This comprehensive inspection was unannounced, which meant the provider did not know we were coming. It was conducted on 17 March 2016.
Willowbank Rest Home is registered to provide care and accommodation for up to 19 adults. The home is situated on the outskirts of Leyland in a quiet residential area and is within easy reach of Preston and Chorley. All accommodation is provided on a single room basis and there are a variety of communal areas for residents’ use. Bathrooms are located throughout the home. A range of amenities are available in the area and public transport links are nearby. There are ample car parking spaces available adjacent to the premises.
This was the first inspection of this service since the change of ownership in November 2015. We identified some areas where improvements needed to be made These are detailed within each relevant section of the report.
People who lived at Willowbank told us they felt safe being there and we found that the recruitment practices were robust, which helped to protect people from harm. There were sufficient staff on duty on the day of our inspection and it was observed that staff were always present in the communal areas of the home.
The management of medicines could have been better and there were areas of the environment and external grounds, where improvements to safety were needed. The window restrictors were not robust and therefore the windows could have easily been forced open. The hot water temperatures were excessively high in some areas, which created a potential risk of scalding. The hoists had been serviced in accordance with recommended guidelines.
Some areas of the home could have been cleaner and more hygienic. Infection control practices could have been better. For example, the external clinical waste bin was unlocked, which potentially created a risk of cross infection.
We noted that people were supported to mobilise, when help was needed and freedom of movement was evident within the home. We observed that call bells were answered in a timely manner.
Care plans did not always reflect people’s assessed needs and some care records provided conflicting information. This did not give the staff team clear guidance about how individual needs were to be best met.
The provision of meals could have been better, although we saw people being supported with their meals in a sensitive manner.
Deprivation of Liberty Safeguard (DoLS) authorisations had not always been extended, in line with the requirements of the Mental Capacity Act.
Records showed that people’s mental capacity had been considered when developing the plans of care, but such assessments were generic and not decision specific. We made a recommendation about this.
We saw people being asked verbally for their consent before care and support was delivered and some consent forms were present in the care files we saw, but these were not always signed and the area of consent could have been extended to incorporate more areas of care and support. We made a recommendation about this.
The staff team were well supported by the management of the home, through the provision of information, induction programmes, supervision and appraisal. The majority of staff we spoke with had a good understanding of people in their care and were able to discuss their needs well.
Interaction by staff with those who lived at the home varied in quality. Some members of staff provided good, sensitive and caring approaches, whilst others failed to promote people’s dignity and respect.
The call bell system was noted to produce a loud, high pitched tone, which could have been quite disturbing for those who lived at the home. We made a recommendation about this.
Records we saw failed to demonstrate that those who lived at Willowbank had the opportunity to be assisted with regular bathing. We made a recommendation about this.
Social care profiles were in place in each person's care file, which reflected peoples' preferences and what they liked to do. However, we found that needs assessments had not always been conducted before people moved in to the home and plans of care were not consistently person centred.
Activities were being provided during our inspection and good humoured interaction took place between staff and those who lived at Willowbank.
Complaints were being well managed.
Records showed that people's views about the quality of service provided were sought in the form of surveys and meetings.
The provider had forwarded the required notifications to CQC, as and when required. Comments we received from community professionals were all positive.
The system for assessing and monitoring the quality and safety of the service provided was not always effective. This did not allow for shortfalls to be identified and improvements to be made.
We found several breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 for person centred care, dignity and respect, safe care and treatment, safeguarding service users from abuse and improper treatment, meeting nutritional and hydration needs and good governance.
You can see what action we told the provider to take at the back of the full version of this report.