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We are carrying out a review of quality at Willow Lodge. We will publish a report when our review is complete. Find out more about our inspection reports.

Reports


Inspection carried out on 19 January 2021

During an inspection looking at part of the service

About the service

Willow Lodge is a care home providing accommodation and personal care for up to 22 people aged 65 and over. There were 17 people living at the service at the time of the inspection. Some of the people lived with dementia and required support with their physical needs.

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

People told us they felt safe and staff were kind and caring. However, our observations showed that people did not always receive safe care and treatment. Staff had not reported safeguarding concerns to safeguarding authorities including unexplained injuries. People’s care was not delivered in a safe environment which had been maintained to acceptable standards. People’s bedrooms, communal toilets and ensuites did not have call bells for summon help in the event of an emergency. People’s bedrooms did not have additional bedside lighting and lifting equipment had not been inspected and maintained as per manufacturer’s recommendation.

People were exposed to risk of the spread of infections due to poor infection prevention practices and poor hygiene standards around the service. People’s safety had been compromised due to the lack of robust positive behaviour risk management processes. Risks to people were not adequately assessed and reviewed to identify ways to reduce deterioration. People were not always supported with their medicines in a safe manner.

We have made a recommendation about the need to improve the environment to promote independence and good outcomes for people who live with dementia.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. People told us staff sought their preferences, however, staff had made some blanket decisions on people’s ability to make specific decisions without assessing their capacity to make their own decisions. The registered provider had not followed national guidance and best practice to support the effective delivery of care. People were not always supported by staff who had the right competences, induction and supervision to meet their needs. Staff supported people to have access to health professionals and specialist support.

The governance and quality checks did not promote the delivery of safe care and treatment. Environmental and governance concerns from our last inspection in 2019 had not been addressed. The provider had not established good governance in line with best practice to improve the care delivered and to ensure compliance with regulations. The provider had not established robust oversight to support staff on the running of the service and compliance with regulations and to monitor people’s experiences.

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 requires improvement (published 15 May 2019) and there were multiple breaches of regulation. We issued a warning notice for the safety of the environment and asked the provider to be compliant by November 2020. The provider also completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found little in the way of improvements to the environment and the provider remained in breach of regulations associated with people’s safety, medicines, good governance and maintenance of the premises.

Why we inspected

We received concerns in relation to the management of behaviours that can challenge others and safeguarding concerns. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only. This inspection was also carried out to follow up on action we told the provider to take at the last inspection.

We reviewed the information we held about the service. No are

Inspection carried out on 1 April 2019

During a routine inspection

About the service

Willow Lodge Nursing Home is in a residential area of Ormskirk, close to the town centre and all local amenities. The home provides accommodation for up to 22 people who need support with personal and nursing care needs, including those who are living with dementia. Both single and shared facilities are available on two floors, served by a passenger lift and stairs. There are communal areas available, including lounges and a dining area. There is a car park to the front of the property and a garden area to the rear of the home. At the time of our inspection there were 17 people living at the home.

People’s experience of using this service

Everyone we spoke with provided us with positive comments about the quality of service delivered. The provider had systems to act on allegations of abuse. People who lived at the home were not able to tell us what it was like living at Willow Lodge. However, family members told us they felt their relatives were safe. A system was in place for the reporting and recording of accidents and incidents and staff were recruited safely.

However, the provider lacked oversight of the service, as they failed to carry out robust checks and to address areas of significant risk. The premises needed upgrading and modernising. Some areas needed a thorough clean and fire safety was a concern in some parts of the home.

The management of medicines was satisfactory. However, the organisation of creams and PRN (as and when required) medicines could have been better. We made a recommendation about this.

Plans of care were detailed and person-centred. They reflected people's assessed needs well and had been consistently reviewed. Any changes in need had been recorded. Activities were not being regularly provided, to prevent isolation and boredom. We made a recommendation about this.

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 supported this practice. However, people were not involved in the planning of their own care, or that of their loved one. We made a recommendation about this.

People's needs and choices were assessed before they moved into the home. We saw some lovely interactions between staff and those who lived at Willow Lodge. However, people’s privacy and dignity were not consistently respected, and the meal service was not always person-centred. We made recommendations in these areas.

The provider did not calculate the staffing levels in accordance with the assessed needs of those who lived at the home, so that an appropriate number and skill mix of staff were deployed on each shift. We made a recommendation about this. New staff received an in-depth induction programme and a broad range of training had been completed by staff, who were regularly supervised and observed at work. However, appraisals had not been introduced at the time of our inspection. We made a recommendation about this.

The provider had policies for the management of complaints and systems for recording complaints had been introduced. Feedback had been obtained from those who used the service and their relatives. Team meetings had been held and staff members felt able to approach the managers with any concerns, should they need to do so. Meetings were not held for those who lived at the home and their relatives. The registered manager told us these meetings were arranged and advertised, but no-one attended. However, she operated an open-door policy, to encourage people to discuss any concerns or areas of good practice.

Rating at the last inspection

This was the first inspection of Willow Lodge since the change of ownership on 3 April 2018.

Why we inspected

This was a scheduled inspection.

Enforcement

We have identified breaches in relation to safe care and treatment, premises and equipment and good governance at this inspection.

Please see the action we have to