Willow Lodge Care Home

About the service

Willow Lodge Care Home is a residential care home providing the regulated activity of accommodation with personal care for up to 40 people. People had a range of care needs including frailty of age, Parkinson’s disease, people living with dementia and people with a learning disability. At the time of our inspection there were 38 people using the service. Accommodation was over three floors in one adapted building or in purpose built garden lodges.

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

People did not always receive safe support with their medicines. People told us they felt safe. A person told us, “I feel safe here and that’s important”. Relatives had no concerns about their loved one’s safety. Systems were in place to protect people from the risk of abuse and improper treatment. Staff knew how to identify potential harm and report concerns. Risks were identified and managed.

Systems and process were in place to monitor the quality of the service being delivered. These had not been effective in providing management oversight of medicines. The culture of the service was positive, and people and staff were complementary of the registered manager and provider. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

There were enough staff to meet people’s needs in a timely and person-centred way. Care plans provided detailed information and guidance for staff. Staff knew people well and provided support in line with people's preferences. People and relatives told us the care people received was very good and the staff were kind, caring and compassionate.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence, and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

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 12 February 2021).

Why we inspected

The inspection was prompted in part due to concerns around the management of medicines and a notification of a serious incident. This incident is subject to further investigation by CQC as to whether any regulatory action should be taken. As a result, this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about the management of risk of medicines.

As a result, we undertook a focused inspection to review the key questions of safe, responsive, and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

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

Enforcement

We have identified breaches in relation to the management of medicines at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Willow Lodge Care Home is a residential care home providing personal care to up to 39 people and specialising in providing care to people living with dementia. At the time of the inspection the service was supporting 33 people. The home is purpose built over three floors. Seven of the bedrooms are in ‘lodges’ located in the grounds of the service.

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

The management team had made significant improvements to the safety and governance of the service. There was a positive and happy atmosphere at the home and people spoke highly of the care they received. In a recent online review we read, ‘I cannot fault Willow Lodge Care home and the amazing team who look after my father. They have been his and my salvation. Nothing is too much trouble and everyone is friendly’.

Since our last inspection the support manager had registered with the Care Quality Commission. A new deputy manager was also in post. Staff had received further training and felt confident in their roles. One staff member told us, “We feel like a team now rather than lots of different people working in one place, we are more coherent and consistent”.

People’s care had been reviewed and updated. Risks to people were assessed and there was clear guidance in place for staff to mitigate risk and keep people safe. Improvements had been made in how staff used personal protective equipment (PPE) to reduce the risk and spread of infection. New social distancing measures were in place in communal areas of the home.

More work was needed in some areas to ensure the care planned and delivered to people was accurately recorded on the systems. The registered manager was aware of this and was working with staff to enhance their understanding of the electronic care planning system.

There were enough staff to keep people safe. Some people said there were certain times of day where it took longer for staff to respond to their call bells and some staff expressed concern about their ability to ensure cover in the communal areas. The registered manager had taken action to address these concerns by deploying senior staff to provide support and increase the staff presence in communal areas.

People received care in line with their needs and choices. Professionals shared examples of how staff had delivered person-centred care which greatly benefited the person’s well-being and in one case avoided a hospital admission. Staff worked effectively and pro-actively with healthcare professionals to ensure people received good support.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

The provider was investing in the premises. The communal lounge had been extended and a new outdoor visiting space was being built.

There was a positive culture at the service and the registered manager welcomed feedback. People and staff felt able to share ideas or concerns. There was a system of checks and audits to ensure the smooth running of the service. Where actions to improve the service were identified, these were recorded and monitored through to completion.

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

Rating at last inspection (and update)

The last rating for this service was requires improvement (published 9 January 2021). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements, and Effective which was also rated requires improvement.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

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

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 Lodge Care Home is a residential care home providing personal and nursing care to up to 39 people, specialising in providing care to people living with dementia. At the time of the inspection the service was supporting 29 people. The home is purpose built over three floors. Seven of the bedrooms are in ‘lodges’ located in the garden area.

