Willow Bank House Residential Home

Willow Bank House is a residential care home providing personal care for up to 63 people aged 65 and over and who maybe living with dementia. The service is split across two floors within one large adapted building. There was a small unit on each floor, one known as Angel Bec and the other Ray Bold. At the time of the inspection 59 people were living in the home.

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

People told us they felt safe and were supported by the staff who worked in the home. Relatives felt their family member was safe and cared for in the right way. Staff recognised different types of abuse and how to report it. The registered manager understood their safeguarding responsibilities and how to protect people from abuse. Potential risks to people's health and wellbeing had been identified and were managed safely. People, and where appropriate, their relatives, had been involved with decisions in how to reduce risk associated with people’s care. There were sufficient numbers of staff on duty to keep people safe and meet their needs. People's medicines were managed and stored in a safe way. Safe practice was carried out to reduce the risk of infection.

People's care needs had been assessed and reviews took place with the person and, where appropriate, their relative. Staff had the training and support to be able to care for people in line with best practice. People were supported to have a healthy balanced diet and were given food they enjoyed. Staff worked with external healthcare professionals and followed their guidance and advice about how to support people following best practice. 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 did support this practice.

People told us staff were kind and treated them well. Relatives felt the staff cared for their family member in a caring and supportive way. Staff treated people as individuals and respected the choices they made. Staff treated people with care and respect and maintained their dignity.

People's care was delivered in a timely way, with any changes in care being communicated clearly to the staff team. We received mixed views in how people were supported to maintain their hobbies and interest. The activities co-ordinator worked with people and their relatives to learn more about people’s likes and dislikes to develop individualised activities. Where people chose to join the activities, they enjoyed these. People had access to information about how to raise a complaint. People's end of life care needs were met in line with their preferences in a respectful and dignified way.

All people, relatives and staff felt the service was well run. The registered manager was visible within the home and listened to people's and staff's views about the way the service was run. The registered manager had put checks into place to monitor the quality of the service provision. The provider had additional checks in place to ensure the service provision was of a good standard.

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 requires improvement (published 24 October 2018).

Why we inspected

The inspection was prompted in part due to some concerns received about staffing and also the previous ratings of the service. A decision was made for us to inspect and examine those risks.

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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Willow Bank House is a residential care home providing personal care for up to 63 people aged 65 and over and who maybe living with dementia. The service is split across two floors within one large adapted building. There was a small unit on each floor, one known as Angel Bec and the other called Ray Bold. At the time of the inspection 59 people were living in the home.

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

The deployment of staff around the home required further consideration, to ensure people remained safe and their needs were being met. People told us they felt safe from abuse and relatives felt their family members were safe. Staff had a good understanding of how to protect people from harm and recognised different types of abuse and knew how to report it. Potential risks to people's health and wellbeing had been identified and were managed. People, and where appropriate, their relatives, had been involved with decisions on how to meet people’s needs safely. People's received their medicines in a safe way, there was safe management and storage of people’s medicines. While the home appeared clean, there was an unpleasant odour in some areas of the home, the registered manager confirmed the provider had planned dates for the carpets to be replaced to rectify this. We saw safe practice was carried out to reduce the risk of infection.

People's care needs had been assessed and reviews took place with the person and where appropriate their relative. Most staff had completed the providers mandatory training, the staff team required more time to complete their enhanced and specialised training and for this to become embedded within their practice. People were supported to have a healthy balanced diet and were given food they enjoyed. Staff worked with external healthcare professionals and followed their guidance and advice about how to support people following best practice. 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 did support this practice.

People were not consistently supported to maintain their personal care and some people appeared unkempt. Staff treated people as individuals and respected the choices they made. Staff spoke to people in a respectful way.

People's care was delivered in a timely way, with any changes in care being communicated clearly to the staff team. People were supported and encouraged to maintain their hobbies and interests. The provider recognised the importance of social activities and supported the activities co-ordinator in their ideas to enhance the quality of people’s social lives. People had access to information about how to raise a complaint. People's end of life care wishes were recorded in line with their preferences in a respectful and dignified way.

It was recognised that the provider had made improvements to the service provision. However we had identified concerns in safe and caring, which demonstrate that the systems and processes in place to rectify these are not yet established, embedded or reflect that they are sustainable in driving improvement. The provider had made good progress in other aspects of the service provision, and we saw this had a good impact for people living in the home. All people and relatives felt the staff and management were welcoming and friendly. The registered manager was visible within the home and listened to people and staff's views about the way the service was run. The provider had put checks into place to monitor the quality of the service provision.

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 Requires Improvement (published 18 December 2018)

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Willow Bank Rest 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.

Willow Bank House is a residential care home registered to provide care to 63 people, including older people and people living with dementia. The accommodation is split across two floors within one large adapted building. There was a small unit each floor, one known as Angel Bec and the other called Raybold. At the time of our inspection, there were 38 people living at the home.

