Background to this inspection
Updated
30 January 2019
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 22 November 2018 and was unannounced. The inspection was carried out by two inspectors.
Before the inspection we reviewed all the information we held about this provider including previous inspection reports, notifications, correspondence and safeguarding information.
We met the five people living in the home. We spoke to three people and we spent time with everyone observing a mealtime and seeing how people interacted with staff and each other.
We met the manager and two care staff individually. We also spoke with another staff member on the phone. We carried out pathway tracking for three people. We read the risk assessments and care plans for the person then checked the daily records to see if the care plan and risk assessments were being followed. We also read the health and medicines records for those people. We checked finance records for one person.
Following the inspection we had feedback from two people’s relatives and one health and social care professional.
We checked all health and safety, fire, maintenance and quality monitoring records. We checked menus and the speech and language therapy guidelines to support people to eat safely. We observed staff supporting two people at risk of choking to see if they followed the written guidelines for safe eating correctly. We checked five staff files including their recruitment, training, appraisal and supervision records. We inspected the building including all bedrooms and communal rooms.
Updated
30 January 2019
This inspection took place on 22 November 2018 and was unannounced.
Willow Care Homes Ltd – 116 Ashurst Road is a care home. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. This care home is registered to accommodate six people who have a learning disability. At the time of this inspection there were five people living in the home.
There was no 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. There was a manager in post but the provider had not put them forward for registration with the Care Quality Commission despite reminders that having a registered manager is a legal requirement.
Following the last inspection in September 2017, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions Safe, Effective and Well led to at least good. They failed to complete an action plan.
At our previous inspection of this service we found four breaches of legal requirements. These were because there were risks to people’s safety resulting from a lack of safe fire procedure in the event of a fire at night and inedible substances not being stored safely. Some carpets were unhygienic and needed replacing, staff did not receive regular supervision and there was a lack of effective monitoring of the service by the provider. We checked these breaches at this inspection and found the provider had not made the required improvements and remained in breach of the same regulations.
The fire procedure to follow at night had been reviewed by the manager and discussed with the Fire Brigade after the last inspection but there was no clear guidance to night staff on how to evacuate each person safely. People’s individual evacuation plans did not contain enough information to guide staff and they did not know what they would do in the event of a fire at night. The provider had not carried out regular checks of fire doors or fire alarm tests. Although cleaning products were now locked away other substances harmful to health if swallowed were in unlocked cupboards.
Some of the carpets remained in a poor unhygienic condition. The provider had not replaced them despite this being raised as a concern at the last inspection.
The provider had reduced night staffing two years ago and this had not been reviewed. There was no record of any risk assessment to state that one staff member could safely meet people’s needs in the event of any emergency. The provider had not ensured staff were up to date with mandatory training. Other than three staff attending first aid trading, the manager told us there had been no training provided in the last year. Staff had not received regular supervision. Despite the lack of training and supervision staff said they felt supported by the manager.
There was no evidence that the provider had carried out any checks or audits and did not have enough oversight of the home to identify the concerns we found. The provider did not have sufficient oversight of the home to ensure continued safe good quality care and had not made any improvements since the last inspection.
People living in the home had lived together for several years and got on well with each other and with staff. People’s relationships with each other were important to them.
The care home was developed before the values underpinning Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen. People living in this home were able to make choices about their lives, the activities they wished to do, the food they ate and their daily routines. Staff encouraged people to be as independent as they were able .People are supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.
Staff were kind and caring. People had weekly routines of attending day services and following their individual interests. They went out regularly, both as a group, and individually with staff to places they chose to go. People enjoyed a balanced diet and those who had swallowing difficulties had good support to eat safely. Staff followed good food hygiene practices.
Staff supported people well with their health and kept good records of their healthcare appointments.
Relatives thought the quality of care in the home was good. People living in the home, staff and relatives praised the manager of the home and thought they were doing a good job. Staff carried out monthly health and safety checks.
We served two warning notices on the provider for failing to comply with legal requirements. One legal requirement was about safe care and treatment and the other was about good governance of the home. The provider was given a date to comply with the warning notices and we will go back to check that they have complied. You can see what action we told the provider to take at the back of the full version of the report.