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Care Home: The Warren

  • 157a Wroxham Road Sprowston Norwich Norfolk NR7 8AF
  • Tel: 01603426170
  • Fax:
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The Warren provides personal care for up to 44 elderly people. The accomodation comprises all single rooms with en-suite facilities. Communal areas and bedrooms are all located on the ground floor. The home is located in a suburban area of Norwich. It is set back from the main road in secluded grounds. The garden extends around the building and outside seating is provided on the lawn. There are pleasant flowerbeds and mature trees. To the front of the home there is a large area for parking. The Warren is owned and operated by Barchester Healthcare. The fees charged by the home depend on individual need, and the room available, but range from 307 to 840 pounds per week. There are extra charges for toiletries, hairdressing, chiropody and private newspapers. Information about the home, including a copy of the latest inspection report, is available from the manager. 0

  • Latitude: 52.65599822998
    Longitude: 1.3209999799728
  • Manager: Manager post vacant
  • Price p/w: ~
  • UK
  • Total Capacity: 44
  • Type: Care home only
  • Provider: Barchester Healthcare Homes Ltd
  • Ownership: Private
  • Care Home ID: 16645
Residents Needs:
Old age, not falling within any other category

Latest Inspection

This is the latest available inspection report for this service, carried out on 20th October 2009. CQC found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

For extracts, read the latest CQC inspection for The Warren.

