Archived: Willow Court Care Home

Willow Court Care Home is a residential care home providing nursing and personal care to 35 older people at the time of the inspection, including some people living with a dementia type condition. The service can support up to 48 people. Care is provided over two floors.

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

There were not enough staff to support people. Staff told us they did not always have time to complete all of their tasks. People and relatives told us staff were sometimes very rushed. In response, shortly after the inspection, the registered manager told us staffing levels had been increased. Accidents and incidents had been reviewed, but the level of detail within investigations varied. Medicines were well managed and the home was clean.

The provider’s quality monitoring system had not addressed the issues we had found. The provider’s tools to assess staffing needs did not include some key performance information. People, relatives and staff were given opportunities to share their views on the service. We were told the registered manager was approachable and hard working, however, they did not have a deputy manager or permanent nursing staff to support with leading the service.

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

Rating at last inspection

The last rating for this service was Good (published 21 March 2018).

Why we inspected

The inspection was prompted in part by concerns we received about staffing levels. As a result, we undertook a focused inspection to review the Key Questions of Safe and Well-Led only

We reviewed the information we held about the service. No areas of concern were identified in the other Key Questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those Key Questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvements. Please see the Safe and Well-Led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

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

Enforcement

We have identified one breach in relation to staffing levels at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

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 will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Following the last comprehensive inspection, we asked the service to complete an action plan detailing what they would do and by when to improve the key questions of safe, effective and well-led to at least good. We saw infection control measures were now in place and medicines were being managed safely. Staff training and induction processes were very robust and regular supervisions were being held with all staff. The mealtime experience had been improved but this was not consistent within each dining room. The governance of the service had improved and we saw evidence of regular audits and actions taken if any issues were highlighted.

Willow Court Care Home is a ‘care home’ located in North Shields. 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. Willow Court Care Home can accommodate 48 people in one adapted building and on the date of this inspection there were 40 people living at the home.

There was a registered manager in post who has been employed at the service since September 2014 and was registered with the Care Quality Commission (CQC) to provide regulated activities in June 2015. 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.

People told us that they felt safe at the home and relatives agreed with these comments. We found there were policies and procedures in place to help keep people safe. Staff had received training and attended supervision sessions around safeguarding vulnerable adults.

Staff were safely recruited and they were provided with all the necessary induction training required for their role. The registered manager continued to provide on-going training for staff and monitored when refresher training was required. Accidents and incidents were recorded correctly and if any actions were required, they were acted upon and documented.

The premises were safe. Regular checks of the premises, equipment and utilities were carried out and documented. Infection control measures were in place and the service was clean. We saw domestic staff cleaning the home regularly during the inspection.

We saw positive and negative dining experiences. During lunchtime on the first day of inspection we observed that there was not enough staff present to support people in the ground floor dining room. People living at the service commented that they had to wait for staff to help them. We saw that there were sufficient staffing levels at Willow Court but the deployment of staff was an issue. People told us that staff were busy and did not help them when they needed it. We observed people asking for staff to support them to the toilet but having to wait to be assisted. We fed this information back to the registered manager who addressed it immediately.

The service had continued to provide safe medicine management. Procedures were in place to ensure the safe receipt, storage, administration and disposal of medicines. We saw a dentist visiting people and there were records regarding other professionals involved in people’s care. People were supported to maintain a balanced diet and we saw people had access to a range of foods and fluids throughout the day.

The premises were ‘dementia friendly’ as the walls, floors and doors were painted in contrasting colours and there was pictorial signage to help people orientate themselves.

The CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) including the Deprivation of Liberty Safeguards (DoLS), and to report on what we find. Applications had been made on behalf of some people to restrict their freedom for safety reasons in line with the Mental Capacity Act 2005. Staff demonstrated their understanding of the MCA. The registered manager had made applications on behalf of most people living at the service to restrict their freedom for their own safety in line with the MCA. We saw staff asking people for consent when supporting and asking for people’s choices for meals and drinks.

Staff treated people with dignity and respect. They showed kind and caring attitudes and people told us the staff spoke nicely to them. We observed people enjoyed positive relationships with staff and it was apparent they knew each other well.

People and relatives knew how to raise a complaint or concern. The complaints system was available to everyone who visited the service. The provider used a live feedback system which was easily accessible to everyone. The results were used to drive continuous improvement throughout the service.

The service was working in partnership with Newcastle University on the ‘Supporting Excellence in End of Life Care in Dementia’ (SEED) project. This had enabled the service to receive specialist support to deliver personalised end of life care for people and to support staff to deliver this.

People had person-centred care plans and risk assessments in place to keep them safe. People, relatives and external health professionals were all involved in best interest decisions and mental capacity assessments. People’s care records were accurate and up-to-date.

The provider and registered manager had a clear vision to care for people living at the home. Staff told us that they could approach the registered manager if they needed support or guidance. Relatives said that they were always welcome at the service. The registered manager carried out regular checks and audits of the service and worked with the provider to achieve positive outcomes for people who used the service.