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

People were not always protected from the risk of infection as some staff did not wear PPE correctly, or removed their masks to speak with people. People were not socially distanced in communal areas of the home. People were able to have visits from friends and family using an outside area or a dedicated cabin used for visits.

Risks to people were not always mitigated and risk assessments were not always personalised for people.

People and their relatives were not always asked for input into their care planning. People were supported to remain active and to eat and drink what they wanted. People enjoyed living at the home and we saw friendly exchanges between people and staff. People were cared for by trained staff.

Communication with healthcare professionals had been inconsistent and the support manager was working to address this and to improve care. Meetings were being arranged and log books used to ensure important information about people’s care was not missed.

The home was clean and uncluttered and clear signs allowed people to navigate around the home. The support manager understood the importance of the mental capacity act and people were only deprived of their liberty with the correct authorisation. People were able to access a secure garden.

Staff were happy working at the home and felt the people were happy there too. Staff were positive about the management team and the changes to the service. A staff member told us, “I love my work and enjoy helping the residents. I enjoy making them smile and laugh. I feel that everything is good. I am happy, I don't like my days off because I want to be at work, I miss the residents.”

People told us they were happy at the home. A person told us, “They can’t do enough for you, it’s better than the Savoy here.”

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 30 January 2019).

We received concerns in relation to managing risks to people, safe medicines management and the running of the service. As a result, we undertook a focused inspection to review the key questions of safe, effective, 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 improvement. Please see the safe, effective and well-led sections of this full report.

Enforcement

We have identified a continuing breach in relation to safe care and treatment at this inspection, in particular how risks to people are managed. We also identified a breach in relation to good governance of the service.

You can see what action we have asked the provider to take at the end of this full report.

Follow up

The provider has an improvement plan outlining what they will do to improve the standards of quality and safety.

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

Willow Lodge Care Home is a residential care home providing personal and nursing care to up to 39 people, specialising in providing care to people living with dementia. At the time of the inspection the service was supporting 29 people. The home is purpose built over three floors. Seven of the bedrooms are in ‘lodges’ located in the garden area.

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

Residents and staff had been through a challenging time as a result of the COVID-19 pandemic. During this time, there had been unforeseen changes to the management team which resulted in the provider employing an interim manager. Support was given to the interim manager from other staff with specific expertise at homes within the provider’s group.

We received a number of safeguarding and whistleblowing concerns during the period of management change. These related to medicines, pressure area care, weight loss, staffing and management arrangements. We held regular calls with the provider and interim manager to monitor their progress in assessing and stabilising the situation at the service. At this inspection we found further progress was needed to ensure the quality and safety of the service. While there were clear plans in place to address the shortcomings and make improvements, we identified concerns in relation to how risks to people and medicines were managed. This has resulted in a breach of regulation.

People spoke highly of the care they received. One person told us, “They are very kind here, I love living here”. A relative said, “I know it sounds gushy but every time I go there I thank everyone, they are so kind to my Mum and really look after her”. Relatives told us communication with the home had been a challenge but had improved. One said, “It makes me feel more connected. I can't praise them enough for what they've done recently.”

Staff were positive about the changes taking place at the home, following a difficult period with COVID-19 and the new management taking control of the service. New staff had been recruited and the reliance on agency staff reduced. A visiting professional told us, “They have struggled recently. COVID-19 did alter them really, it threw them off their feet.” A new staff member said things had “improved greatly” since they joined, which was during the management change at the service. They told us ,”The residents are safe and well cared for. There is always room for improvement, but we are getting there.” Another staff member told us, “There have been a lot of changes now. It is very nice. I am very happy now. The atmosphere is much better. People work together now.”

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 30 January 2019).

Why we inspected

We undertook this targeted inspection to check on specific concerns we had about managing risks to people, including safe medicine management and the running of the service. These concerns related to the period from late-May 2020 following a challenging period dealing with COVID-19 and unforeseen changes in the management at the service.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

The overall rating for the service has not changed following this targeted inspection and remains Good.

Enforcement

We have identified a breach in relation to safe care and treatment at this inspection, in particular how risks to people are managed and safe medicine management.

Please see the action we have told the provider to take at the end of this report.

