Warmere Court

We observed the following good practice.

The home was open to essential visitors only with the exception of relatives who were visiting people receiving end of life care. Safe practices were in place for the arrival of visitors, for example visitors were required to sanitise their hands, have their temperature taken, wear personal protective equipment (PPE) and complete a lateral flow test for Covid-19. There was clear guidance for visitors on what was required of them on arrival and leaving the service, and facilities available for the safe application and removal of PPE.

People were supported by staff to stay in contact with their relatives. Tablet devices were available for phone or video calls and the service had a monthly magazine which updated people and their loved ones on what was happening in the service, and provided a space for relatives to ask questions or give feedback. The provider had a visiting policy in place to support visitors once the home re-opens and was working to create a safe space where visiting could take place.

Furniture throughout the home was spaced in accordance with social distancing guidance. People were observed in communal spaces sitting a safe distance apart and staff regularly supported people to wash and sanitise their hands. Staff were observed wearing correct PPE and had received training in how to safely put on and remove PPE. Staff told us they felt confident in their knowledge of how to use and dispose of PPE safely.

During the outbreak staff were cohorted to a specific area within the service. This meant they supported the same people each shift to reduce the risk of potential cross contamination throughout the home. Symptomatic people and those that had received a positive test were isolated in single occupancy rooms and where possible grouped in one area of the home to reduce the potential spread of Covid-19.

Staff were aware of the impact isolation had on the wellbeing of people and had thought of creative ways to address this. One to one time with people was increased and activities were combined with care. Staff wellbeing was supported through regular supervision, and counselling had been offered to both people and staff following the outbreak.

The premises were clean and hygienic and there were daily cleaning schedules in place for rooms and communal spaces. We observed good practice, including the use of a carpet sweeper rather than a hoover and enhanced cleaning schedules which contained ‘extra cleaning’ for high touch areas. Cleaning schedules are reviewed daily by team leaders to ensure that schedules have been met and any concerns are brought to their attention.

At the time of our inspection the home was closed to admissions as per the recommendation of Public Health England following an outbreak of Covid-19. The provider had a policy which explained the process for safely admitting people to the service. Prior to admission people were required to have an assessment which included a Covid-19 support plan detailing the date and result of most recent Covid test, whether the person has received the first vaccine dose and when the next one is due. New arrivals would only be accepted with a negative Covid-19 test and then isolate for 14 days.

Warmere Court is situated in Yapton, West Sussex and is one of a group of homes owned by a national provider, Shaw Healthcare Limited. It is a residential ‘care home’ for up to 40 people some of whom are living with dementia, older age or frailty. Some people also required support with their nursing needs. At the time of the inspection there were 39 people living in the home.

People’s experience of using this service and what we found

The provider had learned from concerns that had been found during inspections at some of their other services and had implemented training to increase staff’s awareness and skills. Systems and processes had been introduced to help minimise potential risk. However, people had not always been protected from the potential risk of harm. Medicines were not always administered according to prescribing guidance. People requiring modified diets had sometimes been given foods that had the potential to cause them harm. Systems and processes did not always ensure that people were protected from the risk of abuse. There was a lack of oversight when one person had experienced unintentional weight loss. Systems and processes had not always identified the concerns found as part of the inspection. Those systems that had been introduced, were yet to be fully embedded and sustained in practice. The registered manager took immediate action to address the concerns raised and ensure risk was minimised.

People were complimentary about the leadership and management of the home. They told us that the registered manger was, “Someone who listens and cares.” This was demonstrated within the culture and atmosphere of the home, which was warm, welcoming and friendly. Staff felt valued and well-supported by both the registered manager and provider.

There were enough staff to meet people’s needs. People and relatives were complimentary about staff’s skills, who had been provided with training to help increase their awareness of people’s needs. People’s needs were assessed, and staff were provided with guidance to help inform their practice.

People told us they were happy and regarded the service as their home. Comments from people included, “They are interested in my special needs,” “Everyone is treated with kindness,” and “I feel valued, I like living here.” People’s privacy and dignity were maintained, and they were treated with respect, kindness and compassion. People were involved in discussions and decisions about their care and told us that their input and suggestions were listened to and acted upon.

People took part in meaningful activities and pastimes to help occupy their time. They told us how much they enjoyed the varied range of activities and entertainment as well as the visits to places of interest.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Rating at last inspection

At the last comprehensive inspection, the home was rated as Requires Improvement. (Published 18 July 2018). At a focused inspection the overall rating changed, and the home was rated as Good. (Published 27 September 2018). The home has now been rated as Requires Improvement at the last four consecutive comprehensive inspections.

