Willows Lodge Care Home

Willows Lodge Care Home provides accommodation, personal care and nursing care for up to 70 older people, people living with dementia and those who require nursing and palliative care. The service consists of 3 units: Poppy Unit for people living with dementia, Buttercup Unit for people who require nursing and palliative care and Rose Unit for people who require residential care. At the time of the inspection there were 63 people living at the service.

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

People's care was not always delivered safely. Information relating to people's individual risks was not always recorded, up-to-date or did not provide enough assurance that people were safe.

Suitable arrangements were not in place to ensure the proper and safe use of medicines. The staffing levels and the deployment of staff was not suitable to meet people's care and support needs. Training was not always up to date.

People were not protected by the prevention and control of infection. Staff did not always receive adequate training and supervision.

People and their relatives told us they were treated with care and kindness. However, the care provided was not always person-centred.

Not all care plans contained enough information to ensure staff knew how to deliver appropriate person-centred care. People were not supported or enabled to take part in regular social activities that met their needs.

Staff were aware of who they were accountable to and understood their roles and responsibilities in ensuring people's needs were met. The registered manager had good links with a number of health and social care professionals and this helped to ensure people's needs were met.

Management and staff treated people with kindness and compassion. Positive relationships had developed between people and staff. However, people's experiences of care varied considerably.

The new management structure was committed to improving the service and creating a positive and inclusive culture at the service.

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

Rating at last inspection

The last rating for this service was good (published January 2020)

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

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 good to requires improvement based on

the findings of this inspection.

We have found evidence that the provider needs to make improvements.

Enforcement and recommendations

We have identified breaches in relation to safe care and treatment, staffing, nutritional and hydration needs and good governance at this inspection and made a recommendation in relation to the Mental Capacity Act and care plans and risk assessments.

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 inspect next.

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

People told us they were safe, however we found improvements were required to ensure people received their medication as they should. Recruitment practices and procedures required improvement to ensure staff’s fitness to work at the service was appropriate. Not all environmental risks to people using the service had been assessed and acted on to ensure their safety. For example, some freestanding wardrobes were not secured to the wall and personal evacuation plans for people using the service were not up-to-date. We brought this to the provider and registered manager’s attention and immediate action was taken to rectify this. These areas were addressed within 48 hours of the inspection. People told us they were safe. Suitable arrangements were in place to protect people from abuse and avoidable harm. Staff understood how to raise concerns and knew what to do to safeguard people. People’s comments relating to staffing levels at the service were variable, but we found enough numbers of staff were available to support people living at Willows Lodge Care Home and to meet their needs. People were protected by the prevention and control of infection. Findings from this inspection showed lessons were learned and improvements made when things went wrong as soon as possible and practicable.

Staff received mandatory and specialist training and newly appointed staff received an ‘in house’ induction. However, improvements were required to ensure staff received appropriate manual handling training and completed a robust induction, such as the ‘Care Certificate’ in a timelier manner. Following the inspection the provider wrote to us and confirmed these actions had been addressed. Staff felt valued and supported by the registered manager and received formal supervision. Records to evidence the latter required improvement. The dining experience for people using the service was good and people received enough food and drink to meet their needs. People were supported to access appropriate healthcare services and receive ongoing healthcare support. The service worked with other organisations to enable people to receive effective care and support. 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.

People and those acting on their behalf told us they were treated with care, kindness, respect and dignity. Staff had a good rapport and relationship with the people they supported, and observations demonstrated what people told us.

People’s care and support needs were documented but improvements were required to some aspects of record keeping. However, staff had a good understanding and knowledge of people’s needs and the care to be delivered. There was no evidence to suggest improvements required to the service's care planning arrangements and record keeping, impacted on people living at Willows Lodge Care Home. Information relating to people’s end of life care needs was recorded but this too required improvement as the information was brief. This did not impact on the quality of care provided to people who were assessed as being at the end of their life and who required palliative care. Suitable arrangements were in place to enable people to participate in meaningful social activities to meet their needs. Complaints were well managed and a record of compliments to capture the service’s achievements was maintained.

People told us the service was well-led and managed, the registered manager was visible and approachable. Quality assurance arrangements enabled the provider and registered manager to monitor the quality of the service provided, however there was a lack of oversight of the issues highlighted as part of this inspection. However, the provider and registered manager were quick to resolve the issues once highlighted.

Rating at last inspection

The rating at last inspection was good (published May 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as outlined in our inspection programme and schedule. 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

The inspection was completed on 30 and 31 March 2017 and was unannounced. There were 56 people living at the service when we inspected.

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 told us the service was a safe place to live and that there were sufficient staff available to meet their needs. Appropriate arrangements were in place to recruit staff safely so as to ensure they were the right people. Staff were able to demonstrate a good understanding and knowledge of people’s specific support needs, so as to ensure theirs’ and others’ safety. Staff understood the risks and signs of potential abuse and the relevant safeguarding processes to follow. Risks to people’s health and wellbeing were appropriately assessed, managed and reviewed.

Medicines were safely stored, recorded and administered in line with current guidance to ensure people received their prescribed medicines to meet their needs. This meant that people received their prescribed medicines as they should and in a safe way.

Staff received opportunities for training and this ensured that staff employed at the service had the right skills to meet people’s needs. Staff felt supported and received appropriate formal supervision. Staff demonstrated a good understanding and awareness of how to treat people with respect and dignity.

Care records for people were centred on the individual and care plans reflected people’s needs, choices and preferences and included information relating to people’s life history and experiences.

Where people lacked capacity to make day-to-day decisions about their care and support, we saw that decisions had been made in their best interests. The registered manager was working with the local authority to make sure people’s legal rights were being protected.

