Archived: Willow Park Lodge Care Home

Willow Park Lodge is a residential care home providing personal and nursing care. The service can support up to 79 people in a purpose-built building. There are four floors of single room accommodation with en-suite facilities. At this inspection there were 32 people living at the service, six people living on the ground floor and 26 people on the first floor. No one was receiving nursing care.

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

People and relatives told us they felt safe living at the service. Since the last inspection the registered manager had left, the deputy manager had been promoted and was in the process of registering with the Care Quality Commission. The service continued to improve but further improvements were required.

Potential risks to people’s health, welfare and safety had been assessed. There was guidance in place for staff to mitigate the risks, however, some care plans required additional points to be personalised. Accidents and incidents had been recorded and analysed to identify patterns and trends.

Staffing levels were at the minimum to meet people’s needs and keep them safe. The manager continued to recruit care staff. New staff were being inducted during the inspection. Staff were recruited safely.

The service was clean, and staff followed infection control guidelines. Medicines were managed safely. Staff received training and their competency was checked before they administered medicines.

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 supported this practice.

People were treated with kindness and compassion. Staff supported people to be as independent as possible and be involved in making decisions about their care. People and relatives were invited to attend meetings to discuss the service and give their views. Staff attended regular meetings to discuss their practice.

Checks and audits had been completed on all areas of the service. When shortfalls had been identified, action had been taken to rectify them. The provider completed quality checks on the service and a service development plan had been produced, which the manager was using to make improvements. Complaints had been recorded, investigated and action taken if required.

People told us they received care and support in the way they preferred. People had access to activities they enjoyed.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 20 November 2020).

The provider completed an action plan after the inspection in February 2020 to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations. The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

This inspection was prompted by our data insight that assesses potential risks at services, concerns raised and based on the previous rating.

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.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report covers our findings in relation to the breaches of regulation in Key Questions Effective, Caring and Responsive which contain those requirements. The Key Questions Effective, Caring and Responsive were inspected but not rated as not all the domain was covered.

The ratings from the previous comprehensive inspection for those key questions not rated on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has remained Requires Improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Willow Park Lodge on our website at www.cqc.org.uk.

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 Park Lodge Care Home is a residential care home providing personal and nursing care. The service can support up to 79 people. At the time of the inspection there were 37 people living at the service. No -one was receiving nursing care.

The service is a purpose-built building which is split over four floors. At the time of the inspection the ground and fourth floor were not occupied. People who lived with dementia were accommodated on the second floor. At the time of the inspection there were 19 people living on the second floor.

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

People and their relatives told us that there had been a lot of improvements since the new registered manager came to post. A relative said, “We were so worried before and it’s now such a relief to know my relative is getting everything that they need. They are doing all the right things now.”

Since the last inspection the manager had registered with the Care Quality Commission. They and the provider understood their legal responsibilities and had shared information with us and others when they needed to.

Management of the service had improved significantly. The registered manager had oversight and scrutiny of the service and was receiving support from the providers representatives. People, their relatives and staff spoke highly of the registered manager. They were described as ‘approachable’ and ‘got things done.’

The registered manager told us they had worked hard to address the breaches and shortfalls identified at the last inspection. They had worked through a comprehensive action plan.

Rsks to people had been identified and mitigated. However, guidance for some risks had not been fully recorded and further improvements were needed to ensure people were kept as safe as possible and staff were consistent in their approach. Risks concerning the environment had been addressed including the risks previously identified by the local fire officer. There was a clear vision and open culture. A governance framework was in place which covered all aspects of the service and the care delivered. Numerous quality assurance audits had been completed. Shortfalls had been identified and plans were in place to continue with the improvements. We will check that improvements have continued and sustained at the next inspection. People, relatives and staff were engaged in the service. Their views were listened to and acted on.

