Willow Grange Nursing Home

Willow Grange Nursing Home is a residential care home providing personal and nursing care for up to 44 people. At the time of inspection, 29 people were using the service, some of whom were living with dementia.

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

Risks to people’s health were not always identified and managed. Medicines were not always managed well. The medicines policy was not up to date and did not provide sufficient guidance to staff. Staff understood how to identify and report abuse. People were protected from the risk of infection.

Staff required more support in their supervisions. Staff received training to enhance their knowledge. People had access to sufficient food and drink.

Relatives told us that sometimes staff were not always kind and caring. Staff did not always deliver care in a manner that respected people’s dignity and privacy. People were supported to maintain their independence.

Care records were not always consistent and a reflection of people’s needs. There was no registered manager at the service. The provider did not always engage with stakeholders to drive improvement. Lessons were not drawn from incidents that happened at the service to improve the quality of care. Audits had not identified the issues we found during the inspection.

People who used the service and their relatives knew how to make a complaint or raise concerns about the care provided.

We were assured the provider was working within current guidance on good infection prevention and control guidelines in relation to the COVID-19 pandemic. Risk management plans mitigated risks in relation to COVID-19 pandemic and spreading of infections. Staff followed guidance to respond to COVID-19 and other infection outbreaks effectively. Staff had access to sufficient Personal Protective Equipment and used it appropriately. Visitors underwent COVID-19 checks to minimise the risk of spreading of infection.

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 (published 3 December 2019). The service is now rated requires improvement.

This report only covers our findings in relation to the key questions; Is the service Safe, Effective, Caring and Well-led.

Why we inspected

We received concerns in relation to concerns about people’s wishes not being respected, learning from incidents and management of the home. As a result, we undertook a focused inspection to review the key questions of safe, caring and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We also 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. As we did not look at the entire key question of Safe the rating for the Safe key question has not been changed.

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

During this inspection we found breaches in relation to condition of registration of a registered manager, dignity and respect and good governance

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to respect and dignity and good governance at this inspection.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our inspection programme. If we receive any concerning information we may inspect sooner.

Willow Grange Nursing Home is a care home providing nursing and/or personal care to 33 people aged 45 and over at the time of the inspection. The service can accommodate and support up to 44 people in a single adapted three-storey building. The service supports people living with a range of care needs, including those associated with dementia, physical disabilities, acquired brain injuries, mental ill health, learning disabilities, sensory impairment and complex health conditions, such as diabetes.

People’s experience of using this service

At the service’s last inspection, before the it was registered with the current provider they were rated requires improvement overall and there were multiple breaches of regulations in relation staff working practices, their training and deployment in the care home, activities and how quality monitoring systems were operated. t this inspection we found the provider had made enough improvements to ensure they were not in breach of regulations. This was because we found staff treated people with dignity and respect, people received personalised care and support from suitably trained and supported staff who were familiar with people’s individual needs and wishes, people had more opportunities to choose to participate in meaningful social activities, and the providers new and existing quality monitoring systems were more effectively operated.

Similarly, most people using the service and their relatives told us the care home had significantly improved in the last six months under the leadership of the newly registered manager and her management team. A quote we received from a relative summed up how most people felt about the service - “The care has definitely got better. The new manager has done a great job employing lots of new nurses who know how to look after my [family member]. She [registered manager] is far more open to new ideas and approachable compared to the previous one.”

People, their relatives and staff all spoke positively about the leadership approach of the newly registered manager. All the service’s new managers demonstrated a good understanding of the importance of quality monitoring and analysing and learning lessons when things went wrong in order to continuously improve the care home. The managers involved people and staff in the running of the care home. They also worked in close partnership with community professionals and groups.

However, the provider will still need to demonstrate they can continue to effectively operate their new and existing quality monitoring and governance systems. We need to see the improvements described above can be sustained over a much longer period of time.

Progress made by the provider to continually improve the service will be assessed at their next inspection.

Since our last inspection the services main communal areas had all been repainted and furbished with new furniture, light fittings, flooring and soft furnishings.

However, the service still lacked any easy to understand pictorial signage, colour contrasting doors and walls and memory boxes to make the environment more suitable for people living with dementia. The provider had an action plan to display easy to understand pictorial signage and memory boxes near people’s bedrooms.

Progress made by the provider to achieve these stated aims will also be assessed at the service’s next inspection.

People were cared for by staff who knew how to keep them safe and protect them from avoidable harm. People received their medicines safely and as prescribed. Staff continued to undergo all the relevant pre-employment checks to ensure their suitability and fitness for the role. The premises were clean and staff followed relevant national guidelines regarding the prevention and control of infection.

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 offered well-balanced meals that meet their dietary needs and wishes, and were supported to stay healthy and well.

People were treated equally and had their human rights and diversity respected. People had their privacy respected. People were encouraged to make decisions about the care and support they received. People were supported to be as independent as they could and wanted to be.

People had their own individualised care plan for staff to follow. People’s communication needs and preferences continued to be respected and met. People were aware of the providers’ complaints policy and how to raise any concerns or complaints they may have. When people were nearing the end of their life, they continued to receive compassionate and supportive palliative care.

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

Rating at the last inspection

The last rating for this service was requires improvement (published 4 September 2018). Since this rating was awarded the registered provider of the service has changed. This was the first rating under the new provider since its registration in October 2018.

Why we inspected

This was a planned inspection based on our methodology, which states services must be inspected within 12 months of being reregistered with us.

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.