Archived: Willow House

At the time of our inspection, the registered provider was in the process of undertaking a consultation regarding the possible closure of Willow House. We inspected this service on 23 September and 3 October 2016. The inspection was unannounced. This meant the registered provider and staff did not know we would be visiting. At the time of our inspection, Willow House provided permanent accommodation, but also had 4 ‘step-down’ beds providing temporary accommodation for people being discharged from hospital. There were 23 people using the service; 22 people living at the service and one person staying there temporarily in a ‘step-down’ bed.

The service was last inspected in January 2014 and was compliant with the regulations in force at that time.

The registered provider is required to have a registered manager as a condition of their registration for this service. The service did have a manager registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC 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.

During our inspection, we received positive feedback about the management at Willow House. However, we identified a number of issues or concerns relating to the running of the service which demonstrated that the service had not been consistently well-led. Although work was on-going to address a number of these issues and concerns, further progress was needed.

We identified that care plans contained person centred information about people’s needs and how those needs should be met by staff. However, we found that care plans and risk assessments had not always been updated to reflect people’s changing needs and to provide up-to-date guidance to staff about how to safely support that person to meet their needs. We found that Personal Emergency Evacuation Plans (PEEPs) were completed, but had not consistently been added to the ‘emergency file’ when new people had moved into the service. We found that regular fire drills had not been completed.

We received mixed feedback about staffing levels and concerns about the cleanliness of the service. These issues were being addressed and steps taken to ensure that sufficient numbers of general assistants were deployed to keep the service clean. However, we made a recommendation about monitoring staffing levels and staff deployment in the body of our report.

Training records showed that staff training had not been kept up-to-date. The registered provider was in the process of addressing this at the time of our inspection. We have made a recommendation about monitoring staff training in the body of our report.

People who used the service told us there were not enough activities on offer at Willow House. We have made a recommendation about improving the support available to people to engage in meaningful activities in the body of our report.

People who used the service told us they felt safe and we found that people were safely supported to take prescribed medicines. The home environment and equipment used were checked regularly to ensure they were in safe working order.

People who used the service were supported to make decision and had choice and control over their care and support. Consent to care and treatment was sought in line with relevant legislation and guidance. The deprivation of liberty safeguards (DoLS) were appropriately used to ensure people’s human rights were protected.

People who used the service were positive about the food provided at Willow House and staff encouraged people to eat and drink enough. However, accurate records were not consistently kept of people’s food and fluid intake. Although the registered provider had addressed these concerns by the second day of our inspection this was evidence of reactive not proactive management.

People were supported to access healthcare services where necessary and appropriate advice and guidance was sought following accidents and incidents to promote good health and keep people safe.

Staff were generally described as kind and caring. Staff treated people who used the service in a way that maintained their privacy and dignity. Staff demonstrated that they understood people’s needs and how best to support them.

There were systems in place to gather feedback about the service provided, share information and manage complaints. The registered provider had a system of quality assurance audits to monitor and improve the safety and effectiveness of the service provided.

We found a breach of regulation relating to safe care and treatment. You can see what action we told the provider to take at the back of the full version of the report.

Overall we saw some improvements in the quality of records kept. However this improvement needed to be built on and sustained, in order to show that records were always accurate, up-to-date and well maintained.

People have their privacy, dignity and independence respected and wherever possible are included in decisions about their care.

People receive safe, appropriate care that meets their needs.

People's nutritional needs are regularly monitored, and they are supported to have adequate nutrition and hydration.

People live in a clean, hygienic environment that overall is well maintained.

Although the service has a complaints process this could be made more available and accessible for people.

Not all the personal records including medical records are accurate, fit for purpose or provide sufficient guidance for care staff to refer to.