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Archived: Willow Lodge Inadequate

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Reports


Inspection carried out on 3 October 2017

During a routine inspection

Willow Lodge is located in a residential area of Ormskirk, close to the town centre and all local amenities. The home provides support for up to 22 people who require assistance with personal or nursing care needs and who are living with a dementia related condition. Accommodation is available in both single and shared facilities on two floors served by a passenger lift and stairs. There are spacious communal areas available including lounges and two conservatories. There is parking to the front of the property and a garden area to the rear of the home. At the time of our inspection there were 19 people who lived at Willow Lodge Nursing Home.

The registered manager of Willow Lodge had left employment unexpectedly four months prior to our inspection. 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 of the Health and Social Care Act and associated regulations about how the service is run. The deputy manager had taken on the role of acting manager and was on duty throughout the inspection process.

At the last inspection on 6 December 2016 we rated the service as ‘Requires Improvement’. This was because four breaches of legal requirements were found. These were in relation to person-centred care, safe care and treatment, safeguarding service users from abuse and improper treatment and good governance. At that time Willow Lodge was placed in special measures because the area of ‘safe’ was rated as ‘inadequate’. Therefore, we took steps to ensure people were made safe and the provider submitted an action plan detailing the improvements they planned to make. Comments contained in the action plan were considered during this inspection.

We found at this comprehensive inspection on 03 October and 10 October 2017 the provider had met the legal requirements in relation to person-centred care and safeguarding service users from abuse and improper treatment. However, the concerns previously raised in relation to safe care and treatment and good governance had not been adequately addressed. Therefore the provider continued to fail to meet the legal requirements of the regulations in these areas. We also found the provider did not meet the required regulations in relation to fit and proper persons employed. The domains of ‘safe’ and ‘well led’ were rated as ‘inadequate’ and therefore Willow Lodge remains ‘inadequate’ overall and in special measures.

People who lived at Willow Lodge told us they felt safe being there. Fire procedures were readily available, so that staff were aware of action they needed to take in the event of a fire. However, we found parts of the environment to be unsafe and the management of medicines was poor. There was no evidence available to demonstrate all systems and equipment within the home had been appropriately serviced to ensure they were safe and fit for use. Records were not available about how people needed to be assisted from the building, should evacuation be necessary. Therefore, this was a continuous breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We found that quality monitoring systems had been implemented, but these were not always effective, particularly in relation to medicines management, care planning, recruitment and safety and suitability of the premises. The plans of care were in general well written documents. However, the ones we saw had not all been reviewed and updated to reflect people’s current needs. Although the provider was aware of this; action had not been taken to address these failings. Therefore, this was a continuous breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Recruitment practices adopted by the home were poor. Appropriate background checks had not been conducted, which m

Inspection carried out on 6 December 2016

During a routine inspection

Willow Lodge Nursing Home is located in a residential area of Ormskirk, close to the town centre and all local amenities. The home provides support for up to 22 people who require assistance with personal or nursing care needs and who are living with dementia related conditions. Accommodation is available in both single and shared facilities on two floors served by a passenger lift and stairs. There are spacious communal areas available including lounges, dining areas and two conservatories. There is parking to the front of the property and a safe garden area to the rear of the home.

The last inspection of this location was conducted on 26 October 2015 and 6 November 2015, when we found several breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to safe care and treatment, premises and equipment, dignity and respect, person-centred care and good governance. We served a warning notice in relation to none compliance with Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We did not receive any representations from the provider. Actions the provider took in response to our findings at the last inspection are identified below.

This inspection was conducted on 6 December 2016 and it was unannounced, which meant that people did not know we were going to visit the home.

The registered manager was on duty at the time of our inspection. 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 of the Health and Social Care Act and associated regulations about how the service is run.

At our last inspection on 26 October 2015 and 6 November 2015 we found the registered provider had not ensured systems and processes had been established to effectively assess, monitor and mitigate risks relating to the health, safety and welfare of service users. Therefore, this area was in need of improvement, so that the service could be sufficiently monitored under a continuous assessment process and any improvements needed could be identified and addressed in a timely fashion.

This was a breach of regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We made a requirement about this. The provider sent us their action plan, which showed that actions would be completed by 15 April 2016.