What the care home does well There was a good admission process. Everyone who completed a survey indicated that they received enough information to help them decide whether The Warren was the right place for them. The manager carried out an assessment with new people to make sure that staff could understand and meet their needs. There were good relationships between staff and residents. During the inspection we observed staff speaking politely to residents and treating them with respect. One resident wrote, "The carers are superb, always cheerful, helpful and caring." Others described the staff as, "kind" and "friendly." Over half of the staff held a nationally recognised qualification in health and social care. Residents said they were well looked after at The Warren and a relative said they were happy with the care provided. Those who completed questionnaires said they always received the care and medical support they needed. The care records were usually up to date and focused on the most important issues for the residents. Staff encouraged residents to make whatever choices they could about their daily lives. The routines in the home were flexible and revolved around the people who lived there. There was a programme of group activities and a few residents had staff support to maintain individual interests and hobbies. Residents told us they liked the food. One said, "It is really very nice." The home had recently won a company award for 5 star dining. Everyone who completed surveys said they knew who to speak to if they were not happy and would know how to make a complaint. The home was clean and well maintained. It was decorated and furnished to a high standard and residents told us they were happy with the communal rooms and their bedrooms. One told us, "My bedroom is very clean; it`s spotless." Another said, "The way they look after the room is perfect." There were regular health and safety checks in the home. All equipment and appliances in the home were serviced and well maintained. This helped to ensure the health and safety of residents and staff. What has improved since the last inspection? After the last inspection we only made one requirement, which was, that residents or their families had opportunities to be involved in drawing up care plans. This had been met and people were invited to a formal care review every six months. The annual quality assurance assessment showed us that the service had continued to improve other aspects of the service, such as the environment and meals. Some of the improvements were made after taking on board suggestions and comments made by residents. What the care home could do better: Residents` nutritional needs must be assessed and staff must draw up individual plans to reduce any risks to residents` health caused by poor nutrition. Some of the records relating to medication must be improved in order to ensure residents receive their medicines as they are prescribed and to reduce the risk of medication errors. We made a requirement for the service to carry out more thorough recruitment practices to provide safeguards for residents. We also recommended that the staffing levels should be kept under review because we were told, by residents and staff, that there were not always enough staff to spend time with residents to help them to meet their social care needs. Staff training was not completely up to date but this was being addressed, as was staff supervision. Key inspection report Care homes for older people Name: Address: The Warren 157a Wroxham Road Sprowston Norwich Norfolk NR7 8AF     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Jane Craig     Date: 2 0 1 0 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 27 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: The Warren 157a Wroxham Road Sprowston Norwich Norfolk NR7 8AF 01603426170 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: www.barchester.com/oulton Barchester Healthcare Homes Ltd care home 44 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home The Warren provides personal care for up to 44 elderly people. The accomodation comprises all single rooms with en-suite facilities. Communal areas and bedrooms are all located on the ground floor. The home is located in a suburban area of Norwich. It is set back from the main road in secluded grounds. The garden extends around the building and outside seating is provided on the lawn. There are pleasant flowerbeds and mature trees. To the front of the home there is a large area for parking. The Warren is owned and operated by Barchester Healthcare. The fees charged by the home depend on individual need, and the room available, but range from 307 to 840 pounds per week. There are extra charges for toiletries, hairdressing, chiropody and private newspapers. Information about the home, including a copy of the latest inspection report, is available from the manager. 0 Over 65 44 Care Homes for Older People Page 4 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The last key inspection on this service was completed on 14th November 2007. This key (main) inspection includes information gathered since the last inspection and an unannounced visit to the home. The visit was carried out on 20th October 2009 by one regulatory inspector. At the time of the visit there were 42 residents in the home. We met with a few of them and asked about their views of The Warren. We spent time observing daily routines in the home and how staff interacted with residents. Three residents were case tracked. This meant that we looked at their care plans and other records and talked to staff about their care needs. We talked to the deputy manager, the regional operations manager, two visitors to the home and several members of the care team. We looked around the home and viewed Care Homes for Older People Page 5 of 27 a number of documents and records. As part of the key inspection surveys were sent out to residents and staff. Their responses have been taken into account when making judgements about the service. This report also includes information from the annual quality assurance assessment (AQAA), which is a self-assessment report that the manager has to fill in and send to the Commission every year. Care Homes for Older People Page 6 of 27 What the care home does well: What has improved since the last inspection? What they could do better: Residents nutritional needs must be assessed and staff must draw up individual plans to reduce any risks to residents health caused by poor nutrition. Some of the records relating to medication must be improved in order to ensure residents receive their medicines as they are prescribed and to reduce the risk of Care Homes for Older People Page 7 of 27 medication errors. We made a requirement for the service to carry out more thorough recruitment practices to provide safeguards for residents. We also recommended that the staffing levels should be kept under review because we were told, by residents and staff, that there were not always enough staff to spend time with residents to help them to meet their social care needs. Staff training was not completely up to date but this was being addressed, as was staff supervision. