Archived: The Willows Specialist Dementia Unit and Intermediate Care Service

The Willows Specialist Dementia Unit and Intermediate Care Service is purpose built and split into two adjoining units. The dementia unit provides a service for up to 16 people. The intermediate care unit comprises of 10 small flats, which can provide up to six week's rehabilitation following an injury or illness. At the time of our inspection, six people were living in the dementia unit and 10 people were living in the flats. 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 service had a registered manager as required. However, they were on extended leave at the time of the inspection. 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. The deputy manager was overseeing the service in the absence of the registered manager. They assisted us with the inspection on both days.

During this inspection we found breaches of two regulations, Regulation 14 and Regulation 18 of Care Quality Commission (Registration) Regulations 2009. The registered person had not submitted notifications as required in good time informing CQC about the outcome of six applications of Deprivation of Liberty Safeguards. The registered person also had not submitted a notification informing CQC about the absence of the registered manager for longer than 28 days. We informed the management about this on our first day of inspection. However, there was a delay in submitting all notifications required including a notification of the return of the registered manager. You can see what action we have asked the provider to take at the end of the full version of this report. When there is a breach or more, the overall rating cannot be Good.

People told us they felt safe living at the service. Staff understood their responsibilities to raise concerns and report incidents or allegations of abuse. They felt confident issues would be addressed appropriately.

Staff training records indicated which training was considered mandatory. Most of the staff were up to date with their mandatory training but some were due their refresher training. The deputy manager was overseeing and booking training when necessary to ensure all staff had the appropriate knowledge to support people. We have made a recommendation for the management to refer to the current best practice guidance on ongoing training and monitoring for social care staff.

Staff had ongoing support via regular supervisions with their senior staff. They felt supported by the registered manager and senior staff and maintained great team work. Staff had handovers and meetings to discuss any matters with the team. There were appropriate recruitment processes in place. All necessary safety checks were completed to ensure prospective staff members were suitable before they were appointed to post.

The CQC is required by law to monitor the operation of the Mental Capacity Act 2005 Deprivation of Liberty Safeguards and to report on what we find. The deputy manager had acted on the requirements of the safeguards to ensure people’s rights and freedom were protected. They made appropriate applications to ensure people's liberty was not restricted in an unlawful way.

People told us staff were available when they needed them and staff knew how they liked things done. The deputy manager reviewed staffing numbers to ensure enough qualified and knowledgeable staff were available to meet people's needs at all times. Staff were knowledgeable and focused on following the best practice to make sure people were supported appropriately. We observed people were treated with care and kindness. People and their families were involved in the planning of their care.

The management carried out risk assessments and had drawn up care plans to ensure people's safety and wellbeing. Staff recognised and responded to changes in risks to people who use the service. These changes were reported to the senior person to ensure a timely response and appropriate action was taken.

There were contingency plans in place to respond to emergencies. The premises and equipment were cleaned and well maintained. The dedicated staff team followed procedures and practice to control the spread of infection and keep the service clean. The staff ensured maintenance checks were up to date. The premises and adaptations were dementia friendly.

People had sufficient to eat and drink to meet their nutrition and hydration needs. Hot and cold drinks and snacks were available between meals. People were supported to have their meals where necessary. People had their healthcare needs identified and were able to access healthcare professionals such as their GP. Staff knew how to access specialist professional help when needed. The service worked well with other health and social care professionals to provide effective care for people.

People received their prescribed medicine safely and on time. Storage and handling of medicine was managed appropriately. We found one minor error, which was rectified, and records were accurate.

We saw care was provided with kindness and compassion at all times. People told us they were happy with their care and support. The management was working with the staff team to ensure caring and kind support was provided in a consistent way. People confirmed staff respected their privacy and dignity. People were able to engage in activities, spend time with their visitors or if they chose be by themselves. Their choices were always respected. We observed people were offered some activities and were encouraged to join in.

Staff felt the management was approachable and supportive, and they communicated well to ensure smooth running of the service. People felt the service was managed well and that they could approach management and staff with any concerns.

The management team had reviewed, assessed and monitored the quality of care with the help of staff and other members of the organisation. They encouraged feedback from people and families, which they used to make improvements to the service. The service ensured people were protected against the risks of receiving unsafe and inappropriate care and treatment.

