Willow Court Nursing Home

Willow Court Nursing Home is a residential care home providing personal and nursing care to up to 66 people. The service provides support to adults, some of whom were living with dementia. At the time of our inspection there were 59 people using the service, 12 were permanent residents and 47 were receiving short term services.

The care home accommodates 66 people in single rooms over two floors. The premises are purpose built and rooms and communal areas are spacious and bright.

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

People were supported by well trained staff and relatives believed their family members to be safe. Risks were assessed and actions taken to reduce them and ensure people remained safe.

The premises were well maintained and all necessary checks and services took place.

Recruitment was safe and there were sufficient staff deployed with a planned increase shortly.

Medicines were safely managed and we were assured the provider has a high standard of infection prevention and control and was following current guidelines.

The previous registered manager had recently passed away and the service was being overseen by an acting manager who had previously been a deputy manager. There was an open-door approach to management and staff could approach the management team to address concerns.

The provider had an open and honest approach to care delivery and reported accidents and incidents and informed those involved as necessary.

The provider had forged good ongoing relationships with health and social care professionals.

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.

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 14 September 2018).

Why we inspected

The inspection was prompted in part due to concerns received about skin integrity. A decision was made for us to inspect and examine those risks. We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe and well-led sections of this report.

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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has remained good based on the findings of this inspection.

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

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Willow Court Nursing Home is a ‘care home’ and is registered to accommodate up to 66 people. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. At the time of the inspection, 63 people were accommodated at the home. Willow Court is situated in the grounds of Andover War Memorial Hospital.

There was a registered manager in place. 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.

At our last inspection on 27, 28 and 29 September 2016, we found one breach of regulations. The service did not have an effective system in place to monitor and assess the quality of the service provided, or to take action where necessary to address and rectify any shortfalls. During this inspection, we found action had been taken and improvements made.

People felt safe living at Willow Court Nursing Home and they were very much at the heart of the service. Staff enjoyed working at the home and understood the needs of people using the service and supported people in a personalised way. Staff knew people well and we saw that care was provided respectfully and sensitively, taking into account people’s different needs.

Relevant recruitment checks were conducted before staff started working in the home to make sure they were of good character and had the necessary skills. Staff had received training in safeguarding adults and knew how to identify, prevent and report abuse. There were enough staff to keep people safe.

The risks to people were minimized through risk assessments. There were plans in place for foreseeable emergencies and fire safety checks were carried out.

People received varied meals including a choice of fresh food and drinks. Staff were aware of people’s likes and dislikes and went out of their way to provide people with what they wanted.

Staff received regular support and one to one sessions or supervision to discuss areas of development. They completed a wide range of training and felt it supported them in their job role. New staff completed an induction programme before being permitted to work unsupervised.

Staff had an understanding of the Mental Capacity Act (MCA) and were clear that people had the right to make their own choices. Staff sought consent from people before providing care and support. The ability of people to make decisions was assessed in line with legal requirements to ensure their rights were protected and their liberty was not restricted unlawfully. People are supported to have maximum choice and control of their lives and staff supported them in the least restrictive way; policies and systems in the service support this practice.

People were cared for with kindness, compassion and sensitivity. Care plans provided comprehensive information about how people wished to receive care and support. This helped ensure people received personalised care in a way that met their individual needs.

People were supported and encouraged to make choices and had access to a range of activities.

The registered manager maintained a high level of communication with people through a range of newsletters and meetings. ‘Residents meetings’ and surveys allowed people and their families to provide feedback which was used to improve the service. People felt listened to and a complaints procedure was in place.

There were appropriate management arrangements in place. Regular audits of the service were carried out to assess and monitor the quality of the service.

Willow Court provides nursing, short term respite and residential care for up to 66 older people. The home accommodates people with a range of needs, including those living with dementia, epilepsy and diabetes. At the time of our inspection 63 people were living in the home.

Willow Court is a purpose built nursing home situated in the grounds of Andover War Memorial Hospital. The home comprises of single occupancy bedrooms with ensuite toilet and hand washing facilities. The home is over two storeys with the first floor accessible to those with mobility needs via a lift. Willow Court is divided into seven distinct living areas, Acacia, Juniper, Saffron, Rosemary, Jasmine, Primrose and Lavender with appropriate signage to make it easier for those with dementia to navigate independently. The building is situated around a secure garden which is accessible to people and visitors by double opening doors on the ground floor.

There was a registered manager at this location. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the HSCA and associated Regulations about how the service is run.

We make recommendations to signpost providers to potential action they can consider to help them improve the quality of the service they provide to people who use it. We follow up recommendations at our next inspection. At our last inspection on 19 and 23 January 2015 we made two recommendations where the provider could take action. These concerned the documentation and practice regarding ‘as required’ medicines and pain assessments and ensuring that activities were offered which meet the needs and wishes of the people using the service.

During this inspection we saw that appropriate documentation was in place to provide guidance to staff in peoples care plans about the use of as required medicines. We saw that people were encouraged to participate in activities which better suited their needs. However we saw activities staff were also completing other functions within the home. We have made a recommendation that the role of the activities coordinator is reviewed to ensure they remain dedicated and able to complete the role they are employed to fulfil.

The provider did not always ensure that effective quality assurance and auditing systems were in place in order to drive improvements in the quality of the service people received. Action was not always taken to rectify where shortfalls in service provision were found.

