The inspection took place on 30 December 2014, 5 and 13 January 2015.
Willow House is a care home providing accommodation and personal care for up to 18 older people. Most of the people in the home were living with dementia. When we visited there were 17 people living at the home. The home is a converted residential dwelling with accommodation over two floors. People live in single or shared rooms and bathroom facilities are shared. There is a dining room and sitting room which is also used as an activity room.
The service had a registered manager in post. This is required as a condition of its registration. A registered manager is a person who has registered with the Care Quality Commission (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 and associated Regulations about how the service is run.
People living at the home, their visitors and visiting health professionals were complimentary about the quality of care and the support provided by the registered manager and staff. However, our own observations and the records we looked at did not always match the positive descriptions they had given us.
During this inspection we checked whether the provider had taken action to address the two regulatory breaches we found during our inspections in August 2014. We told the provider they needed to improve their record keeping by 14 October 2014. The provider sent an action plan in relation to care and welfare and stated they would achieve compliance in this area by 31 October 2014. At this inspection we found that the provider had not made improvements in the two areas where we had previously found breaches in legal requirements.
People’s safety was not consistently promoted. Arrangements in place to protect people from harm were not always implemented. When safety incidents occurred these had not always been analysed so preventative action would be taken to keep people safe.
Staff recruitment processes were not robust to ensure people were supported by staff of good character. There were sufficient staff, however, staff did not always understand their roles and responsibilities to provide care that met people’s health needs and wishes. Staff were not always responsive to people’s individual needs and care was not tailored for each individual. This was especially the case for people living with dementia that could not direct staff to meet their needs. These people were not always given opportunities to retain their skills, remain involved in day to day tasks and live a stimulating life. Staff had received limited training and one to one supervision with the registered manager to support them to do their job effectively. Shortfalls in staff knowledge would not be readily identified and could lead to poor practice when supporting people.
We found the service was meeting the legal requirements relating to Deprivation of Liberty Safeguards (DoLS). Where people could not consent to living at Willow House arrangements were being put in place to ensure they were cared for without unlawful restrictions placed on their movement.
The registered manager aimed to promote a culture of openness and personalised care where people came first. However, their efforts did not always deliver a person focused service as people and staff were not actively involved in the delivery and improvement of the service. Especially people living with dementia, who could not communicate their wishes to staff, were not always full partners in their care and service planning.
Though the provider knew improvements to the service were required systems were not in place to deliver improvements in care.
We found several breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, including two continuous breaches from previous inspections. You can see what action we told the provider to take at the back of the full version of this report.