This inspection took place on 26 and 27 November 2015 with the first day of the inspection unannounced. A previous inspection undertaken in March 2014 found no breaches of legal requirements.
Willow Lodge is a purpose built care home in the North Shields area of North Tyneside. It is registered to provide accommodation for up to 48 people. At the time of the inspection there were 32 people living at the home, some of who were living with dementia. Accommodation is provided over two floors with more residential needs catered for on the lower level and nursing needs supported on the upper floor, although not exclusively so.
The home’s currently identified registered manager had recently left the home. A new manager had been appointed and she was in the process of registering with the Care Quality Commission. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.
Staff were aware of the need to safeguard people from abuse and had a good understanding of potential abusive situations. They told us they had received training in relation to this area and were able to describe the action they would take if they had any concerns. Records showed that any safeguarding issues had been dealt with appropriately and relevant authorities notified. Staff were also aware of the registered provider’s whistleblowing policy and told us they would immediately raise any concerns they had about care.
On the first day of the inspection there were transient odours in some areas of the home. The treatment room areas (where medicines are stored and some dressings changed), some parts of the kitchen and food trolleys were in need of cleaning. On the second day of our inspection we saw action had been taken and both treatment rooms had been thoroughly cleaned and food trolleys were much improved.
Checks on fire and other safety systems had not taken place for a period of around three months. This was because the previous maintenance man had left the home and no interim system had been put in place to ensure that safety systems were checked. A new maintenance man had recently been appointed and was starting to address this issue.
People’s views of staffing were mixed, with some people telling us there were enough staff and others suggesting they had to wait for assistance. There was one nurse and six care workers on duty during the inspection. However, only two staff were rostered to support the ground floor, with at least three people in this floor requiring help from two staff at time throughout the day. We also observed period of 20 minutes or more when lounge areas were not observed or checked. Suitable recruitment procedures and checks were in place to ensure staff had the right skills to support people at the home.
We found some issues related to the safe management and administration of medicines. Some people’s medicines were signed for before they had been given and people were not always given sufficient time to understand what was being asked of them during medicine administration. Poor ordering systems meant there was both under and over stocking of medicines.
People and relatives told us they felt staff had the right skills to support them. Staff confirmed they had access to a range of training, although highlighted the reliance on ELearning to maintain training levels. Staff also told us regular supervision took place and they received annual appraisals. A small number of staff were still in the process of updating their training and were due to receive supervision and appraisals in the near future.
People had mixed views regarding the meals provided at the home. Some people told us they were very good, whilst others said the quality was variable. We spent time observing lunches at the home and noted the food to be bland and unappetising. People who required a special diet did not always get a choice of meal. People who required assistance were not always supported with their meals in a dignified and appropriate way. Staff often talked over people whilst they were helping them and did not engage in conversation with people during support, neglecting the social aspect of the meal experience. People’s weight and dietary intake were regularly monitored and reviewed.
CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS). DoLS are part of the Mental Capacity Act 2005 (MCA). These safeguards aim to make sure people are looked after in a way that does not inappropriately restrict their freedom. Staff understood the concept of acting in people’s best interests and the need to ensure people made decisions about their care. The registered manager confirmed applications had been made to the local authority to ensure appropriate authorisation and safeguards were in place for those people who met the threshold for DoLS, in line with the MCA.
People we spoke with and their relatives told us they were happy with the care provided. We observed staff treated people patiently and appropriately. Staff were able to demonstrate an understanding of people’s particular needs. People’s health and wellbeing was monitored, with ready access to general practitioners, dentists, opticians and other health professionals. Staff were able to explain how they maintained people’s dignity during the provision of personal care and demonstrated supporting people with dignity and respect throughout the inspection.
Care plans reflected people’s individual needs and were reviewed to reflect changes in people’s care. Care plans also reflected advice from visiting professionals such as occupational therapists or speech and language therapists. Some activities were offered for people to participate in but people also had the opportunity to spend time on their own or in their rooms pursuing their own interests.
People and relatives told us they would speak to the manager if they wished to raise a complaint. We saw from records complaints had been dealt with appropriately and a response offered to the person who made the original complaint.
Audits and checks on the home and the environment had ceased to be carried out after September 2015. Where audit processes were in place, they had failed to pick up on some of the issues we identified, such as the lack of safety checks and the cleanliness of aspects of the home.
Staff felt supported and were positive and enthusiastic about the recently appointed manager’s impact on care and the running of the home. Staff felt the new manager listened to their views or concerns. The new manager told us she was looking to ensure people were at the centre of the home and care was personalised.
We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This related to Person centred care, Safe care and treatment, Staffing and Good governance. You can see what action we told the provider to take at the back of this report.