About the service:

Warren Lodge Care Home is a residential care home with nursing for 64 older people, people who live with dementia and people who need support to maintain their mental health. At the time of this inspection 53 people were living in the service.

For more details, please read the full report which is on the CQC website at www.cwc.org.uk

People's experience of using the service:

• All of the people living in the service and most of the relatives were positive about the service. A person said, "I’m okay here as the staff are kind and I have pretty much everything I need.” A relative summarised the views of most relatives when they said, “The care here is first class and the staff are excellent.” However, one relative said, “Sometimes I need to ask for things to be done and it shouldn’t be up to me to point out what care my family member needs.”

• People received safe care and treatment from nurses and care staff who had the knowledge and skills they needed.

• People were safeguarded from the risk of abuse, received person-centred care and were supported to safely take medicines.

• People and their relatives were consulted about the care provided and their consent had been obtained.

• There were robust arrangements to manage complaints and quality checks had been completed.

• Good team work was promoted and regulatory requirements had been met.

Rating at last inspection:

The service was rated as ‘Requires Improvement' at the inspection on 13 March 2018 (the inspection report was published on 24 April 2018). At the inspection in March 2018 there was a breach of regulations. This was because the registered provider was not operating a safe recruitment and selection procedure. At this inspection in April 2019 the recruitment and selection procedure had been strengthened and the breach of regulations had been resolved. At this inspection in April 2019 the overall rating of the service has improved to ‘Good’.

Why we inspected:

This was a planned inspection based on the rating we gave the service at the inspection in March 2018.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit in line with our re-inspection programme. If any concerning information is received we may inspect sooner.

The inspection was carried out on 13 March 2018, and was unannounced.

Warren Lodge is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Warren Lodge is registered to provide nursing and personal care for up to 64 people .There were 55 people using the service during our inspection; who were living with a range of health and support needs. These included; diabetes, catheter care, dementia and people who needed support to be mobile. Warren Lodge is a purpose built premises situated in Ashford, Kent. The service had very large communal lounges/dining rooms available on each floor; with armchairs and TVs for people and a separate, quieter lounge, where people could entertain their visitors.

At the last Care Quality Commission (CQC) inspection on 23 and 24 February 2017, the service was rated Required Improvement in Safe, Effective, Caring, Responsive and Well Led domains with an overall Required Improvement rating. We found breaches of Regulations 9, 12, 13 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We issued a warning notice for the breach of Regulation 17 because there remained shortfalls in diabetes management and quality assurance. We found that there were no assessments about choking for people who were known to be at risk, and no guidance for staff about actions to take in the event of a choking incident. Staff did not raise the alarm appropriately when a person fell; delaying nurse input. Staff had not always followed the provider's processes for reporting incidents to the registered manager, which meant some had not been discussed with the local safeguarding authority. Some aspects of people's healthcare required improvement to ensure people received consistent care and treatment, but other areas were well-managed. People's individual needs were not always met because care plans contained confusing information. Quality assurance processes had not picked up and addressed the issues we found during this inspection. We also recommended that the provider obtains training for staff from a reputable source for diabetes, epilepsy and end of life care. That the provider carries out a full review of PEEPS to ensure they are completely legible and that the provider ensures that people's hopes and wishes for the end of their life are individually discussed and documented wherever possible.

We asked the provider to take action to meet the regulations. We received action plans on 18 April 2017, which stated that the provider will be meeting the regulations by 14 April 2017.

We carried out a focused inspection on 20 July 2017 to check that the provider had met Regulation 17. We found they had met the warning notice for Regulation 17. Improvements had been made in relation to meeting Regulation 17. The provider had taken action to address some of the concerns raised at the previous inspection. However, further work was required to ensure safeguarding incidents were robustly monitored and reported and behaviour which could challenge others was managed positively. Quality assurance processes had not been wholly effective in identifying risks to people in these areas.

We asked the provider to take action to meet the regulations. We received action plans on 21 September 2017, which stated that the provider will be meeting the regulations by 31 October 2017.

At this inspection we found the service remained Requires Improvement.

The service has a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

We carried out an unannounced comprehensive inspection of this service on 23 and 24 February 2017. The provider was served with a Warning Notice for a breach of regulation 17 of the Health and Social Care Act.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach. We undertook a focused inspection on the 20 July 2017 to check that they had followed their plan and to confirm that they now met the legal requirements.