There was a registered manager in post who was present during 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 in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At our previous inspection on 8 and 15 March and 8 April 2018, we rated the service as 'Inadequate,' and it was therefore placed in 'special measures.' We identified seven breaches of the Regulations. These included the provider’s failure to ensure people were protected from abuse and improper treatment, and people were provided with care in a personalised way from staff who had the support and training to carry out their roles. In addition, the provider had not ensured the premises met people’s individual needs, the principles of the Mental Capacity Act 2005 were adhered to and the overall leadership and governance of the service was effective.

As a result of the inspection, we asked the provider to send us a report explaining the actions they were going to take to improve the service. We also imposed conditions on the provider's registration. These conditions meant the provider was required to tell us, monthly, about how they were auditing aspects of people’s care to ensure people received high quality care. In addition, how the provider supported people’s safety by tracking and analysing incidents and accidents to reduce these from happening again.

At this inspection, the provider showed us sufficient improvements had been made to the service and it was no longer rated as inadequate overall or in any of the key questions. Therefore, the service is no longer in 'special measures.' However, we found the work to improve the service was still ongoing and further time was required to evidence the improvements could be sustained in the longer term which we have reflected in the ratings.

The culture of the service was changing and staff were more confident in recognising and reporting abuse. Staff now had faith in the management team so risks to people’s safety were shared and reduced promptly. The registered manager had made improvements to the processes in place to record incidents and accidents so these were reduced from happening again. They had also improved practices in submitting notifications to us of incidents including abuse as required by law.

Staffing arrangements were now supporting people better so they received safe, effective and responsive care which met their individual needs. There had been a reduction in the number of agency staff used to improve consistency in the care people were provided. Staff were deployed in specific areas of the home to supervise people to promote people's safety and to reduce the risks of people’s safety being compromised.

The systems in place to support the registered manager in monitoring medicines were mostly managed safely. The registered manager understood the improvements required to manage medicines more safely and effectively which included the recommended temperatures at which to store medicines. Staff recruitment procedures reduced the risk of employing staff unsuitable to work in a care environment.

Ongoing improvements were being made to care records so these provided more detail about people, and risks related to people's health and well-being.

The premises and equipment were clean. There were areas of the home environment which had an odour. Staff practices did not always ensure risks of infections were reduced as there were items found in a communal toilet and bathroom/shower room.

People’s mealtime experience had improved and people who were at risk of malnutrition or dehydration were getting more support from staff to encourage them to eat and drink healthily.

Checks were now being undertaken to identify when people had not eaten or drank so staff could provide further encouragement. People had access to health professionals when their health needs changed but further improvements were required to ensure staff always recorded the care provided to make sure this evidenced advice given.

Staff now received better access to training and support to meet the needs of people they cared for. The management team were checking staff’s knowledge and practices to assure themselves people were provided with effective care and improvements were ongoing. Staff felt more supported in their roles. Individual one to one sessions were being planned, and the registered manager was more accessible. Staff had more opportunities to discuss their work issues with management.

We saw improved responses from staff when providing support to people living with dementia, and in respecting people's privacy. Staff had improved their practices in promoting people’s dignity but some people required further support so their continence needs were met better.

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. People’s choices and decisions were now promoted as we saw people spent times in different communal rooms according to their needs and not because it was easier for staff to manage people’s behaviour.

The provider had made some improvements to the home environment. The management team were aware these needed to continue to ensure the home environment meets the needs of people who they had agreed to provide care for.

People had more opportunities to have fun and interesting things to do. Staff were more able to support people with gaining recreational activities which they enjoyed doing and improvements were ongoing with providing items to stimulate people’s different senses.

People who lived at the home and relatives now had more opportunities to share their opinions about the care provided by the provider. Complaints were being managed according to the provider's policy and procedure. Staff felt the provider was now supporting them and the service to improve.

The provider, registered manager and their management team had worked hard to improve the service. They were improving their quality checks to make sure these supported people to receive safe, effective and responsive care. They had made a good start. They needed to ensure the improvements made would be sustained over time and when a higher number of people lived at the home.

Further information is in the detailed findings below.

This inspection visit was a responsive fully comprehensive inspection because we had received information of concern, specifically related to allegations of poor care and mistreatment. We looked at these concerns as part of this inspection and found evidence that supported what we had been told.

This inspection started on 8 March 2018 and was an unannounced visit. We returned announced on 15 March 2018 so we could speak with more staff, more people, to speak with the provider and to look at the provider’s quality assurance systems.

