Willow Lodge

Willow Lodge Nursing Home is a residential care home providing personal and nursing care to up to 22 people. The service provides support to older people and people living with dementia. At the time of our inspection there were 11 people using the service.

The home is set over 2 floors which are accessible via a lift. There is a communal area available, with a garden and car park.

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

People were not always kept safe as systems to manage the safety of the environment were not effective. Some improvements had been made in managing medicines, however further work was required to embed the changes. Improvements had been made regarding the incident recording process to make sure mistakes were not repeated. People were looked after by enough staff who knew them well. A relative said, “There are lots of changes of staff, but the permanent ones know him especially well.” The home was kept clean.

People were not always kept safe as recruitment processes needed improving. We have made a recommendation about systems to monitor staff training and competencies. People had limited fresh food options. People’s bedrooms looked bare and were not decorated according to their preferences. The manager completed appropriate assessments regarding health and well-being, and decisions were made in people’s best interests.

People and their relatives spoke highly of the staff and said they were very kind, friendly and caring. Some relatives mentioned that agency staff did not always have the same rapport, or knowledge about people’s individual needs and preferences.

People did not have many opportunities for going into the local area or to participate in activities within the home. The registered provider needed to make improvements regarding using different communication strategies. Although complaints were recorded it was not clear what processes were used to resolve them and make sure people’s care was improved.

People were at risk of receiving poor quality care because the registered provider had failed to ensure effective oversight of risks, quality of care and the environment. The registered provider did not always request feedback from people, their relatives or staff. However, staff enjoyed their jobs and were committed to providing good care for the people that used the service.

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.

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 inadequate (published 26 October 2022) and there were breaches of 3 regulations. The provider was asked to complete an action plan after the last inspection to show what they would do and by when to improve however this was not received. At this inspection we found the provider remained in breach of 2 regulations.

At our last inspection we recommended that the provider look at their incident recording processes, and at this inspection we found that some improvements had been made.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

The overall rating for the service has remained inadequate 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 off this full report.

Enforcement

We have identified breaches in relation to the safety of the premises, recruitment and the governance of the service.

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

Follow up

The registered provider made the decision to close Willow Lodge Nursing Home in the days following the inspection. However, until this process has been finalised CQC will continue their normal processes for services rated inadequate and in special measures as follows:

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.

The overall rating for this service is ‘inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Willow Lodge is a residential care home providing personal and nursing care to up to 22 people. The service provides support to older people and people living with dementia. At the time of our inspection there were 12 people using the service.

The home is set over two floors which are accessible via a lift. There are communal areas available for people to use and a good-sized garden and car park.

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

People were not always kept safe as systems to manage the safety of the environment were not effective. Medicines were not managed safely. The registered provider did not look at reasons why things went wrong, and so people remained at risk of harm from incidents. We made a recommendation about the incident recording processes. People were looked after by enough staff who knew them well and the home was overall kept clean.

People were at risk of receiving inconsistent, poor quality care because the registered provider had failed to ensure effective oversight of the quality of care, care records and the environment. However, many changes had been made to improve the environment and this was ongoing. Staff were positive about the changes made so far and commented that they could see the benefits.

People and their relatives were happy with the care. A relative said, “There is an overall feeling of kindness,” another said, “We are absolutely happy, I am going there tomorrow, (my relative) is settled and happy.”

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.

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 29 September 2021) and there were breaches of regulation. The service has now changed to inadequate and there continues to be breaches of regulation.

Why we inspected

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 received concerns in relation to the overall governance of the service, and the premises. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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 inadequate based on the findings at 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 read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Willow Lodge 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 monitor the service and will take further action if needed.

We have identified breaches in relation to the governance of the service, the safety of the premises and medicines management.

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

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 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.

The overall rating for this service is ‘inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

We found the following examples of good practice:

Prior to our inspection, we received information of concern about infection prevention and control (IPC) practices at this service. During our inspection, we found the home was odour free but improvements and repairs to the environment were needed. There were designated domestic staff and cleaning schedules were followed. The manager had commenced checks of the environment and cleanliness and shortfalls were being acted on.