Why we inspected

This was a planned inspection based on the previous comprehensive inspection rating. We have found evidence that the provider needs to make improvements. Please see the Safe and Well-led sections of this full report.

Enforcement

We have identified two breaches in relation to people’s safety. You can see what action we have asked the provider to take at the end of this full report. Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded. The registered manager took prompt action after the inspection, to ensure that risks were lessened.

Follow-up

We will continue to monitor the intelligence we receive about this service. We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We plan to inspect in line with our re-inspection programme. If we receive any concerning information we may inspect sooner.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Warmere Court on our website at www.cqc.org.uk.

Warmere Court is situated in Yapton, Arundel, in West Sussex and is one of a group of homes owned by a national provider, Shaw Healthcare Limited. Warmere Court is registered to accommodate 40 people. At the time of the inspection there were 40 people accommodated in one adapted building, over two floors which were divided into smaller units comprising of ten single bedrooms with en-suite shower rooms, a communal dining room and lounge. These units provided accommodation for older people, those living with dementia and people who required support with their nursing needs. There were also gardens for people to access. The home also contained an unregulated day service facility where people could attend if they wished; however, this did not form part of our inspection.

The home had a registered manager. A registered manager is a ‘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 home is run. The management team consisted of the registered manager, a deputy manager, a clinical lead and team leaders. An operations manager also regularly visited and supported the management team.

We carried out an unannounced comprehensive inspection of this home on 11 December 2017. The home was rated as ‘Requires Improvement’ for a third consecutive time and a breach of legal requirements was found. This was because although it was recognised that the registered manager had made significant improvements since being in post, there was a concern regarding the overall ability to maintain standards and to continually improve the quality of care. Records to document people’s care, were not always completed in their entirety. Areas in need of improvement related to the sufficiency of staff to meet people’s needs for those living in the residential units as well as staff’s understanding and implementation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS).

We undertook this focused inspection to check that improvements had been made and to confirm that the provider was now meeting legal requirements. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Warmere Court on our website at www.cqc.org.uk. At this inspection we found that improvements had been made and the provider was no longer in breach of legal requirements. However, one area of practice that needed improvement, had been made, but needed to be further embedded in practice. This related to the monitoring and timely application of DoLS.

Staff were suitably trained and supported to enable them to meet people’s needs effectively. There were sufficient staff to meet people’s needs. People told us, and our observations confirmed, that when people required assistance from staff they responded promptly. One person told us, "The staff are very good. They are very respectful and private. They are very good with the call bell. They will answer it straight away but if dealing with an emergency will come back as soon as possible”.

People were protected from harm. Staff were vigilant and were aware of how to identify when people were at risk of harm. Staff demonstrated reflective practice and ensured that lessons were learnt when incidents and accidents had occurred. This helped to prevent reoccurrence. Appropriate actions were taken when there were concerns regarding people’s safety and wellbeing. People could maintain their independence through the assessment of risks and appropriate measures had been taken to ensure that people were safe.

People’s needs were assessed and met. People were involved in their care and able to discuss their needs and preferences. People’s healthcare was maintained. They had access to registered nurses and external healthcare professionals to monitor their health. People received timely intervention when they experienced pain or a decline in their health. Medicines were managed safely and actions were taken when there were changes in people’s needs and medicine requirements. There was a co-ordinated approach to people’s healthcare. Infection control was maintained and people were protected from the risk of cross-infection.

People had access to a homely environment that had been adapted to meet their needs. Spaces for interaction with others, as well as private rooms, enabled people to choose how they spent their time. People were involved in decisions about the decoration of the home. People told us that they felt ‘at home’.

The home was led and managed-well. There was consistent, complimentary feedback from people, relatives, staff and health and social care professionals. They told us that the registered manager and their team were supportive, approachable and competent. A quality assurance process enabled the registered manager and provider to monitor the performance of systems and staff to ensure that people’s needs were met. Partnership working and links with external healthcare professionals, as well as community projects, ensured that staff did not work in isolation and good practice was shared.

Warmere Court is situated in Yapton, Arundel in West Sussex and is one of a group of homes owned by a National provider, Shaw Healthcare Limited. Warmere Court is registered to accommodate 40 people. At the time of the inspection there were 36 people accommodated in one adapted building, over two floors which were divided into smaller units comprising of ten single bedrooms with en-suite shower rooms, a communal dining room and lounge. These units provided accommodation for older people, those living with dementia and people who required support with their nursing needs. There were gardens for people to access and a hairdressing room. The home also contained an unregulated day service facility where people could attend if they wished; however, this did not form part of our inspection.

