Willett Lodge

Willett Lodge is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The care home provides accommodation and nursing care for up to 20 people in one adapted building. The home provides support for people living with a range of healthcare, mobility and sensory needs, including people living with dementia. There were 18 people living at the home at the time of our inspection.

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

People were not always protected from avoidable harm because risks to people's health and wellbeing were not consistently managed. Processes were not in place to ensure care plans and risk assessments were reviewed and updated following specific risk incidents or events. Care plans did not contain detailed and person-centred information to accurately reflect the needs of people and mitigate identified and potential risks.

There was no adequate process for ensuring that care recommended by specialist healthcare professionals was implemented. People's risk management plans lacked important detail to guide staff on how to keep people safe or manage specific health conditions.

Staff were recruited in accordance with the providers policy, although recruitment processes for agency staff were not always robust enough ensure that agency staff employed at short notice were inducted sufficiently, or had the skills, training and competence to provide safe care.

We observed a task focussed culture of the service which meant that care was not consistently person centred and did not always promote good outcomes for people. Staffing levels were not always sufficient in meeting people's emotional or psychological needs in a person-centred way, and staff did not always have time to provide structured, meaningful activities for people to engage in.

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.

People were cared for by staff who were kind and compassionate. People received support from a consistent team of staff who knew them well. Relatives told us they thought their loved ones were safe and there were enough staff to support them and meet their needs.

Staff had received training in infection prevention and control (IPC) and IPC practice within the home was aligned with current government guidance.

Rating at last inspection

The last rating for this service was Good (published 27 March 2018).

Why we inspected

The inspection was prompted in part by notification of a specific incident, where concerns had been raised regarding the security of the home. This incident is subject to a police investigation. The information CQC received about the incident identified concerns about the assessment and management of risks, people’s safety and neglect. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. This inspection examined those risks.

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 reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from ‘Good’ to ‘Requires Improvement’. 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 Willett Lodge on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service.

We have identified breaches in relation to providing safe care and treatment, recruitment and the overall governance of the service at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

After the inspection we contacted the provider about some of the urgent concerns found during inspection. The provider sent us assurances and evidence that informed us of the immediate actions they had taken to address these concerns.

We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Willett Lodge is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The care home can provide accommodation and nursing care for 20 people in one detached building that is adapted for the current use. The home provides support for people living with a range of healthcare, mobility and sensory needs, including people living with dementia. There were 17 people living at the home at the time of our inspection.

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 managers, 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.

At the last inspection on 14 March 2017, the service was rated Good. At this inspection we found the service remained Good

People and relatives told us they felt the service was safe. People remained protected from the risk of abuse because staff understood how to identify and report it. A social care professional told us, “Based on recent reviews of people’s placements, I can confirm that resident’s safety whilst living at Willett’s Lodge is one of the most important areas for the care team.”

The registered manager completed risk assessments and a programme of regular health and safety checks to ensure quality was measured and maintained. We observed audit activity for areas including, medicines, and fire safety and infection control.

The provider had arrangements in place for the safe ordering, administration, storage and disposal of medicines. People were supported to have their medicine safely when they needed it. People were supported to maintain good health and had access to health care services.

People and their relatives felt staff were skilled to meet the needs of people living with dementia and provide effective care. One relative told us, “It’s not posh but it’s good care”. Staff told us they received training that the importance of understanding people’s life experiences and supported them to work empathically when delivering person centred care.

Staff considered peoples capacity using the Mental Capacity Act 2005 (MCA) as guidance. People’s capacity to make decisions had been assessed. 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. The provider was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS).

Staff supported people to eat and drink and their nutritional needs were met. One person told us, “The food is always lovely here.” Where special dietary needs were required in relation to people being at risk of malnutrition or choking staff followed guidance given by care plans and the health professionals.

People’s relatives told us and we saw that the staff were caring and respectful. One person told us, “They care about people, they care about us”. Care and support provided was personalised and met peoples’ diverse needs. People and their relatives were included in the assessment of their needs and development of care plans.