Records were in place and accessible including information on safeguarding and accidents and incidences. People and their relatives told us they or their family members felt safe and well supported at the service. People were protected from abuse and avoidable harm and were treated with respect and dignity. When accidents or incidents occurred, learning was identified to reduce the risk of them happening again.

The management of medicines had improved. People received their prescribed medicines when they needed them. The service worked in partnership with other professionals, and the community when able to do so.

The registered manager and staff promoted and encouraged person centred care to ensure people were treated as individuals. They knew how people preferred to receive their care and support.

There were enough staff available to make sure people received the personal care and support that they needed. People's needs had been assessed and assessments had been used to plan staffing levels. Staff had been recruited safely to make sure they were suitable to work with people at Willow Park Lodge.

Rating at last inspection and update

The last rating for this service was inadequate (published 15 June 2020) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations in the domains we inspected. There were areas that needed further improvement.

This service has been in Special Measures since 15 June 2020. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We carried out a comprehensive inspection of this service on 5 and 7 February 2020. Breaches of legal requirements were found. We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the key questions safe and well-led which refer to those requirements.

The ratings from the previous comprehensive inspection for those key questions, not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from inadequate to requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Willow Park Lodge on our website at www.cqc.org.uk.

Follow up

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

Willow Park Lodge Care Home is a residential care home providing personal and nursing care to 49 people at the time of the inspection. The service can support up to 79 people.

The service is provided in a purpose-built building which is split over four floors, however at the time of the inspection the fourth floor was not occupied. People who lived with dementia were accommodated on the second floor. At the time of the inspection there were 23 people living on the second floor.

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

Relatives told us that the service had been very poor, but the new manager had made some improvements and they were hopeful things would continue to improve. Comments included, “It went downhill quickly. It was heart breaking. Just coming in today I have noticed a change already. It’s tidier.” And, “We’ve not been very happy but now it is a lot cleaner, the staff are happier. There are a lot of agency, but we are hoping that things will improve.”

Management of the service had been exceptionally poor, and the providers had lacked oversight. Communication between staff needed to be improved. Records were absent for a large portion of the previous year including records of safeguarding and incidents. The nominated individual told us that some records had been deleted from the system without the providers agreement.

Incidents had not been well investigated and some safeguarding concerns had not been reported to the Care Quality Commission (CQC) or the local authority at the time they occurred. Since the deputy manager took over running the service concerns had been reported to safeguarding where appropriate. However, there continued to be concerns about reporting safeguardings to the Care Quality Commission (CQC).

There had been no regular audits of the service. When concerns had been identified the provider had not acted in a robust and timely manner to ensure that these were resolved quickly and that standards of care were improved.

Staffing levels had fallen to very low levels and at the inspection, they had been increased again. However, we found they still needed to be improved. Staffing levels have been increased since the inspection. However, we were unable to assess the impact of these changes and if improvements had been sustained.

Staff training needed to be improved to ensure that staff had the skills and confidence to meet people’s needs safely and effectively. Staff had not always been well supported.

The management of medicines needed to be improved. Although they were well organised, and records were complete, staff administering medicines were also responsible for receiving and making phone calls. This meant on some days some medicines rounds were long and there was a risk doses would be given too close together.

People’s needs had been assessed. However, assessments had not been used to plan staffing levels or ensure that staff had the training they needed to meet people’s needs. Risks to people had not been well managed and there was a lack of monitoring in place. The monitoring of people’s hydration needed to be improved. Risks from the environment needed to be addressed including developing an appropriate action plan to resolve some concerns raised by the local fire and rescue service. Care plans were not up to date, and staff told us they had not had the opportunity to spend time reading care plans.

Staff lacked the time to provide person centred care and support people in a dignified manner. People were not always treated as well as they should have been. However, people told us most staff were kind and caring.

The environment needed improvement to ensure it was more dementia friendly and in line with best practice guidance. Feedback about the food was mixed. However, most people said the food was nice. People told us they had not been asked for their feedback about the food.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. Capacity assessments for specific decisions had not been completed and there were no records of decisions being made in people’s best interests.

