Warberries Nursing Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

People told us they felt safe living at the service and were complimentary about the staff and the service. Improvements in relation to managing risk had been made since the last inspection and the provider was no longer in breach of regulations. However, some further improvement was needed, and improvements were also needed to some aspects of medicines management. People’s relatives described staff and managers as approachable and contacted them when things had gone wrong. Most people told us there were enough staff available to meet their needs and spend time with them. People were cared for by staff who had been safely recruited and records confirmed staff received regular individual supervision and group supervisions to help them develop within their role. People and their relatives did not raise any concerns about the safety of the environment.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People’s relatives described staff and managers as approachable and contacted them when things had gone wrong. One relative said, “She had a fall, and they are quickly on the phone.” Another relative told us about what happened when there was a safeguarding concern with their relative, “I got an email, and I spoke to the manager about it. They dealt with it well.”

The registered manager and provider told us following the last inspection the service had learned from the experience and committed to make the changes needed to ensure people received good care. The registered manager told us they completed an action plan to address the concerns raised and involved staff through regular staff and clinical team meetings in the change process. The registered manager said, “We try and be honest with each other, hold our hands up when something has gone wrong and learn from it. We are very responsive; we are not resistive and want to learn and are always happy to receive feedback.” Staff told us they felt supported to raise concerns. One staff member told us, “Every 3 months we have a staff meeting. It is very helpful and if staff have any problems, we can discuss them and where things can be improved.”

The registered manager understood their responsibilities in relation to Duty of Candour. Duty of candour is a legal requirement that ensures providers are open and transparent with people who use services when things could have been done differently. Accidents and incidents were recorded, monitored and action was taken to address concerns. Monthly reviews of accidents and incidents were completed to look for pattern’s, trends and themes. When things had gone wrong, staff meetings were held to discuss incidents and accidents and what learning they could take from the incident and how they could improve care.

People’s needs and preferences were assessed before they moved into the service and staff worked hard to make the transition easier for people. One relative told us, “[Relatives name] was in his shell after being in hospital and staff spent time and patience with him. He communicates with them now.” Most of the relatives we spoke with told us they were involved in people’s care and support and were informed of any changes or issues. One relative, told us, “They always phone me if there are any issues, for example, if she has a fall.” However, one relative commented that they would like more involvement in care planning.

Staff knew people well and were knowledgeable about their health and care needs. Staff told us they received daily handovers and team meetings that kept them informed about people’s needs and described working with health professionals to meet people’s needs. For example, staff told us they liaise with the physio when people experience an increase in falls.

We did not receive any concerns from external health and social care professionals regarding management of safety and risk.

Before people moved into the service pre-admission assessments were carried out to ensure the service could meet people’s needs. People, their relatives and health professionals where appropriate, were involved in planning their care to ensure people were cared for as they wished. If people's needs changed, referrals were made to appropriate health professionals for further advice and guidance. Processes were in place to ensure safe transition between healthcare services. For example, people’s records contained a hospital passport which went with them if they were admitted to hospital ensuring important information about the person was shared with health professionals who needed to know.

People told us they felt safe living at the service and were complimentary about the staff and the service. One person told us, “Yes, I am comfortable and safe, definitely.” Another person commented, “They are very good, they look after me. I can talk to them. They come in every day; all the staff are pretty good.” Relatives we spoke with were happy with the care and felt their family member was safe and well cared for. One relative said, “I can’t speak highly enough of them. I’ve no worries about safety.” Another commented, “Yes, she has actually said that she feels safe. The carers are very caring. They appear to look after her very well, know what her needs are. I visit her every day.”

Staff told us they received safeguarding training and knew what to do if they thought people were being abused. One staff member said, “I would definitely report it if I saw anything and then record the information. If there was no action, I am pretty sure we can make a direct approach to the safeguarding team.”