At this inspection we found that quality monitoring systems had been implemented, but these had not always identified shortfalls recognised by the inspection team and therefore they were not consistently effective, particularly around medication management, where we found some significant shortfalls. Therefore, this constituted as a continued breach of regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

At our last inspection on 26 October 2015 and 6 November 2015 we found that the registered person had not ensured that the premises were properly maintained throughout. This was a breach of regulation 15 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We made a requirement about this.

The provider sent us their action plan, which showed that actions in relation to the premises were on-going.

During the course of this inspection we toured the premises and found that significant improvements had been made to the environment. Several areas of the home had been decorated, upgraded and modernised. More suitable flooring had been installed in the lounge area and new furniture had been purchased, including profile beds. The laundry department had been upgrade. Therefore, the breach of regulation 15 had been met.

At our last inspection on 26 October 2015 and 6 November 2015 we found that the registered person had not ensured that people were consistently treated with dignity and r

Inspection carried out on 26/10/2015 & 06/11/2015

During a routine inspection

This comprehensive inspection was unannounced, which meant the provider did not know we were coming. It was conducted over two days on 26 October 2015 and 06 November 2015.

Willow Lodge Nursing Home is located in a residential area of Ormskirk, close to the town centre and all local amenities. The home provides both single and shared facilities on two floors served by a passenger lift and stairs. There are spacious communal areas available including lounges, dining areas and two conservatories. There is parking to the front of the property and a garden area to the rear of the home. Willow Lodge provides nursing care for up to 22 people who live with Dementia.

The last full scheduled inspection was conducted on 06 October 2014. The service was, at that time fully compliant with all five outcome areas assessed.

On the first day of our inspection the registered manager was not available, due to annual leave. However, the inspection team was assisted by the nurse in charge of the home at that time. 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. The registered manager was on duty on the second day of our inspection.

We found that each plan of care we saw varied in quality. Some were well written, person-centred documents, whilst others did not provide staff with clear guidance about people’s needs and how these needs were to be best met.

The cleanliness of the premises could have been better. Areas of the environment were found to be dirty and unhygienic. Some areas were also in need of modernising, updating and improved maintenance. Systems and equipment within the home had been serviced in accordance with the manufacturers’ recommendations, to ensure they were safe for use. However, during our tour of the home we found some areas unsafe and therefore this did not consistently protect people from harm.

We noted several hazards within the environment, including inadequate fire safety arrangements, which had not been identified and therefore created a potential area of risk for those who lived at the home. Therefore, people were not consistently safe.

We looked at medication practices adopted by the home and found failings, which meant that people were not protected against the risk of receiving inappropriate or unsafe care and treatment, because medicines were not being well managed.

On our arrival at the home there were five care staff on duty, including the registered nurse. We observed that although the staff responded pleasantly to people’s needs, it was not always in a timely manner and there were times when the communal areas of the home were void of staff members. We were told that care staff were also responsible for laundry duties during the day. Some people we spoke with felt that there were not enough staff on duty. We have made a recommendation about this.

New staff were appropriately recruited and therefore deemed fit to work with this vulnerable client group. Induction programmes for new employees were formally recorded. Supervision and appraisal meetings for staff were regular and structured. This meant the staff team were supported to gain confidence and the ability to deliver the care people needed. A wide range of training programmes were provided.

Evidence was available to show that surveys for those who lived at the home and their relatives were conducted. However, these were not on public display at the time of our inspection. We have made a recommendation about this. We saw that staff meetings took place, but meetings for those who lived at the home and their relatives had not yet been established. We have made a recommendation about this.

Consent had been obtained through best interest decision making processes before care was provided. We found that people were not consistently treated with dignity and respect. The planning of people’s care varied. Some records were person centred and well written, providing staff with clear guidance about people’s needs and how these were to be best met. However, some did not identify all assessed needs. Some records were not maintained in a confidential manner. We have made a recommendation about this.

Meal times were not conducive to a pleasant dining experience and the importance of respecting people’s privacy and dignity when sharing a bedroom was not recorded within individual plans of care. We have made recommendations about these areas.

We found several breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 for safe care and treatment, premises and equipment, dignity and respect, person-centred care and good governance.

You can see what action we told the provider to take at the back of the full version of this report. We are taking enforcement action against the service and will report on that when it is complete. We have served a warning notice in relation to none compliance with Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We have not received any representations from the provider. The provider is required to become compliant by 27 March 2016.

