Archived: Willow Cottage Residential and Nursing Home

At the previous inspection carried out 1, 2 and 3 March 2017 we rated the home as Requires Improvement and identified concerns around the safety of equipment, compliance with the Mental Capacity Act 2005 (MCA), person centred care and the lack of audits undertaken. This inspection was undertaken on the 11, 16 and 17 January 2018. The inspection was prompted by continued concerns raised with the CQC about staffing levels, staff retention, the leadership of the home, recruitment of staff and the lack of action taken to address staff performance.

We liaised with other professionals and services such as the local authority safeguarding team, local authority Deprivation of Liberty Safeguards (DoLS) team, environmental health, the fire service and the local authority planning department.

At our inspection we found that the provider had failed to make the improvements needed and the overall rating for this home is now Inadequate.

During this inspection, we found that the registered provider was in breach of multiple regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

There was a registered manager in post, however they had handed in their notice. They left the organisation on the 15 January 2018 after our first day of inspection. There was a new manager in post and they planned become the registered manager. 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 environment of the home was not safe. Environmental risks were not consistently identified or addressed, consequently people were exposed to the risk of serious harm. The provider had failed to develop a plan to support the refurbishment of the building to an appropriate standard. The quality monitoring of the home had failed to give an accurate view of all the improvements needed.

There was not enough staff employed at the home to meet people's needs and consequently there was a reliance on agency staff to fulfil both nursing and caring roles. The provider had not employed enough staff to fill the gaps in the rota. The provider had not used the needs of the people living at the home to inform the number of staff required per shift to provide safe care for people.

However on a positive note people said they were treated in a kind and caring manner and staff said they had access to, and obtained support and guidance from, external health care professionals.

Appropriate checks had been completed for new staff to ensure they were safe to work with vulnerable people. We identified gaps in the staffs training and regular supervisions to support staff had lapsed and had not been undertaken. The registered manager at the time of our inspection told us the quality manager was now undertaking staff supervision. We spoke to the quality manager who told us this was not the case.

People's privacy and dignity was not fully respected and we observed poor care practices. Some care practices in the home were institutional which included people being put to bed by staff early in the afternoon. Locks were not fitted to toilet, bathroom and bedroom doors.

People’s care records were not person centred and did not contain information regarding people’s likes, dislikes and life history. End of life care plans for people were clinical and did not contain information about people’s wishes.

People's wellbeing was not supported by the activities offered to them and some people chose not to take part in the planned activities. Relatives had raised concerns about the lack of activities.

Where people had been unable to make the decision to live at the home the provider had not submitted appropriate applications for assessment under the Deprivation of Liberty Safeguards which meant people were being deprived of their liberty without the appropriate legal authorisation in place. Where people were not able to make decisions for themselves care records were not clear. They lacked essential detail regarding people’s capacity to make decisions and best interest decisions.

Quality monitoring systems were not in place to identify, monitor, manage and mitigate risks to people's safety and welfare.

There was a lack of effective leadership in the home. The provider had little insight into what was going on in the service and this has led to there being multiple breaches of regulations. Lack of communication from the provider with people, staff and relatives had led to an increased level of anxiety.

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, 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.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Willow Cottage Residential and Nursing Home is a care home with nursing care for up to 34 predominately older people. People have general nursing care needs and some are living with dementia. At the time of our visit there were 24 people living at the home.

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 of the Health and Social Care Act 2008.

We found a number of breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

Appropriate steps were not taken to mitigate the risks to people. Risk assessments were not adequately completed and lacked essential detail about the risks to people.

Staff knew people well enough to understand their preferences and were familiar with the Mental Capacity Act 2005 (MCA). However people’s mental capacity to make day to day or significant decisions had not always been assessed. Mental capacity forms that were in place lacked essential detail. It did not give guidance to staff regarding information about best interest decisions made and reasons for the decision.

People’s care records did not reflect people’s needs and preferences. Care records lacked essential detail regarding people’s needs and how their individual needs should be met.

We found that the home had some systems in place to assess and monitor the quality of service. However, other audits undertaken had not been effective as we had identified areas that require improvement that were not picked up. Peoples' feedback had been sought through questionnaires and meetings.

Staff were knowledgeable about recognising the signs of abuse. All staff had received training in safeguarding adults.

Medicines were administered to people safely by staff that had been trained.

The registered manager conducted pre-employment checks prior to staff starting work, to ensure their suitability to support people who lived in the home. Staff were not able to work until these checks had been completed.

Staffing numbers on each shift were adequate to ensure that each person’s care and support needs could be met.

People were satisfied with the quality of the food and drink provided. Food and fluid intake was monitored where risks of weight loss or dehydration had been identified. Arrangements were made for people to see their GP and other healthcare professionals as and when they needed to do so.

Staff received induction and training. A training programme was in place and staff had been encouraged to complete all mandatory refresher training. Staff had supervision meetings and team meetings were held to support them in their role.

People said they were treated in a kind and caring manner. We observed that staff treated people with dignity and respect. People were able to make choices about the way they were cared for.