Archived: Willow Brook Care Home

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, their relatives and the staff told us.

If you want to see the evidence that supports our summary please read the full report.

Prior to our inspection we reviewed all the information we had received from the provider. We used a number of different methods to help us understand the experiences of people using the service, because some people using the service had complex needs which meant they were not able to tell us their experiences.

We spoke with three people via telephone conversations, who visited their friends and relatives on a regular basis. This was to establish their views on the quality of service provision.

We spoke with the management team, three care workers, the maintenance technician and a representative from the domestic team. We also looked at some of the records held in the service including the care files of four people. We observed the support people who used the service received from staff and carried out a tour of the building.

Is the service safe?

Visitors to the home told us they felt their relatives and friends received their care and support in a safe and considerate manner. Comments included, 'I visit the home three or four times a week at different times. I have no concerns about people's respect not being promoted.' And, 'I think the care people get at the home is excellent.'

Visitors to the home also told us they felt confident in reporting any complaints to the management team if they had any concerns about the quality of service provision. One visitor told us, 'I have never complained about anything, if I did, I'm sure the manager would sort it out.'

Records showed and staff spoken with told us that they had received training in the safeguarding of vulnerable adults. They had a good understanding of the organisations reporting procedures and how to alert others if they were concerned for a person's safety or welfare.

We had concerns as we saw staff were not always adhering to the organisations infection control policy. On one occasion we saw a member of staff removing contaminated bed linen without wearing the appropriate Personal Protective Equipment (PPE) such as gloves and aprons. This meant there was potential risk to people due to acquiring or spreading healthcare associated infections.

On the day of our inspection the manager told us of an incident where a person who used the service absconded from the home. Following this incident, which was reported to the Care Quality Commission (CQC) in a timely manner, we found that this person's free access from the building had been restricted in the interests of their safety.

We asked the manager if they had followed procedures to determine if this person had capacity to make informed decisions as highlighted in the Metal Capacity Act (2005). The act is in place to ensure that people are not deprived of their liberty unlawfully. The manager told us that an assessment had not been performed but an assessment would be undertaken as a matter of priority.

Is the service effective?

We found that systems were in place to ensure that people's individual support needs could be identified. We also established that staff had an understanding of people's individual needs and preferences and how they were to be met.

On the day of our inspection we found that people's care plans in relation to the management of diabetes and pressure ulcer prevention required additional details to be effective in meeting people's individual needs.

We also found that supplementary records were, in some cases of poor quality and inconsistent. We also found that some records relating to night checks had been falsified.

Is the service caring?

Visitors to the home told us they felt their relatives and friends received their care and support in a caring manner. They also felt the staffing levels were sufficient in meeting people's needs.

Whilst we observed staff to be caring, we also observed that on occasions people did not receive interventions in a timely manner and were not adequately supervised. This could compromise the quality of care provision such as if people were at risk of falls. Staff attributed this to insufficient staffing levels. One member of staff told us, 'Sometimes we don't have enough staff. It can result in delays in people having their dinner, and our ability to respond to call bells.'

We also noted that on occasions staff were not using appropriate language when referring to people. One member of staff made reference to 'feeders' whilst another referred to people as 'wanderers'. We also overheard a member of staff telling a person, 'You've just opened your bowels.' This was said in a communal area and several people would have been able to hear the statement. This meant people's respect and dignity was not always maintained.

Is the service responsive?

We found that needs assessments were performed when people began to use the service. The assessment process utilised information from people's relatives and professionals such as social workers when available. This was to ensure an understanding of people's individual support needs could be identified.

We had concerns as the care planning review procedures were not responsive in ensuring peoples care plans were up to date. This issue was predominantly identified in the care records of people who were assessed as needing nursing interventions.

The manager told us that the organisation was in the process of finding alternative accommodation for people who had nursing needs. We were told that once the process was complete the registration status would be amended to reflect that the home would no longer provide nursing care. The area manager told us that they envisaged the process would take approximately six weeks and was in response to recruitment issues they had identified.

Is the service well-led?

Visitors to the home told us they had confidence in the newly appointed manager. Comments included, 'I find the new manager to be very approachable and feel I can discuss anything.' And, 'All the staff are very approachable, including the manager.' Members of staff also told us they had confidence in the management team.

Records showed the manager had initiated an auditing process which examined the provision of individualised care and treatment to people residing at the home. Issues relating to human resources, such as staff absenteeism, medication management and home's management systems were looked at in this process. On examination of the aforementioned auditing documentation we found that the manager had identified similar issues of concern to the ones we had identified on the day of our inspection.

We also found the manager had initiated and amended procedures and practices following our inspection to ensure our issues of concern could be addressed in a timely manner.

The provider has sent us an action plan to demonstrate how they will Improve areas of concern which we identified.

We spoke with one person who used the service who told us, 'It's ok here.' A relative told us, 'The care's got considerably better in the last five or six weeks. My relative's much more relaxed now.'

The service had safely secured and administered medicines.

The provider had not protected people by ensuring appropriate and fully functioning equipment was available.

There were effective recruitment and selection processes in place. We looked at three staff files which contained evidence of the application and interview process.

The service had covered its staffing levels but some shifts had required senior care and nursing staff to work to ensure adequate cover.

We looked at a complaint received by the service during the last year. We found that the service had acknowledged the complaint in line with the complaints policy but had not provided responses to the complainant within the timescales specified in the service's complaints policy. This meant the service had not responded appropriately to the complainant and had not acted in accordance with the service's complaints policy.

We spoke with three staff and they were all able to describe care and treatment required by individual people. We saw evidence in people's care plans that GPs, community nurses and social workers were involved in people's care which met their individual needs.

We spoke with a person who used the service. They said, 'My room is clean and tidy.' We spoke with three staff who confirmed there were sufficient supplies of equipment to prevent and control infection, including aprons and gloves.

Members of staff we spoke with said, 'Sometimes there's enough staff but the staffing levels can be variable.' The manager told us that a small number of agency staff had been regularly used in the previous two to three months to cover staff shortages and sickness. The manager also confirmed the home used the same agency staff to ensure continuity of care for people and that the home is actively recruiting to any vacant hours.

We saw audits completed for care plans, risk assessments, medication and infection control. We saw action plans in place to address any issues found during audits.

We were told by the manager that meetings were held monthly for people who use the service and their relatives. One relative told us, 'The relatives meetings have been useful.'