.

We carried out this unannounced inspection on 20 and 21 August 2015 to check whether the provider had met the legal requirement. We carried this out as a comprehensive inspection because we received concerns about the care of people using the service and the lack of action by the provider in investigating safeguarding matters.

Warrior Park is registered to provide care for up to 56 people, but there are only 48 bedrooms following the reduction of shared rooms and conversion of some bedrooms for storage. It is a two storey, purpose-built home with secure gardens. The ground floor provides accommodation for people needing personal or nursing care whilst the first floor provides accommodation for people living with dementia who require personal or nursing care. There were 42 people living at the home at the time of this inspection.

There had been four different managers involved in running the service since the last inspection. The home had not had a registered manager since February 2015. 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 the time of our inspection there were three safeguarding concerns currently open and being investigated. There was not always evidence to show that home staff had investigated safeguarding incidents, such as reviewing documentation and conducting staff interviews. Where some investigation had taken place it did not always follow a robust and thorough process.

Risk assessments about people’s individual needs were either inaccurate or not in place, for example about the use of bedrails. A fire safety risk assessment carried out in October 2014 had identified several shortfalls some of which had still not been addressed.

The records of new staff did not include satisfactory recruitment records, such as application forms, references and disclosure and barring checks (these are checks about criminal convictions and whether applicants are barred from working with vulnerable adults). This meant the provider did not make sure that staff were suitable to work with the people who lived there.

Staff did not know how to make sure people’s rights under the Mental Capacity Act 2005 were upheld. (MCA is a law that protects and supports people who do not have the ability to make their own decisions and to ensure decisions are made in their ‘best interests’) .In some cases staff had assessed some people as not having capacity but had not identified what major decision the assessment was for. In other cases staff had not assessed people’s capacity but had placed restrictions on their lifestyle.

The provider had not made sure people received personalised care. This was because people’s individual care records did not accurately reflect their needs or were incomplete. This meant that it was not always possible to be clear if a person was appropriately cared for and supported in the right way.

The provider’s quality monitoring processes were not effective in managing risk or making sure people received a safe or quality service. This was because shortfalls that had been identified but no remedial action had been taken so the issues were not addressed.

During this inspection we identified six breaches of regulations. You can see what action we told the provider to take at the back of the full version of the report.

At the last inspection of this home we found the provider had breached a regulation relating to the support and development of staff. This was because staff had not received supervision or appraisals, so they were not being offered support in their role as well as identifying the need for any additional training. During this inspection we found this had improved and individual staff members had taken part in one-to-one session and group supervision sessions with a line supervisor.

People who could express a view, and their relatives, felt the home met their care needs. They told us staff were competent at caring for the people who lived there. One person told us, “They are skilled in what they do. Some [people] are very difficult but the staff know how to distract them and stop them being agitated.”

Visiting healthcare professionals told us the staff contacted them at the right times for advice and guidance. They felt care staff were knowledgeable about individual people and were able to spot any changes in their wellbeing.

Staff had access to training in care and in health and safety. Many of the care staff had had training in dementia awareness and knew how to support people who were living with dementia when they became upset. We saw staff supported people in a calm and reassuring way.

People enjoyed a choice of meals at the home and they described the quality of the food as “very good”. People and relatives made many positive comments about the caring attitude of staff. One person described the staff as “fabulous”. One relative told us, “The staff are very caring, respectful and friendly.”

There were daily in-house activities and occasional entertainment and social events. People had information about how to make a complaint or comment and they felt these were acted upon. People and relatives had opportunities to make other comments and suggestions about the service at resident/relatives meetings and through the provider’s new computerised feedback system.