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 27 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People were not admitted to the home unless their assessed needs could be met. Evidence: The annual quality assurance assessment (AQAA) described a clear admission process. Information was sent out to anyone making enquiries about a place and on admission they were given a welcome pack. This told people about the service and the facilities they could expect. All the residents who completed surveys indicated they received enough information to help them decide that The Warren was the right place for them. Everyone also said they had received a statement of terms and conditions, which helped to ensure that people were aware of their rights as a resident of the home and the rights of the company. However, during a recent complaint, a family raised concerns regarding information they were given about the fee structure and termination of their contract for short term care. The outcome of the complaint was inconclusive. There was another, very recent, complaint which included concerns about shortfalls in information about fees. This complaint was awaiting further Care Homes for Older People Page 10 of 27 Evidence: investigation at the time of our inspection. The brochure, which was sent out to people making enquiries about the home, did not include information about a management fee that was payable on admission. Anyone thinking of moving into the home was assessed by senior staff. This was to make sure that their needs were understood and could be met by the staff team at the Warren. The assessments we saw during the visit included information about the prospective residents needs, abilities and preferences for care. The resident or their family were involved in the process, which helped to make sure that issues that were important to them were taken into account. Care Homes for Older People Page 11 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People received health and personal care that met their assessed needs. Evidence: We looked at the care records for three residents. All three had a set of care plans that addressed their needs as identified in their assessments or ongoing progress notes. Some plans were very detailed and the directions for staff helped to ensure that they provided support which matched the residents individual needs and priorities. For example, the plan for one resident acknowledged that food was very important to her and to ensure she had what she requested. The plan for another resident indicated that appearance was very important to her and the plan directed staff accordingly. Some of the other care plans were quite brief and contained little person centred information. However, from speaking to staff it was apparent that they knew residents very well and understood their wishes and preferences. Care plans were generally reviewed every month. There were some good examples of evaluation notes, which showed that staff were monitoring the care given and residents progress towards meeting their goals. A number of care plans had been Care Homes for Older People Page 12 of 27 Evidence: amended when the residents needs had changed. However, in some cases there was a lack of clarity about what information should be recorded in the review summaries and what information should be transferred to care plans to ensure it became part of everyday care. There were six monthly care reviews, when residents and relatives were formally invited to meet with the staff to discuss care and participate in care planning. The AQAA told us that residents had a set of assessments to monitor risks to their health. We saw up to date assessments and risk management strategies relating to falls, moving and handling, bed rails and pressure sores. However, none of the residents we case tracked had an up to date nutritional assessment. Nutritional needs were not always kept under review. For example, it had been identified during a review that one resident had a reduced appetite and staff should consider charting her food and fluid intake, and monitor her weight more frequently. However, the residents weight had not been recorded since before the review and, in the week before our visit, the daily progress notes only made mention of four meals. All of the care staff we spoke to said that this resident ate well and there were no current concerns about her nutrition. The lack of clear and up to date risk assessments and management plans could result in residents health care needs not being met. We discussed this with the deputy manager who told us that these shortfalls had already been identified and, the week after our visit, staff were due to have more training in the use of the nutritional screening tool. Care records showed that residents were referred to health care professionals as necessary. Residents who completed surveys indicated that they received the care and support they needed and that staff made sure that they received the medical attention they needed. Those we spoke to confirmed that they were well cared for. One said, I dont have to ask them to help me if I am not well, they just do it. A relative told us, I am happy with the care, the staff are efficient and kind. During the course of our visit we observed that care practices respected residents privacy, dignity, and choice. Medication was stored securely in individual residents rooms. Staff who handled medication had received appropriate training and had company policies and procedures to refer to. At the time of our visit none of the residents looked after their own medicines. There were complete records of medicines received into the home and of any returned to pharmacy at the end of the monthly cycle. There were no stocks carried over to the following month. These records contributed to the audit trail and helped to minimise Care Homes for Older People Page 13 of 27 Evidence: any risk of mishandling. There were no gaps on medication administration record (MAR) charts, which indicated that residents were receiving their medication as it was prescribed. Appropriate codes were used to show when medicines were omitted. One person was prescribed pain relief as a variable dose. Staff signed when they had administered the tablet(s) but not the dose they had given. This meant that other staff could not be sure what dose the resident had received and whether they could administer more. Everyone who was prescribed medication to be given when required was able to decide for themselves when they needed to take it. There were a number of handwritten entries on MAR charts but there was no evidence that these were checked to ensure the instructions for staff exactly matched those on the medication containers. This could increase the risk of medication errors. Staff had failed to update the controlled drug register when a controlled drug had been received into the home, because the person for whom it was prescribed no longer needed it. This meant that there was not a clear audit trail for this particular medicine and greatly increased the risk of mishandling. All other controlled drugs were stored, recorded and administered safely. Care Homes for Older People Page 14 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home had choice and control over their daily lives Evidence: Staff and most residents told us that the routines in the home were flexible. There were no set times for getting up and going to bed. Staff said, We know which people usually like to go to bed early but we still ask them. There were dining times but some people chose to have their meals at different times. Throughout the course of our visit we saw that staff consulted residents and gave them choices, for example, about care, meals and activities. Assessments and care plans recorded information about residents past and present interests. Some of the social care plans were quite