There were enough stocks of personal protective equipment (PPE). We observed staff and management were using PPE correctly and there were procedures in place to support staff with its use. Staff had received training in the use of PPE, infection control and hand hygiene and the manager had commenced checks on staff practice to ensure safe IPC procedures were followed. We discussed ensuring all staff received refresher training. Signage was in place to remind staff, visitors and people about the use of PPE, the importance of washing hands and regular use of hand sanitisers.

There were effective processes to minimise the risk to people, staff and visitors from catching and spreading COVID-19. These included regular testing of staff and people living in the home and testing of visitors to the home. Safe visiting processes were followed and the vaccination status of all visitors to the home was checked in accordance with the current guidance. We discussed utilising the role of essential care giver and provided the manager with some guidance in relation to this.

There were sufficient staff to provide continuity of support should there be a staff shortage. Recruitment of additional care and domestic staff was underway. At the time of the inspection, admissions to the service were restricted; the manager was aware of current guidance.

IPC policies and procedures were kept under review. There were safe processes in place to take appropriate action during an outbreak. We discussed how the environment could be utilised more effectively to improve IPC practices with regards to cohorting and isolation. The local commissioners IPC lead nurse was providing advice and support to management and staff.

Willow Lodge is a care home providing accommodation with personal care and nursing care for up to 22 people aged 65 and over. There were 15 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

Improvements had been made since the last inspection. However, the provider’s quality assurance systems were not robust enough to ensure the quality of the service. There was a lack of clarity on who was responsible for carrying out audits and maintenance checks.

We found some areas of the building still required attention and upgrade. The Fire Officer, following our visit, served an Enforcement Notice. The provider immediately developed and sent into us an Improvement and Maintenance plan that included addressing the fire safety issues.

People and their relatives told us they were happy with the care and support and provided positive feedback about the staff and the new registered manager. They were confident their relative was safe and getting their support needs met.

People felt safe and were protected from harm. Staff understood how to protect people from abuse. Medicines were being safely managed. The processes to record and investigate accidents and incidents had improved. Staff members followed effective infection prevention and control procedures.

The registered manager had assessed the risks to people with their care and support. Staff members were knowledgeable about these risks and knew what to do to minimise the potential for harm to people.

There were enough staff on duty to meet people’s needs in a timely manner. Staff received training and support to enable them to effectively meet the needs of the people they supported. Staff had been safely recruited.

We made a recommendation about improving staff knowledge of supporting people with dementia and making the environment more dementia friendly.

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's consent was being gained and recorded.

People were supported to maintain good health and nutrition. Staff worked closely with professionals such as speech and language therapists, GP’s, commissioners and other health professional.

The new registered manager had prioritised and addressed many of the issues identified at the last inspection. They had provided strong leadership and developed a staff team that was motivated to drive up the quality of care. Relatives spoke very highly of the manager and how the home was now being well managed.

The registered manager had kept CQC informed about significant events at Willow Lodge and were working in partnership with commissioners of the service to further improve and develop.

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 inadequate (Published 05 March 2021) and there were multiple breaches of regulation. The provider completed action plans after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made the provider was no longer in breach of regulations 9 (Person-centred care), 11 (Need for consent), 12 (Safe care and treatment), 13 (Safeguarding services users from abuse and improper treatment) and 18 (Staffing).

However, the provider had a continuing breach of regulation 15 (Premises and equipment) and regulation 17 (Good governance).

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

This service has been in Special Measures since 05 March 2021. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We carried out an unannounced inspection of this service on 19 January 2021. Breaches of legal requirements were found in relation to safe care and treatment, poor infection control practices, responding to changes in people’s needs, the safe maintenance of equipment and premises, seeking consent and poor 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 of Safe, Effective and Well-led which contain those requirements.

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 changed from inadequate 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 Willow Lodge 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 COVID-19 and other infection outbreaks effectively.

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 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.

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 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 Requires improvement to inadequate. This is based on the findings at this inspection.

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.

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.

At this inspection we identified breaches in relation to keeping people safe from preventable harm such as unexplained injuries, poor infection control practices, responding to changes in people’s needs, the safe maintenance of equipment and premises, seeking consent and poor 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 request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

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 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 monitor the progress of the improvements working alongside the provider and local authority. We will return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

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