All inspections: The Willows Care Home - Care Quality Commission

The Willows care home provides accommodation for people who require personal care. At the time of our visit there were 18 people living at the home. The Willows Care home is made up of two floors. It has communal areas including a dining area and two lounges, a conservatory area and outdoor space, kitchen, manager’s office and staff room. There are 25 single rooms and one double room, a kitchen and laundry facilities.

At the last focussed inspection on the 30 April and 8 May 2015 we found breaches of legal requirements were found. After this inspection we issued the provider a notice of decision to restrict admissions into the home.

The provider wrote to us to say what they would do to meet legal requirements in relation to the following breaches:

Good governance, records and audits
Staff training was not up to date

At the previous comprehensive inspection undertaken on the 1 and 3 December 2014 we found breaches of legal requirements and found the service to be inadequate. After this inspection we issued a warning notice that they must be compliant by the 17 March 2015. The provider wrote to us to say what they would do to meet legal requirements in relation to the following breaches:

Consent to care and treatment
Care and welfare of people who use services
Safeguarding people who use services from abuse
Managements of medicines
Incidents and accidents

Warning notices were issued in relation to

Assessing and monitoring the quality of service provision
Records

This was an unannounced comprehensive inspection and took place on 10 and 11 November 2015. At this inspection there were still concerns relating to previous breaches; records were inaccurate and incomplete and there was a lack of robust quality audits and staff training to ensure staff had skills and knowledge. We also found the following breaches;

Need for consent
Safeguarding people from abuse and improper treatment
Safe care and treatment
Meeting nutrition and hydration needs

At the previous inspection we asked the provider to take action and ensure the service had a registered manager in post. At this inspection there was not a registered manager in place but the manager was being supported by a manager who was registered at a different home. 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 at risk of unsafe care due to not having referrals or actions taken when there were safeguarding concerns. People’s support plans and risk assessments were not always in place and did not always adequately detail what support might be required if they became anxious or upset. People were at risk of receiving medicines in an unsafe way due to inadequate records, unsafe storage, disposal and security.

People who did not have the capacity to make specific decisions did not have best interest decisions in place as required by The Mental Capacity Act 2005. People were supported by staff who had not always received training. If staff had received training they were not always able to demonstrate they had necessary skills and knowledge to undertake their role. Staff demonstrated they were supportive when people required assistance. However, people had periods of time when there were no interactions from staff. Some people benefited from activities but not everyone had the same opportunities.

People’s meal time experience was not ensuring people had opportunities to socially engage with one another. People were not receiving adequate nutritional and hydration needs to meet their specific individual needs.

People and relatives felt staff demonstrated a kind and caring approach. People were supported by staff who had received necessary checks prior to employment.

Complaint records did not always show that investigations had taken place or what learning had taken place by the provider. People did not have detailed personal emergency evacuation plans in place that confirmed what support staff would need to provide or equipment required if there was an emergency.

The home did not have systems and audits in place that identified areas of concern found during this inspection. This included not identifying areas of concern within peoples care plans, assessments, the homes incidents and accident logs. There were no actions plans in place to address the concerns.

People were at risk of receiving inadequate care this was despite the support provided by the home’s management team and consultancy support. We have made these failings clear to the provider and they have had sufficient time to address them. Our findings do not provide us with any confidence in the provider’s ability to bring about lasting compliance with the requirements of the regulations.

The action we took is at the back of this report.

The Willows Care Home is registered to provide accommodation for up to 27 people who require personal care. At the time of our inspection 14 people were living at the home.

We carried out an unannounced comprehensive inspection of this service on 10 & 11 November 2015. After that inspection we received information about concerns in relation to the service. As a result we undertook a focussed inspection on 10 March 2016 to look at concerns in relation to people’s safe care and treatment. This report only covers our findings in relation to this. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Willows Care Home on our website at www.cqc.org.uk

There was a manager in post. They were not yet registered with us although they had submitted an application to CQC, which was in progress. 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 and associated Regulations about how the service is run.

We found people to be at risk of not receiving safe care and treatment due to staff failing to follow guidelines within one person’s risk assessments. This placed them at significant risk of harm. Poor record keeping meant another person was at risk of not having changes to their behaviour identified and responded to ensure their safety.

