We carried out an unannounced inspection of Willowbank on 12 and 13 November 2014. Willowbank is a care home which is registered to provide care for up to 53 people. It specialises in the care of people who have dementia or mental ill health. The service provides nursing care. At the time of the inspection there were 49 people accommodated in the home.
The home is set in a residential area approximately a mile from Burnley town centre with shops, a post office, public houses and a bus route nearby. The home is a detached three storey building with a purpose built extension set in 1.5 acres of gardens.
At the previous inspection on 16 July 2013 we found the service was meeting all standards assessed.
There is a registered manager in day to day charge of the 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 made positive comments about the management arrangements. Staff told us, “There is a good atmosphere. The manager is easy to approach.” Comments from health and social care professionals included, “The manager is willing to listen and work with us” and “The manager is really good and has made changes that are beneficial to the home.”
People told us they felt safe and were looked after. One person said, “They (the staff) are very kind.” A relative told us, “I have not seen the staff do anything they shouldn’t.” Staff knew what to do if they witnessed or suspected any poor practice. Management and staff had responded promptly and appropriately to any incidents.
The Mental Capacity Act 2005 (MCA) sets out what must be done to make sure the rights of people who may lack capacity to make safe decisions are protected. The Deprivation of Liberty Safeguards (DoLS) provides a legal framework to protect people who need to be deprived of their liberty to ensure they receive the care and treatment they need. We found staff had varied levels of understanding of the MCA and DoLS processes. However, the registered manager had made appropriate referrals to ensure people were safe and their best interests were considered.
We observed people being offered choices and, where possible, consenting to care and treatment. Staff had a good understanding of people’s abilities to make safe decisions and choices for themselves which should help make sure restrictions on their freedom were no more than was necessary.
People were able to take risks as part of their daily lifestyle which meant their independence, rights and lifestyle choices were respected. One person said, “I tend to do my own thing. I tell them when I leave and when I get back; they like to know to make sure I am safe.” Some people living in the home behaved in a way that could place themselves and others at risk of harm. Staff had received training to help them respond appropriately and keep themselves and others safe.
A safe and fair recruitment process had been followed which should help protect people from unsuitable staff. We found the arrangements for managing people’s medicines were safe.
There were sufficient nursing, care and ancillary staff to meet people's needs. A health and social care professional told us, “The staffing ratio is good.” A person living in the home said, “There always seems to be staff around if you need them.” A relative said, “I have always seen plenty of staff and never seen anyone having to wait a long time for anything.” During our visit we observed staff in attendance in all areas of the home and people's calls for assistance were promptly responded to.
Staff received appropriate supervision, training and induction to give them the necessary skills and knowledge to look after people properly. We observed staff being kind, friendly and respectful of people's choices and opinions. People living in the home told us they were happy with the staff and information from the recent customer satisfaction survey was very positive. One person said, “All the staff are very kind and friendly.”
There were strong odours in some areas of the home. The registered manager was aware of the problem and described the action taken to date and further plans to resolve the issue. The registered manager was confident the issue would be resolved within a short timescale. Following the inspection we were told new flooring would be fitted in December 2014.
People's nutritional needs had been assessed which helped determine whether they were at risk of dehydration or malnutrition and staff were able to provide specialist diets as needed. People told us they enjoyed the food and were offered choices. A visitor said, “The food seems good, I have eaten here and my relative has put weight on.” We observed the lunch time meal in both dining areas and saw people were given support and encouragement as needed. In the ‘quiet’ dining room there was very little conversation between staff and people living in the home and people chose to sit alone. The main dining room was very busy with lots of chatter and encouraging words from staff. However, there was little room to move around once everyone was seated. We noted people were provided with plastic plates and cups when there appeared to be no reason for this. The registered manager suggested how people’s dining experience could be improved.
Care plans were well presented and contained information about people’s likes and dislikes and any risks to their well-being as well as their care and support needs. A visitor confirmed they had been involved in developing the care plan and consulted about their relative’s care needs.
There were opportunities for involvement in a range of suitable activities both inside and outside the home. Activities included aromatherapy massage, garden parties, themed parties, visits from local entertainers, tea dances, crafts, bingo and clothing parties. People were able to discuss the activities they would prefer which should help make sure activities were tailored to each individual.
The complaints procedure was displayed in each person’s room and around the home. People told us they knew who to complain to if they were unhappy about any aspect of their care. One person said, “I will tell the staff if I am unhappy about anything.” People were encouraged to discuss any concerns during regular ‘chit chat’ meetings, during day to day discussions with staff and management and also as part of the annual satisfaction survey.
There were systems in place to assess and monitor the quality of the service with evidence these systems had identified a number of shortfalls and improvements had been made. However, the registered manager was currently reviewing the audit tools.
During the inspection we found the service was meeting the required legal obligations and conditions of registrations. The registered manager had notified the commission of any notifiable incidents in the home in line with the current regulations. There were effective systems to ensure any accidents and incidents were recorded and analysed to identify any patterns or areas requiring improvement.