Archived: Willow Brook House

Willow Brook House is a residential care home providing personal care for up to 48 people aged 65 and over. At the time of inspection there were 38 people living at the home. The home was split over two floors. People living with dementia were cared for on the ground floor with access to a garden area.

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

People told us they enjoyed living at the home and staff treated them kindly, however people had to wait for staff to help them and they were not always given choices about their care. We also saw that people’s privacy was not always respected.

The service did not have a registered manager and had been without one since February 2019. This is a requirement of all registered services. There was a peripatetic manager in post which oversaw the management of the home whilst the provider attempted to recruit a new registered manager.

Improvements were required to ensure quality assurance systems identified and remedied where improvements were required in a prompt manner. For example, auditing systems had failed to identify people’s care records, including those people who were at risk of pressure ulcers, had been completed correctly. There were areas within the home that required immediate attention to ensure people had a comfortable and peaceful time, for example, there was a constant beeping sound downstairs all day.

People were protected from abuse, staff were knowledgeable about safeguarding procedures. The management team completed in depth investigations following accidents and incidents to help prevent similar occurrences.

Risk assessments were in place to manage risks within people’s lives, and staff we spoke with felt safe supporting people with a wide range of needs. Staff recruitment procedures ensured appropriate pre-employment checks were carried out.

Medicines were stored and administered safely, and records showed they were administered correctly. Staff were well trained to support people effectively.

People’s nutritional needs were monitored, and people were given additional support to maintain a healthy weight. Healthcare needs were met, and people had access to health professionals as required. Care plans outlined any support people required to manage their healthcare needs.

People's consent was gained before any care was provided, and when there were restrictions on their liberty people were supported to have as much independence as possible. People were supported in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice

Care plans reflected peoples’ likes, dislikes and preferences. People were able to participate in activities within the home or within the local community. A complaints system was in place and used effectively.

The manager was keen to ensure people received good care and support and listened to feedback when provided.

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 3 August 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Willow Brook House provides accommodation for people requiring personal care and is registered to accommodate up to 48 people. At the time of our inspection there were 48 people using the service many of whom were living with Dementia.

There was a registered manager in post. 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 received care from sufficient numbers of experienced staff that were supported to carry out their roles to meet the assessed needs of people living at Willow Brook House. Recruitment procedures protected people from receiving unsafe care from care staff unsuited to the role. Staff received training in areas that enabled them to understand and meet the care needs of each person.

People’s care and support needs were continually monitored and reviewed to ensure that care was provided in the way that they needed. People had been involved in planning and reviewing their care and had detailed individualised plans of care in place to guide staff in delivering their care and support.

People’s health and well-being was monitored by staff and they were supported to access health professionals in a timely manner when they needed to. People were supported to have sufficient amounts to eat and drink to maintain a balanced diet.

Staff understood the importance of obtaining people’s consent when supporting them with their daily living needs. People experienced caring relationships with the staff that provided good interaction by taking the time to listen and understand what people needed.

People’s needs were met in line with their individual care plans and assessed needs. Staff took time to get to know people and ensured that people’s care was tailored to their individual needs.

People had the information they needed to make a complaint and the service had processes in place to respond to any complaints.

People were supported by a team of staff that had the managerial guidance and support they needed to carry out their roles. The quality of the service was monitored by the audits regularly carried out by the registered manager and provider. The registered manager was accessible and knew people well.

Willowbrook House provides accommodation for people requiring personal care and is registered to accommodate up to 48 people. At the time of our inspection there were 46 people using the service many of whom were living with Dementia.

There was a registered manager in post. 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.

Staffing levels during the day were not always sufficient to provide safe, person centred and responsive care to people. People, staff and our observations consistently demonstrated that there were not sufficient numbers of staff deployed in order to meet people’s needs.

People’s individual plans of care lacked sufficient detail to ensure people were receiving person centred care and treatment appropriate to meet their needs and reflect their personal preferences.

There were not appropriate systems or processes to assess, monitor and improve the quality and safety of the service in a timely manner. Quality assurances processes implemented by the provider were effective at identifying shortfalls, however these were not addressed in a sufficiently timely manner to minimise the impact on people.