One person was at risk of not seeing their GP when changes to their wellbeing had failed to be identified and recorded on incident forms so that the manager had a detailed overview of all the incidents and accident where this person had fallen over a period of time. Their daily records confirmed a significant deterioration in their mobility and wellbeing over this period of time.

People who were at risk of inadequate nutrition and hydration did not have an assessment that identified what their daily intake should be so that any concerns could be identified so that immediate action could be taken. One person was also at risk of not receiving care appropriate to their nutritional and hydration and their end of life care.

People’s care plans relating to developing pressure sores had risk assessments and guidelines in place.

We found one breach of regulations 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.

We carried out an unannounced comprehensive inspection of this service on 1 and 3 December 2014.

Breaches of legal requirements were found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the following breaches:

• Consent to care and treatment.

• Care and welfare of people who use services.

• Safeguarding people who use services from abuse.

• Management of medicines.

• Incidents and accidents.

Warning Notices were issued in relation to

• Assessing and monitoring the quality of service provision.

• Records.

We undertook this focussed inspection on the 30 April & 8 May 2015 to check that they had followed their plan and met their legal requirements. We also inspected in relation to concerns raised since the last inspection. These concerns related to inadequate staffing and lack of training specific to moving and handling and management of medicines.

This report only covers our findings in relation to the breaches and concerns raised.

At this inspection we found action had been taken to ensure people were safeguarded against abuse and mental capacity assessments had been completed in accordance with The Mental Capacity Act (2005). There were still concerns relating to records as we found they were still inaccurate and there was a lack of robust quality audits, and staff training was not up to date. We had received all notifications as required by law in relation to incidents and safeguarding’s. We are taking action against the provider regarding our concerns.

The Willows Care Home is registered to provide personal care and accommodation for up to 27 people. On the day of our visit there were 22 people living at the home.

At our last inspection we asked the provider to take action and ensure the service had a registered manager in post. At this inspection there was not a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manager 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 continued to be at risk of receiving inadequate care because the provider’s actions did not sufficiently address the on-going failings. This was despite the support provided by the home’s management team. There has been on-going evidence of inability of the provider to sustain full compliance since 01 October 2010. We have made these failings clear to the provider and they have had sufficient time to address them. Our findings do not provide us with any confidence in the provider’s ability to bring about lasting compliance with the requirements of the regulations. We are taking further action in relation to this provider and will report on this when it is completed

The overall rating for this provider is ‘Inadequate’.

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

We carried out this inspection on the 1 and the 3 December 2014. At our last inspection in May 2014, we had wide spread concerns in all areas of our inspection. The areas of concern included people not receiving safe appropriate care with accurate assessments. Staff not receiving adequate supervision and support along with poor record keeping and a failure to robustly identify through quality audits areas of concern throughout the service. The manager/ provider sent us an action plan to confirm how the service was going to address these areas of concern. We issued warning notices for two areas where no improvements had been made.

The Willows Care Home provides accommodation for up to 27 people who require personal and/or nursing care. At the time of our visit there were 25 people living at the home. The Willows Care Home is made up of two floors. It has communal areas including two dining areas, a lounge, conservatory and outdoor space. There are single and one double room, a kitchen and laundry facilities.

There was no registered manager in post at the time of our inspection. We have asked the provider to ensure they register a manager and that we see evidence of this. It is a requirement that the service must have a registered manager 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. The Home had appointed an acting manager who was responsible for improving the quality of the service. There was also a deputy manager who was responsible for the day to day running of the home.

At this inspection risks to people’s safety were not always reported and acted on. We found incidents and accidents which had failed to be addressed. Assessments relating to moving and handling did not include all specific details relating to care and treatment. Where there were risks within the communal areas the service had failed to reduce these risks by having a completed risk assessment in place.

Staff did not manage people’s medication in a safe manner. This was because staff left medication unattended. This practice placed people at risk of harm.

Care plans did not always reflect people’s individual and changing needs. Some information relating to people's individual needs, preferences and choices had not been updated in the main care plan.

The home failed to have robust systems and audits in place. This included not identifying areas of concern within people’s care plans, assessments, the homes incident and accident logs and records. There were no action plans in place to address concerns.