We undertook this focused inspection on 13 June 2017 to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Willow Court’ on our website at www.cqc.org.uk

Willow Court is a residential care home situated in North Shields. It provides accommodation, personal and nursing care for up to 48 people with physical and mental health related conditions. At the time of our inspection 43 people lived at the service and one person was on a short break stay.

There was a registered manager in post who has been employed to manage the service since September 2014 and was registered with the Care Quality Commission (CQC) to provide regulated activities in June 2015. A registered manager is a person who has registered with the 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.

The service had a history of non-compliance dating back to 2014 which related to issues such as safeguarding, infection control, staff training and medicine management; however we found improvements had been made in all of these areas.

At our last inspection we found that medicines were managed inconsistently throughout the home and not always in line with company policy. At this inspection, we found that improvements had been made to ensure all staff followed the same working practices and that company policy was followed. We found up to date documentation was in place and it was completed to a good standard. This meant people’s medicines were safely managed.

At our last inspection there was a strong malodour throughout the corridors and in some communal areas. We made a recommendation about this. At this inspection, we found this had reduced as the registered manager and staff had taken appropriate action to address this issue.

At this inspection, people told us they felt safe living at the home and relatives echoed this. Staff had an awareness of safeguarding vulnerable adults and risk assessments were in place to minimise the likelihood of people coming to any harm.

Accident and incidents continued to be recorded and monitored by the registered manager. They had referred these as necessary to external agencies such as the local authority or the CQC.

The premises were safe. Routine checks of the premises and equipment were conducted by staff and recorded.

We heard mixed comments from people and relatives about staffing levels and we witnessed one example where staff were not present when needed. We identified that this was around the deployment of staff because there were sufficient staff on duty.

Staff continued to be safely recruited and they had been trained in topics relevant to their role. Staff now had their competency checked more often and refresher training was in place. New care staff had undertaken a robust induction process.

The provider had ensured that the design of the home was ‘dementia friendly’. Walls, floors and doors were pained in brightly contrasting colours and had appropriate pictorial signage. The décor in people’s bedrooms and communal areas was homely and objects of memorabilia were used to stimulate memories and conversation.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) including the Deprivation of Liberty Safeguards (DoLS), and to report on what we find. The registered manager told us she had made applications on behalf of most people to restrict their freedom in line with the Mental Capacity Act 2005. All staff demonstrated an understanding of the MCA and worked within its principals.

People were given a choice of meals and there were alternatives on offer. The chef fully engaged with people and was familiar with their special dietary needs. The food looked appetising and nutritious and there was plenty available for seconds. The dining rooms were still crowded and there was very little space. Improvements had been made to the dining rooms to make them more homely and optimise the space available.

At our last inspection, despite processes being in place to monitor the quality and safety of the service, we found these were ineffectively operated and had failed to identify the concerns we raised. At this inspection, we found the provider and registered manager had undertaken a comprehensive review of the service and had used the systems effectively in order to identify and address any shortfalls promptly. They had worked in partnership with external agencies for support and guidance.

The provider and registered manager had an action plan in place which they used to ensure the identified safety and quality issues throughout the service were addressed and improvements were carried out. Information inputted into the provider’s quality assurance electronic monitoring system was automatically uploaded to the provider’s system for oversight which we saw was robustly monitored.

Staff told us they were well supported by the registered manager and had received regular supervision and appraisal. Staff and ‘resident’ meetings had taken place and there was good communication throughout the home.

We have not changed the rating of the home at this inspection. This was because we wanted to be certain that the improvements made would be sustained over a longer period of time.

Willow Court is a residential care home situated in North Shields. The home has two floors and all bedrooms have en-suite facilities. It provides accommodation, personal and nursing care for up to 48 people with physical and mental health related conditions. At the time of our inspection 42 people lived at the service.

There was a registered manager in post who has been employed to manage the service since September 2014 and was registered with the Care Quality Commission (CQC) to provide regulated activities in June 2015. A registered manager is a person who has registered with the 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.

The service has historical non-compliance which related to safeguarding, infection control, cleanliness and medicines management; however we found the provider was complying with these regulations when we last inspected the service on 28 May 2015. At the inspection in 2015 the service still required some improvement, particularly with regards to safety and responsiveness.

The registered manager carried out daily, weekly and monthly checks on the safety and quality of the service using an electronic audit system. This automatically presented information and gave oversight to the registered manager and the provider. Although these processes were in place, they were not always effective enough to identify the issues we raised during the inspection with regards to compliance with statutory regulations. After the inspection, we discussed this with the registered manager who told us action would be taken to address the shortfalls in the service.

There was a medicines policy and associated procedures in place; however medicines were managed inconsistently throughout the home and not always in line with company policy. We found issues with the storage, administration, stock control and recording of medicines which meant medicines were not managed safely.

People we spoke with told us they felt safe living at Willow Court. Relatives confirmed this. Staff had been trained with regards to safeguarding of vulnerable adults and demonstrated awareness of their responsibilities towards protecting people from harm. Policies, procedures and systems were in place to support staff with the delivery of the service. Individual risks which people faced in their daily lives had been assessed (with the exception of some risks associated with medicine administration) and control measures were in place to reduce the possibility of an incident or accident occurring.