We carried out a short observational framework inspection (SOFI) to help us understand the experiences of people using the service who may not be able to verbally share their feedback. We observed staff were kind and caring with people and staff were quick to respond to their needs. We observed people appeared comfortable with staff and we saw the service was calm and relaxed.

Processes were in place to ensure people were protected from the risk of abuse and avoidable harm. Where safeguarding concerns had been raised, these had been fully investigated and appropriate action had been taken. Staff had access to regular safeguarding training and learning from safeguarding concerns was discussed with staff during meetings and supervisions.

People who were able, described to us what action staff took and what was in place to keep them safe and manage risks. For example, people told us about equipment staff used to help them move around safely and how staff protected their skin from skin damage. One person told us, “I have an air mattress and use a frame, wheelchair and shower chair. Staff put cream on me when necessary.” Relatives we spoke with on the whole felt risks were managed well. One relative told us, “They are extremely good; he has complex needs with mental health and dementia, and he broke his hip. They are excellent, they have worked really hard with him and are always lovely and amenable.”

The registered manager told us since the last inspection highlighted issues in relation to monitoring people’s care needs, they had improved their oversight of care delivery. The registered manager told us they continuously access their electronic care planning system to ensure care tasks such as, repositioning and food and fluid monitoring, is being completed according to people’s assessed needs. The registered manager told us where they identified gaps in care delivery, immediate action is taken to address this. Staff knew people well and were able to tell us about their care needs and how they were supporting people to minimise risk. For example, staff described how they support people at risk of choking to eat safely, how they protect people’s skin and what measures were in place to prevent people falling. One staff member described what action they would take if a person had lost weight, “With people with low weight, we would fortify their diets. If someone continued to lose weight, we would refer to the dietician and they may give supplements. Everyone is monitored for food and fluids and if we had concerns, they go onto weekly weights instead of monthly and they are monitored more closely.”

We observed staff supporting people to move safely and staff had access to appropriate equipment to do so. Where people were at risk of falling or at risk of developing pressure damage, equipment was in place to mitigate risk, such as, pressure relieving mattresses and sensor alarms. We observed staff supporting people with their meals, safely.

Improvements in relation to managing risk had been made since the last inspection and the provider was no longer in breach of regulations. However, some further improvement was needed. Risks to people were assessed and care plans and risk assessments were in place to guide staff on managing people’s individual risks. Whilst we found care plans and risk assessments had improved in the level of guidance and consistency, further improvement was needed to ensure care records contained enough information in relation to managing people’s wounds. Processes were in place to ensure risks to people were being monitored and mitigated. For example, food and fluid intake was being monitoring for people at risk of weight loss. Whilst we found monitoring records were mostly being completed well and evidenced risk was being mitigated, improvements were needed to ensure that all people were being repositioned according to their assessed needs. Advice had been sought from health professionals when needed. For example, staff had sought advice from the speech and language therapy team (SALT) for people at risk of choking. People assessed as at risk of falls were being monitored and appropriate action had been taken such as, increased monitoring and using bed rails and sensor alarm mats to keep people safe.

People and their relatives did not raise any concerns about the safety of the environment. One relative told us, “The building is old and needs constant maintenance. In winter there was a bit of mold on the coving in her room; within a couple of days, it had been removed and repainted.”

Staff were aware of their role and responsibilities in maintaining a safe environment. Staff confirmed they received health and safety training including fire safety. The provider and registered manager told us there were regular checks of the environment to ensure it was safe for people living at the service.

We observed people lived in an environment that was safe and well maintained. We saw that equipment was available to help people move around the service safely. Corridors and bedrooms were uncluttered and did not present any obvious health and safety risks. Fire safety equipment was in place to safely evacuate people in the event of a fire. Windows were appropriately restricted according to legislation.

Systems and processes were in place to monitor, review and drive improvement in relation to the safety of the environment. Equipment was serviced as required and the provider had environmental risk assessments in place. Health and safety checks were completed regularly, including fire and legionella checks. Clear processes were in place to manage maintenance issues. Personal Emergency Evacuation Plans (PEEPs) had been completed to show staff how to safely support people in the event of a fire or if it was necessary to evacuate the building.

