Willesden Court

Willesden Court is a nursing home registered for a maximum of 60 people. It is managed by Methodist Homes, a large social care provider in England. People using the home may require nursing or personal care or have dementia. The home is located close to shops and transport links. At the time of our visit, there were 46 people living in the home.

People’s experience of using this service

People were safe in the home. Risks to people’s health and wellbeing had been carefully assessed. There was detailed guidance for staff on how to minimise risks to people.

Arrangements were in place to protect people from abuse. Staff had received training on how to safeguard people from abuse and were aware of the procedure to follow if they suspected that people were subject to abuse.

People received their prescribed medicines. The home had suitable arrangements for the safe administration of medicines.

There were sufficient numbers of staff to attend to people’s needs. Staff had been carefully recruited and essential pre-employment checks had been carried out.

The home was well maintained, clean and tidy. The service had taken measures to help prevent and control the spread of COVID -19 and other infections. There was a record of essential maintenance carried out. Fire safety arrangements were in place.

Staff understood their obligations regarding the Mental Capacity Act 2005 (MCA). People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

The service was well managed. Management and senior staff monitored the quality of the services provided via regular checks and audits. The results of the last satisfaction survey indicated that people and their representatives were highly satisfied with the care and services provided.

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 8 January 2020). At this inspection we found the provider remained good.

Why we inspected:

We received concerns in relation to safeguarding people from the risk of abuse and their safety. As a result, we undertook a focused inspection to review the key questions of safe, and well-led. We reviewed the information we held about the service. No areas of concern were identified in the other key questions. The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has remained as good.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Willesden Court on our website at www.cqc.org.uk.

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 coronavirus and other infection outbreaks effectively.

Follow-Up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We found the following examples of good practice.

• The service had been taken suitable steps to protect their staff and people who used the service. They had ensured that visitors to the home were carefully screened so that they do not present a risk to people in the home. Visitors’ temperatures were checked at the door. Personal protective equipment (PPE) including face masks and disposable gloves were available for visitors to wear before entering the home. Hand sanitizers were also provided. This was aimed at preventing and controlling the spread of infection. To further minimise the risks, a gazebo with heating was available in the garden for use by visitors and people who used the service.

• The home had a caring approach regarding ensuring that people had contact with their friends and relatives. Contact was maintained via the telephone and the internet. Effort had been taken by the home to ensure that people can be visited by their relatives. Visits had been arranged each day where people can have face to face contact with their relatives.

• Staff had a good understanding of infection prevention and control measures. They were aware of procedures to follow when caring for the people who had been tested positive for the corona virus. All staff had received the appropriate training in infection control and prevention.

• In order to prevent the spread of infection, the home could not organise their usual group activities. However, effort was made to provide stimulation where possible. The home was able to still arrange activities either for people individually or in small groups. These included pet therapy each week, baking, karaoke and playing chess. The home also had a social media page for people and this was with their consent. The purpose of these activities was to provide social and therapeutic stimulation for people who used the service.

•Throughout the pandemic, senior managers of the organisation were in constant contact and had visited the home to provide support and check on the welfare of both people who used the service and staff members.

Further information is in the detailed findings below.

Willesden Court is a nursing home providing personal and nursing care to 50 people aged 65 and over at the time of the inspection. The service can support up to 60 people. The service is currently undergoing major refurbishment; to be able to accommodate this the provider decided to keep ten rooms unoccupied until the work is completed in Spring 2020. People who used the service received care and support over three floors. The second floor specialises in dementia care.

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

People were looked after and supported by a consistent, caring and well-established service. We found some of the medicine’s audits did not highlight the discrepancy in stock levels of medicines we found during our inspection. The discrepancy with the medicines was only found on the top floor of the home. People told us that they felt safe at Willesden Court. One person said, “This is one of the cleanest places I’ve ever lived. Very safe.” Generally, people were protected from harm or risk of harm. However, some greater attention is needed in formulating risk management plans for specific health conditions people may have.

People's needs, and choices were assessed and recorded. 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. People were provided with healthy, well presented and nutritious meals and told us that they were able to choose alternatives if they wished to do so.

People were cared for by kind, considerate staff who took time to chat with people throughout the day. Staff ensured that people’s privacy and dignity was maintained, and people were encouraged to engage and contribute to their care, which helped them to stay or gain greater independence.

Care plans were person centred and provided staff with the necessary information on how to care for them, though they would benefit from greater in-depth information in how to care better for people who had specific healthcare conditions. People benefited from a wide range of individual or group-based activities, which ensured that they were engaged and stimulated mentally and physically.

