Archived: Willow Lodge

Updated 8 December 2017

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.

Willow Lodge is a ‘care home’. People in care homes receive accommodation and nursing care as single under one contractual agreement. CQC regulates both the premises and care provided. We looked at both during this inspection.

Willow Lodge is situated near the centre of Ormskirk, with all amenities close by. The home provides both single and shared room accommodation for up to 22 adults who are living with a dementia related illness and who need assistance with personal and nursing care. Accommodation is provided over two floors; the first floor being served by a passenger lift and stairs. There are spacious communal areas available including lounges, dining areas and two conservatories. There is parking to the front of the property and a garden area to the rear of the home.

This inspection visit took place on 03 October and 10 October 2017. The first day was unannounced. The acting manager was given short notice of the second day of our inspection. This was so that she could be available to provide the information we needed to see.

The inspection activity started on 01 October 2017 and ended on 10 October 2017. It included reviewing the service’s previous inspection report and notifications, which the provider is required to send to us by law about important things that have happened. These included accidents, deaths and safeguarding incidents. Prior to our inspection visit we contacted the commissioning department at Lancashire County Council and Healthwatch Lancashire. Healthwatch is an independent consumer champion for health and social care. This helped us to gain a balanced overview of what people experienced when using the service. We also looked at the information we had received from other sources, such as community professionals involved in the care and support of those who lived at Willow Lodge Nursing Home.

At the time of our inspection there were 19 people who lived at Willow Lodge. Due to those who lived at the home being affected by dementia related conditions, it was not possible to converse with many of them. However, we were able to gather feedback from four people who lived at Willow Lodge and three relatives of those who used the service. In addition we spoke with three members of staff and the acting manager of the home.

We looked at care records of five people who lived at Willow Lodge. We also looked at three staff personnel files to establish the quality of recruitment practices, staff training and supervision. We assessed the arrangement for meal provision and the management of medicines. We also looked at records relating to the management of the home and how staffing levels were calculated. In addition we checked the building to ensure it was clean, hygienic and a safe place for people to live.

We toured the premises, viewing all communal areas and private accommodation with permission. We observed the day-to-day activity within the home. During our inspection, we used a method called Short Observational Framework for Inspection (SOFI). This involved observing staff interactions with people in their care. SOFI is a specific way of observing care to help us understand the experience of people who could not talk.

The inspection team consisted of two adult social care inspectors and a medicines inspector from the Care Quality Commission. The provider had completed and submitted a Provider Information Return (PIR) prior to our last inspection six months previously. We therefore did not request another to be submitted on this occasion. A PIR is a form that asks the provider to give us some key informatio

Updated 8 December 2017

Willow Lodge is located in a residential area of Ormskirk, close to the town centre and all local amenities. The home provides support for up to 22 people who require assistance with personal or nursing care needs and who are living with a dementia related condition. Accommodation is available in both single and shared facilities on two floors served by a passenger lift and stairs. There are spacious communal areas available including lounges and two conservatories. There is parking to the front of the property and a garden area to the rear of the home. At the time of our inspection there were 19 people who lived at Willow Lodge Nursing Home.

The registered manager of Willow Lodge had left employment unexpectedly four months prior to our inspection. 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 of the Health and Social Care Act and associated regulations about how the service is run. The deputy manager had taken on the role of acting manager and was on duty throughout the inspection process.

At the last inspection on 6 December 2016 we rated the service as ‘Requires Improvement’. This was because four breaches of legal requirements were found. These were in relation to person-centred care, safe care and treatment, safeguarding service users from abuse and improper treatment and good governance. At that time Willow Lodge was placed in special measures because the area of ‘safe’ was rated as ‘inadequate’. Therefore, we took steps to ensure people were made safe and the provider submitted an action plan detailing the improvements they planned to make. Comments contained in the action plan were considered during this inspection.

We found at this comprehensive inspection on 03 October and 10 October 2017 the provider had met the legal requirements in relation to person-centred care and safeguarding service users from abuse and improper treatment. However, the concerns previously raised in relation to safe care and treatment and good governance had not been adequately addressed. Therefore the provider continued to fail to meet the legal requirements of the regulations in these areas. We also found the provider did not meet the required regulations in relation to fit and proper persons employed. The domains of ‘safe’ and ‘well led’ were rated as ‘inadequate’ and therefore Willow Lodge remains ‘inadequate’ overall and in special measures.

People who lived at Willow Lodge told us they felt safe being there. Fire procedures were readily available, so that staff were aware of action they needed to take in the event of a fire. However, we found parts of the environment to be unsafe and the management of medicines was poor. There was no evidence available to demonstrate all systems and equipment within the home had been appropriately serviced to ensure they were safe and fit for use. Records were not available about how people needed to be assisted from the building, should evacuation be necessary. Therefore, this was a continuous breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We found that quality monitoring systems had been implemented, but these were not always effective, particularly in relation to medicines management, care planning, recruitment and safety and suitability of the premises. The plans of care were in general well written documents. However, the ones we saw had not all been reviewed and updated to reflect people’s current needs. Although the provider was aware of this; action had not been taken to address these failings. Therefore, this was a continuous breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Recruitment practices adopted by the home were poor. Appropriate background checks had not been conducted, which meant the safety and well-being of those who used the service was not adequately protected. There was no evidence on the staff personnel records that induction programmes had been completed by new employees. This was a breach of Regulation 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Business continuity plans were in place, should evacuation be necessary. However, key staff had not received training in this area. We made a recommendation about this.

We noted that attention to detail in relation to the environment was lacking. We made a recommendation about this.

The plans of care we saw were not always being followed in day to day practice and the provision of activities was limited. We made recommendations in these areas.

We saw 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 adopted by the home were in accordance with the principles of the Mental Capacity Act 2005 (MCA). Records showed detailed Mental Capacity Assessments had been conducted before applications to deprive someone of their liberty were submitted. However, relevant documentation was not retained for those who had legal authority to act on a person’s behalf. We made a recommendation about this.

The acting manager had notified us of any significant events, such as deaths, safeguarding referrals and serious incidents.

We found the risk assessment process in relation to health and social care was satisfactory and systems for the recording of safeguarding incidents had been implemented. The staff team had received training in safeguarding adults and whistle-blowing procedures. Staff members we spoke with were confident in making safeguarding referrals, should the need arise.

We noted there was always a staff presence within the communal areas of the home and people looked comfortable being with staff members. We observed some good interactions between staff and those who lived at Willow Lodge and we found people’s privacy and dignity was, in general respected throughout the day. Staff members were seen to be kind, caring and compassionate.

Where agency workers were used, then these were often the same members of staff, which helped to promote continuity of care and support.

Records showed supervision sessions for staff were completed, although these could have been more structured. Annual appraisals had not been implemented. We made a recommendation about this.

Staff told us they received effective training and they gave some good examples of learning modules, which they had completed. Certificates of training were retained on the personnel records we saw. However, the training matrix did not match this information. We made a recommendation about this.

Meal times were pleasant and relaxed and people we spoke with were complementary about the staff team. They felt they were treated in a kind, caring and respectful manner. People expressed their satisfaction about the home and the services provided.

People we spoke with were aware of how to raise concerns, should they need to do so. A complaints procedure was in place at the home and a system had been implemented for the recording of complaints received. The service worked well with a range of community professionals. This helped to ensure people's health care needs were being appropriately met.

Regular meetings were held for the staff team. This enabled those who worked at the home to discuss topics of interest in an open forum. People's views were also gained through processes, such as satisfaction surveys. However, we made recommendations around the provision of meetings and gathering feedback about the quality of service provided.

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.