Archived: Willowbank Nursing Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question inadequate. At this assessment the rating has changed to Requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

At the last assessment, the provider was in breach of legal regulation in relation to record keeping, managing risk, staffing levels, safe recruitment and management of medicines. Improvements were found at this assessment and the provider was no longer in breach of this regulation.

This service scored 59 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a proactive and positive culture, based on openness and honesty. Staff listened to concerns about safety and investigated and reported events. Lessons were learnt to continually identify and embed good practice. Staff commented on a learning culture, with one staff member saying, “when I first started at Willowbank, I was given an in depth induction, had lots of online training to do along with moving and handing and fire training I was also given shadow shifts so I could learn about the residents and feel comfortable and confident before I worked on my own or with another staff member. I also got lots of support on my return to work after maternity leave where I got keeping in touch days and shadow shifts until I was confident. I would feel comfortable in asking for support should I need it.” A relative said, “The manager is very approachable. He’s very organised so it runs well. He keeps us all up to date with everything.” Lessons learnt from incidents and accidents were analysed and shared with the staff team during handovers and team meetings.

The provider routinely worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services. Managers carried out pre-admission assessments to ensure a smooth transition from home or hospital to Willowbank. One person told us, “Managers do assessments, so we have information before people move in. We can then prepare regarding how to support the new resident and what they need.” We did however find that on occasion information was not always kept up date or cascaded to all staff as required, one relative told us that documents they had completed were lost and the information was not shared with staff members as required. This impacted on the persons transition into the service.

The provider did not always work well with people and healthcare partners to understand what being safe meant to them and how to achieve that. They did not always concentrate on improving people’s lives or protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider did not always share concerns quickly and appropriately. We saw evidence that contact with health professionals was not always made in a timely manner. A relative told us. “She came in from hospital after a long stay with an infection in her foot. She has regular appointments at the diabetes clinic, and I explained to [registered manager] any problems they need to call the hot foot clinic. I found out she had been unwell for a few days, and no one had called the clinic.” This meant that people were not always safeguarded from harm.

Systems that were in place to manage risk were not always effective. Staff generally knew people well and worked with individuals to understand and manage risks. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them. Staff supported people safely and appropriate equipment was available if people needed assistance. Staff told us they encouraged people to make their own choices, and they respected their decisions. One staff member said, "We help people to make their own choices, such as what they want to eat and wear.” However, we saw evidence that people’s food and drink was not always recorded in the detail, there was no evidence that this had caused harm to people at the time, however good record keeping is paramount to keep people safe We also identified that the risk regarding call bells and how people could access these was not always considered. These concerns were fed back to the manager and action was undertaken to address these concerns.

Staff at the service detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. Staff were observed to check equipment prior to use and ensured that the person was well supported prior to hoisting from chair to wheelchair. One person told us. “The home is very nice and clean, I am assisted using a hoist and have no complaints regarding this, the staff are really good.” Health and safety checks and environmental audits were regularly completed and action taken when required. Radiators were covered as required and the environment was clutter free.

Staff were kind and caring, however we received mixed feedback from people about the number of staff on duty. Rotas and staffing on the days we visited showed that staff numbers were in line with requirements, however people, relatives and staff told us that there was not always enough qualified, skilled and experienced staff. One staff member told us. “On a morning it can be a struggle to meet everyone’s care needs, we do often have to rush around, with residents not always getting the time they deserve. Most days having to leave some personal care such as washes until the afternoon. We work 2 carers upstairs and 2 carers downstairs.” One person told us. “There is usually enough staff, however sometimes I have to wait as they are busy with someone else, I don’t mind, they can be rushed off their feet at times. “Staff recruitment processes were in place with relevant checks of staff’s employment history, character, right to work, and checks with the disclosure and barring service (DBS).

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly. Staff told us personal protective equipment (PPE) and all cleaning materials needed were available. We observed cleaning taking place. Infection prevention control audits took place regularly and actions were taken to address areas identified as needing improvement. Staff confirmed they had received infection control training. A relative told us, “It’s all very clean as far as I am concerned.”

The service had systems in place to safely store, administer and record the use of medicines. However, these were not always followed: Instructions for medicines which should be given at specific times were not available. Administering medicines as directed by the prescriber reduces the risk of the service user experiencing adverse effects from the medicine. The use of topical creams and ointments were recorded on the medicines administration records (MARs). However, instructions were not always available to show staff the site of application.

Managers and members of staff qualified to handle medicines regularly completed audits (checks) to make sure that procedures were followed. However, the shortfalls we found during the inspection had not been identified.

The service had individual fire risk assessments in place for people who were prescribed paraffin-based skin products. We checked the quantities and stock balances, and we found them to be correct. This meant that we could be assured that the correct doses of medicines had been administered as signed for by staff. Thickeners used to thicken fluids for people with swallowing problems were recorded when they had been used. People’s preferences of how they wanted their medicines to be administered were recorded. The date of opening had been recorded on bottles containing medicines in liquid form. This meant that we could be assured that these medicines were not being used beyond the manufacturers recommended period after the date of opening. Temperature records to ensure the safe storage of medicines were completed in accordance with national guidance. This meant we could be assured that medicines requiring refrigeration were safe for use. Detailed guidance specific to each person on how to administer medicines prescribed as and when people required them, known as “PRN” was available to staff. There were appropriate arrangements in place for the management of controlled drugs (medicines that require extra checks and special storage arrangements because of the potential for abuse). Records showed that staff completed regular balance checks in accordance with national guidance. There was evidence that there was a process in place to record medicines related incidents or errors. Staff had completed a training and induction process for medicines management. Staff competencies were assessed regularly to make sure they had the necessary skills.