Incidents and accidents were recorded electronically; there was evidence of an investigation by the registered manager and these were monitored by the provider. Action plans were implemented to reduce the likelihood of a repeat event. The registered manager had reported all incidents to external bodies as required and had written letters of apology to people and relatives if necessary.

Routine safety checks were carried out around the premises; we observed the handyman completing these checks during the inspection and a practice fire drill took place. We also found the provider had suitable emergency contingency plans in place should these be required to be activated by staff.

There was a strong malodour throughout the corridors and in some communal areas. We have made a recommendation about this. We found the design of the home had elements of best practice with regards to dementia care. Walls and floors contrasted and doors were brightly coloured with appropriate signage. The décor in people’s bedrooms and communal areas was homely and objects of memorabilia were used to stimulate memories and conversation.

People and relatives told us they felt there was enough staff employed at the service. We observed staff responded quickly to people when called upon. Care workers told us they did not feel hurried in their duties and felt they were able to meet people’s needs. Staff had been recruited safely. They had completed training in topics relevant to their role, however refresher training was not routinely carried out. Staff competencies were not always checked in a timely manner and not all staff had completed a robust induction.

The Care Quality Commission (CQC) is required by law to monitor the operations of the Mental Capacity Act 2005 (MCA) including the Deprivation of Liberty Safeguards (DoLS), and to report on what we find. MCA is a law that protects and supports people who do not have the ability to make their own decisions and to ensure decisions are made in their ‘best interests’. It also ensures unlawful restrictions are not placed on people in care homes and hospitals. In England, the local authority authorises applications to deprive people of their liberty. We found the provider was complying with their legal requirements.

The staff offered people a choice of meals and alternatives were provided if people preferred something else. The food looked nutritious, well-balanced and appetising. Special diets were catered for and the kitchen staff were familiar with people’s dietary needs. People appeared to enjoy their meals; however the dining rooms were very crowded, lacked the atmosphere of a homely environment and didn’t provide much of an opportunity for socialisation.

All staff displayed kind and caring attitudes and people told us the staff were nice to them. We saw care workers treated people with dignity and respect whilst assisting with personal care and we saw positive interactions with people throughout the inspection. People appeared to enjoy a friendly relationship with the staff and it was apparent the staff knew people well.

We examined six individual care records in-depth and found 9with the exception of medicine records) they were person-centred, detailed and had been regularly updated and evaluated. Individual people’s needs were assessed and the records contained personalised information.

There was an activities coordinator employed at the service. We saw information on display about forthcoming events and we observed people engaging in activities during the inspection. Interesting and meaningful stimulation was provided on a one-to-one and group basis.

There was a complaints procedure in place and we saw information about it displayed in communal areas. We reviewed four response letters to complaints made about the service and saw evidence of internal investigations into the issues raised had taken place. Complainants had received a response in line with company policy. An electronic quality assurance system was in place to gather immediate feedback from people, relatives, visitors and staff. Nobody we spoke with raised any complaints, however one relative was not satisfied with the response to their complaint and this was on-going.

Staff told us they felt supported by the registered manager and had received regular supervision and appraisal. Staff meetings had taken place and there was good communication throughout the departments within the home.

We have identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, relating to safe care and treatment and good governance. You can see what action we told the provider to take at the back of the full version of the report.

We were unable to speak to some of the people using the service because of the nature of nature of their condition.

We spoke with four people, three relatives and five care workers about the care and support provided by the service. One person told us, 'I'm happy here. The best part about being here is that I am comfortable and I am well looked after.' Another person commented, 'I find the girls very good really. They really care and they know what they are doing.' A relative told us, 'The staff are well trained. Overall, we are very happy with service here.' Another relative said, 'They have good staff here and the care and support is really good. X [staff members name] is a real gem; he has really good interactions with my dad.'

We found that staff received appropriate training, professional development, appraisal and supervision. One care worker told us, 'We have regular staff meetings, supervisions and plenty of training. I feel supported by management.'

We found people's needs were assessed and care and treatment was planned and delivered in line with their individual care plans. Relatives we spoke with were positive about the care and support people received. One relative told us, 'I find the place wonderful, the care here is fantastic.' Another relative said, 'The carers are so caring."

We found that there were suitable numbers of skilled, qualified and experienced care staff. Relatives were complimentary about the staff. One person told us, 'I have recommended the home to other friends; the nursing staff are all excellent.'

Staff informed us that they were appropriately trained; however we found that suitable appraisal and supervision arrangements were not fully in place.

We found that effective systems were in place to regularly assess and monitor the quality of service provided.

We saw that people's personal records, staff records and other records relevant to the management of the home were accurate and fit for purpose.

In this report, the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a registered manager on our register at the time.

As we walked around the premises we spoke with some of them, although most people had complex needs which meant they were not able to tell us their experiences.

We viewed care records for six people. We found that care was planned and delivered in a way which met people's individual needs.

We found that appropriate arrangements were in place for the management of medicines at the service and that care was provided in an environment which was suitably designed and adequately maintained.