People when needed received ‘end of life care’ that was responsive to their health care needs and respected their wishes and diverse cultural needs.

Feedback received showed relatives were satisfied overall, and felt staff genuinely cared. People and relatives felt listened to and any concerns or issues they raised were addressed suitably and dealt with in a timely way.

Quality assurance audits completed by the registered manager and provider were embedded to ensure a good level of quality was maintained. The provider was committed to improving the service through satisfaction surveys and as an active partner in local forums. The provider consistently demonstrated that the service monitored and made improvements to the systems when required.

Willett Lodge is registered to provide accommodation and nursing care for up to 20 people with a range of healthcare needs, including people living with dementia. At the time of our inspection, 20 people were accommodated at the home. Willett Lodge is situated in a residential area of Worthing close to the town centre and seafront, with easy access to public transport. The home has a large sitting room, dining room, hall area and sun lounge. Bathrooms are accessible and equipped for people with limited mobility. Some bedrooms have en-suite facilities. There is a garden to the rear of the property and a decking area so that people can sit outside.

A registered manager was 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 in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People felt safe living at Willett Lodge and their relatives spoke positively about the care delivered by staff. People were protected from harm and staff had been trained in safeguarding adults at risk. Risks to people were identified, assessed and managed appropriately. Guidance for staff was contained within people’s care plans in a range of areas, such as moving and handling, nutrition and risks associated with specific health conditions. People at risk of malnourishment were monitored appropriately. Safe moving and handling techniques were observed. Various parts of the home were in need of repair or refurbishment and the provider had plans in place to address these. Some refurbishment was in progress at the time of this inspection. Staffing levels were sufficient to meet people’s needs. Safe recruitment practices were in place. Medicines were managed safely and people received their medicines as prescribed.

A registered manager was 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 in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People were supported to be safe by staff who had been trained to recognise the signs of potential abuse and knew what action to take if they suspected abuse was taking place. Risks to people were identified, assessed and managed appropriately. Accidents and incidents were recorded and monitored and, where needed, risk assessments and care plans were updated. Premises and equipment were managed to keep people safe. Environmental risks had been identified and assessed and safety checks undertaken as needed. There were sufficient numbers of staff on duty and when new staff commenced employment, checks were undertaken on their suitability to work in the care profession. People’s medicines were managed so they received them safely by trained staff. The home was clean and hygienic and staff wore personal protective equipment when delivering personal care and serving meals.

Staff were trained in a wide range of areas so people received effective care. New staff undertook an induction programme and followed the Care Certificate, a universally recognised qualification. Staff received regular supervision and had annual appraisals. The requirements of the Mental Capacity Act 2005 and associated legislation under the Deprivation of Liberty Safeguards were understood by the registered manager and staff. Where required, decisions were taken in line with this legislation and best interest meetings held. People were supported to have sufficient to eat and drink and to maintain a healthy lifestyle. They had access to a range of healthcare professionals and services. People were encouraged to personalise their rooms with photos and ornaments that were important to them. The provider was in the process of redecorating the home.

People were looked after by kind and caring staff who knew them well. Staff cared for and supported people in a warm, friendly and reassuring way. One relative said, “They do over and above what they have to do, but they do it because they care”. People were treated with dignity and respect and were encouraged to be involved in decisions about their care. Care plans were reviewed monthly and relatives were consulted and involved in care planning. Staff were trained to support people as they reached the end of their lives to enable people to have a comfortable and pain-free death.

Care plans contained comprehensive information about people and provided guidance to staff on how they wished to be cared for. Some care plans did not contain personal histories about people and the registered manager was in the process of completing these, in conjunction with people’s relatives. A range of activities was on offer, with group activities or staff spending 1:1 time with people to engage in their hobbies or games. People were encouraged and supported by staff to go out into the community. Complaints were managed appropriately and, where necessary, appropriate action taken to prevent the risk of reoccurrence.

