Willowbrooke Residential Home

Updated 5 April 2018

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 visit took place on 27 February 2018 and was unannounced.

The inspection team consisted of one adult social care inspector, who is the lead inspector for the service and an expert by experience who had experience of caring for older adults and those living with dementia. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of service.

Prior to the inspection we had received information of concern and other safeguarding concerns about the service. The concerns had been reported to the local safeguarding authority who had undertaken investigations. We also explored how safeguarding concerns were managed in the service as part of this inspection.

We used information the provider sent us in the Provider Information Return. This is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make.

Before the inspection we reviewed the information we held about the service. This included safeguarding alerts and statutory notifications sent to us by the manager about incidents and events that had occurred at the service. A notification is information about important events, which the provider is required to send us by law. We also contacted health and social care professionals who worked alongside the service. We also reviewed the information we held about the service and the provider.

We spoke with a range of people about the home including seven people who lived at the home, three visitors and five staff. In addition, we also spoke with the chef, the deputy manager, the interim manager and one of the directors.

We looked at the care records of six people who lived at the home, training records and three recruitment records of staff members and records relating to the management of the service.

Updated 5 April 2018

This unannounced inspection took place on 27 February 2018.

Willowbrooke Residential Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. The care home accommodates 19 people. At the time of the visit there were 16 people who received support with personal care. There is no nursing care at this service.

At the time of our inspection there was no registered manager in post. The registered manager had recently left. A new manager had been appointed and was in the process of completing an application to become the registered manager. A registered manager is a person who has registered with the 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.

At the last inspection in March 2017, we found shortfalls in a number of areas. This included shortfalls in the effective management of risks to receiving care and a failure to implement systems and processes for seeking consent and mental capacity assessments. We also found shortfalls in the governance systems. This included a lack of evidence to demonstrate the oversight provided to the registered manager to ensure compliance. The provider had also failed to implement systems and processes for auditing and assessing the quality of the care. These were breaches of Regulation 11, 12 and17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Following the last inspection, we took enforcement action and issued the provider with a warning notice for the failure to maintain good governance and for failing to seek consent. We also met with the provider and asked them to complete an action plan to show what they would do and by when to improve the key question(s), ‘Is the service safe, Is the service effective, and Is the service well-led?’ to at least good.

During this inspection we reviewed actions the provider told us they had taken to gain compliance against the warning notice and breaches in regulations identified in March 2017. We found necessary improvements had been made in relation to the management of risks to receiving care, the safe management of medicines and seeking consent. We also found significant improvements had been made in relation to good governance and the provision of oversight at the service.

We received positive feedback from people and their relatives regarding the quality of the care delivered. Visiting professionals we spoke with also gave positive feedback about the service. People who lived at the home told us that they felt safe and spoke highly of the owner and the care staff.

We found there had been significant improvements to the quality of care provided since our last inspection. The registered provider and their staff had made necessary improvements to address the shortfalls we found in March 2017 to ensure the service was compliant with regulations. Necessary improvements had been made to the management of risks to receiving care. Risk assessments had been developed and reviewed to minimise the potential risk of harm to people who lived at the home.

People told us they received their medicines as prescribed and staff had been trained in the safe management of medicines. Improvements had been made to the management of topical creams and thickening powders. Regular medicine audits had been carried out and issues were identified and rectified promptly.

There were significant improvements to processes for seeking consent. The staff who worked in this service made sure that people had choice and control over their lives and supported them in the least restrictive way possible. Staff had improved their knowledge and understanding of the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). People’s consent to various aspects of their care was considered. This was a noted improvement since our last inspection.

Staff had received safeguarding training and knew how to report concerns to safeguarding professionals. Accident and incidents had been recorded and staff had sought medical advice where necessary. Safe recruitment of staff and checks were carried out to ensure suitable people were employed to work at the home.

The environment had been adapted to suit the needs of people living at the home. In addition the home had been decorated and maintained to high standards and kept clean. There was an ongoing program of renovation and improvements.

Risks associated with fire had been managed and fire prevention equipment serviced in line with related regulations. Risks of infection had been managed. The environment was clean.

Care plans were in place detailing how people wished to be supported. People’s independence was promoted.

The provider had sought people’s opinions on the quality of care and treatment being provided. Relatives and residents meetings and surveys had been undertaken to seek people’s opinions. We saw the provider was responsive to people’s views and opinions and took prompt action to respond to people’s feedback. However, they needed to formally analyse surveys and give people feedback.

We observed that regular snacks and drinks were provided between meals to ensure people received adequate nutrition and hydration. People’s nutritional needs were met. Risks of malnutrition and dehydration had been assessed and monitored. Comments from people who lived at the home were all positive about the quality of meals provided. We found people had access to healthcare professionals and their healthcare needs were met. Relevant health care advice had been sought so that people could receive the treatment and support they needed.

There were a variety of activities for people including regular fitness exercises, crafts and outdoor trips. We observed people being encouraged to participate in activities of their choice. Feedback from people was positive.

People who used the service and their relatives knew how to raise a concern or to make a complaint. The complaint’s procedure was available and people said they were encouraged to raise concerns.

Staff had had been provided with training, supervision and induction.

Staff told us there was a positive culture within the service. Staff we spoke with told us they enjoyed their work and wanted to do their best to enhance the experience of people who lived at the home.

The provider had considered best practice in various areas and had invested in assistive technology to meet people’s needs. There was a commitment to provide high standards of care.

The registered provider used a variety of methods to assess and monitor the quality of care at the home. Governance and management systems in the home had improved and the provider had sought external support to monitor the quality of the service. There were checks in various areas such as medicine, care plans, health and safety.