Archived: The Willows Care Centre

Updated 22 November 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 took place on 9 and 10 October 2018 and was unannounced. The inspection team consisted of one inspector, a medicines inspector and an expert by experience in older persons care. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Before the inspection we reviewed the information about the service the provider had 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. We also looked at notifications and reports received by the Care Quality Commission. A notification is information about important events, which the provider is required to tell us about by law.

Before the inspection we also asked for feedback on the service from community professionals and other visitors who had involvement with the service and staff. We received information from a GP, a podiatrist, a pharmacist, a paid advocate, local authority safeguarding and commissioning staff and a clinical nurse specialist for older people who has supported the registered manager and staff.

We looked at five people’s care and support records and associated risk assessments. We looked at everyone’s medicine records. We looked at management records including two staff recruitment, training and support records and staff meeting minutes. We observed people spending time with staff. We spoke with the registered manager, deputy manager, five staff and 16 people who use the service and their relatives.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

Updated 22 November 2018

The Willows Care Centre is a ‘care home’. People in care homes receive accommodation and nursing 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. The service is a large converted property. Accommodation is arranged over three floors and a lift is available to assist people to get to the upper floors. The service provides care for up to 40 older people, people living with dementia or people with a mental health condition. There were 32 people living at the service at the time of our inspection.

At the last inspection we found continued breaches of regulations 12, 17 and 18 of the Health and Social Care Act 2008 and the service was rated Requires Improvement. Following the inspection, we asked the provider to complete an action plan to show what they would do and by when to address the breaches. At this inspection we found that the provider had completed their action plan and the service was no longer in breach of regulations.

Since our last inspection the provider had completed their plan to stop providing nursing care at The Willows Care Centre. People who required nursing care had been supported to move to alternative services and the provider no longer employed registered nurses.

At our last inspection in August 2017 we found people were at risk of harm because their medicines were not managed safely. At this inspection we found that significant improvements had been made to the management of people’s medicines and people were no longer at risk.

People were now protected from the risk of harm. Previously risks to people had not been assessed and action had not been taken to mitigate risks. Risks had now been identified and action had been taken to manage them.

Records about people and the care they received were now accurate and complete, held securely and easily accessible to staff when they needed them. The provider had addressed the shortfalls in the record keeping and storage found at our last inspection.

Previously effective systems to assess, monitor and improve the quality and safety of the service were not in operation. Since our last inspection the provider had improved the checks completed at the service and now had oversight of the service. The registered manager and the provider checked all areas of the service regularly to make sure it met the standards they required. Any shortfalls had been identified and action was planned and completed to address them. The views of people, their relatives, staff and community professionals were asked for and acted on to continually improve the service.

A registered manager was leading the service. 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.

Staff felt supported by the registered manager and were motivated. A member of the management team was always available to provide the support and guidance staff needed. Staff worked together to support people to be as independent as they wanted to be. All the staff we spoke with told us they would be happy for their relatives to live at The Willows Care Centre.

Staff were kind and caring and treated people with dignity and respect. They took time to get to know each person well and provide the care people wanted in the way they preferred. People received the care and support they wanted at the end of their life. Since our last inspection the provider had begun to implement the Gold Standards Framework (GSF) for end of life care. The GSF is a recognised approach to ensuring that everyone receives appropriate and individualised care which takes account of their wishes and preferences at the end of their life.

Assessments of people’s needs and any risks had been completed and care had been planned with them, to meet their needs and preferences and keep them safe. Accidents and incidents had been analysed to look for patterns and trends. The registered manager worked in partnership with local authority safeguarding and commissioning teams, and a clinical nurse specialist for older people and acted on their advice to develop the service and improve people’s care.

Staff knew the signs of abuse and were confident to raise any concerns they had with the registered manager or provider. People were not discriminated against and received care tailored to them. A process was in operation to investigate and resolve complaints to people’s satisfaction. People had enough to do during the day, including activities to keep them physically and mentally active.

Changes in people’s health were identified and people were supported to see health care professionals, including GPs when they needed. People were offered a balanced diet of food they liked and that met their cultural needs and preferences. Staff supported people to be as independent as they wanted at mealtimes.

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 support this practice. The registered manager knew when assessments of people’s capacity to make decisions were needed. Information was available to people in a way their understood to help them make decisions and choices. Staff treated people with dignity and gave them privacy. The registered manager understood their responsibilities under Deprivation of Liberty Safeguards (DoLS), and had applied for authorisations when there was a risk that people may be deprived of their liberty to keep them safe.

There were enough staff to provide the care and support people needed when they wanted it. New staff were recruited safely. Disclosure and Barring Service (DBS) criminal records checks had been completed to make sure staff were suitable for their role. Staff were supported meet people’s needs and had completed the training they needed to fulfil their role.

The service was clean and staff followed infection control processes to protect people from the risk of infection. The building was well maintained and plans were in operation to maintain and improve the environment. People were able to use all areas of the building and grounds and were encouraged to make their bedroom feel homely.

The registered manager had informed CQC of significant events that had happened at the service, so we could check that appropriate action had been taken.

Services are required to prominently display their CQC performance rating. The provider had displayed the rating in the entrance hall and on their website.

Further information is in the detailed findings below.