Willow Bank Care Home

We found the following examples of good practice.

The home had a clear system in place to support relatives and friends to visit people. Government guidance was being followed to support safe visiting. Visitors were required to complete a COVID-19 test before visiting and wear PPE.

The provider had appropriate arrangements for vaccinating and testing staff and people. There was a designated clinical lead who coordinated this.

The premises were clean and communal areas were spacious and well ventilated. Staff followed detailed cleaning schedules to ensure all areas of the home were regularly cleaned. The provider had made changes to the environment to support people to social distance. This included creating additional communal lounge, dining and quiet areas on the first floor.

We observed staff wearing the appropriate levels of personal protective equipment. Regular checks were carried out to ensure staff were following guidance including observations of how they were washing their hands and following infection prevention and control guidelines.

The registered manager told us the staff team had been supported by the provider with regular team meetings and access to well-being networks. The provider had up to date infection prevention and control procedures and regular quality checks were in place.

Willow Bank Care Home is a residential home situated in Bradford. The home provides accommodation and personal care for up to 59 older people and people living with dementia. At the time of the inspection there were 38 people living at the home. The care home accommodates people across two wings, each of which has separate adapted facilities.

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

Recruitment was generally managed safely but some improvements were needed. Checks had been completed but we found gaps in staff employment histories had not always been fully reviewed. We have made a recommendation recruitment processes are updated.

People’s care needs were assessed. Care plans were person centred and generally up to date and staff understood how to support people.

People and relatives told us they thought the service was safe. They praised the standard of care at the home and described staff as kind and caring. The atmosphere in the home was relaxed and inclusive.

Medicines were managed safely. People’s health needs were met and there were close links with health professionals and other agencies.

The home and the grounds were accessible and well maintained. Some areas had been recently been refurbished.

Staff were knowledgeable about people and the topics we asked them about. They received a range of training, supervision and appraisal.

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 provided the home with leadership and promoted a strong team culture. They maintained good oversight through communication with people and the team and a detailed scheduled of audits. They were passionate about continuing to improve the quality of the service.

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 14 August 2018) and there were multiple breaches of regulation. 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

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Willow Bank Care Home on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Willow Bank Care Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Willow Bank accommodates a maximum of 59 people. The home provides care and support to older people in two units, one of which (Elizabeth Wing) provides personal care for people living with dementia. There were 47 people living at the home at the time of the inspection.

The service had a manager in place but at the time of this inspection they were not yet registered with the Care Quality Commission. 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.

During this inspection, we identified a continuing breach of regulations related to dignity and respect, nutrition and hydration and good governance. We found the previous breaches to regulation relating to person centred care, safe care and treatment and fit and proper persons employed, had been addressed.

Improvements were needed to the management of fire safety. Fire training was not up to date and there was no equipment in place to enable staff to evacuate people in the event of an emergency.

There had been concern regarding the management of people’s skin integrity. We saw a number of actions had been implemented by the manager including staff training and taking steps to improve communications with the district nurse team,

Staff recruitment was safe. People told us there were sufficient staff but some relatives were concerned that recent changes to the allocation of staff at the home may impact upon people’s care. Additional staffing support had been provided to Elizabeth Wing since the last inspection.

Medicines were not always stored safely but action was taken at the time of the inspection to address this. Suitably trained staff administered medicines, in a kind and caring manner. Staff administered medicines as prescribed but we found the management of creams still needed to be improved.

People were mainly complimentary about the meals, although we found not everyone’s nutrition and hydration needs were met. Where staff recorded peoples diet and fluid intake, these records were not accurate.

Staff received an induction when they commenced employment at the home. Supervision was ongoing but we found staffs training was not up to date.

People were able to access other healthcare professionals as needed although the district nurses they said they were concerned communication within the home was effective.

Decision specific capacity assessments and best interest’s decisions were evident in people’s care plans, but people were not always supported to have maximum choice and control of their lives. There was a lack of evidence to suggest people and their families were involved in the care planning process. Where people had limited verbal communication, alternative methods of communication were not used. We have made a recommendation about the Accessible Information Standard.

