Willowmead Care Home

About the service

Willowmead Care Home is a residential care home providing the regulated activity of personal care to up to 60 people. The service provides support to older people and people living with dementia. At the time of our inspection there were 49 people using the service within 2 houses [Hatfield House and Wickham House].

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

Right Support:

Staff did not do everything they could to avoid restraining people. There was a lack of evidence to demonstrate how the provider learned from those incidents and how they might be avoided or reduced in the future.

People had a choice about their living environment and were able to personalise their rooms.

Staff supported people to take part in activities.

Staff communicated with people in ways that met their needs.

Staff supported people with their medicines in a way that achieved the best possible health outcome. We have made a recommendation about medicines being stored securely and PRN protocols being developed and implemented.

Right Care:

People received care that was kind. Staff understood and responded to people’s individual needs.

The service had enough staff to meet people’s needs and keep them safe, but improvements were required to ensure the skill mix of staff was appropriate and the use of agency staff reduced. We have made a recommendation about this, staff training and induction.

Risks people might face were mostly assessed and recorded.

Right Culture:

Staff knew and understood people well and were responsive to their needs.

Staff respected people’s choices and wherever possible, accommodated their wishes.

Staff felt respected and supported by the manager and deputy manager.

The service apologised to people, and those important to them, when things went wrong.

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 Requires Improvement [Published October 2022]. The service remains rated Requires Improvement following this inspection. This service has now been rated Requires Improvement for the last 2 consecutive inspections.

Why we inspected

The inspection was prompted in part due to concerns received about safeguarding and risk. A decision was made for us to inspect and examine those risks. We found that improvements were required for safeguarding, risk and to the provider’s quality assurance arrangements.

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 COVID-19 and other infection outbreaks effectively.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement and Recommendations

We have identified breaches in relation risk management, safeguarding and quality assurance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Willowmead Care Home is a care home in a rural location near Hatfield Peverel which provides accommodation with personal care for up to 60 older people, some of whom may be living with dementia. At the time of inspection there were 58 people living at the service. Willowmead Care Home is made up of two units called Hatfield and Wickham which are based in separate houses attached by shared communal gardens. The main offices are based in the larger Hatfield Unit.

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

Most people at Willowmead Care Home had some form of dementia and were unable to speak with us. We carried out observations to look at the care they received.

We found some broken fixtures and fittings that posed a risk to people's safety, however, these were rectified either on our day of inspection or shortly afterwards.

Infection prevention and control measures were in place. However, some staff were not wearing their face mask effectively. We also had some concerns around the storage of people's hoist slings and some bathrooms being maintained.

The registered manager completed a range of checks on the quality of the service, however some of these were still not as effective as they could be.

People received their medicines safely, by appropriately trained staff.

People were cared for by staff who showed empathy and kindness.

People and staff spoke highly of the registered manager, and about how approachable they were. The registered manager had worked hard to make some improvements to the service, these included activities for people. These improvements need to be sustained. The registered manager led by example and was aware of the needs of the people living in the service.

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 01 June 2022). At this inspection we found some further improvements needed to be made therefore the overall rating has changed to requires improvement.

Why we inspected

We received some concerns that the provider was not maintaining the building in order to keep people safe. We also had some concerns around infection control, medicines and with regards to staff being kind and caring. We therefore carried out an unannounced focused inspection of this service.

This report only covers our findings in relation to the Key Questions Safe, caring and Well-led.

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 changed from good to requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Willowmead Care 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.

Willowmead Care Home is a care home in a rural location near Hatfield Peveril which provides

accommodation with personal care for up to 60 older people, some of whom may be living with dementia. At the time of inspection there were 58 people living at the service. Willowmead Care Home is made up of two units called Hatfield and Wickham which are based in separate houses attached by shared communal gardens. The main offices are based in the larger Hatfield Unit.

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

Most people at Willowmead Care Home had some form of dementia and were unable to speak with us. We carried out observations to look at the care they received.

We found broken fixtures and fittings that posed a risk to peoples safety, however, when we returned on the second day of inspection, these had been rectified.

Infection prevention and control measures were in place and staff were trained in using appropriate Personal Protective Equipment. (PPE) Staff were recruited safely and in line with the legal requirements. People received their medicines safely, by appropriately trained staff.

People and staff spoke highly of the registered manager, and about how approachable they were. Improvements to the service had been made including activities for people. . The registered manager completed a range of checks on the quality of the service, however some of these were not as effective as they could be.

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 requires improvement. (Published 06 April 2021) with breaches of regulation 12 (Safe Care and Treatment) and regulation 17 (Good Governance). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out an unannounced inspection of this service on 16 February 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

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 changed from requires improvement to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Willowmead Care 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.

Willowmead Care Home is a care home in a rural location near Hatfield Peveril which provides accommodation with personal care for up to 60 older people, some of whom may be living with dementia. There were 45 people living at the service. Willowmead Care Home is made up of two units called Hatfield and Wickham which are based in separate houses attached by shared communal gardens. The main offices are based in the larger Hatfield Unit.

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

Most people at Willowmead Care Home had some form of dementia and were unable to speak with us. We carried out observations to look at the care they received.

The infection control and prevention measures in place within the service were ineffective. There was an increased risk people could have been exposed to COVID-19. The registered provider had not done all they could have to reduce the risk of transmission or exposure.