Staff told us they felt there was a lack of clear leadership and the acting manager was not always accessible. Staff had received supervision and team meetings and there were daily handovers to keep staff informed of people's change in need. We found that staff were not receiving annual appraisals which meant opportunities to set goals and identify training needs had not happened.

Whilst people told us that they had no reason to complain we found that the service was not analysing complaints and ensuring that they were learning from them.

The home had a variety of snacks and meals which maintained a healthy diet. Staff offered choice and options at meal times and people were happy and relaxed within the meal time experience.

We saw that staff provided care that was caring and where people became upset they supported them in a professional calming manner. Staff we spoke with confirmed how they provide dignity and privacy to people they support.

We considered our inspection findings to answer questions we always ask; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

If you would like to see the evidence supporting our summary please read the full report.

Is the service safe?

People were not being protected against abuse. We found there had been two separate incidents of physical assault recorded in the person’s daily records but no action had been taken. Staff we spoke with confirmed they knew what actions to take if they suspected or witnessed abuse. However we saw no action was taken when abuse was raised. A compliance action has been issued in relation to this and the provider must tell us how they plan to improve.

We saw the home sought assistance from GP’s and District nurses when the need arose.

We saw on the day of our inspections that the home had enough staff on duty to meet people’s needs.

We saw there was a fire risk assessment in place for the building but there was no information relating to procedures for individual people within the home.

CQC monitors the operation of Deprivation of Liberty Safeguards which applies to care homes. There were no current applications in place at the time of this inspection.

Is the service effective?

One person that we spoke with was happy about the care they received. We saw one member of staff provide a really positive interaction with one person who was living with dementia. However at lunch time we saw another member of staff provide a very poor interaction with a person they were supporting. We informed the provider about this. They addressed this straight away with the member of staff.

Most people were living with dementia. We saw that this was recorded in the person’s care plan. We saw that the home had failed to undertake Mental Capacity Assessments for people and best interest decisions involving family, relatives and significant others into decisions that were being made. A compliance action has been issued in relation to this and the provider must tell us how they plan to improve.

Staff had regular meetings and had access to the manager when they needed to speak to them. However staff were not having regular formal supervision sessions and appraisals in line with the home’s policy. A compliance action has been issued in relation to this and the provider must tell us how they plan to improve.

We saw people’s care plans lacked details relating to their care needs and the support they required. This meant people were at risk of receiving care and support that did not meet their individual care needs. A compliance action has been issued in relation to this and the provider must tell us how they plan to improve.

Is the service caring?

Staff we spoke with told us how they supported and cared for people with dementia. They said “I look at their body language and gauge their reaction” Another member of staff said “I always give them choices, I use visual prompts so they can see me and I talk to them slowly”. Staff confirmed how they offered people support and choice.

We saw two positive staff interactions when people required assistance. One member of staff provided a reassuring and calm attitude to someone who was worried about their children. Another member of staff offered their support and encouragement to wash a person’s hands. This was done in a respectful and encouraging manner. We did however see one member of staff provide poor support to someone at lunch time. We raised this with the provider who addressed the situation.

Is the service responsive?

People had access to daily activities. They could choose what activities they wanted to undertake. One person said “I join in with the activities I want to.”

We saw that where people’s care needs changed the home had failed to identify and document these changes. We saw staff responded to these changes but there was a failure to apply new guidelines for staff to follow. A Warning Notice has been issued in relation to this and the provider must take action to address this.

Is the service well-led?

Staff we spoke with told us how approachable they found the manager.

Relatives we spoke with said what a difference the new manager had made.

We reviewed the home’s auditing system. They had undertaken audits in relation to care plans however no other audits were available for us to see. We asked for other audits and were told there were none. A Warning Notice has been issued in relation to this and the provider must take action to address this.

The home had taken action to seek views from people and relatives by sending out questionnaires and holding a residents and relative meeting.

There was no information from the analysis of accidents and incidents on what actions had been taken to identify changes and improvements, to minimise the risk of them happening again.

People’s personal care records, and other records kept in the home, were not always accurate and complete. A Warning Notice has been issued in relation to this and the provider must take action to address this.

At the time of our inspection the provider did not have a registered manager in post. The acting manager was applying for registration with the Care Quality Commission. In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a registered manager on our register at the time.