People were involved in developing the service and their views, together with their relatives, were obtained through annual surveys. Staff felt supported by the registered manager and there was an ‘open door’ policy so that staff could discuss any issues of importance to them. Relatives spoke highly of the registered manager and feedback was positive about the home overall. A range of quality audit systems was in place to regularly check on the quality of the care delivered and to drive continuous improvement.

We looked at respecting and involving people who use services, care and welfare of people, safeguarding, supporting staff and the assessment and monitoring of service provision. We spoke with one person who uses the service, five relatives, and the manager.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led?

This is a summary of what we found

Is the service safe?

The relatives of people living at Willett lodge told us they thought their family members were safe at Willett Lodge. Safeguarding procedures were in place and staff understood how to safeguard the people they supported. Relatives told us they were able to report any safeguarding concerns they had. Systems were in place to support the manager and staff to learn from events such as accidents and incidents, complaints and concerns.

CQC is required by law to monitor the operation of the Mental Capacity Act 2005 Deprivation of Liberty Safeguards (DoLS) and to report on what we find. One person living at Willett Lodge was subject to this safeguard and the appropriate process had been followed. Staff had been trained to understand when an application should be made, and how to submit one.

Is the service effective?

People we spoke with and their relatives told us they were happy with the care that was provided. From what we observed and from speaking with the staff it was clear that they understood people's care and support needs. Staff had received training and development to meet the needs of the people living at the home. Risks were assessed and care plans written to reflect the support provided.

Is the service caring?

We saw that staff were attentive and kind to the people who needed support. Staff told us they encouraged people to maintain their independence. People's preferences, interests and diverse needs had been recorded in the care plans we reviewed. One relative told us they were 'Very impressed with the level of care and interest' that staff provided.

Is the service responsive?

People's needs had been assessed before they moved into the home. Information had been recorded on detailed care plans. People and their relatives knew how to make a complaint if they were unhappy. We saw that a copy of the complaints procedure was given to everyone when they moved to Willett lodge. People living at the home participated in a range of activities that were tailored to their individual needs.

Is the service well-led?

The service worked with other agencies and services to make sure people received their care in a joined up way. A quality assurance system was in place and where issues had been identified these had been rectified by the manager. Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and quality assurances that were in place. People using the service and their relatives were offered a questionnaire to complete. Where shortfalls or concerns were raised they had been addressed and discussed with the person.

One person told us it was “Very nice indeed” at the service. Relatives we spoke with told us that people received good care. One relative said “They look after him really well. He’s very happy there.” Another relative told us that their family member “Receives very good care. The staff answer my questions honestly. Staff are kind, caring and patient.”

People told us that staff understood the needs of the people who used the service and that they provided appropriate care and support. One relative said “Staff know what they’re doing, we’re very impressed with them.” We observed that staff were responsive when people asked for assistance and offered people choices about how their care was provided.

Sufficient numbers of staff with the relevant training, skills and experience were employed to meet peoples’ needs. Records showed that the service took account of peoples’ views. A relative told us “I feel free to mention things to the manager if there’s anything I’m not happy about”. The service monitored the quality and safety of the service provided and took action where needed.

One person we spoke said “they take good care of me, no doubt about it.” Relatives and visitors we spoke to said the level of care was good, and a relative said to us that staff were “very caring and committed to all the residents.”

The provider had addressed the concerns we found at our previous inspection. We found that the provider had monitored that people were receiving safe care and improvements were made where needed. We observed that safe care was provided to people, and that activities people wanted to participate in took place.

Conversation with people was limited due to their disabilities. However, we also spent time with them and observed the care they received from staff in order to understand what it was like to live at this care home

We spoke to the relatives of one person who were visiting the service. They confirmed they were satisfied with the standard of care provided. They told us, 'The staff are always kind and caring.'

We spoke with the nurse in charge of the shift and two members of care staff who were on duty. They demonstrated they knew about the level of care that each person required. They told us that they felt well supported by the manager.