The leadership, management and governance arrangements did not always provide assurance the service was well-led. Quality assurance and governance arrangements were not reliable or effective in identifying shortfalls in the service and meeting regulatory requirements.

The registered provider must notify CQC of certain events or occurrences. The registered provider had failed to notify the CQC of seventeen key events or occurrences.

Information relating to risks to people was recorded. Suitable arrangements were in place to ensure the safe management of medicines.

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 30 April 2019).

Why we inspected

We inspected the service because there had been a recent COVID-19 outbreak and some concerns about the environment people were living in had been raised. We carried out an inspection to examine these risks.

We found infection and prevention control measures were not effective, so we widened the scope of the inspection to a focused inspection which included the key questions of safe and well-led.

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.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We, therefore, did not inspect them.

Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to requires improvement. This is based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Willowmead Care Home on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care and treatment relating to infection prevention and control, failing to notify the CQC of events, and good governance.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Willowmead Care Home is a care home in a rural location near Hatfield Peveril which provides accommodation with personal care for up to 60 older people, some of whom may be living with dementia. There were 50 people living at the service on the day of our inspection. The service is made up of two units called Hatfield and Wickham which are based in separate houses attached by shared communal gardens. The main offices are based in the larger Hatfield Unit.

People’s experience of using this service:

Historically, Willowmead Care Home had been unable to maintain improvements over time and the quality of care and accommodation people received had not been consistently good. At this inspection, we found the management team was committed to ensuring people received good quality care and improvements were sustained.

Every aspect of the service had improved since our last inspection. Feedback from people and their families about the changes was overwhelmingly positive.

The service was managed in a more structured and efficient way. The management team knew what was happening at the service and used learning from audits, mistakes and complaints to make things better. The provider had shown their commitment by investing in the property and in the resources required to implement the changes.

The management of risk had improved, with clearer advice provided to staff in care plans and guidance. Staff considered people’s needs in a more holistic manner and worked well with outside professionals to maintain their health and wellbeing.

Staff were recruited safely. Better organisation meant agency staffing had decreased so people were increasingly supported by a consistent staff group who knew them well. Feedback from staff was mixed. They told us it had been a challenging year, with an increase in paperwork and the fast pace of change. However, staff also consistently said the service had improved for the people they supported.

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 promoted this practice.

Retention of dedicated activity staff had been an ongoing issue which the provider was addressing. Despite this concern, staff worked well as a team to ensure people received personalised care which met their needs.

Support was provided in a dignified manner. The management team promoted a culture which was focused on people’s needs.

Rating at last inspection:

Requires improvement. The last report was published on 20 April 2018.

Why we inspected:

This was a planned inspection based on the previous rating.

Follow up: We will continue to monitor Willowmead to ensure people receive care which meets their needs. We plan our inspections based on existing ratings and on any new information which we receive about each service.

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

This unannounced inspection took place on 15 and 18 January 2018.

The service did not have a registered manager in post. 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. We met the new manager during our visit and they told us were applying to become the registered manager of the service.

There had been a great deal of disruption at the service over the last year, with the departure of the registered manager and other key staff. The provider had not managed change well over this period. There had been a number of area managers responsible for the service over this time which resulted in an unsettled time for people, families and staff.

The provider had started to address the concerns and had increased investment in all areas of the service, including the fabric of the building and additional staffing. There was a new management team in place and increased support from the wider organisation to help drive the improvements. However, there had not been enough time for us to measure whether these changes were sustainable.

The provider had not ensured there were clear plans in place to manage risk to people’s safety. Where staff knew people well, they provided them with safe support. However, lack of clear guidance to staff meant people could not be confident they would receive consistent support when they were at risk.

The provider had invested in improving the maintenance and cleanliness of the property, and had dealt robustly with concerns regarding infection control. Staff supported people to take their medicines safely. The provider and manager reviewed mistakes in the administration of medicine and used this information positively to make improvements.

Care plans were not always person-centred. People’s support was not reviewed in a consistent manner. An additional member of staff had been recruited to improve the activities and stimulation provided to people at the service. There were more resources available to provide activities for people with dementia, however not all staff were offering these to people. The provider had implemented effective systems in place to investigate complaints, however they had not been well managed for a period in 2017. Care staff continued to communicate well with families.

Staff supported people when they were at risk of abuse and worked well with outside professionals to investigate concerns about people’s safety. There were enough safely recruited staff to meet people’s needs.

Staff were effective in meeting people’s needs. The manager and provider had made changes to provide more support to staff and to improve the training on offer. We made recommendations about improving training for people with dementia.

Staff worked well with outside professionals to meet people’s health care needs. People had enough to drink and eat in line with their preferences. Communication between the kitchen staff and the manager was improving. We made recommendations around increasing involvement and consultation with people when redecoration and improvements were planned to the property.

The manager met their responsibility under the Mental Capacity Act 2005 (MCA). Where people did not have capacity to make decisions, the manager consulted families and professionals to ensure decisions were made in the person’s best interest.

Staff knew people well and treated them with kindness and affection. There were personalised systems in place to communicate with family members and involve them in the care of their relatives. Care plans included guidance on how people preferred to communicate. People were treated with respect and dignity.