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London Care (Willow House) Requires improvement

Inspection Summary


Overall summary & rating

Requires improvement

Updated 16 March 2019

This inspection of Willow House took place on 28 November 2018. It was an announced comprehensive inspection. At the last inspection in November 2017 the service was not meeting two regulations under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

This scheme provides care and support to older people and people with mental health needs living in specialist ‘extra care’ housing. Extra care housing is purpose-built or adapted single household accommodation in a shared site or building. Willow House is a purpose-built block of flats on three levels, containing 40 flats. People remain independent and live in their own flat within their community. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for extra care housing; this inspection looked at people’s personal care. There were 38 people living at the scheme at the time of this inspection.

The service had 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 2008 and associated Regulations about how the service is run.

The scheme had auditing systems to ensure they met legal requirements. However, these had not identified the shortfalls we identified during our inspection. The scheme was not consistently undertaking mental capacity assessments or escalating concerns relating to capacity to relevant authorities.

Joint working arrangements and shared services promoted co-ordinated person-centred care. However, we judged the scheme still needed to develop further links with the local authority in managing admissions. We judged that more joint working could improve access particularly in situations where people could choose their own care provider from an external agency rather than the on-site care team if they so wished.

At this inspection we found that improvements had been made. Risks were being planned for, managed and mitigated appropriately. Risks associated with people's care and support needs had been identified in care records along with guidance about how to support people to keep them safe.

The scheme had taken steps to respond to concerns we raised in the previous inspection about the management of risk for people with dementia. The scheme was now offering more tailored assistive technology to support individuals to complement support from care workers.

The scheme had clear systems to keep people safe and safeguarded from abuse. All care workers received up-to-date safeguarding and safety training appropriate to their role. Staff checks were also carried out on recruitment and on an ongoing basis. Disclosure and Barring Service (DBS) checks were undertaken where required.

There were sufficient care workers on duty to meet people's needs and keep them safe. Care workers worked in an unhurried way and met people's individual needs. Rotas suggested there were sufficient staff deployed to support people. Extra care workers were made available if needed.

There were appropriate systems for safe handling of medicines, health and safety and infection control. These systems were subject to regular auditing. The management had established policies, procedures and activities to ensure safety and assured themselves that they were operating as intended.

Although there were elements of good practice in the application of the Mental Capacity Act 2005, this was not across the board. Improvements had been made relating to the use of liberty restricting measures such as location devices, door sensors and the use of verbal distraction techniques. However, decisions about capacity were not consistently taken and reviewed in a structured way. We judged that further improvements were required in this area.

Care workers received supervision

Inspection areas

Safe

Good

Updated 16 March 2019

People told us they felt safe. Risks associated with people's care and support needs had been identified in care records along with guidance about how to support people to keep them safe.

There were clear systems to keep people safe and safeguarded from abuse. The scheme carried out staff checks on recruitment and on an ongoing basis. Disclosure and Barring Service (DBS) checks were undertaken where required.

The scheme had systems for appropriate and safe handling of medicines.

Care workers had completed infection control training and had access to personal protective equipment.

Effective

Requires improvement

Updated 16 March 2019

We found elements of good practice in the application of Mental Capacity Act 2005. However, further improvements were needed.

Care workers received supervision annual appraisal on a regular basis. There was evidence of on-going essential training.

People were supported to have sufficient amounts to eat and drink.

People were supported to maintain their health and wellbeing by accessing external health and social care professionals.

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Caring

Good

Updated 16 March 2019

Care workers treated people with compassion, dignity and respect. Care workers were focused on the needs of people with dementia, and took time to make them as comfortable as possible.

Care workers had a good understanding of the need to protect people's human rights. They had received equality and diversity training. The scheme treated people�s values, beliefs and cultures with respect.

Care workers were knowledgeable about people's preferences. People�s care records contained recorded key information about their care. This included people�s likes and dislikes, gender, interests, culture and language.

Responsive

Good

Updated 16 March 2019

The scheme remained responsive to people�s needs. People told us they received care when they wanted it.

People's care plans were regularly reviewed and any changes in their needs were communicated to care workers. Their families, health and social care professionals were involved.

People knew how to raise a concern or complaint if they were unhappy. There was a complaints policy in place which was available to people.

Well-led

Requires improvement

Updated 16 March 2019

The scheme had auditing systems to ensure they met legal requirements. However, these had not identified the shortfalls we identified during our inspection.

There were systems and processes for learning and continuous improvement. The scheme made use of internal and external reviews of incidents and complaints to make improvements.