This report only covers our findings in relation to the well-led domain and the warning notice we served. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Warren Lodge Care Home’ on our website at www.cqc.org.uk’

Warren Lodge is registered to provide nursing and personal care for up to 64 people .There were 60 people using the service during our inspection; who were living with a range of health and support needs. These included; diabetes, catheter care, dementia; and people who needed support to be mobile.

Warren Lodge is a purpose built premises situated in Ashford, Kent. The service had very large communal lounges/dining rooms available on each floor; with armchairs and TVs for people and a separate, quieter lounge, where people could entertain their visitors.

A registered manager was not in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. 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. A new manager had been appointed in May 2017 and had started the process for applying with The Commission for their registration; they were present throughout the inspection.

At the previous inspection in February 2017 there were shortfalls in diabetes management and quality assurance processes. We also found other issues which needed to be addressed to protect people's health, safety and well-being.

The provider had taken action to address some of the concerns raised at the previous inspection. However, further work was required to ensure safeguarding incidents were robustly monitored and reported and behaviour which could challenge others was managed positively. Quality assurance processes had not been wholly effective in identifying risks to people in these areas.

People that were at risk of choking benefited from risk assessments which identified the steps staff should take to prevent choking and staff understood how to respond appropriately.

People’s diabetes and catheter care was managed well and staff knew how to support people with their individual needs. Management of health conditions such as epilepsy were well monitored and responded to. Care plans were person centred and provided individualised information on how to care for and support people.

Staff said they had received more training and felt supported by the manager. The views of people and other individuals were sought so the service could improve.

We found a continued breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

This inspection took place on 23 and 24 February 2017 and was unannounced.

Warren Lodge is registered to provide nursing and personal care for up to 64 people .There were 63 people using the service during our inspection; who were living with a range of health and support needs. These included; diabetes, catheter care, dementia; and people who needed support to be mobile.

Warren Lodge is a purpose built premises situated in Ashford, Kent. The service had very large communal lounges/dining rooms available on each floor; with armchairs and TVs for people and a separate, quieter lounge, where people could entertain their visitors.

A registered manager was in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. 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.

Warren Lodge was last inspected in October 2015. At that inspection it was found to require improvement. We issued requirement actions about the storage of medicines, recruitment checks, fire drills, diabetes management and quality assurance processes. At this inspection some of these areas had improved, but there remained shortfalls in diabetes management and quality assurance. We also found other issues which needed to be addressed to protect people’s health, safety and well-being.

There were no assessments about choking for people who were known to be at risk, and no guidance for staff about actions to take in the event of a choking incident. Staff did not raise the alarm appropriately when a person fell; delaying nurse input. Assessments about other types of risk however were detailed and offered staff advice about reducing the likelihood of them happening.

Staff had not always followed the provider’s processes for reporting incidents to the registered manager, which meant some had not been discussed with the local safeguarding authority. Most safeguarding concerns however were referred appropriately.

There were enough staff on duty to meet people’s needs, but staff training could be improved in some areas.

Some aspects of people’s healthcare required improvement to ensure people received consistent care and treatment, but other areas were well-managed. People enjoyed nutritious meals and were offered plenty to drink. Referrals were made in a timely way to dieticians when necessary but people’s individual needs were not always considered to ensure they received a reasonable level of intake.

There were scant records about people’s hopes and wishes for the end of their life; although the provider introduced new paperwork relating to this during the inspection. People’s individual needs were not always met because care plans contained confusing information.

Quality assurance processes had not picked up and addressed the issues we found during this inspection.

We recommend that the provider obtains from a reputable source: diabetes, epilepsy and end of life care training for staff.

We recommend the provider carries out a full review of PEEPS to ensure they are completely legible.

We recommend that the provider ensures that people’s hopes and wishes for the end of their life are individually discussed and documented wherever possible.

Medicines were well-managed and safely administered by staff. The service was maintained to a good standard and all equipment was routinely safety checked. People had individual emergency evacuation plans and staff knew the location of fire exits and assembly points.

Staff received regular supervision and completed the Care Certificate induction programme. There was a robust recruitment system in operation and all necessary checks had been made prior to taking on new staff. Staff were kind and considerate and treated people with dignity and respect.

People’s consent had been sought formally and verbally for day-to-day care tasks. Staff were

On 26 and 27 February 2013 we inspected Warren Lodge Nursing Home and found non-compliance in the areas relating to respecting and involving people who use services, care and welfare, staffing, supporting workers and assessing and the monitoring the quality of the service provided. This was a follow up inspection to check compliance against those areas.