Generally, people told us there were enough staff available to meet their needs and spend time with them. Comments included, “You can talk to somebody all the time. Being rushed has not been a problem” and “Occasionally there is a shortage on a Saturday or Sunday, or some residents have extra needs. I have never had any objections with the carers. Whatever I ask they will do.” Relatives told us, “There are loads of staff, there’s always someone around. We are happy with her being there. It’s safe and secure” and “I have never come across a situation when the staff member was needed and there wasn’t anyone there. As soon as I press the button they are there. She has not complained of them taking a long time.” However, one relative commented that they would like staff to respond quicker to prevent falls and another relative was concerned there were not enough staff to accompany people to hospital following a fall.

Staff told us they felt there were enough staff available to care for people. Comments included, “Most of the time when residents press their bells, we are there within 2-3 mins. Sometimes there may be a delay but generally people do not have to wait too long”, “No, I do not feel rushed. We have enough staff, and we do have time to do our tasks. We have 10 or 11 staff every day and we also have our senior staff who help us” and “Yes, I feel there is enough staff here. We probably have more staff now than anywhere in the Bay.” Staff told us they were happy in their roles and felt well supported by the managers. Staff told us they received appropriate training and supervision.

We observed people were cared for by enough staff to meet their needs. Staff were available to respond quickly to call bells and we saw staff had time to spend with people other than assisting them with their care needs.

People were cared for by staff who had been safely recruited. New staff had a thorough induction and were able to spend time shadowing more experienced members of staff before working alone. Records confirmed staff received regular supervision and group supervisions to help them develop within their role. The staff training matrix confirmed staff received training appropriate to their roles. The registered manager told us they did not use a dependency tool to help determine staffing levels but tried to maintain a ratio of 3:1 staffing, and this was working well at the service. Where people required 1:1 support, this was provided in addition to their core staffing levels.

People and their relatives told us the service was clean and staff wore appropriate personal protective equipment (PPE) when supporting them. One person said every day their room was kept very clean, as was the hall and lounge, commenting, “They are spotless”. One relative told us, “She and the building are always clean and always fresh bedding. Always clean and tidy.”

Staff told us they completed infection prevention and control (IPC) training and competency assessments. Staff understood their responsibilities in relation to IPC. One staff member told us, “We have to put PPE on including gloves before you go inside the bedroom and then take it off before you leave the room. We need to wash our hands before and after personal care and we have competency assessments on that.” Domestic staff described the processes in place to ensure the service was kept clean and free from infections. Domestic staff told us they had regular meetings where they discussed how they could improve IPC and cleanliness at the service

We observed the service was clean and free from unpleasant odours. We saw PPE was available for staff to use throughout the service and we observed staff using PPE appropriately.

Processes were in place to ensure the service was clean and free from infection. Infection prevention and control policies were in place and senior staff completed monthly audits including audits in relation to housekeeping and IPC. The service had a team of domestic and laundry staff on duty every day and cleaning checklists were completed to ensure all areas of the service were cleaned.

We observed medicines being given safely, with staff taking time with people to help them take their medicines. People received their medicines in the way prescribed for them, and at suitable times.

Staff told us that generally systems worked well, and they felt supported with medicines. They said they could raise any problems and knew how to report any errors or issues. They told us they had training and competency checks to make sure they gave medicines safely.

People’s records showed that they received their medicines as prescribed. There were suitable arrangements for the storage, administration and disposal of medicines. There was detailed and person-centred information for medicines prescribed ‘when required’ to guide staff when these might be needed. Medicines audits took place and had identified and actioned some areas for improvement. However, there were some care plans which lacked details and relevant risk assessments for some medicines, for example, blood thinning medicines and flammable topical preparations.