The home had a registered manager. A registered manager is a ‘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 home is run. The management team consisted of the registered manager, a deputy manager and team leaders. An operations manager also regularly visited and supported the management team.

At the previous inspection on 4 and 5 August 2016 the home received a rating of ‘Requires Improvement’ and was found to be in breach of the Health and Social care Act (Regulated Activities) Regulations 2014. Following the last inspection, we asked the provider to complete an action plan to inform us of what they would do and by when to improve the key questions of safe and well-led to at least good. This was because there were concerns about the sufficiency and knowledge of staff. In addition, the provider had failed to submit notifications to CQC to inform us of incidents and events that had occurred to enable us to have oversight and ensure that the relevant actions were being taken. At this inspection improvements had been made and the provider had met the previous breach. However, this is the third consecutive time that the home has been rated as Requires Improvement. There were concerns with regards to the maintenance of records to ensure people received appropriate and consistent care. Records did not always contain sufficient detail and were not always completed in their entirety. This related to people’s healthcare plans, as well as food and fluid intake and cream application charts. It was not evident if people had received appropriate care or if staff had just failed to update the records. The maintenance of records was an area of concern.

There was mixed feedback with regards to the staffing levels within the home. People who resided in the nursing units of the home felt that there were sufficient staff and that their needs were met promptly, whereas people who resided in the residential units within the home felt that there was insufficient staff and they sometimes had to wait for support. When this was fed back to the registered manager they explained that the provider was in discussions with the local authority and was reviewing the staffing provision within the home. This is an area of practice in need of improvement.

People were able to take risks to maintain their independence and development. Most risks had been formally assessed to ensure that appropriate measures were in place to ensure that people were not exposed to harm. However, not all risks had been formally assessed and not all risks associated with one person’s certain lifestyle choice had been considered. When this was fed back to the management team, immediate action was taken and a risk assessment identifying and minimising these risks was developed and implemented. This was an area of practice in need of improvement.

People, their relatives and visitors told us that people were asked their consent before staff supported them and our observations confirmed this. The management team and staff had an understanding about the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS), however, had not consistently implemented this in practice. Some people had their capacity assessed in relation to specific decisions where as others, who had health conditions that might affect their ability to make decisions, did not. Consent forms, providing written confirmation that people had given their consent to a decision, were not always signed by relevant people who had the legal right to make decisions on people’s behalves. Applications had not always been made to the local authority to ensure that people were not being deprived of their liberty unlawfully. This is an area of practice in need of improvement.

People, relatives and visitors told us that staff were kind, caring and compassionate and our observations confirmed this. Comments from people included, “They will do anything for you, you only have to ask”, and “They all do their very best”. People’s privacy and dignity were maintained and they were treated with respect. People were protected from abuse as they were supported by staff that knew the signs and symptoms to look for and who knew what to do if they had any concerns about people’s safety. Staff learned from instances and changed practice to ensure that people’s well-being was promoted and maintained.

The provider had a clear set of values that encompassed a person-centred approach. People were involved in their care and treated with compassion, dignity, equality and respect. These values were implemented in practice and were in the culture of the home. The provider and management team had good quality assurance processes and audits that monitored the practices of staff and the effectiveness of the systems and processes at the home. The provider, management team and staff, worked with external agencies and professionals and continually reflected on their practice and learned from incidents and occurrences to ensure that the service continually improved.

People received a service that was responsive and centred around their needs. People received support from external healthcare services when required and told us that they had faith in staffs’ abilities to notice when they were unwell. Staff were trained and competent and supported people in accordance with their needs and preferences. People had access to medicines to support their health and there were safe systems in place with regards to medicines management. The home was clean and there were good systems in place to maintain infection control and minimise the occurrence of cross-contamination.

People had access to activities and meaningful occupation and told us that they were happy living at the home. One person told us, “I like the entertainers and singers”. People were involved in the development and on-going review of care plans and were able to voice their wishes and contribute to a plan of care that was specific to their needs and preferences. People were involved in decisions that affected their lives at the home. Regular meetings ensured that people were able to express their wishes. The provider welcomed feedback and had worked in accordance with their policy when they had received complaints and concerns. Different departments in the home worked together to ensure that people received an effective and coordinated approach to their care. People’s hydration and nutritional needs were met and people told us that they enjoyed the food. People were able to plan for their end of life care and received dignified and appropriate care to ensure their comfort.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the registered manager to take at the back of the full version of the report.

