About the service The Willows is a residential care home providing personal care to 42 older people at the time of the first day of our inspection on 10 May 2021. Some of the people were living with dementia. The service can support up to 66 people in one adapted building. The service had three floors, at the time of our inspection only the ground floor and first floor were being used.
People’s experience of using this service and what we found
There were not enough staff working in the service at the time of our inspection to ensure people’s needs were met at all times, including their emotional and social needs. During our inspection staff were being recruited to replace the staff who no longer worked in the service.
There were insufficient domestic staff in the service to undertake cleaning, this is particularly important to ensure enhanced cleaning was undertaken throughout the pandemic. Whilst we found the service was generally clean, we found the hygiene standards in the kitchenette on the first floor needed improvement.
There had been some improvements in the systems to monitor and assess the service provided, such as falls analysis. However, the governance systems in place were not robust enough to identify the shortfalls we found during this inspection. There was inconsistent management in the service; over the four inspections of this service since registration, there had been a different manager each time. This had a destabilising effect on the staffing, morale and improvements being made and sustained.
The manager was in the process of making improvements following a recent staff survey. However, we were concerned that staff’s concerns relating to staffing levels had not been addressed.
We had received concerns relating to the lack of social interaction and activity provided to people. At the time of our inspection improvements were being made, but this was not yet fully implemented to ensure people received meaningful activity to reduce social isolation and boredom.
We identified positive caring and respectful interactions from staff and examples of good practice relating to improving people’s wellbeing. However, due to the staffing numbers we were not assured people were always receiving a caring service.
Systems in place reduced the risks of people not receiving their medicines safely and when they needed them. However, there had been a recent introduction of a new medicines system, for which staff had not received formal training.
Staff had been trained in keeping people safe from abuse. However, a recent incident had not been reported to the management and as a result to the appropriate professionals responsible for investigating safeguarding. Staff were recruited safely.
Staff wore personal protective equipment (PPE) during our inspection. The service was following guidance relating to visits, and testing during the pandemic.
Prior to moving into the service people’s needs were assessed. These were used to formulate care plans and risk assessments which guided staff how to meet people’s needs and mitigate risks, this included people’s end of life decisions. We found some shortfalls in the records maintained to show when people had received personal care.
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 supported to maintain a healthy diet and where risks were identified actions were taken to reduce them. People had access to health care professionals where required.
There was a complaints procedure in place. People and their relatives were asked for their views of the service provided and these were being used to improve 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 (and update)
At our last comprehensive inspection (published 21 February 2020) the rating for this service was inadequate and there were multiple breaches of regulation. The key questions Safe and Well-led were rated inadequate and the key questions Effective, Caring and Responsive were rated requires improvement. The provider completed an action plan after the last comprehensive inspection to show what they would do and by when to improve. The service had been in Special Measures since 21 February 2020.
We undertook a focused inspection (published 10 August 2020), we reviewed the key questions Safe and Well-led only. The ratings from the previous comprehensive inspection for those key questions not looked at were used in calculating the overall rating at this inspection. The overall rating for the service had changed from inadequate to requires improvement. We checked the provider had followed their action plan, to confirm they met legal requirements and we found the service was no longer in breach of regulations. The service was no longer rated as inadequate overall or in any of the key questions. Therefore, this service was no longer in Special Measures.
The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Willows on our website at www.cqc.org.uk.
Why we inspected
This was a planned comprehensive inspection based on the previous rating. The inspection was also prompted in part due to concerns received about staffing, staff morale, lack of social activity, safeguarding and leadership. A decision was made for us to inspect and examine those risks.
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.
We have found evidence that the provider needs to make improvements. Please see the safe, caring, responsive 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.
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 a breach of regulation in relation to staffing 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 for the provider to understand what they will do to improve the standards of quality and safety. We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.