Because of our concerns, following this inspection, we formally wrote to the provider asking them to tell us how they would address our immediate concerns. The provider sent us their response and action plan and we agreed to complete a third inspection visit to assure ourselves, improvements to the service had taken place. We returned unannounced on 4 April 2018. Some improvements had been made however they required more robust monitoring to ensure the improvements were embedded in staff practice. We continued to find evidence of poor practice despite the provider’s action plan and improved control measures.

Willow Bank House is a residential care home registered to provide care to 63 people, including older people and people living with dementia. People in care homes receive accommodation and nursing and/or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. At the time of our inspection visit, 56 people lived at the home. Care was provided across two floors with a small unit on each floor. One unit supported five people living with advanced dementia and was called Angel Beck. The other unit was a female only unit for five people called Raybold.

A requirement of the service’s registration is that they have a registered manager. 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 and the associated Regulations about how the service is run. At the time of our inspection visit there was a registered manager in post, but they were on a temporary leave of absence. At the time of our inspection visits, an interim deputy manager was managing the service.

People were not safe. Although some people and relatives said they felt the service was safe, we found risks to people were not managed well and were not always known or clearly understood by staff. Risks to people were not consistently assessed and therefore people were not kept safe from the risk of harm. Recording of risks was not always evident, and in some cases the records had not been reviewed when needed to reflect changes in people's care and support needs. People were not kept safe from risks associated with some aspects of the environment and staff’s lack of attention placed people at unnecessary risk.

The provider had not always ensured staff had the training or knowledge they needed to undertake their roles safely and appropriately. Staff attended training, but there were significant gaps in staffs knowledge about current good practice. Some staff did not feel supported, especially when reporting poor practice. The staff team consistently included agency staff. The mix of agency staff and staff who lacked experience and knowledge of people’s needs meant staffing was not effective in responding to people’s needs. Staff deployment did not support people’s identified needs so put people at risk.

People were not supported in a consistently caring way. Staff did not always support people in a dignified way and people's rights to privacy were not always respected by the staff.

Staff told us people made their own decisions, but this did not match what we saw or what people and relatives told us. People spent time in different communal rooms according to staff decisions, not according to people’s choice which had a detrimental impact on their wellbeing. Records did not explain how best interests decisions were made, or who made them, on behalf of people who lacked capacity.

People who were at risk of poor nutrition did not receive the support and encouragement they needed to eat and drink enough. Staff did not record people’s food and fluid intake accurately, which meant they were unable to identify increasing risks to people’s nutrition. The provider had failed to adequately explore ways of making the home more dementia friendly. People had access to health professionals when their health needs changed, but the provider's systems and records did not demonstrate that people's healthcare needs were being met and professional’s advice was followed.

People had limited opportunities to follow their interests and hobbies. Some people enjoyed their own company or some group activities, but for others who wanted to be involved in activities that interested them, there were minimal opportunities. People wanted staff to spend time with them, but this was not achievable because staff were too busy supporting people with task based care. People did not always receive care that was responsive to their individual needs and their care was not person centred because choices were not always supported.

Systems used to monitor the quality of the home were not effective at identifying concerns and protecting people from risks to their health, safety and well-being. The governance system at the time of our inspection was not robust and in most areas it was ineffective. Between the first and last day of our inspection visit, there had been very little improvement in the quality of the service in response to our concerns. The provider had not taken the actions to mitigate risks, as described in their own action plan.

The registered manager had not submitted statutory notifications to us in accordance with their legal responsibility to do so.

There were seven breaches of the regulations and the overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special Measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care, should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still 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 this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

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

Willow Bank House Residential Home is registered to provide accommodation for up to 63 people who may be older people or living with dementia or physical disability. There were 60 people living at the home at the time of our focused inspection on12 May 2017.

A registered manager was in post 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 in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People were relaxed when supported by staff. People and their relatives were confident if they raised any concerns about people's safety or well-being staff would take action to support them.

Staff understood risks to people’s safety and took action to meet people’s safety needs. Staff sought and followed the guidance given by external health professionals, so people’s safety would be promoted.

There were enough staff to care for people promptly and to chat to people so they did not become isolated. People were supported by staff to have the medicines they needed in ways which reduced risks of errors.

People and their relatives found the registered manager and senior team to be approachable. The culture in the home was open and relatives were kept informed of developments at the home.

Staff knew what was expected of them and were supported to provide good care.

The registered manager regularly checked the care people received and used their findings to drive through improvement in the care provided. The registered manager recognised people’s needs were changing and worked with other organisations so people would enjoy the best well-being possible as their needs changed.

People had their own rooms and the use of a number of communal areas including a choice of lounges, dining rooms, an internal café and accessible garden areas.

A registered manager was in post 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 in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Risks to people's safety were understood by staff and staff took action to support people in ways which helped them to stay safe. Staff understood what actions to take if they had any concerns for people's safety or wellbeing. There was enough staff available to support people so their care and safety needs would be met. People were supported to take their medicines so they would remain well.

