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Inspection Summary


Overall summary & rating

Requires improvement

Updated 29 August 2018

This unannounced inspection took place on 8 and 10 January 2018. Prior to the inspection we had received concerns about how the home managed people’s medicines, whether people were having their nutritional and hydration care needs met, staffing levels as well as the management of the home, and attitude of some staff.

Willow House is a ‘care home’. 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 House is registered to provide personal care and support for up to 30 older people some of whom may be living with dementia or have a physical disability. The home does not provide nursing care; people living there would receive nursing care through the local community health teams. At the time of the inspection there were 17 people living at the home.

Willow House has been inspected five times since May 2015. At each of these inspections, we found breaches of regulation and the home was rated as ‘Requires Improvement’.

At this inspection, we found further improvements had been made, although some improvements were still needed. People told us they felt safe and happy living at the home, however we found that risks to people were not sufficiently well managed. Support was not always provided in a person centred way: governance systems have not been sufficiently robust over a period of the last three years to identify and bring about the required improvements.

The home did not have a registered manager. A new manager had been appointed; they had applied to be registered with the Care Quality Commission and were available throughout this inspection. They were referred to as the manager throughout this report. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run.

The home’s quality assurance and governance systems were not effective. Although some systems were working well and improvements had been made since the last inspection, other systems had not identified the concerns we found during this inspection.

Risks to people’s health and wellbeing were not always managed safely and the systems in place to minimise risks to people’s health and safety were not always understood by staff. Where risks had been identified, action had not always taken to minimise these risks. For example where guidance had been provided by external professionals, it was not always followed. This placed people at increased risk of choking, developing pressure ulcers and increased risk of falls.

Whilst some premises checks had been completed we noticed a number of bedrooms windows were not properly restricted. There was no evidence the provider had carried out any form of risk assessment in relation to needs of people currently living at the home and the risks posed by having unrestricted windows that were easily assessable. Following the inspection, the manager gave assurance that following a risk assessments all windows identified were now being appropriately restricted.

Some improvements were needed to the homes recruitment processes to ensure people were kept safe. We looked at the recruitment files for ten staff. We found some recruitment checks had been carried out, but others had not. For example, one person did not have a DBS certificate in place and had been working at the home since November 2017. This meant the provider could not be assured they had taken sufficient action to ensure staff were of good character. Following the inspection, the manager assured the commission that the persons DBS was now in place.

Some people’s care and support was not always appropriate, did not meet their need

Inspection areas

Safe

Requires improvement

Updated 29 August 2018

Some aspects of the home were not always safe.

Risks to people’s health, safety and well-being were not always being effectively assessed, managed or mitigated.

People were not protected from receiving care from staff who may not be suitable to work in the care profession. Safe recruitment practices and relevant checks were not always followed before staff commenced work.

The provider could not be assured all confidential information was not always stored securely and in accordance with the Data protection Act 1998.

There were enough staff on duty to meet people’s needs. However, the provider did not have a systematic approach to assessing staffing levels to ensure they could meet the needs of people living at the home.

Staff were trained in safeguarding adults and were aware of how to identify and respond to allegations and signs of abuse and how to raise any concerns.

People received their medicines as prescribed. The systems in place for the management of medicines were safe and protected people who lived at the service

Effective

Good

Updated 29 August 2018

The home was effective

People’s consent was gained before care and support was delivered and the principles of the Mental Capacity Act 2005 were followed.

People were cared for by skilled and experienced staff who received regular training and supervision, and were knowledgeable about people’s needs.

People were referred to healthcare services and professionals were involved in the regular monitoring of their health.

People were supported to maintain a balanced healthy diet.

Caring

Good

Updated 29 August 2018

The home was caring.

People were positive about the care and support they received and felt staff were kind, caring and treated them with respect.

People were encouraged to be involved in how their care and support was delivered were supported daily to make choices.

Staff supported people to remain as independent as possible.

People were supported to maintain relationships with family and friends.

Responsive

Requires improvement

Updated 29 August 2018

Some aspects of the home were not always responsive.

People were at risk of not having their care needs met in a consistent way that respected their wishes and preferences.

Care plans did not provide easily accessible information for staff about people’s care needs and how people wished to be supported.

People enjoyed a variety of social activities.

People were confident that should they have a complaint, it would be listened to and acted upon.

Well-led

Requires improvement

Updated 29 August 2018

Some aspects of the home were not always well-led.

Although quality assurance systems were in place, they were not being used effectively or undertaken robustly enough to identify the issues seen during the inspection. As a result, people could not be assured they would receive safe, high quality care and support

People’s care records were not accurate or kept up to date.

People have been receiving a less than good service for over three years.

Action plans identified to address concerns from the last inspection had not been effective in making the changes needed or meeting regulations.

The home valued and responded to people’s feedback and the manager was well regarded by people, relatives and staff.