The Willows Nursing and Residential Home

The Willows Nursing and Residential Home is a residential care home providing the regulated activity personal and nursing care to up to 57 people. The service provides support to older people. At the time of our inspection there were 32 people using the service.

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

Some improvements were required to the physical environment. The building was safe, but was tired and in need of redecoration and maintenance in several areas.

Risk assessments were in place to manage risks within people’s lives, and staff understood how to manage risk. Staff recruitment procedures ensured that appropriate pre-employment checks were carried out. Medicines were stored and administered safely, and staff had training in this area. Staffing support matched the level of assessed needs within the service during our inspection. Staff were supervised and felt confident in their roles.

People told us they enjoyed the food prepared for them, and food and fluid intake was monitored when required. Healthcare needs were met, and people had access to health professionals.

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 registered manager was open and honest, and worked in partnership with outside agencies to improve people’s support when required. Audits of the service were in place and had identified areas for improvement.

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 23 September 2022.)

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

We carried out an unannounced comprehensive inspection of this service on 1 August 2022. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

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, Effective and Well-led which contain those requirements.

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 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 The Willows Nursing and Residential Care Home on our website at www.cqc.org.uk.

Follow up

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

The Willows Nursing and Residential Home is a residential care home providing personal and nursing care to up to 57 people. The service provides support to younger adults and older people with dementia, mental health needs, sensory impairments and physical disabilities. At the time of our inspection there were 31 people using the service.

The Willows Nursing and Residential Home accommodates up to 57 people in one adapted building. Care is delivered over three floors in three separate wings, each of which has separate adapted facilities and communal areas. There is access to all upper floors via a vertical lift or stairlift.

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

Environmental risks to people were not always identified and people’s feedback had not always been considered. Quality assurance systems and processes to monitor the quality and the safety of the service were not always reliable or effective as they had not always identified concerns we found.

The service was difficult to navigate. We have made a recommendation about the decoration and layout of the service to support people to orientate. The service followed government guidance in relation to infection prevention during the COVID-19 pandemic. However, we identified some areas that were not cleaned during the inspection.

Training was not always provided in line with the providers training policy. Following the inspection, the registered manager reviewed the services training programme and policy. People were supported by staff that knew how to keep them safe from abuse and had been safely recruited. Safe staffing levels were maintained. Medicines were stored safely and administered by nurses.

Risks arising from people’s individual needs were assessed, and measures put in place to reduce these risks. People were supported to eat and drink enough by staff that knew their dietary needs. Prompt action was taken to seek medical advice when people’s health deteriorated resulting in good health outcomes for people.

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. However, we found staff had not accessed training relating to the Mental Capacity Act.

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 14 May 2019).

Why we inspected

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.

We received concerns in relation to moving and handling, staffing, nutrition and skincare. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

Whilst we found no evidence during this inspection people were at risk of harm from the concerns we received, we have found evidence that the provider needs to make improvements. Please see the safe, effective and well-led sections of this report.

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.

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

Enforcement and Recommendations

We have identified breaches in relation to safe care and treatment and governance at this inspection.

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

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

We found the following examples of good practice

• Safe staffing levels were maintained at the service. All staff had completed external health service led training in relation to infection prevention and control (IPC) and correct use of personal protective equipment (PPE), including donning and doffing.

• Regular refresher training sessions were held with the in-house trainer who also completed regular competency checks.

• Robust systems were in place to ensure safe visiting, including checking vaccination status of professionals attending the service. Comprehensive information was provided to all visitors to ensure they were familiar with the service's IPC procedures and PPE policy.

• Cleaning schedules were in place and frequently audited to ensure the equipment and premises were clean. High touch areas were cleaned at least four times every 24 hours with appropriate cleaning products.

• Policies, procedures and risk assessments in relation to COVID-19 were up to date and reviewed regularly.

• Where government guidance had changed the provider had systems in place to ensure this information was shared with the registered manager in a timely manner, who then communicated these changes to staff, people and their relatives.

People’s experience of using this service:

¿ People received kind and caring support from staff. We observed staff talking kindly to people and treating them with respect.

¿ Care staff kept people safe whilst supporting them.

¿ People were supported with their dietary needs. People were positive about the choice of food though some said they would like more variety.

¿ People had personalised plans of care which care staff read to develop their knowledge about people’s needs and preferences.

¿ There were enough staff to be able to support people safely.

¿ Care staff assessed, reviewed and managed risks associated with people’s care needs.

¿ People were supported to take their medicines safely, and to access healthcare in a timely manner.

¿ People were cared for by staff who were appropriately trained to support them with their needs in line with national guidance and legislation.

¿ People were 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.

¿ People had the choice to engage with a variety of activities, including activities with local nursery school children.

¿ People and relatives told us that management were approachable and that any concerns raised would be dealt with effectively.

¿The registered manager had quality monitoring systems in place. They were aware of their responsibilities and worked in partnership with others to ensure people received safe care and support.

¿The registered manager had a plan in place for the refurbishment or replacement of some of the older furnishings and décor.

More information can be found in the detailed findings below.

Rating at last inspection: Good: Report published 20 September 2016

Why we inspected: This was a planned inspection based on the previous rating.

Follow up: We will continue to monitor the service through the information we receive.

