Background to this inspection
Updated
12 January 2016
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
This inspection took place on 30 November, 2 and 4 December 2015 and was unannounced.
The inspection team consisted of two inspectors and an expert by experience. An expert by experience is someone who has personal experience of this type of service.
Before our inspection we reviewed previous inspection reports and notifications we had received. A notification is information about important events which the provider is required to tell us about by law.
During our visit we spoke with the regional manager, an administrator, an electronic calls officer (responsible for monitoring care calls electronically), 12 care workers, 17 people, 11 relatives and three healthcare professionals and representatives from the local authority.
We pathway tracked eight people using the service. This is when we follow a person’s experience through the service and get their views on the care they received. This allows us to capture information about a sample of people receiving care or treatment and looked at a further 10 people’s care records. We looked at staff duty rosters, eight staff recruitment files, medication records, team meeting minutes, staff training records, supervision and appraisal records, staff induction programmes, safeguarding alerts, complaints and quality assurance documents.
We last inspected the home on 13 and 17 March 2014 where no concerns were identified.
Updated
12 January 2016
The inspection was announced and took place over three days, on 30 November, 2 and 4 December 2015. We inspected at this time because we had received a number of concerns about the care provided. We gave the provider 48 hours’ notice to give them time to become available for the inspection.
The service did not have 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. The commission had not received an application in respect of a registered manager.
At the time of our inspection Willow tree provided 281 hours of care in Totton, 335 hours of care in Southampton and 880 hours of care in New Milton. We found the provider had widespread shortfalls in the number of suitably skilled, qualified and experienced staff to meet people’s needs. There were a significant number of missed care calls which put people at risk of not receiving the care and support they needed. People were often not being supported to take their medicines and not being supported with personal care.
People were not always treated with dignity. People and relatives told us office staff often failed to return their calls and said some staff were not always respectful during care visits.
People were not always supported to take their medicines safely. Staff, relatives and people told us documentation for the recording of medicines administered were not always in place. Staff were not always trained to administer medicines.
Learning and development opportunities for staff were not always provided and placed people at high risk of receiving inappropriate and unsafe care. Records showed significant gaps in staff training. Relatives, healthcare professionals and people told us they were not confident staff had the skills and knowledge to deliver effective care.
Staff were inadequately supported and supervised. Supervision, appraisal, competency assessments and spot checks were not consistently conducted. Staff told us they had not had supervision and on occasions told us they were unsure if they were performing effectively due to the lack of support and direction.
Decisions made in people’s best interests were not assessed in line with the requirements of The Mental Capacity Act 2005. Assessments were not related to specific decisions and did not take account of possible risks, benefits, other options and possible consequences.
People who were at risk of malnutrition and dehydration were not always supported effectively. Staff told us the high number of missed calls resulted in some people going without food and drinks at the times they needed it. Nutritional care plans were not always detailed and assessments that were in place were not reviewed frequently.
People’s care records were not always personalised and did not always reflect their actual needs and preferences. Staff told us records were not accurate due to the lack of reviews in people’s care.
Staff, people and relatives told us they were confident in the new management and felt the direction needed to make improvements was clearer.
We found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. CQC is considering the appropriate regulatory response to resolve the problems we found.
The overall rating for this service is ‘Inadequate’ and the service is therefore in 'Special measures'. The service will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, it will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.
You can see what action we told the provider to take at the back of this report.