specific about the residents preferences for activities and occupation, but they did not generally provide clear directions about what support the resident needed to pursue their individual interests. For example, some plans just directed staff to encourage people to join activities. The home employed two activity co-ordinators. We spoke with one, who said they read the assessment and life story of new residents and talked to them to find out what they liked. They organised activities to meet as many interests as possible and Care Homes for Older People Page 15 of 27 Evidence: there was a varied programme of group sessions, which included trips out and external entertainers. Most residents who returned surveys indicated that there were always activities for them to join and one person commented that this was something the home did well. There were mixed views about the level of stimulation for people who did not join group activities. The AQAA told us that some residents had regular support to pursue individual activities. However, one resident wrote, It would be nice if carers had more time to spend with us, and a member of staff said, It would be lovely to sit with people but call bells are going all the time. We were told that a volunteer worker was currently being recruited so that one to one support could be extended. The open visiting arrangements helped residents to stay in touch with their friends and family. Visitors we spoke to said they always felt welcome and were kept up to date with important issues. One told us, The manager holds a big meeting every so often and he lets us know what is going on. The home had recently achieved a five star dining award. This was awarded by Barchester after the home met the necessary criteria in various food related areas, for example, choice, nutrition and presentation. Residents had a choice at each mealtime. The lunchtime meals on the day of our visit all looked appetising and were served in pleasant surroundings. The residents who returned surveys all said they liked the meals. One wrote, Diet is well planned, varied and nicely presented. Another resident told us, I go to the restaurant twice a day and have plenty to eat. It was usual practice for staff to eat with residents at lunchtime. In addition to enhancing the social aspects of the mealtime, it also enabled residents to give regular feedback. Care Homes for Older People Page 16 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home were protected by the complaints and safeguarding procedures. Evidence: A clear complaints procedure was on display in the home and each person received a copy in their welcome pack. Residents who completed surveys indicated that they knew how to make a formal complaint and a visitor told us he would see the manager if there were any problems. The home had received two complaints in the past year. One had been received just prior to our visit and was awaiting investigation. The other, which concerned the care of someone previously accommodated at The Warren, had been referred to and investigated by social services under their safeguarding protocol. There was no formal outcome at the time of the inspection. Staff received regular training in adult protection issues and they had written guidance to refer to. The staff we spoke to said that, having had the training, they felt confident that they would recognise if a resident was the victim of abuse. They were all clear that they would report any suspected incident to the manager, or outside the home if necessary. Care Homes for Older People Page 17 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People lived in a safe, well maintained and comfortable home, which helped them to maintain their independence. Evidence: From looking around the building it was evident that the home was well maintained and in a good state of repair. Safety measures, such as radiators with low surface temperatures were in place. The home was also adapted to assist residents to remain mobile. There were grab rails around the building and in the bathrooms. There was a choice of quiet lounges and TV rooms. There was also a separate, restaurant style, dining room. The communal rooms were decorated and furnished to a good standard. A large conservatory had been added since our last inspection and there was a new kitchen/diner/lounge. The AQAA indicated this was a resource for residents and relatives to be able to have a drink or snack together as they would when visiting each other at home. The residents we asked said they were happy with their bedrooms. All those we saw were personalised to a high degree. The rooms in the newest wing had door knockers and letter boxes to increase the feeling of privacy and individuality. The AQAA stated that the home kept a store of pictures and ornaments to help residents, who did not bring in any personal belongings, to decorate their room to their own taste. A resident Care Homes for Older People Page 18 of 27 Evidence: told us, I feel very lucky to be living here, I have a lovely room. There were various assisted bathing facilities round the home. Staff had put ornaments and pictures in the bathrooms to help to reduce the clinical feel of the bathrooms. However, two bathrooms housed large laundry skips, which dominated the room. In addition to being unsightly and detracting from the homely environment, there could be a potential infection control issue if dirty laundry remains in an area used by residents. The deputy manager was aware of this but there was a lack of suitable storage space in the home for the laundry containers. There were well kept gardens around the home, which one resident told us they loved to use in summer. A large space had been adapted to enable residents to take part in gardening activities. There were several raised beds and a greenhouse with access for wheelchairs. A number of residents had participated this year, either in gardening or observing, and we were told that it was becoming a very popular activity. The home was clean and fresh smelling and residents who returned surveys indicated it was always like that. One wrote, The cleanliness of the place and the fresh smell everywhere helps us to feel at home very quickly. Another resident told us, The way they look after the room is perfect. Most staff had attended refresher training in infection control and there was written guidance for them to refer to. There were ample hand washing facilities throughout the home and staff had access to gloves and aprons when assisting with personal care. Care Homes for Older People Page 19 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service were supported by a staff team with appropriate training but recruitment practices were not thorough enough to provide complete safeguards. Evidence: The deputy manager told us that there had been some staff shortages over the summer due to holidays and high levels of staff sickness. We were told that these had improved over the past few weeks. However, residents and staff who completed surveys, and those we spoke to during our visit, had varying views on whether staffing levels were sufficient. Staff stressed that residents did not miss out on essential personal or health care. One said, We have had some bad periods but residents dont go short, they take priority over everything. A number of staff did tell us there were sometimes not enough staff to spend as much time with residents as they would like. One said, It would be lovely to sit with people but bells are going all the time. One of the residents