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

The Willows Nursing and Residential Home provides both care and nursing for up to 57 people with a range of needs. These include younger adults, people who are aged over 65, who are living with Dementia, who have a physical disability or a sensory impairment. The service is located on three floors. Each person had their own room. There were a number of communal lounges, kitchens and dining rooms where people could spend time together. At the time of inspection there were 43 people using the service.

The service 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.

People’s medicines were not always handled safely. We found that staff had not always signed when they had administered medicines. We also found that the area where medicines were stored was consistently recorded as being at a temperature that was above the recommended storage temperature for medicines. This meant that the medicines could have reduced effectiveness. Staff competency to administer medicine had been checked but had not been recorded. Where someone had a medicine that was taken as and when needed, there was no guidance in place to tell staff when this could be taken.

People were protected from the risk of harm at the service because staff had undertaken training to recognise and respond to safeguarding concerns. They had a good understanding about what safeguarding meant and how to report it.

There were effective systems in place to manage risks and this helped staff to know how to support people safely. The provider dealt with accidents and incidents appropriately.

Checks and risk assessments to make sure the building was safe had been completed. Evacuation plans were in place for people to help support them safely in the event of an emergency. We found that one person did not have an evacuation plan in place. People’s equipment was regularly checked and there were plans to keep people safe during significant events, such as a fire.

There were enough staff to meet people’s needs. They were recruited using robust procedures to make sure people were supported by staff with the right skills and attributes. Staff received appropriate support through a structured induction and regular supervision. There was an on-going training programme to provide and update staff on safe ways of working.

People were supported to maintain a balanced diet and guidance from health professionals in relation to eating and drinking was followed. We saw that people were able to choose their meals and were involved in making them.

People were supported to make their own decisions. The registered manager had an understanding of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). We found that assessments of mental capacity had been completed; however they needed to be for a specific decision. Applications for DoLS had been made where these were needed. Staff told us that they sought people’s consent before delivering their support.

People were involved in decisions about their support. They told us that staff treated them with respect. People knew how to make a complaint. There was a complaints policy in place that was displayed in the home.

People received care and support that was responsive to their needs and preferences. Care plans provided detailed information about people so staff knew what people liked and what they enjoyed. People were encouraged to maintain and develop their independence. People took part in some activities that they enjoyed. People were offered the chance to be involved in reviewing their care plan each month.

People and staff felt the service was well managed. The service was led by a registered manager who understood their responsibilities under the Care Quality Commission (Registration) Regulations 2009.

Systems were in place which assessed and monitored the quality of the service. People were asked for feedback on the quality of the service that they received.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records.

Is the service safe?

We observed that people were treated kindly and respectfully by staff. Staff were attentive to people's needs and offered people choice. People we spoke with felt safe. Staff had a good understanding about safeguarding people from abuse. They knew the correct procedures to follow in the event of suspected abuse and about who to inform.

There was evidence that learning from incidents / investigations took place and appropriate changes were implemented. The manager carried out a weekly falls analyses so that changes could be made to reduce further risk.

People were cared for in a clean and hygienic environment. Since our last inspection the provider had made significant improvements in this area. We saw that the

environment was clean and well maintained.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. This means that when people have their liberty deprived in order to keep them safe, this was only done following a best interest assessment carried out by the local authority DoLS team. At the time of our visit there was nobody using the service who required a DoLS authorisation. All staff had received training about DoLS.

Staff recruitment and selection procedures were robust. This meant that appropriate checks were carried out and only people who were suitable were employed.

People we spoke with told us that staffing levels were good and they did not have to wait for staff to attend to them.

Is the service effective?

People told us that they were happy with the care that had been delivered and their needs had been met. It was clear from our observations and from speaking with staff that they had a good understanding of people's care and support needs. One person told us "I get on really well with staff'. Another person said "I like the staff, we have a laugh'.

Staff had received appropriate training to meet the needs of the people living at the home.

Is the service caring?

People were supported by kind and attentive staff. We saw that staff showed patience and gave encouragement when supporting people. People who used the service appeared relaxed and at ease with the staff supporting them.

People's health and care needs were assessed before they moved in. Each person had a care plan in place for each identified need. People's relatives told us they were always made welcome. One person told us that staff enabled them to maintain as much independence as possible. A relative told us 'They treat my relative as if they were one of their own.'

Is the service responsive?

People had access to activities that were important to them and had been supported to maintain relationships with their friends and relatives.

People completed a range of activities in and outside the service. Appropriate activities were available to suit the needs of people with cognitive impairment.

People knew how to make a complaint if they were unhappy. People told us that staff

would listen to them and take appropriate action.

Residents meetings were held and people were asked for feedback about their experience of care, treatment and support.

Is the service well-led?

Staff had a good understanding of the ethos of the home and quality assurance processes were in place. The registered manager and other members of the management team were approachable and accessible to people who used the service, their relatives and to staff.

We saw that staff usually gave people choice about the care and support they received. People said they liked the food. It was evident that people were given a choice of meal and if they changed their mind, an alternative was provided.

There was a range of recreational and social activities on offer. Some people said they would like more opportunities to go out. People had their medicines managed safely and effectively. We looked at cleanliness and infection control. While the majority of areas were clean and tidy, some areas required attention. Staff spoken with had a good knowledge of how to prevent the spread of infection.