Background to this inspection
Updated
18 October 2019
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
Inspection team
Two inspectors carried out this inspection.
Service and service type
The Willows Residential and Nursing Home 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 service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
This inspection was unannounced.
What we did before the inspection
The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.
We did however review information we had received about the service since the last inspection. We also attended a meeting with the local authority, other professionals involved with the service and representatives for the provider. After the meeting, we contacted the nominated individual for further information. The nominated individual is responsible for supervising the management of the service on behalf of the provider.
We used all of this information to plan our inspection.
During the inspection
We spoke with five people who used the service and two relatives about their experience of the care provided. We observed the care and support being provided to 28 people during different points of the day including meal times, activities and when medicines were being administered. We spoke with twelve members of staff including the registered manager, deputy manager, group clinical director, two service quality managers, two nursing staff (including a clinical lead), a senior support worker, an agency support worker, the chef, the administrator and the activities coordinator.
We reviewed a range of records. This included care records for five people, as well as other records relating to the running of the service. These included staff records, medicine records, audits and meeting minutes, so we could corroborate our findings and ensure the care and support being provided to people were appropriate for them.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We asked for information about staffing, recruitment checks, cleanliness, internal audits, dignity and privacy and the premises.
We attended another meeting with the local authority, other professionals involved with the service and representatives for the provider. This included the chief executive officer and operations director.
Updated
18 October 2019
About the service
The Willows Residential and Nursing Home is a residential care home providing personal and nursing care. The service can accommodate up to 32 people in one adapted building. At the time of this inspection 30 people were using the service who had a range of needs including dementia and physical disabilities.
People’s experience of using this service and what we found
Some people, particularly those cared for in bed, felt lonely and isolated. Although staff told us activities were provided for people in their own rooms, this did not happen during the inspection. Staff carried out regular checks on people, but some of the interactions were task based and they assisted people with their care and support with little or no communication. In contrast, other people commented on how kind and caring some of the staff were.
People raised concerns about staff deployment in the home and we observed times when there were no staff in certain areas. Not everyone was able to use a call bell to summon assistance in these areas. The provider had recognised that the layout of the current building presented certain challenges, and they had a long-term plan to address this. In the interim the provider assured us that a senior staff member would make regular checks around the building to ensure staff were visible and people’s needs met.
The provider checked to make sure staff were safe to work at the service, but the checks being made did not always fully meet the legal requirements. This meant the provider’s recruitment checks were not robust enough to ensure people’s safety and wellbeing.
People’s privacy and dignity was not always upheld. Bedroom doors were routinely left open, meaning that people could be viewed easily by other people and visitors. Sometimes the people inside were asleep or not fully dressed. At times staff also failed to announce themselves when they entered people’s rooms and did not explain why they were there.
Some good attempts had been made to ensure some people’s communication needs were understood and met, but improvements were needed to explore everyone’s preferred communication methods.
The provider checked to make sure people received good quality, safe care and support. However, the auditing systems in place needed strengthening to ensure all legal requirements were met and to drive continuous improvement.
Staff ensured people received their medicines when they needed them. Risks to people were assessed too, to ensure their safety and protect them from harm, including the risk of infection. Staff understood how to report concerns and who to report to.
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. Staff asked people for their consent and involved them in planning their care and support. People were given the opportunity to make suggestions and provide feedback about the service provided to them. People’s concerns were listed to and acted on.
Staff supported people to stay healthy. Staff ensured people had a choice of food and had enough to eat and drink. They helped people to access healthcare services when they needed to and supported them at the end of their life to have a comfortable and dignified death.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
The last rating for this service was Good (published 25 May 2017).
The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection. This is the fourth time since 2015 that the service has been rated requires improvement, although not all following consecutive inspections.
Why we inspected
The inspection was prompted in part due to allegations of poor care practice and abuse involving one person living at the service. This incident is subject to a criminal investigation. As a result, this inspection did not examine the circumstances of the incident. However, we did focus on checking the safety and wellbeing of other people living at the service during the inspection.
We have found evidence that the provider needs to make improvements. Please see the safe, caring, responsive and well-led sections of the full report. We have identified breaches in relation to staff recruitment checks and the checks the provider makes in order to assess the quality and safety of the service.
You can see what action we have asked the provider to take at the end of this full report.
The provider responded immediately after the inspection by telling us they had arranged for all staff files to be checked for gaps, to ensure they contained all the required checks. They also planned to review their auditing tools.
Follow up
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.