The home provides nursing care and accommodation for up to 40 older people including older people living with dementia. The home is purpose built and has two floors accommodating up to 20 people on each floor. People who required nursing care lived on the first floor and those who needed personal care on the ground floor. At the time of the inspection 37 people lived at the home. Each person had their own bedroom with an en-suite facility. Communal areas consisted of lounge areas, dining rooms and rooms where people could meet others. There was a garden which people could access. A day centre for up to eight people was run in one area of the home and residents were able to attend. This facility is not registered with the Commission and therefore did not form part of this inspection. The home had a staff team of four registered nurses: two full time and two part time plus staff for catering and domestic duties. The provider was taking action to recruit additional nurses.

The home did not have a registered manager, but there was a manager in post who was in the process of applying to register with the Commission. 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 previous inspection report for an inspection on 2 June 2015 made two requirements where we found breaches of the regulations:

• Care was not always provided safely to people. This included people being placed at risk when being moved in a wheelchair and a lack of care planning for managing pressure areas on people’s skin.

• Staff did not always respond to people’s requests for assistance.

The provider submitted an action plan on how these requirements would be met. At this inspection we found the provider had taken action to address these requirements, but there were still some areas for improvement. People were observed to be safely moved in wheelchairs. Care records showed pressure areas on people’s skin were well managed. However, we found air mattresses used to reduce pressure on people’s skin were not always set correctly. This negated the benefits of the equipment to relieve pressure on people’s skin. The manager took action to address this at the time of the inspection. Risk assessments clearly identified areas of risk to people and care plans gave staff guidance on how to mitigate risk. Staff were observed to help people when they needed it, but we observed two occasions when staff were slow to support two people with their food at lunch time.

Sufficient numbers of registered nurses were not employed. This included a lack of a registered nurse who could act in a role to co-ordinate nursing care to people as well as a lack of nurses appropriately trained to provide catheter care to some residents.

The Commission were not always notified of incidents as required by the Regulations.

Staff were trained in safeguarding adults procedures and knew how to report any concerns.

Since the last inspection, concerns were raised by the local community nursing team regarding medicines procedures for people living with diabetes. At this inspection we found people’s medicines were safely managed. Staff were trained and assessed as being competent to handle and administer medicines.

People told us they were supported by staff who were well trained and competent. Staff had access to a range of relevant training courses and said they were supported in their work.

The CQC monitors the operation of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Staff and the manager were aware of the principles and guidance associated with the MCA. Where needed, assessments of people who lacked mental capacity to consent were carried out and applications made for DoLS.

People were supported to eat and drink and to have a balanced diet. Special dietary needs were catered for and nutritional assessments carried out when these were needed so people received appropriate support. There was some criticism from people about the quality of food and the provider confirmed this was already being addressed after being highlighted during the provider’s quality audit.

People’s health care needs were assessed and recorded. Care records showed people’s physical health care needs were monitored and that people had regular health care checks.

Staff treated people with kindness and had positive relationships with people. Staff were observed to ask people how they wanted to be supported. People and relatives described the staff as caring and helpful.

People’s care needs were assessed and care plans reflected people’s preferences on how they wished to be supported.

A range of activities were provided for people and there was an activities co-ordinator.

The complaints procedure was displayed and people said they knew what to do if they were dissatisfied with the service they received. A record was made of any complaints along with details of how the issue was looked into and resolved.

The manager had a good awareness of the issues facing the service and of the care of each person. The provider sought the views of people and their relatives about the service. A number of audit tools were used to check on the effectiveness of care plans, medicines procedures, the environment, catering and cleanliness. These were carried out by the manager and by the provider.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

We spoke with two relatives and they were happy with the care their family members received in the home.

People's needs were assessed and care and treatment was offered according to their individual plan.

People were protected from abuse.

Medicines were administered safely in the home.

There was a complaints procedure in the home and complaints were taken seriously.

People told us that privacy and dignity was respected and that independence was encouraged.

We spoke with three health professionals. We were told that on the residential floor, care staff followed instructions on how to care for people. We were also told that on the nursing floor there was a lack of continuity in the nursing staff and much use of agency staff. Not all people in the home were having their nursing needs met.

There were some quality assurance systems in place but these did not identify gaps in staff training.