Archived: The Willows Care Home

Updated 20 May 2016

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 10 and 11 November 2015 and was unannounced. It was carried out by three adult social care inspectors and a specialist advisor. A specialist advisor is a person who has specific expertise. The specialist advisor used in this inspection had specific knowledge relating to people with dementia and was a qualified nurse. An expert by experience made phone calls to relatives to gain their views on the service. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service.

We spoke with people living at The Willows Care Home. Some people had communication and language difficulties associated with their dementia. We therefore used a 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 to us.

We spoke with the manager, the supporting registered manager, the deputy manager, seven members of staff and two senior team leaders, the administrator, two cleaners, one chef and one kitchen assistant. Following the inspection we contacted six relatives, three health care professionals and two activity co-ordinators.

We looked at seven people’s care records and documentation in relation to the management of the home. This included five staff files including supervision, training and recruitments records, quality auditing processes and policies and procedures. We looked around the premises, observed care practices and the administration of medicines.

Before our inspection we reviewed all the information we held about the home. We looked at previous inspection records, intelligence we had received about the service and notifications. Notifications are information about specific important events the service is legally required to send us. We did not request a Provider Information Return (PIR) prior to this inspection as we had received one within the last year. The PIR is a form that asks the provider to give some key information about the service, what the service does well and the improvements they plan to make.

Updated 20 May 2016

The Willows care home provides accommodation for people who require personal care. At the time of our visit there were 18 people living at the home. The Willows Care home is made up of two floors. It has communal areas including a dining area and two lounges, a conservatory area and outdoor space, kitchen, manager’s office and staff room. There are 25 single rooms and one double room, a kitchen and laundry facilities.

At the last focussed inspection on the 30 April and 8 May 2015 we found breaches of legal requirements were found. After this inspection we issued the provider a notice of decision to restrict admissions into the home.

The provider wrote to us to say what they would do to meet legal requirements in relation to the following breaches:

• Good governance, records and audits
• Staff training was not up to date

At the previous comprehensive inspection undertaken on the 1 and 3 December 2014 we found breaches of legal requirements and found the service to be inadequate. After this inspection we issued a warning notice that they must be compliant by the 17 March 2015. The provider wrote to us to say what they would do to meet legal requirements in relation to the following breaches:

• Consent to care and treatment
• Care and welfare of people who use services
• Safeguarding people who use services from abuse
• Managements of medicines
• Incidents and accidents

Warning notices were issued in relation to

• Assessing and monitoring the quality of service provision
• Records

This was an unannounced comprehensive inspection and took place on 10 and 11 November 2015. At this inspection there were still concerns relating to previous breaches; records were inaccurate and incomplete and there was a lack of robust quality audits and staff training to ensure staff had skills and knowledge. We also found the following breaches;

• Need for consent
• Safeguarding people from abuse and improper treatment
• Safe care and treatment
• Meeting nutrition and hydration needs

At the previous inspection we asked the provider to take action and ensure the service had a registered manager in post. At this inspection there was not a registered manager in place but the manager was being supported by a manager who was registered at a different home. 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.

People were at risk of unsafe care due to not having referrals or actions taken when there were safeguarding concerns. People’s support plans and risk assessments were not always in place and did not always adequately detail what support might be required if they became anxious or upset. People were at risk of receiving medicines in an unsafe way due to inadequate records, unsafe storage, disposal and security.

People who did not have the capacity to make specific decisions did not have best interest decisions in place as required by The Mental Capacity Act 2005. People were supported by staff who had not always received training. If staff had received training they were not always able to demonstrate they had necessary skills and knowledge to undertake their role. Staff demonstrated they were supportive when people required assistance. However, people had periods of time when there were no interactions from staff. Some people benefited from activities but not everyone had the same opportunities.

People’s meal time experience was not ensuring people had opportunities to socially engage with one another. People were not receiving adequate nutritional and hydration needs to meet their specific individual needs.

People and relatives felt staff demonstrated a kind and caring approach. People were supported by staff who had received necessary checks prior to employment.

Complaint records did not always show that investigations had taken place or what learning had taken place by the provider. People did not have detailed personal emergency evacuation plans in place that confirmed what support staff would need to provide or equipment required if there was an emergency.

The home did not have systems and audits in place that identified areas of concern found during this inspection. This included not identifying areas of concern within peoples care plans, assessments, the homes incidents and accident logs. There were no actions plans in place to address the concerns.

People were at risk of receiving inadequate care this was despite the support provided by the home’s management team and consultancy support. We have made these failings clear to the provider and they have had sufficient time to address them. Our findings do not provide us with any confidence in the provider’s ability to bring about lasting compliance with the requirements of the regulations.

The action we took is at the back of this report.