CQC report explained · a residential care home
What the CQC found at The Warren
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- Risks were assessed and steps were taken to reduce them. Medicines were stored, given and recorded safely, but some people said call bells were not always answered promptly.
- Effective?
- Good
- Staff had training and support to meet people's needs. People were supported with food, drink, healthcare and decisions under the Mental Capacity Act.
- Caring?
- Good
- People and relatives said staff were kind, caring and respectful. Inspectors saw staff protecting people's privacy, dignity and choices.
- Responsive?
- Good
- Care plans gave staff guidance and people were involved in their care and activities. Some plans needed updating when people's needs had changed.
- Well-led?
- Good
- The home used regular audits, meetings and feedback to identify and make improvements. There was no registered manager in post during the inspection, but management support was in place.
What inspectors found, August 2018
Rated Good; inspectors found safe, kind and person-centred care, but call bells were not always answered promptly and some care plans needed updating.
This was an unannounced inspection on 18 June 2018. Inspectors spoke with people living in the home, a relative and staff. They reviewed care records, medicines records, health and safety records and quality checks. They also watched how people were supported in shared areas.
The home was rated Good in all five areas: Safe, Effective, Caring, Responsive and Well-led. Inspectors found that risks were assessed, medicines were managed safely, staff were trained and people received kind and respectful care. People had access to health professionals, food and activities suited to their needs.
The home had improved since the February 2017 inspection, when it was rated Requires Improvement. The provider had acted on earlier concerns about risks, medicines, timely support and quality monitoring. However, some people said call bells were not always answered promptly, and some care plans did not reflect recent changes in people's needs.
Improved safety
The home had addressed earlier concerns about risk assessments. Staff had clear information about how to reduce risks, including falls risks.
“We found the risk assessments to be detailed and that they contained the information the staff required so that they were aware of what action they should take to minimise any risks.” from the report
Safe medicines
Staff were trained and checked before giving medicines without supervision. Records matched the medicines in stock, and medicines were stored securely.
“We found that the medication administration records tallied with the amount of medication in stock.” from the report
Kind and respectful care
People said staff were caring and respectful. Inspectors saw staff asking for consent and protecting privacy during personal care.
“All the people and their relatives we spoke with said that staff worked hard and were kind, caring and respectful to them.” from the report
Activities and personal choices
People were offered activities, trips and hobbies based on their interests. They were supported to make choices about daily life.
“There was a varied programme of activities including activities held in the service, trips out and entertainers that came into the home.” from the report
Quality monitoring
The home used regular checks, meetings and feedback from people, relatives and staff. Actions were taken when improvements were needed.
“There was an effective quality assurance system in place to ensure that, where needed, improvements were identified and made in the home.” from the report
Call bells were sometimes slow
needs fixingSome people did not feel call bells were answered quickly enough. The home was trialling a pager system and monitoring whether it worked.
“Although people told us there was normally enough staff to meet their needs they did not always feel that call bells were answered in a timely manner.” from the report
Some care plans were out of date
needs fixingSome care plans did not contain current information after people's needs changed. Staff knew the current information and were providing the right care, but records still needed updating.
“However, some care plans needed updating with current information when people's needs had changed.” from the report
No registered manager in post
minorThere was no registered manager when inspectors visited. A new manager had been appointed and planned to apply for registration after starting work.
“At the time of the inspection there was not a registered manager in place.” from the report
- 01How quickly are call bells answered now, and what happened with the new pager system?
- 02How do you make sure care plans are updated promptly when someone's needs change?
- 03Has the new manager started, and have they applied to become registered with the CQC?
- 04How do you check that staffing levels remain suitable for people's current needs?
- 05How can residents and relatives raise concerns, and how are those concerns followed up?
This was an unannounced inspection covering all five CQC questions and the overall rating. This explanation was written from the published report of 24 August 2018 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, April 2017
The Warren was rated Requires Improvement; inspectors found serious shortfalls in staffing, medicines, risk management and care planning.
This was an unannounced inspection on 22 and 23 February 2017. Inspectors spoke with people living in the home, relatives, staff and a healthcare professional. They observed care and checked care records, medicines records, staff files, training, audits and maintenance records.