During this inspection we spoke with 10 people who used the service, 5 relatives and friends, the registered manager and 12 members of staff. Some people who were living at the service were unable to talk to us directly about their experiences due to their complex needs, so we used other methods to help us understand their experiences.

People told us their privacy and dignity was respected and that the staff “are all nice” and “kind”. We saw that generally people were treated with dignity and respect. People felt they were able to express their views and were involved in decisions about their care and support.

People were satisfied with the care and support they received. One relative said, “This is by far the best (service). The care is excellent, beyond normal caring - they really know and love her (family member)”.

People and most relatives felt there was sufficient staff on duty to assist people when they needed help. People were complimentary about the staff team and felt staff had the right skills and experience in order to meet their needs.

People had opportunities to give feedback about the service provided. There were effective systems in place to regularly assess and monitor the quality of service people received.

People and their relatives told us they were involved in decisions about their care and support and that their privacy and dignity was respected. Relatives commented on how good the care was. People told us they were happy with the care and support they received. Relatives felt the staff were well trained and knew how to care for people with dementia.

A relative told us that she found the layout of the home very straight forward and she could access the lift with the wheelchair easily.

This was an unannounced inspection which took place on 14 and 15 October 2015. The service was last inspected on 15 October 2013 when we found it was meeting regulations.

This service provides accommodation and personal care for up to 64 people. People at the service are older people living with dementia, some of whom have limited mobility. There were 64 people living at the service at the time of our inspection. Accommodation is arranged over two floors and people had their own bedroom. Access to the first floor is gained by a lift, making all areas of the service accessible to people.

The service had a registered manager in post. A registered manager is a person who is 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 and their visitors commented positively about the care and support received and their experience at the service. However, the inspection highlighted some shortfalls where the regulations were not met. We also identified areas where improvement was required and made recommendations that the service should adopt.

Medicine was not always stored at the correct temperature and medicine, prescribed to be given to people as and when it was needed, was routinely given to people without evaluating the need or recording the reasons why.

Staff had not practiced fire evacuation drills and may not be familiar with what to do in an emergency. Some checks needed to ensure staff were suitable to work at the service were not recorded.

Some health care plans, intended to inform people’s recovery and prevent deterioration, were not completed in accordance with instructions. This devalued the purpose of the health care plans because some required actions were not met.

Quality audits carried out by the registered manager and the provider were not fully effective because they had not provided continuous oversight of all aspects of the service. Authorisations made under the Mental Health Act 2005 to deprive people of their liberty were not notified to The Commission when they needed to be.

Services and equipment including the electrical installation, gas safety certificate, portable electrical appliances, fire alarm and firefighting equipment were checked when needed to help keep people safe. The service was well maintained and comfortable.

The registered manager and deputy manager had a good understanding of the Mental Capacity Act 2005, and Deprivation of Liberty safeguards. They understood in what circumstances a person may need to be referred, and when there was a need for best interest meetings to take place. We found the service was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS) and that people’s rights were respected and upheld.

There were enough staff to meet people’s needs. Staff understood how to protect people from the risk of abuse and the action they needed to take to alert managers or other stakeholders if necessary if they suspected abuse to ensure people were safe.

New staff underwent an induction programme and shadowed experienced staff, until they were competent to work on their own. There was a continuous staff training programme, which included courses relevant to the needs of people supported by the service. Most care staff had completed formal qualifications in health and social care or were in the process of studying for these.

There were low levels of incidents and accidents and these were managed appropriately by staff who sought appropriate action or intervention as needed to keep people safe. Risks were identified and strategies implemented to minimise the level of risk.

Care plans were reviewed regularly and included the views of the people and their relatives or advocates when needed. The service showed an awareness of people’s changing needs and sought professional guidance, which was put into practice.

People were able to choose their food each meal time, snacks and drinks were always available. The food was home-cooked. People told us they enjoyed their meals, describing them as “excellent” and “first class”.

The service was led by a registered manager who worked closely with the deputy manager, clinical manager and the staff team. Staff were fully informed about the ethos of the service and its vision and values. They recognised their individual roles as important and there was good team work throughout the inspection. Staff showed respect and valued one another as well as people living at the service.

We found four breaches: Three related to the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breached the Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take at the back of the full version of the report.