The Warren 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.

The Warren accommodates a maximum of 27 people in one adapted building. People were receiving either nursing or residential care. There were 25 people using the service at the time of this inspection.

Lycette Care Ltd took ownership of The Warren 8 December 2017 since when there have been two registered managers. 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 current registered manager has left the service and is the process of deregistering. A new manager started at The Warren the week following this inspection. At the time of the inspection the provider was managing the service on a day to day basis. They assisted with this inspection.

This was the first inspection since Lycette Care Ltd. took ownership. This means there was no previous rating.

Quality monitoring arrangements had not ensured people received a safe service which met their individual needs. This included omitting to assess where there was a high risk to a person’s health. Not all care plans provided staff with the information they required to provide person centred care. Some information was contradictory, some missing and some no longer used, as it was out of date. This had the potential to increase risk.

There were not always enough staff available to meet the needs and wishes of people using the service. Staffing was a concern mentioned by most staff, who said they were sometimes unable to provide care to the standard they themselves expected. People also spoke of having to wait for care but “didn’t want to make a fuss”.

Meaningful, individual activities were not always promoted. Some people had not continued following their interests, on a misinformed belief this would not be possible. The provider said they would follow this up robustly. Some people enjoyed group activities.

Medicines were managed in people’s best interest but best practice was not always followed. Securing oxygen cylinders and not double checking hand written entries, for example. We have made a recommendation in relation to medicines.

Staff considered the standard of training to be satisfactory but said they could not always attend it, as they were needed to provide care when it was taking place. The provider said this was now being addressed. There had been a trial of one to one supervision meetings, but this was not found to be satisfactory and so staff were not currently receiving this. There were plans to reintroduce supervision using a different approach. Staff received a yearly appraisal of their work.

People were protected through the recruitment arrangements.

Staff had a good understanding of the types of abuse and what steps to take if they believed a person was at risk. People were protected from discrimination.

The premises was kept in a safe state. Improvements had been made to better meet people’s diverse needs and the provider had further improvements planned, once they had asked people’s views about this.

The premises was very clean and fresh. Equipment to promote hygiene was properly maintained. Staff had the protective equipment they needed. Some had not yet received training in infection control, but his was being arranged.

People’s legal rights were understood and protected. Where people lacked capacity to make informed decisions these were made in their best interest.

People’s health was closely monitored. Where external advice and expertise were required, this was arranged. Letters of compliment indicated that