Further information is in the detailed findings below.

As part of this inspection we spoke with 12 of the 23 people who use the service, the registered manager and the two deputy managers. We spoke with five care staff, two kitchen staff and one member of the domestic staff team. We reviewed records relating to the management of the home which included: five care plans; daily care records and health and safety monitoring records. We also looked at satisfaction surveys for people living at the home and the report of an independent and in-depth review of the home from January 2014.

Below is a summary of what we found. The summary describes what people using the service and the staff told us, what we observed and the records we looked at.

Is the service safe?

People who use the service were protected from the risk of abuse because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. People living at the home told us they felt safe living there and said they would tell the manager, or another staff member, if they had any concerns.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. The manager was aware of a recent Supreme Court judgement changing the way a 'deprivation of liberty' is determined. The manager had reviewed all people at the home that the ruling may apply to and relevant assessments and applications had been made as required under DoLS legislation.

Is the service effective?

CQC monitors the operation of the Mental Capacity Act 2005 which applies to all services providing care and support for people. Staff we spoke with demonstrated a good understanding of people's rights to make their own decisions. However, arrangements were not in place for ensuring only those lawfully able to give consent were asked to do so where the person receiving the care lacked capacity to consent. Where people did lack capacity to consent to their care, and there was no-one able to lawfully consent on their behalf, there were no arrangements in place for establishing and recording the decision that the care was in their best interests.

People we spoke with told us they felt their needs were being met and their care was delivered in the way they preferred. One person commented: "I have everything I need. I couldn't want for more." Another person told us: "I am here as they are helping me to get back home. I am so lucky this place exists."

Is the service caring?

People experienced care and support that was planned and delivered in a way that was intended to ensure people's safety and welfare. People's needs for meaningful activities were being met.

Observations we made of interactions between staff and people living at the home showed staff had a good knowledge of people's needs and the way they liked things done. Staff were calm and caring and worked with people in a skilled and professional way.

Is the service responsive?

The provider took account of complaints and comments to improve the service. People we spoke with were aware of how to make complaints. Observations we made on the day of our visit showed staff were quick to recognise and respond to any indications of concern expressed by the people living at the home.

Is the service well-led

The provider had an effective system to regularly assess and monitor the quality of service that people receive.

People who use the service, their representatives and staff were asked for their views about their care and treatment and they were acted on. People we spoke with confirmed they were asked their opinion on the service provided. One person told us: "They ask me every morning if I am ok and if everything is alright." At lunch we saw staff checking people were enjoying their food. One person told us: "They ask us about the meals we like and don't like. It is all very nice."

During our inspection we spoke with two of the 14 people living in the dementia home and three visiting relatives. We also had the opportunity to talk with one person staying in the short term intermediate care unit. People living in the dementia home told us they were happy with the home. The person staying in the short term intermediate care unit told us, 'I do as much for myself as I can, as the point is to get me ready to go back home.'

People were protected from the risks of inadequate nutrition and dehydration and their personal records were accurate and up to date so care workers knew what care people needed.

Care workers were supported by management and were given opportunities for training to continue their personal development. We saw evidence that staff had regular one to one supervision and yearly appraisals.

The provider had an effective system to regularly assess and monitor the quality of service that people receive. The quality of the service was monitored by management and changes were implemented when audits highlighted areas of improvement. There was adequate management of the premises and grounds.

We spoke with three relatives of people who live in the dementia unit. They told us their relatives were well looked after and enjoyed living at the home. One relative told us, 'Mum is looked after wonderfully, I think they do an excellent job.' Another told us, 'X is looked after well; I have no concerns with the home.'

We spoke with two people in the intermediate unit who told us they were very happy with the care they were receiving. One person told us, 'I have only been here a few weeks but I cannot fault it, they do a great job and really do get us ready to go back home.'

We observed care workers speaking to people politely and in a calm and friendly manner. Care was delivered with individual needs in mind and reflected people's preferences. Care plans were regularly updated. The manager sought the views of people and their families to improve the service.

We looked at four recruitment files which contained the relevant information. Procedures were in place to support people and their families to make complaints.