The dining experience for people was positive and people were complimentary about the quality of meals provided. Consideration by staff was evident to ensure that eating and drinking was an important part of people’s daily life and treated as a social occasion.

Staff told us that the overall culture across the service was open and inclusive and that they felt supported by the registered manager and the management team. Staff told us that communication between them, the registered manager and the management team was positive and that they felt listened to. Staff told us that morale within the staff team at all levels was much improved.

There was an effective system in place to regularly assess and monitor the quality of the service provided. Quality assurance checks and audits carried out by the provider and the management team of the service were in place and had been completed at regular intervals in line with the provider’s schedule of completion. The provider and management team of the service were able to demonstrate an understanding and awareness of the importance of having good quality assurance processes in place. This had resulted in better outcomes for people using the service.

Following our inspection to the service in January 2016, an Urgent Notice of Decision was issued to the registered provider advising that no further admissions could be made to the service until 31 March 2016. In addition, the Care Quality Commission met with the registered provider on 28 January 2016 to discuss our on-going concerns. During the meeting the registered provider gave an assurance that things would improve.

This inspection was completed on 21 March 2016 and 22 March 2016. There were 49 people living at the service when we inspected.

A registered manager was not in post at the time of the 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 in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The service was managed on a day-to-day basis by the registered provider and they were supported by an area manager from within the organisation. A new manager had been appointed and commenced their role at the service on 4 April 2016.

Suitable arrangements were not in place to ensure that the right staff were employed at the service and improvements were required. The arrangements for the effective management of medicines on two out of three unit’s required further development as there were unexplained gaps on the medication administration records and not everyone had received their prescribed medication.

Further development of the registered provider’s quality assurance arrangements were required to ensure that these were robust. Record keeping in some areas relating to people who used the service also required reviewing and improvement, particularly in relation to people’s food and fluid monitoring and where they required their body to be repositioned at regular intervals so as to prevent the development of pressure ulcers.

Improvements were required to ensure that effective arrangements were in place for the management of complaints and to ensure that there was a clear audit trail of actions undertaken.

Improvements were still required to ensure that people who predominately remained in bed or in their bedroom received opportunities for social stimulation.

Although people were not complimentary about the quality of meals provided, the dining experience for people was positive and people received appropriate support and assistance to eat and drink.

Sufficient numbers of staff were available and satisfactory deployment of staff was observed to meet people’s care and support needs. Staff had received additional basic mandatory training and this was embedded in staffs practice. Staff felt supported and now received formal supervision. Staff had a good understanding of safeguarding procedures to enable them to keep people safe.

People received personalised care that was responsive to their individual needs. People’s care plans included information relating to their specific care needs and how they were to be supported by staff. Risks were identified to people’s health and wellbeing and risk assessments were in place to guide staff on the measures to reduce and monitor these. Appropriate assessments had been carried out where people living at the service were not able to make decisions for themselves and to help ensure their rights were protected. People were treated with kindness and care by staff. Staff had a good relationship with the people they supported.

You can see what actions we told the provider to take at the back of the full version of the report.

The inspection was completed on 12 January 2016, 13 January 2016 and 19 January 2016. There were 55 people living at the service when we inspected.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve.

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will be kept under review and if needed could be escalated to urgent enforcement action.

A registered manager was in post. 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.

Arrangements were in place to inform the provider and registered manager of what was going on in the service. Although these were in place, they were not as effective as they should be and there was a lack of provider and managerial oversight of the service as a whole, as areas of concern were identified. Checks were not effective to monitor and ensure pressure mattresses were set at the correct setting each day. Records were not properly maintained, for example, in relation to staff supervision, food and fluid monitoring and end of life care. Systems in place to identify and monitor the safety and quality of the service were inadequate.

Although staff had a good understanding of safeguarding procedures, robust arrangements were not in place to ensure that people using the service were protected from abuse. Risks were not appropriately managed or mitigated so as to ensure people’s safety and wellbeing.

Although there was a complaints system in place, management arrangements to investigate complaints thoroughly and to evidence outcomes were inconsistent.

The deployment of staff, particularly on Poppy Unit and Buttercup Unit was not always appropriate to meet the needs of people who used the service and required reviewing so as to ensure people’s care and support needs were met. Staff did not always have enough time to spend with people to meet their needs.

The implementation of staff training was not as effective as it should be so as to ensure that staff knew how to apply their training and provide safe and effective care to the people they supported. Some staff did not demonstrate an understanding of how to support people living with dementia and how this affected people in their daily lives and how to support people who required end of life care. Though staff told us that they felt supported by the registered manager, staff had not received a thorough induction or received regular formal supervision.

People’s comments were variable about the care and support provided. The majority of interactions by staff were routine and task orientated and we could not be assured that people who remained in their bedroom received appropriate care to meet their needs. Some aspects of care practices required improvements. These related to assisting people to eat and drink, communication with people living at the service and care and support to be less routine and task focused.

The dining experience for people was variable and not always appropriate to meet people’s individual nutritional needs. Consideration by staff was not well-thought-out to ensure that eating and drinking was an important part of people’s daily life and a positive experience.

Appropriate assessments had been carried out where people living at the service were not able to make decisions for themselves and to help ensure their rights were protected.

Appropriate recruitment checks were in place which helped to protect people and ensure staff were suitable to work at the service. The management of medicines within the service ensured people received their medication as they should. Suitable arrangements were in place to ensure that the service was clean, hygienic and free from offensive odours.

You can see what actions we told the provider to take at the back of the full version of the report.