Staff used their knowledge and skills when caring for people so they would get the support they needed in the way they preferred. Staff worked with other organisations so people's freedom and rights were protected. People were supported by staff to enjoy a range of food and drinks. Where people needed extra support to have enough to eat and drink staff cared for them in the ways people chose. Staff worked with health organisations so people would receive the care they needed as their needs changed.

Caring relationships had been built with staff and the registered manager and people were given reassurance when they needed it. Staff supported people so they were able to make their own choices about what daily care they wanted. People's need for dignity was understood and acted upon by staff.

Staff understood people’s individual care and support needs and their preferences and responded to these. People benefited from living in a home where staff took action when people's needs changed. Complaints about the service were treated as opportunities to develop people’s care further and processes were in place so lessons would be learnt.

People, relatives and staff felt listened to when they made suggestions for developing the home further. Staff understood what was expected of them and were supported through training and discussions with their managers. People benefited from living in a home where links had been developed with the community and other organisations. Regular checks were undertaken on the quality of the care by the provider and registered manager and actions were taken to develop the home further.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

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

This is a summary of what we found:

Is the service safe?

People we spoke with told us that they felt their relatives were safe living at the home and their needs were met by staff that knew them. Staff also said that they felt people were safe and their needs were met.

Is the service effective?

We observed that people received appropriate care to meet their physical needs and maintain their comfort. All the staff we spoke with told us about the individual needs of the people that used the service. People did not have to wait for help or support with their health care. This meant that people’s needs could be met more effectively.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We found that DoLS assessments for some people had been reviewed and there were proper policies and procedures in place.

Is the service caring?

We observed that staff were kind and polite. We found that staff treated the people that lived there with dignity and respect. All the staff we spoke with were able to tell us about people’s individual likes and dislikes. People’s wishes had been respected.

Is the service responsive?

Relatives told us that they felt if people’s needs changed the staff were always quick to respond and contact other professionals so that people's needs could continue to be met safely. We found that the care records showed that people who lived at the home saw other professionals including speech and language therapists and doctors when their health needs changed. The provider had acted appropriately to guidance from other professionals when people’s needs changed.

We found that there was a complaints system in place that ensured that people were listened to. We also saw that the provider encouraged feedback from families so that any concerns or comments could be actioned appropriately.

Is the service well led?

The provider had systems in place to effectively monitor the quality of the service. Regular audits and clear action plans showed that the provider had taken steps to ensure that the quality of the service was constantly being monitored and improved.

We found that there was an effective system in place to ensure that risks were identified and actioned appropriately. During this inspection we found that improvements had been made. The procedure had been improved and there were now further checks by the registered manager and clear actions had been taken when risks or improvements had been identified.

Is the service Safe?

We looked at eight staff records. We found that the manager had not carried out robust checks to ensure that staff appointed were suitable to work with vulnerable people.

Is the service Caring?

We observed that staff were generally kind and polite. However we did see some instances where people’s individual needs were not met within an appropriate time. People’s privacy and dignity was not always respected.

Is the service Responsive?

We found that the care records showed that people that lived at the home saw other professionals including the district nurses and doctors when their health needs changed. However we found that there were not enough suitably experienced staff to meet people’s needs if they changed.

Is the service Effective?

We observed that people had not always received appropriate care to meet their physical needs and maintain their comfort.

Is the service Well Led?

The quality assurance systems in place were not always effective in highlighting and addressing shortfalls in a timely manner.

We found that people who lived at the home were complimentary about the staff that cared for them. One person said, “They are lovely”. However, people told us there were not enough staff and they had not always received the care they had expected. One relative told us, “The staff are wonderful, they are just very busy and don’t have time to do the little things”.

Care and treatment was not always planned and delivered in a way that was intended to ensure people's safety and welfare.

People who lived at the home told us that they had been provided with a choice of suitable and nutritious food and drink.

We looked at staff recruitment files. People are put at risk because staff are not recruited and assessed appropriately.

We looked at staffing levels. We found that there was not enough qualified, skilled and experienced staff to meet people’s needs.

People’s complaints were fully investigated and resolved where possible, to their satisfaction.

Records were kept securely and but we had not been able to access all the records we required during the inspection.

We spent some time during this inspection observing and talking with people who lived at Willow Bank House. We saw that people were well cared for and treated with dignity and respect by all staff. We were told that regular activities took place and saw a game of skittles played during our inspection.

People told us that they were able to make choices about their lifestyle. They could choose when they went to bed at night and what time they got up in the morning. People also said they could have meals outside the planned serving times if they wanted this.

Staff told us they were trained and supported to give people the care and support they needed, and that they knew how to keep people safe.

We saw that people who lived at Willow Bank House were given the opportunity to express their views about the service they received. We saw completed questionnaires that showed where staff had supported people where they had needed help to give their views.