We were not able to speak to people as they had complex needs and difficulty communicating. We gathered evidence of people's experiences by reviewing records, observing care practices and talking with the manager, staff and family members.

During our visit we observed there was a relaxed atmosphere with people choosing where they wished to spend their time. We observed staff treating people with kindness and patience. Staff demonstrated they knew people's needs and ensured people were treated with privacy and dignity.

We looked at people's records and noted that they did not fully encompass people's safety and well-being. Staff and family members knew how to raise a complaint and felt confident in doing so. We reviewed the quality of the service and found a shortfall in the recording of documentation. We looked at the cleanliness and infection control procedures and found that the provider had inadequate systems in place to ensure the safety of the people who used the service regarding the control of substances hazardous to health.

During this inspection we spoke with seven people who lived in the home, one visitor, five members of staff and a healthcare professional.

People spoken with told us they were very happy with the care and support they received at The Willows. One person was unable to communicate verbally but when asked if they were happy responded with a nod of the head and a smile. Other people were happy to tell us how they felt. One person told us, 'Well I've been here a while now and they know me very well. I think they are all very good'. One visitor told us, 'They really do care here, not just the personal care you would expect. It is all done with love, I know that sounds odd but they do treat people with love'. One visiting healthcare professional told us, 'I have been coming here a long time now, they deliver a very good standard of care and people I visit are happy and want to stay here'.

We observed staff organised meaningful activities and treated people who lived in the home with respect and dignity.

We found that care planning was person centred and agreed by the individual, a family member or an advocate. Regular reviews were carried out and involved the individual where possible.

We found the receipt, storage and administration of medication was managed safely within the Royal Pharmaceutical Society guidelines.

Staff confirmed they were given the opportunity to build on their skills and received appropriate support from the registered manager.

We saw people being cared for and supported by staff and the manager in a kind and sensitive way. People looked relaxed and engaged in conversations with the staff who were looking after them. One person told us that they feel that The Willows is a lovely place to live, another person told us that the home is 'excellent'.

We saw the staff team spending time listening to people and talking to them in a warm, good humoured way. The staff had a kind manner when they were communicating with people who use the service.

We saw that people who use the service each have an informative and unique care plan written about their care needs. A care plan is a document written about people who use the service, to guide and inform the staff about what care and support they need. The care plans contain useful information about peoples needs. We also read information about what to do to support people to live a varied and fulfilling life.

We found that people who use the service are being supported by the staff to eat a tasty and nutritious diet. We saw that people who have special diets are supported to eat the food that they require. We also saw that people's cultural dietary needs can be met at the home.

We found that people who use the service live in a clean home. We saw that there are procedures for the staff to follow that help to minimise infection risks in the home. However people would be better protected from infection risks if all care staff followed a safe procedure if they go in to the kitchen. There needs to be a system in place that ensures staff who provide personal care, do not create infection risks when they go in to the kitchen.

We found that people are getting the medicines they need for their health and wellbeing. However improvements are needed in staff record keeping. There must be an accurate record of the dose of these medicines maintained. This is to ensure people are not given too much of these medicines.

We saw that people who use the service live in a comfortable, homely and satisfactorily maintained environment. The environment is enhanced because there are art works created by people who use services on display. We also saw the extension that has been completed since our last inspection. We saw that bedroom doors in the new extension have been painted bright, different colours to help people to easily find their rooms.

We saw that the staff have done training courses on subjects to do with people who use the service. This training for staff in a range of subjects relevant to people helps ensure they are cared for by staff who understand how to meet their needs.

We found that people are being cared for by staff who are properly monitored and supervised in their work. This means staff know how to give people the care they need.

We saw that there are methods in place to seek the views of people who use the service about the quality of service and care they get. We also saw that the manager acts on the views of people to improve overall outcomes for them.

People benefit from how complaints they make are handled by the service. There is a helpful procedure used that means complaints are investigated.

Archived: The Willows Care Home

All Inspections

10 & 11 November 2015

During a routine inspection

10 March 2016

During an inspection looking at part of the service

30 April & 8 May 2015

During an inspection looking at part of the service

1 and 3 December 2014

During a routine inspection

28 May and 4 June 2014

During a routine inspection

22 November 2013

During a routine inspection

30 January 2013

During a routine inspection

11 May 2011 and 9 May 2012

During a routine inspection