Archived: Willow Care Homes Limited - 116 Ashurst Road

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.

This inspection took place on 26 September 2017 and was unannounced. At our previous inspection of this service in March 2016 we found five breaches of legal requirements. These were because improvements were needed in medicines management, managing risks for people, managing people’s money. There was a lack of staff supervision and lack of effective monitoring of the service. We checked these breaches at this inspection and found there had been some improvements.

We found medicines were being managed appropriately, risk assessments had improved and there were improvements in managing people’s money. However, we did find that although staff had received an appraisal, they were still not all receiving regular supervision.

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. The previous manager had recently left and the provider informed us that the deputy manager had been promoted to manager but she had not yet applied for registration with the Care Quality Commission.

The manager had a good understanding of safeguarding people and shared her knowledge with staff.

People had up to date care plans reflecting their needs and wishes. Staff knew their needs well. People and their relatives said they were happy living in the home. They had lived together for several years and got on well with each other and with staff. Staff were kind and caring. People enjoyed their weekly routines of attending their respective 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. Staff followed good food hygiene practices.

Staff had to complete online training for the role in their own time so some were not up to date with all training, but they felt supported by the manager and said the team worked well together.

The manager carried out internal audits and checked money and medicines daily to ensure no errors were made.

At this inspection there were four legal requirements not being met. There was a risk to people’s safety as the fire procedure to follow at night was not clear. Substances harmful to health if swallowed were in unlocked cupboards. There was a lack of oversight of staff supervision and training due to the change of manager. Some of the carpets were in a poor unhygienic condition and the overall monitoring of the home had not addressed these concerns.

You can see what action we told the provider to take at the back of the full version of the report.

We carried out an unannounced inspection of this home on 31 March 2016 and 4 April 2016. The service was last inspected in May 2013 and there were no concerns.

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.

At this inspection we found people were given individual support to take part in their preferred hobbies and interests. People told us and demonstrated that they were happy at the service by showing open affection to the staff who were supporting them. Staff were available throughout the day, and responded to people’s requests for care. Staff communicated well with people, and supported them when they needed it. There were systems in place to obtain people’s views about the service. These included reviews and individual meetings with people and their families.

We found that medicines were not always managed safely. We found gaps in medicine administration records (MAR).

Staff had been trained in how to protect people, and they knew the action to take in the event of any suspicion of abuse towards people. Staff understood the whistle blowing policy. They were confident they could raise any concerns with the registered manager or outside agencies if this was needed.

The provider and staff contacted other healthcare professionals for support and advice.

People were provided with a diet that met their needs. We observed that staff offered people drinks and snacks throughout the day.

Staffs had been subject to the necessary employment checks before working for the service. Risk assessments were not up to date and did not reflect people’s individual risks. Systems to monitor the quality of the service were not always effective.

We found five breaches of regulations relating to safeguarding in respect of managing people’s money, obtaining consent, safe care and treatment, staff supervision and quality assurance.

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During our last inspection on 27 November 2012 we found non-compliance with staffing. Staff had not received an appraisal since 2008 and staff supervision was inconsistent. The provider submitted an action plan to address non-compliance and at our inspection on the 10 May 2013 we found that the provider had made some improvements.

Staffing levels were based on dependency levels; however we noted a staff working long hours. Systems were in place to gather information about the quality of the service.

People were given choices and the option to participate in various activities provided by the service. We saw evidence of that recorded in people's files and the activities programme for each person living at the home. On the day of our inspection four of the five people who use the service were out attending day centres and participating in activities.

There were systems in place to ensure that people were protected from abuse and that they received the care they needed. However, we were concerned that the provider did not have arrangements to ensure staff consistently received supervision and appraisal.