Follow up

The provider has an improvement plan outlining what they will do to improve the standards of quality and safety. We will work alongside the provider to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Willow Lodge Care Home is a care home for 35 older people. 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. The home is purpose built over three floors. At the time of our visit there were 35 people living at the home, most of whom were living with dementia.

The home had a registered manager. 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.

At our last inspection, on 5 April 2016, we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At this inspection we found the service remained Good overall.

Why the service is rated Good.

We have made a recommendation about making the environment more dementia-friendly to promote people’s independence.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the systems in the service did not always reflect this practice. People were involved in day to day decisions about their care.

People were treated with kindness and compassion. Staff respected and upheld people’s privacy and dignity. People’s independence was promoted. Staff knew people well and understood their interests and hobbies. Visitors were welcomed.

There were sufficient staff available to meet people’s needs. Safe recruitment practices were used. Staff were supported with regular supervision and training. There was a positive and person-centred culture. Staff worked together as a team.

People needs were assessed before they moved into the home and as things changed. Care plans and risk assessments were person centred. Information was stored confidentially. People and their relatives understood how to raise a complaint and when these were made they were managed in a timely and effective way.

Risks to people due to the environment and their own needs were well managed. Plans were in place in the case of an emergency. Risks regarding the control of infection were well managed. Staff understood safeguarding and how to report any concerns. Action was taken to reduce the risk of incidents reoccurring. Quality assurance systems were used to reflect on practice and improve the service provided.

Prescribed medicines were managed safely. People had enough to eat and drink and were supported to eat, as required. People’s healthcare needs were met and staff worked in partnership with other agencies. Care at the end of people’s lives was planned for and people received personalised support at the end of their lives.

Willow Lodge Care Home provides accommodation and care for up to 32 older people, most of whom have a diagnosis of dementia. The home is purpose built over three floors. At the time of our visit there were 29 people living at the home.

The service has a registered manager. 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 spoke positively about the care they received. They told us that staff were kind and friendly and that they were able to participate in a wide range of activities and outings. During our visit we heard lots of laughter and observed that people and staff enjoyed good relationships.

People felt safe at the home. Risks to people’s safety were assessed and reviewed. Any accidents or incidents were recorded and reviewed in order to minimise the risk in future. Staff understood local safeguarding procedures. They were able to speak about the action they would take if they were concerned that someone was at risk of abuse. People received their medicines safely. The home was clean and there were systems in place to protect people from the risk and spread of infection.

There were enough staff to meet people’s needs. Staff had received training and were supported by the management through regular supervision and appraisal. Staff were able to pursue additional training, such as in supporting people living with dementia which helped them to improve the care they provided to people. The provider was making improvements to the environment to make it more dementia friendly, such as by improving lighting.

People told us that staff treated them with respect. Staff understood how people’s capacity should be considered and had taken steps to ensure that people’s rights were protected in line with the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). We have made a recommendation about reviewing the use of locks on bedroom doors to ensure that people’s freedom of movement is not unnecessarily restricted.

People enjoyed the food and were offered a choice of meals. Staff were attentive to people’s needs and supported those who required assistance to eat or drink. People’s weight was monitored and prompt action taken if any concerns were identified.

People were involved in planning their care and were supported to be as independent as they were able. Where there were changes in people’s needs, prompt action was taken to ensure that they received appropriate support. This often included the involvement of healthcare professionals, such as the GP, district nurses or optician.

The registered manager had a system to monitor and review the quality of care delivered and was supported by the provider. People, their relatives and staff felt confident to raise issues or concerns with the registered manager. Where improvements had been identified prompt action had been taken.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at. The home could accommodate 32 people and, when we visited, there were 29 people living in the home.

We spoke with five people living in the home and with four of their relatives who were visiting. We looked in detail at five care plans. We spoke with the registered manager, the head of care, the cook, two members of care staff and a member of the ancillary staff. We also spoke with a community psychiatric nurse who was visiting at the time of our inspection.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

Detailed assessments were undertaken to ensure the right level of care was available and staff were guided in their work by comprehensive care plans. Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. A dependency assessment was used to ensure that there were enough staff on duty. Staff were trained and competent to deliver a safe level of care. This meant that people were receiving a safe service.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place. Relevant staff have been trained to understand when an application should be made, and how to submit one.