People and their relatives had not been consulted about their views. However, the new manager had started to make improvements in this respect. There were no records of some complaints made.

There was a schedule of activities. However, there was no evidence that people had been consulted about these or offered an alternative activity if they did not want to attend a group activity that day. There were no records of staff spending social time with people who were cared for in bed or spent most of their time in their room.

A new manager had been recruited who started at the service the two days prior to the inspection. The new manager was supported by a deputy manager. The new manager had started to make improvements to the service.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was Good overall and Requires Improvement in Well-Led (published 01 June 2018). However, there were no breaches of regulation at the last inspection and the provider was not required to submit an action plan to show what they would do and by when to improve.

At this inspection we found the service had deteriorated and there were multiple breaches in regulation.

Why we inspected

The inspection was prompted in part due to concerns we received about the management of the service and standards of care. A decision was made for us to inspect and examine those risks.

Enforcement

We have identified breaches in relation to risks to people, risks from the environment, staffing levels, staff training, consent, person centred care, complaints, treating people with dignity, management, reporting concerns to the Commission.

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

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

Willow Park Lodge 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; both were looked at during this inspection. Willow Park Lodge accommodates up to 79 people in purpose built building. At the time of the inspection there were 20 people living at the service. The service will continue to be monitored as additional people move into the service.

There was a registered manager in post. 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 protected from abuse. Staff knew how to recognise the signs of abuse and how to report any concerns. The registered manager had reported any concerns to the local safeguarding authority when appropriate.

Potential risks to people’s health and welfare had been assessed and staff had detailed guidance to mitigate the risk and keep people safe. Accidents and incidents were recorded and analysed to identify any trends and patterns, action was taken to reduce the risk of them happening again.

Checks and audits were completed on all aspects of the service. The audits had identified shortfalls, however, action plans to show what action needed to be taken, by whom and if the action had been completed were not always in place. This was an area for improvement. Records showed that action had been taken and the shortfalls had been rectified. Checks had been completed on the environment and equipment people used to keep people safe.

Willow Park Lodge was purpose built and met people’s needs. People had access to outside space. The service was clean and odour free.

People were supported to express their views about their care; however, information was not always available in different formats to assist people’s understanding. People, relatives and staff were invited to give their views on the service. The responses were mainly positive but when suggestions had been made the outcomes had not been consistently recorded or analysed. We have made a recommendation about this.

There were sufficient staff to meet people’s needs, staff had been recruited safely. Staff told us they felt supported by the registered manager and had received supervision to discuss their practice and development. New staff completed an induction, their competency was assessed, staff received training appropriate to their role.

People received their medicines safely and when they needed them. Staff monitored people’s health and referred them to specialist healthcare professionals when needed. Staff followed any guidance given. People had access to health professionals such as dentists when required. People had enough to eat and drink and were supported to eat a healthy diet.

People’s needs were assessed before they moved into the service using recognised tools in line with current guidance. Each person had a care plan that detailed their choices and preferences, these care plans were reviewed regularly. People were asked about their end of life wishes and these were recorded when people wanted to discuss them.

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.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The registered manager had a system in place to track and monitor applications and authorisations.

The provider had a complaints policy, complaints had been investigated in line with the provider’s policy.

People were treated with dignity and respect. People were encouraged to be as independent as possible. Staff supported people to take part in activities that interested them and encouraged them to be part of the community.

The registered manager’s vision for the service was to provide excellent quality care and community engagement to ensure people are able to live their lives fully. Staff shared this vision and understood their roles and responsibilities to ensure the vision is attainable. The service had and was continuing to build links with the community. The registered manager worked with outside agencies such as the local safeguarding authority.

Services that provide health and social care to people are required to inform CQC of important events that happen in the service. This meant we could check that appropriate action had been taken. The registered manager had informed CQC of important events in a timely manner as required.