Where we have identified a breach of regulation during inspection which is more serious, we will make sure action is taken. We will report on any action when it is complete.

Inspection carried out on 6 October 2014

During a routine inspection

During the course of this inspection we gathered evidence against the outcomes we inspected, to help answer our five key questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with those who used the service, their relatives, support staff and the manager and from looking at records. We were able to speak with four people who lived at Willow Lodge. They all gave us positive responses to the questions we asked.

If you want to see the evidence supporting our summary please read our full report.

Is the service safe?

People we spoke with told us they felt safe living at Willow Lodge and their dignity was always respected. Systems were in place to help managers and the staff team to learn from untoward incidents, such as accidents. This helped the service to continually improve.

The home had proper policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards. Applications were made, as was needed. This helped to ensure people's freedom was not being unnecessarily restricted. People (or their relatives) were involved in making decisions about the care and support provided.

At the time of our visit to this location, we looked at infection control protocols. We found the environment to be clean, hygienic and pleasant smelling throughout. Equipment was well maintained and serviced regularly. Therefore, people were not put at unnecessary risk.

Is the service effective?

People were supported to access advocacy services, if they wished to do so. This meant they could have additional help from an independent person, if they wanted it. The health and personal care needs of those who used the service had been thoroughly assessed, with a range of people involved in their care and support.

Systems were in place to ensure the practices of the home were effectively assessed, so the quality of service provided could be consistently monitored. A broad range of training modules were provided for staff, with regular mandatory updates. This helped to ensure the staff team delivered effective care and support for those who lived at the home.

People were supported to move around the home freely and safely. Visitors confirmed they were able to see people in private and visiting times were flexible.

Is the service caring?

We asked those who lived at the home about the staff team. Feedback from them was very positive. They said staff were kind and caring towards them and helped them to meet their needs. We saw that people were offered a range of choices throughout the day and they were supported to remain as independent as possible.

When speaking with staff and observing their interactions with those who lived at Willow Lodge, it was clear they genuinely cared for those they supported and were seen speaking with people in a respectful and friendly manner.

People's preferences and interests were well recorded and care and support was provided in accordance with people's wishes. One person commented, "I like doing things here. I like painting and drawing." A relative told us, "We got a good feeling about this place, when we came to have a look around. We had been to see plenty homes, but this seemed to be the friendliest and most caring."

Is the service responsive?

People completed activities in and outside the service regularly. Staff were seen to be responding to people well by anticipating their needs appropriately.

The home worked well with other agencies and services to make sure people received care and support in a consistent way. Evidence was available to show Willow Lodge responded well to any suggestions for improvement and appropriate action was taken to rectify any shortfalls identified.

Is the service well-led?

The service had a quality assurance system in place and records showed that identified problems and opportunities to change things for the better were addressed promptly. As a result, the quality of service provided was continuously monitored.

Staff spoken with had a good understanding of their roles. They were confident in reporting any concerns and they felt well supported by the managers of the service. People who lived at Willow Lodge and their relatives completed satisfaction surveys periodically. Systems were in place so that any shortfalls or concerns raised could be taken on board and dealt with appropriately.

Inspection carried out on 15 August 2013

During a routine inspection

People told us they were asked about their care requirements. One person told us �Yes I usually tell the staff what I want. They are always about. I please myself what I do and the staff are lovely. They wouldn�t do anything I didn�t want them to�.

Care plans reflected people�s needs, preferences and diversity. They were sufficiently detailed to make sure peoples� care and support would be provided according to their needs and safety. Lifestyle profiles provided staff with insight into peoples� life experiences and values.

People who had limited communication were represented in their best interests to ensure decisions made about their care were right for them.

We looked at records and found care and support was planned and delivered in a way that ensured people�s safety and welfare.

People who use the service were protected from the risk of abuse, because staff had been trained on identifying and responding to signs and allegations of abuse. We observed people were comfortable around staff and showed no sign of fearful or concerning behaviour around them.

People were cared for by staff that had character checks as to their suitability to undertake caring duties, and who were trained.

Standards of quality and safety were being monitored and there was a continuing improvement plan being followed.

A family member said they were very happy with the standards and described the service as �A care home run by people who care�.