Staff did not always treat people with dignity and were not always respectful to people or their belongings. Confidential information was not always stored securely.

Care records were person centred but were not always a reflection of people’s current care and support needs. Where changes had taken place, staff did not always update all the relevant documentation, where action had been taken this was not always documented.

There were a range of activities provided for people to participate in.

Complaints were addressed by the manager but low-level concerns were not routinely recorded by the manager. Feedback was obtained from staff, people who lived at the home and relatives through meetings and questionnaires.

There was an audit plan in place outlining when specific audits were to be completed. Audits were also completed by the quality manager and an external consultant. Internal audits were not always completed in a timely manner and an action plan submitted by the manager did not detail the issues to be addressed or how they were to be actioned.

The governance systems were still not sufficiently robust had not yet addressed all the regulatory breaches identified at the previous inspection.

This service had been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us improvements have been made and are no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures. However, we found a continuing breach 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.

When we inspected the service in December 2014 we identified one regulatory breach which related to staff training and support (Regulation 18). At this inspection we found the provider had made the necessary improvements in this area but identified further breaches of regulations.

Willow Bank Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Willow Bank Care Home can accommodate up to 59 people across two separate floors, each of which have separate adapted facilities. The service provides care and support to older people and people living with dementia. There were 53 people using the service when we inspected. The home was purpose built and provides single bedroom with en-suite toilet facilities. There are lounge and dining areas on the ground floor.

There was no registered manager in post. The Registered Manager was dismissed for their position in October 2017. 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.

Staff were not always being recruited safely although there were enough staff they were not always deployed in a way to keep people safe and to deliver person centred care. Whilst some staff were seen to deliver caring, kind and compassionate care, there were practices in the home which did not treat people with dignity and respect.

Staff were receiving appropriate training and they told us the training was good and relevant to their role. Staff said they felt supported by the manager and were receiving formal supervision where they could discuss their on-going development needs.

People’s care plans did not always provide accurate and up to date information about their current needs. Some information was contradictory. Risk assessments were being completed; however, these were not always being followed or had been completed incorrectly. This meant we were not confident action was being taken to mitigate risks to people using the service.

People’s healthcare needs were being met and medicines were being managed safely.

People who used the service made some positive comments about the meals; however, we found people’s nutritional and hydration needs were not always being met. We also found people’s mealtime experience was poor.

There were some activities on offer and trips out were being arranged. There were also some good links with the local community.

We found the service was working within the principles of the Mental Capacity Act and Deprivation of Liberty Safeguards. People were supported to have maximum choice and control of their lives and staff supported people in the least restrictive way possible; the policies and systems in the service did support this practice.

Staff knew how to recognise and report concerns about people’s safety and welfare.

The home was generally clean, tidy and odour free. However, we did note there was an odour of stale urine in one of the lounges.

There was a complaints procedure in place and formal complaints had been investigated.

There was a lack of leadership and direction for staff, with no oversight of key issues for people's care and support. Systems and processes for monitoring the quality of the care provision were weak and there was no robust management of the service. At the time of the inspection a new management structure had recently been introduced, but it was too soon to be able to assess how effective these changes would be.

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.

We identified six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

'Very good, plenty to eat, great staff, I would recommend."

'I am well cared for. Those with higher needs than myself also seem well cared for.'

We also spoke with two relatives and they also told us they were pleased with the care, treatment and support their relative's received at the home. They said the manager and staff were quick to inform them of any significant changes in their relative's general health and they were always made to feel very welcome when they visited.

We found people were able to make decisions in relation to their daily lives. Where people did not have capacity to make decisions for themselves, systems were in place to ensure decisions made were in their best interests.

We found care was planned and people's needs assessed so appropriate care could be delivered.

The home was clean and effective infection control procedures were in place.

We found staffing levels were adequate.

An effective complaints system was in place.