People could take part in meetings and contribute to the organisation of the home. Regular audits were completed by the provider to consider areas that required improvement. People and staff told us that they were supported by a kind management team.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection (and update) The last rating for this service was Good (published 26 July 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

At our previous comprehensive inspection on 18 November 2014 we rated the service as “Good”. We found one breach of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The breach was in respect of Regulation 12 HSCA RA Regulations 2014 in relation to safe care and treatment. The registered provider had not ensured that the administration of medicines was recorded accurately to show that people received their prescribed medicines safely. At this inspection the service demonstrated that they had taken action to comply and the required checks and documented evidence was in place. The arrangements for the recording, storage, administration and disposal of medicines were satisfactory. Audit arrangements were in place and people confirmed that they had been given their medicines.

People informed us that they were satisfied with the care and services provided. They had been treated with respect and felt safe living in the home. There was a very positive atmosphere within the home. The welfare of people was at the centre of the service. Management and staff worked well together to ensure people had a meaningful and enjoyable life. There was a safeguarding adult's policy and appropriate arrangements for safeguarding people. Safeguarding allegations were taken seriously and reported promptly. The service co-operated fully with investigations by the local safeguarding team. The home had a safeguarding folder with full details of action taken following each safeguarding allegation.

People’s care needs and potential risks to them were assessed and care workers were aware of these risks. Personal emergency and evacuation plans (PEEP) were prepared for people to ensure their safety in an emergency. Care workers prepared appropriate and up to date care plans which involved people and their representatives. People’s healthcare needs were carefully monitored and attended to. The home had a varied activities programme to ensure that people could participate in social and therapeutic activities. There were several examples of good practice where people had made significant improvements in their well-being. Two people who previously required a high level of care had improved to such an extent that they were able to return home.

The premises were kept clean and tidy to a high standard. No unpleasant odours were detected anywhere in the building. Infection control measures were in place. There was a record of essential inspections and maintenance carried out. There were arrangements for fire safety which included alarm checks, drills, training and a fire equipment contract. Fire drills had been arranged.

The CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLS ensures that an individual being deprived of their liberty is monitored and the reasons why they are being restricted are regularly reviewed to make sure it is still in the person’s best interests. We noted that the home had suitable arrangements in place to comply with the MCA and DoLS.

The dietary needs and preferences of people were met. Most people informed us that they were satisfied with the meals provided. There was a varied and innovative activities programme which was arranged to meet the needs and choices of people. This included the needs of people with dementia and promoting the independence of people. there were outdoor movies in the garden and outings to places people had requested.

Careful thought had been given to ensure that the home had a pleasant and relaxed environment and this included having fresh flowers in the dining rooms. There was a moving picture of a waterfall. This was coupled with a sound device that had different settings for sounds of birds singing, water falling, crickets and frogs in the back ground.

There were enough care workers deployed to meet people's needs. They were knowledgeable regarding the needs of people. The service actively worked to develop good teamwork and effective communication among care workers. Care workers had received a comprehensive induction and training programme together with support from a "buddy" so that they could care effectively for people. There were arrangements for support, supervision and appraisals which focussed on strengths and achievements of care workers. Managers were highly motivated and met regularly with staff to ensure they were well informed and discuss the daily care of people.

The service listened to people who used the service and responded appropriately. There were opportunities for people to express their views and experiences regarding the care and management of the home. Regular residents’ meetings had been held for people and their suggestions and concerns noted. People knew who to complain to. Complaints made had been carefully recorded and promptly responded to.

The service had a culture of promoting excellence and a high quality of care for people. It had won several recent awards for outstanding care and management. These identified good staff moral and team work, stability of the management team, audit tracking and dealing with issues immediately. Comprehensive audits and regular checks of the service had been carried out by the registered manager and the service manager. Audits were carried out monthly and included checks on care documentation, medicines, and maintenance of the home. A recent satisfaction survey indicated that people were very satisfied with the care provided. There was an action plan accompanying the survey together with evidence that it had been followed.

We spent some time observing the interactions between staff and people who had complex needs which meant they were not able to tell us their experiences. Staff gave each person individual attention and encouraged them to be alert and aware of their surroundings.

Accurate records were maintained of the care provided for each person, and of how specific needs were met.

Everyone in the home was assessed regularly for the risk of malnutrition. The assessments included records of weight to assess if people were losing weight and therefore not receiving appropriate nutrition to maintain their health.

People were provided with a choice of suitable and nutritious food and drink.

Several people told us that they really enjoyed the food, and one person said, 'It's like I am in my own home.'

Medicines were handled appropriately and were safely administered. People we spoke with told us that the staff managed their medicines properly, and that they received them on time.

The staff who we spoke with told us that they received support and training that supported them to meet the needs of the people in the home.