Is the service effective?

We found that staff had received appropriate training to meet the needs of the people living at the home. This included regular updates in areas such as manual handling, first aid and fire safety. In addition, there was additional training in areas such as dementia and end of life care.

Staff were using effective practices, for example, to treat pressure sores and to prevent falls. We also found care staff sought advice, where appropriate, from qualified nurses and other healthcare professionals. This meant that the service was effective.

Is the service caring?

We saw how the staff interacted with people living in the home and that they were caring and sensitive. We spoke with a community psychiatric nurse who was visiting and said, 'I think they genuinely care for the residents in this home. What I like is that they 'phone me in good time and do not wait for a crisis to occur. They are proactive and the care they offer is lovely to see.'

We spoke with people living in the home and they all were happy with the care. One relative we spoke with said, 'They know what they are doing here and standards are high. I have no complaints and no worries about the care.'

Is the service responsive?

We saw that staff responded promptly to call bells and helped people with eating, drinking and moving about the home. We found evidence in the care plans that staff contacted appropriate healthcare professionals when required and informed relatives of any changes.

The provider invited and listened to feedback and made changes where they were reasonably practical. Recent changes had included investment in the building, changes to the layout and improvements in lighting. People we spoke with said they enjoyed the food, that it was suited to their individual needs and was well balanced and nutritious.

Is the service well-led?

The home was well managed with a qualified team of professional care staff. The staff we spoke with said that the managers were approachable and supportive.

The provider conducted an annual independent audit of the service and was working through an action plan to continually improve standards. There was also an annual survey to take feedback and suggestions from people who lived in the home and their relatives. Feedback from the relatives we spoke with was extremely positive and the people living in the home were happy with the care they received.

We spoke with four people who told us they were happy with the care and support they received from members of staff.

Due to the complex needs of some people, we also spent some time observing people and saw that they were engaged in activities of their choice and at a level that was appropriate for them. We also used the Short Observational Framework for Inspection (SOFI). The SOFI tool allows us to spend time watching what is going on in a service and helps us to record how people spend their time and whether they have a positive experience. This includes looking at the support that is given to them by the staff and also staff interactions with people. Although no formal activities were taking place during our visit, we observed members of staff interacting with people and supporting them to listen to music, read the newspaper or watch television.

We found members of staff were friendly in their approach to people and treated them with dignity and respect. They addressed them in a manner that was appropriate to them and which corresponded with their preferred method of address.

Throughout our inspection, we found people appeared content in the presence of members of staff and there was a friendly and calm atmosphere. People were at ease with the care staff and we saw positive interactions throughout our stay.

The care records we inspected showed that relatives were encouraged to participate in people's care reviews and were kept updated with any changes in conditions. We spoke with three relatives who told us they were delighted by the service provided by the home.

Two relatives we spoke with told us that the home was clean and tidy. We found the rooms, bathrooms, toilets, lounge, dining and to be clean.

We reviewed the medication records and saw that people received prescribed medications on time and that the medication was stored safely.

We found that the provider had effective recruitment policies and procedures in place to ensure staff were both fit and able to meet people's needs.

People told us the staff treated them well. One person said, 'The staff are very good. They are very helpful and they are nice people.' Relatives also commented on the kindness and patience of the staff. One relative said, 'The staff are delightful,' and, another said, 'The staff are A1. Never a dull word. Always with a smile.'

Relatives also said the staff were skilled in working with people who have dementia.

People and their relatives said the home met people's needs. A relative told us, 'I am absolutely delighted with the place as is my relative.' A relative commented that staff were responsive to people's requests for assistance.

Two relatives commented on how good the environment was. One relative said how light and airy the home was and a person told us the home was kept clean.

People and their relatives said people were able to make choices in how they spent their time and in the meals they had.

People and their relatives said they considered the home to be a safe place for people to live.

Relatives told us the home asked them to give their views on the home by a satisfaction survey. We were also told by relatives that they felt able to raise any issues with the home's management team.