There were sufficient numbers of staff deployed to meet people’s individual needs. Processes were in place to regularly review the required level of staff to ensure this remained appropriate.

The home provided both long term and short term care for people including those living with dementia and the environment was designed and decorated in a way to support people to move around the home safely enabling them to remain independent. Corridors were wide and well lit with contrasting different coloured handrails to aide people who were able to walk. Appropriate signage helped people to orientate themselves around the home.

Relatives of people using the service told us they felt their family members were cared for safely. Staff understood and followed the provider’s guidance to enable them to recognise and address any safeguarding concerns about people.

People’s safety was promoted because risks that may cause them harm had been identified and guidance provided to manage these appropriately. People were assisted by staff who encouraged them to remain independent. Appropriate risk assessments were in place and regularly reviewed to keep people safe.

Thorough recruitment procedures were completed to ensure people were protected from the employment of unsuitable staff. Induction training for new staff included a period of time working with experienced colleagues. This ensured staff had the skills and confidence to support people safely. Staff were happy to raise any concerns with their colleagues and senior staff and received regular supervisions. Staff told us they felt supported as a result.

Contingency plans were in place to ensure the safe delivery of care in the event of adverse situations such as a loss of accommodation as a result of fire or flooding. Fire drills were documented and practiced to ensure people were kept safe.

People were protected from the unsafe administration of medicines. Nurses responsible for administering medicines had received detailed training and were subject to competency assessments to ensure people’s medicines were administered, stored and disposed of correctly.

People received sufficient food and drink to maintain their health and wellbeing. Snacks and drinks were encouraged between meals to support good nutrition and ensure people remained hydrated. People assessed as requiring a specialised diet, for example a pureed and diabetic diet, received these.

People were supported by staff to make their own decisions. Staff demonstrated that they complied with the requirements of the Mental Capacity Act 2005 when supporting people. This involved making decisions on behalf of people who lacked the capacity to make a specific decision for themselves. Documentation showed people’s decisions to receive care had been appropriately assessed, respected and documented.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Appropriate applications had been submitted to the supervisory body to ensure that people were not being unlawfully restricted.

The staff and manager promptly engaged with other healthcare agencies and professionals to ensure people’s safety and wellbeing.

Staff demonstrated they knew and understood the needs of the people they were supporting and people told us they were happy with the care provided. The manager and staff were able to identify and discuss the importance of maintaining people’s respect and privacy at all times.

People had care plans which were personalised to their needs and wishes. They contained detailed information to assist staff to provide care in a manner that respected each person’s individual requirements. Relatives told us they were encouraged to be involved at the care planning stage, during regular reviews and when their family members’ health needs changed.

People told us they knew how to complain and would be confident that the registered manager would take the appropriate action to deal with their concerns. Procedures were in place for the registered manager to monitor, investigate and respond to complaints in an effective way. People and relatives were encouraged to provide feedback on the quality of the service during regular care plan meetings and resident and relative meetings.

The provider’s values were displayed within the home. We could see these standards were evidenced in the way care was delivered.

The registered manager and staff promoted a culture which focused on providing care in the way that staff would wish to provide to their family members. The registered manager provided strong leadership and had fulfilled the requirements of their role as a registered manager. The registered manager had informed the CQC of notifiable incidents which occurred at the service allowing the CQC to monitor that appropriate action was taken to keep people safe.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) 2014. You can see what action we asked the provider to take at the back of the full version of this report.

People were being supported to be able to eat and drink sufficient amounts to meet their needs. During the lunch time meal, we observed that staff provided people with assistance to eat and drink, where required, in a patient, calm and friendly manner. A person who had just finished their meal told us: 'The food is good'. The provider had also taken steps to ensure there were enough qualified, skilled and experienced staff to meet people's needs. Additional staff were on duty and further recruitment was taking place. Throughout the inspection we observed staff meeting people's needs in a timely and responsive manner. All of the above improvements will need to be embedded in practice and sustained.

Staff worked in ways that respected people's privacy and dignity and took their views and experiences into account. A person who used the service said that the meals were very good and they could choose what they would like to eat. However, we found that people were not always protected from the risks of inadequate nutrition and dehydration. Staff received appropriate professional development, supervision and training and staff we spoke with demonstrated their knowledge of people's needs. Records showed that external health professionals were appropriately consulted about changes in people's health and well-being.

One person told us 'the care is wonderful'. Another person said that they felt 'well looked after'. They said that staff came quickly if they pressed the call bell. They told us that that they got on well with staff and looked forward to seeing them. However, other evidence showed that there was not an effective system in place to ensure that people's needs were assessed and care and treatment was planned and delivered in line with their individual needs. There were not always enough qualified, skilled and experienced staff to meet people's needs. We found that people were not protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were not being maintained.

People told us staff provided the care and support that they needed. Comments from people included 'Staff provide all the care I need' and 'Staff come quickly when I use the call bell and provide good care'. People said they had been involved in developing and reviewing their care plan and that staff provided the care detailed in their plan.

People told us the home was always kept clean. Comments included, 'The place is always very clean, smells very fresh' and that the home is 'Cleaned everyday'.

People we spoke with said they were able to raise concerns with the staff or manager and were confident that action would be taken to address the issue. One person said they could raise issues at residents' meetings and staff would 'Do something about it'. Another person said they had not had to make any complaints, but were confident that any concerns would be taken seriously and resolved.