The food provided to people living in the home was of a variable quality. People were not involved in the planning of meals and people’s individual preferences were not always considered when providing meals.

Staff were not consistently caring in their interactions with people because they were rushed. Much of the interaction between staff and people in the home was task focussed because staff did not have time to have meaningful engagement with people.

People were supported by staff that had the skills and knowledge necessary to provide safe and effective care and support. People’s consent was sought prior to care and support being delivered by staff.

There were appropriate recruitment processes in place and people felt safe in the home. Staff understood their responsibilities to safeguard people and knew how to respond if they had any concerns.

There were a range of activities which people told us that they enjoyed. These included one to one activities as well as group activities and days out.

People knew how to make a complaint. Where complaints had been received, these were investigated and responded to appropriately.

The registered manager was visible and approachable within the home. The local community were encouraged to play an active part in the home and were utilised to provide activities and meaningful interaction with people living in the home.

We found three breaches of regulation during this inspection. You can see the action that we have asked the provider to take at the end of the report.

Is the service safe?

We found that people's needs had been assessed, and that regular reviews had taken place to ensure that people’s individual requirements had been met at Willow Brook House.

Is the service effective?

We found that there were sufficient members of care staff and other workers such as housekeeping and kitchen staff which ensured that the service was run effectively to meet people’s needs.

Is the service caring?

One member of staff we spoke with on the telephone demonstrated a kind and caring attitude to the people that lived at Willow Brook House. They also described the importance of person centred care.

Is the service responsive?

We were told about a recent review of people’s requirements which demonstrated when people’s needs had changed that the provider sought the advice of external professionals.

Is the service well led?

The manager was able to describe the changes that had been introduced and some actions that had been taken which confirmed their ability to manage the service effectively and safely. We concluded that the service was well led.

This is a summary of what we found-

Is the service safe?

People's needs had been assessed before they moved into the home and care plans described how any identified risks to people were minimised. Recent increases in staff meant that there were enough staff on duty to meet the fundamental needs of the people living there. A member of the management team was available on call in case of emergencies. People had been cared for in an environment that was safe, clean and hygienic.

Is the service effective?

It was clear from our observations and from speaking with staff that they had a good understanding of the needs of the people living in the home and that they knew them well. People living with dementia were able to express themselves and staff understood their needs. Where people moved into the service arrangements were made to ensure they settled in and had access to activities to maintain their sense of well being. Staff received training to meet people's needs.

Is the service caring?

People were supported by kind and attentive staff who understood them and engaged in conversation. We noted that care workers showed patience and gave encouragement when supporting people. People living with dementia were observed to move freely around the unit without unnecessary restrictions. We observed and people told us they were able to do things at their own pace and were not rushed. We observed that staff were very supportive of people to enable them to attend activities.

Is the service responsive to people’s needs?

We saw that care plans had been updated when people’s needs had changed and that referrals had been made to health and social care professionals when needed. We noted that when people needed assistance then staff were responsive to their needs. One relative told us they were very pleased with the care their mother received. The service was very busy and on the dementia unit there were times when people did not always have access to staff to respond to their immediate needs. This meant there was a breach of the Health and Social Care Act regulations. A compliance action has been set and the provider must tell us how they plan to improve.

Is the service well-led?

There was a registered manager in post who managed the service on a day to day basis. There were systems in place to audit how people were cared for, if medication was administered safely and to ensure staff were competent to carry out their job role. People were encouraged to attend meetings to shared their views on the care at the home along with meetings for their relatives and staff. The manager had made changes to the premises, the staff team and the rota to ensure people were cared for safely.

We found that the home provided a programme of organised activities which helped people pass the time and kept them stimulated. These activities took account of people's needs, capabilities and their ability to concentrate.

People told us they felt safe living at the home and we found that people were able to express themselves freely and openly.

We found that the provider needed to make improvements to the way they agreed and communicated people's care needs and to their quality assurance systems so the people and their relatives experienced a good service.