Willow Grange Nursing Home

Updated 1 September 2021

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection team consisted of three inspectors, with two attending on both days of the site visit and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Willow Grange Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service did not have a manager registered with the Care Quality Commission. This means that the provider was legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

The inspection was unannounced.

What we did before the inspection

The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make.

We took this into account when we inspected the service and made the judgements in this report. We reviewed the information we held about the service since the last inspection. We sought feedback from professionals who work with the service. We used all of this information to plan our inspection.

During the inspection

We spoke with two people who used the service and 10 relatives about their experience of the care provided. We spoke with 13 members of staff including the nominated individual, area manager, nurses and care workers. The nominated individual is responsible for supervising the management of the service on behalf of the provider.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

We reviewed a range of records. This included six people’s care records. A variety of records relating to the management of the service, quality assurance including policies and procedures were reviewed.

After the inspection

We asked the area manager to send documents to further support how the service was run and to validate evidence found.

Updated 1 September 2021

About the service

Willow Grange Nursing Home is a residential care home providing personal and nursing care for up to 44 people. At the time of inspection, 29 people were using the service, some of whom were living with dementia.

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

Risks to people’s health were not always identified and managed. Medicines were not always managed well. The medicines policy was not up to date and did not provide sufficient guidance to staff. Staff understood how to identify and report abuse. People were protected from the risk of infection.

Staff required more support in their supervisions. Staff received training to enhance their knowledge. People had access to sufficient food and drink.

Relatives told us that sometimes staff were not always kind and caring. Staff did not always deliver care in a manner that respected people’s dignity and privacy. People were supported to maintain their independence.

Care records were not always consistent and a reflection of people’s needs. There was no registered manager at the service. The provider did not always engage with stakeholders to drive improvement. Lessons were not drawn from incidents that happened at the service to improve the quality of care. Audits had not identified the issues we found during the inspection.

People who used the service and their relatives knew how to make a complaint or raise concerns about the care provided.

We were assured the provider was working within current guidance on good infection prevention and control guidelines in relation to the COVID-19 pandemic. Risk management plans mitigated risks in relation to COVID-19 pandemic and spreading of infections. Staff followed guidance to respond to COVID-19 and other infection outbreaks effectively. Staff had access to sufficient Personal Protective Equipment and used it appropriately. Visitors underwent COVID-19 checks to minimise the risk of spreading of infection.

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 Good (published 3 December 2019). The service is now rated requires improvement.

This report only covers our findings in relation to the key questions; Is the service Safe, Effective, Caring and Well-led.

Why we inspected

We received concerns in relation to concerns about people’s wishes not being respected, learning from incidents and management of the home. As a result, we undertook a focused inspection to review the key questions of safe, caring and well-led only.

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.

We also 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. As we did not look at the entire key question of Safe the rating for the Safe key question has not been changed.

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

During this inspection we found breaches in relation to condition of registration of a registered manager, dignity and respect and good governance

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 respect and dignity and good governance at this inspection.

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 inspection programme. If we receive any concerning information we may inspect sooner.