The home was not always safe. There were not enough staff, and people sometimes waited a long time for help. Inspectors also found problems with medicines, risk assessments and follow-up after falls. Care plans were often incomplete or out of date.
Some care was good. People's food, drink and healthcare needs were met. Staff had training, independence was encouraged and activities were varied. However, people's dignity and privacy were not always protected, and care was not consistently personal to each person.
The overall rating changed from Good at the January 2016 inspection to Requires Improvement. The home breached four regulations. Inspectors also recommended further support and training on the Mental Capacity Act.
Food and healthcare
Inspectors found that people's nutritional and healthcare needs were met. People had enough food and drink, a choice of meals and access to healthcare professionals.
“People's nutritional needs were met and where people required specialist diets, this was provided.” from the report
Training and induction
New staff received an induction and existing staff had relevant, up-to-date training. Recruitment checks were also in place before new staff started work.
“Staff told us that they had received training, that it was up to date and relevant.” from the report
Activities
People enjoyed a varied programme of activities. Staff encouraged participation and offered individual help where needed.
“During our inspection visits, we saw that activities were available to people and that these were varied to suit differing needs.” from the report
Independence and choice
Staff asked for consent before providing support and encouraged people to remain as independent as possible. People said they could make choices about their daily lives.
“People's independence was encouraged and they told us they appreciated this aspect of the service.” from the report
Staffing and waiting times
seriousThere were not enough staff to meet people's needs promptly. Call bells were seen ringing for between 10 and 33 minutes, and some people reported much longer waits at night.
“There were not enough staff to meet the individual needs of those that used the service. People had to wait inappropriate amounts of time for assistance.” from the report
Medicines
seriousInspectors found missing guidance, incomplete risk assessments, medicines being given late and supplies not always being available. These problems put people's health and wellbeing at risk.
“People did not consistently receive their medicines as the prescriber intended.” from the report
Risk assessments and care plans
seriousRisk assessments and care plans were not always reviewed after falls, weight loss, hospital stays or other changes. Staff did not always have enough accurate information to provide safe, individual care.
“Care plans lacked guidance for staff to meet people's needs in a safe and individual manner.” from the report
Dignity and privacy
needs fixingInspectors saw people being assisted with personal matters in public areas and heard language that was not respectful. People's dignity and privacy were not consistently protected.
“People were not always assisted in a way that maintained their dignity.” from the report
Weak follow-through
needs fixingThe home had identified many problems through its own audits, but action had not been completed promptly. Staff reported low morale and said they did not feel listened to or supported.
“Timely action had not been taken to rectify the identified issues.” from the report
- 01How many care staff are now on each shift, including at night, and how do you monitor call bell response times?
- 02How do you make sure medicines are available, given at the prescribed time and supported by up-to-date guidance?
- 03How quickly are risk assessments and care plans reviewed after a fall, hospital stay, weight loss or other change in health?
- 04What has been done to make sure people's privacy and dignity are protected during personal care and support?
- 05Which of the actions required after this inspection have been completed, and how can we see evidence of the improvements?
This was an unannounced inspection of the overall service and covered all five CQC questions, following concerns about staffing, medicines and management responsiveness. This explanation was written from the published report of 26 April 2017 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of The Warren
3 rated inspections over 2 years: the service has held its Good rating throughout.
- August 2018Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- April 2017Requires improvementdown from GoodSafe: Requires improvementEffective: GoodCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- March 2016GoodSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- March 2014
Report published without a new overall rating.
- May 2013
Report published without a new overall rating.
- February 2013
Report published without a new overall rating.
- June 2012
Report published without a new overall rating.
- February 2011
Registered with the Care Quality Commission on 15 February 2011.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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13 live-in carers within about an hour of Norfolk
These are self-employed carers on PrimeCarers, the introductory agency that runs this directory. Each has a profile with their own rates and reviews from families, and you choose who to talk to.
Most charge £990 to £1,120 a week. 9 can care for a couple. 14 years' experience on average.
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