also wrote, It would be nice if carers had more time to spend with us. Another resident told us that it sometimes took staff too long to answer bells and then it was too late, but we did not see any evidence of this during our visit. The recent staffing rosters showed that the numbers of staff usually met the target levels, which, we were told, were calculated on the needs of residents living at the home. It was not clear, however, whether residents needs for social contact were included in the calculation. We were also told that the manager had the authority to increase staffing levels on a temporary basis, should the needs of the residents increase. Care Homes for Older People Page 20 of 27 Evidence: We heard some positive feedback from residents and visitors about the staff. One wrote that staff were, Superb, always cheerful, helpful and caring. Others described staff as, friendly, lovely girls and very kind. We looked at two staff files. Pre-employment checks were carried out before the staff started work at the home and the required documents were kept on file. However, we found that one member of staff did not have a reference from their previous employer and the other had either incomplete or unfavourable references. There was no evidence that these had been discussed with the applicants. There were records to show that information about previous criminal offences was discussed with employees. However, there was no evidence to show that any potential risk to people living at the home had been assessed prior to accepting staff with previous offences. New staff completed an induction training programme that covered the common induction standards set by the national training organisation. The theoretical part of the training was computer based and staff were then mentored for the practical aspects. Senior staff assessed the trainee before signing them off as competent to carry out all aspects of their role. Staff who completed surveys indicated that their induction training mostly covered everything they needed to know when they started work. Other training was facilitated by a nominated training officer. At the time of our visit there was a training programme in place to cover the refresher courses for mandatory topics, some of which were overdue. Staff told us there were good opportunities for other training relevant to their role, which helped to ensure they had the knowledge and skills to meet the individual needs of the residents at The Warren. We were told that the company was increasing the number of training courses that were computer based and that some staff had difficulties with with this. The training manager confirmed that he was able to assist staff with e-learning but that there was generally a better response from staff to other types of courses. The AQAA told us that half of the care staff held an NVQ at level 2 or above and four other staff were undertaking the course. Staff who returned surveys indicated that they often received support from their manager. However, the process of formal supervision had ceased sometime ago. One member of staff we spoke to said that the manager was quite approachable but staff tended to support each other. Another said they had not had supervision for ages but that it used to be good. The lack of supervision had been highlighted and the deputy manager had put a plan into place to restart formal sessions for all staff. Care Homes for Older People Page 21 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home was run in a way that safeguarded the health and welfare of the people living there. Evidence: The Warren is owned by Barchester, who have clear management and administration procedures. There is an established management structure within the company to provide support to senior staff working within their services. There had been a change of manager at The Warren since our last inspection. An acting manager had been in charge of the day to day running of the home for a over a year but was not registered with the Commission. The manager was supported by the deputy, heads of department and other senior staff, each of whom had a defined role. However, the systems for communicating information could be improved to ensure that senior staff have sufficient knowledge and understanding of the day to day management processes in the absence of the manager. There were systems in place for monitoring the quality of the service. There were a Care Homes for Older People Page 22 of 27 Evidence: number of audits of procedures and practices. The latest one had been carried out prior to our visit. We found that most of the issues identified as needing attention, had been addressed. Views of residents and relatives were sought through an annual satisfaction survey. The AQAA also described a six monthly community forum, where residents, relatives and staff met for information sharing and planning. Some of the staff we spoke with said they did not always feel they were listened to if they made suggestions for change. For example, a few staff told us they had requested a verbal handover when coming on duty but so far this had not happened. The deputy manager said that the flexible shift patterns meant that staff came on duty at different times, which made it difficult to have one handover, but it was being looked at further. The manager did not act as appointee for any of the residents and the company did not hold any money on their behalf. There was a comprehensive health and safety policy. The maintenance person was nominated as the person responsible for day to day health and safety in the home. The company also commissioned regular health and safety inspections, carried out by external bodies. Staff received fire safety training and participated in drills. The fire systems were serviced and alarms were tested regularly. The AQAA told us that maintenance and servicing of all other installations and equipment was up to date. Care Homes for Older People Page 23 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 8 13 Risks to residents health caused by reduced nutrition must be assessed and plans drawn up to reduce any risks. To promote the residents health and safety. 30/11/2009 2 9 13 There must be complete and 30/11/2009 accurate records of medicines received into the home and administered to residents. This would include controlled drugs and variable dose medication. This is to ensure residents have the medication they are prescribed and there is a clear audit trail. 3 29 19 The recruitment practices must be more thorough. This would include obtaining meaningful references and conducting a risk assessment if an employee has a previous criminal 30/11/2009 Care Homes for Older People Page 25 of 27 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action conviction on their CRB disclosure. This is to provide safeguards for people living in the home. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 9 Handwritten entries on medication administration record charts should be witnessed to ensure that they accurately match the instructions on the medication package. Staffing levels should be kept under review to ensure there are always sufficient staff to meet the personal, health and social care of people living at the home. 2 27 Care Homes for Older People Page 26 of 27 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 27 of 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!

Other inspections for this house

The Warren 14/11/07

The Warren 06/06/06

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