Willowbank Rest Home

Willowbank Rest Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. Willowbank Rest Home accommodates up to 19 people in one building. It provides accommodation for persons who require personal care. At the time of our inspection 17 people were living in the home.

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

Recruitment procedures were in place and were thorough. There were sufficient staff to care for people. Safeguarding training was mandatory, staff were aware of the processes to follow should they see any abuse. Risks were assessed and checked to ensure individuals safety and promoted their independence. People received their medicines safely.

The management team at Willowbank Rest Home had auditing systems to maintain ongoing oversight and make improvements when required. Quality assurance processes ensured people were able to give their views of the service. There was a positive culture within the home. One person commented, “The staff work as a team, and this makes for a happy place. I know I can always tell the staff if I am unhappy or worried about anything.” One staff member told us, “I enjoy making people happy and safe, and meeting their care needs. Staffing and management are brilliant.”

People were supported to have maximum choice and control of their lives and staff supported /did not support 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 16 October 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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 Willowbank Rest 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.

Following the last inspection, we asked the provider to complete an action plan to show us what they would do and by when to improve the key questions of safe, effective, caring and well led to at least good. During this inspection, we found the service was meeting the requirements of the current legislation.

Willowbank Rest Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Willowbank Rest Home accommodates up to 19 people in one building. It provides accommodation for persons who require personal care. All bedrooms were of single occupancy with separate bathing facilities, lounges, dining room and outside gardens areas and car parking. At the time of our inspection 17 people were living in the home.

The service had a registered manager in post at the time of our inspection. 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 was run.

All people we spoke with told us they felt safe in the home. Staff were able to discuss what actions they would take to deal with allegations of abuse. Records we looked at confirmed staff had received safeguarding training. Risk assessments had been completed for the environment and people’s individual needs.

Systems that ensured only suitable people were employed to work in the home was in place. Duty rotas were completed and staff we spoke with said there was generally enough staff to deliver people’s care. Staff received up to date and relevant training that supported them to deliver their role effectively.

Medicines were administered and stored safely, however we noted a controlled drug record did not match the quantity of medicine in the controlled drugs cupboard, the registered manager investigated this and confirmed this was a recording issue and stock levels were correct.

Improvements were noted in relation to the way the service recorded people’s formal consent. Best interest’s meetings had been held and capacity assessments had been completed where it was required. People were supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible; the policies and systems in the service did not support this practice.

The food people were served looked appetising and nutritious. People told us they were happy with the meals in the home.

We saw positive, caring and meaningful interactions taking place between people who used the service and staff. People told us they were very happy with the care they received. Advocacy information was available for people to access if they needed support with important decisions.

Care records were detailed and contained good person-centred information about how to support people’s individual needs. An activities programme had been developed and we saw activities provided to people during our inspection.

Team meetings were undertaken regularly and surveys and feedback had been obtained recently that provided information about people’s views. A system to deal with complaints was in place. We saw positive feedback about the care people received in the home. We received positive feedback about the registered manager and nominated individual. People told us the directors of the company were regular visitors to the home.

A system to audit and monitor the service was seen that demonstrated the management team ensured the home was safe for people to live in.

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 adjacent to the premises.

At our last inspection on 17 March 2016 we found six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to person centred care, dignity and respect, the premises, infection control, medicines management, safeguarding service users from abuse and improper treatment, meeting nutritional and hydration needs and good governance The provider submitted a detailed action plan to show that all areas requiring improvement would be completed by 28 August 2016.

During this inspection we consulted the provider’s action plan and found that substantial improvements had been made since our previous inspection. We found that regulations 9, 10, 12, 13, 14 and 17 were no longer in breach, in relation to continuous shortfalls. However, we did identify other areas that were in need of attention. We found that the provider had not always safeguarded service users from abuse and improper treatment, because they had failed to report a serious incident of alleged abuse on behalf of a service user. This was in breach of regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider had not always obtained formal consent in relation to the provision of care and treatment. This was in breach of regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. A more detailed description of the breaches is contained within each relevant section of this report.

Although the nutritional plan of care for one person was very detailed in relation to choking risks, a separate risk assessment had not been developed on this occasion. We made a recommendation about this.

We observed that the dietary intake charts did not record any snacks taken during the day or night and some fluid balance charts had not been totalled. Therefore, it was not easy to determine if people were receiving sufficient fluid intake. We made a recommendation about this.

Personal Emergency Evacuation Plans [PEEPs} were in place for those who lived at Willowbank. However, not all relevant information was always recorded to support a safe evacuation, should this be required. We made a recommendation about this.

Records showed that people's views about the quality of service provided were sought in the form of surveys and meetings and complaints were managed well. The provider had forwarded the required notifications to CQC, as and when required. However, the management of safeguarding incidents had not been well managed, as an allegation of abuse had not been appropriately reported. We made a recommendation about this.

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.

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.

The staff team were well supported by the management of the home, through the provision of information, induction programmes, supervision, appraisals and training modules. The staff members 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 was positive. Staff members provided good, sensitive and caring approaches. People were treated with kindness and compassion. Their privacy and dignity was consistently promoted.

A wide range of community professionals were involved in the care and treatment of those who lived at the home. This helped to ensure that people’s health and social care needs were being appropriately met.

We found that detailed social care profiles contained some good information and these reflected peoples' preferences and what they liked to do. Information in relation to allergies would have been better placed at the front of the care records, in order to make it more prominent and easily accessible, should it be needed in an emergency situation.

Activities were being provided during our inspection and good humoured interaction took place between staff and those who lived at Willowbank.

At this inspection we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to need for consent and Safeguarding service users from abuse and improper treatment.

You can see what action we told the provider to take at the back of the full version of this report.

People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

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.