Willowbank Nursing Home

Updated 2 November 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by 4 inspectors and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Willowbank Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Willowbank Nursing Home is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority, the local health and care partnership, Healthwatch and professionals who work with the service. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spent time in communal areas observing the care and support provided by staff and visited people in their room. We spoke with 7 people who used the service, 4 relatives and 11 members of staff including representatives of the provider, registered manager, lifestyle co-ordinator, care assistants, care practitioners and nurses. We reviewed a range of records. This included 13 people's care records and multiple people's medicine records. We looked at 3 staff recruitment files. A variety of records relating to the management of the service were reviewed.

Updated 2 November 2023

About the service

Willowbank Nursing Home is a nursing home providing personal and nursing care to older people and people with a physical disability. The service can accommodate up to a maximum of 37 people. At the time of our inspection there were 29 people using the service. The nursing home accommodates people in one adapted building with bedrooms on the ground and first floor. The main communal areas are on the ground floor.

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

There were examples of safe practice but in general people were not safe. People were at risk of harm because the provider did not always identify or mitigate risks. This included risks relating to people's health and wellbeing, and environmental risks such as fire safety. Medicines were not always managed safely. Accidents and incidents were not always appropriately recorded. The service did not ensure staff had the time to give people the care they needed. Robust recruitment checks were not completed before staff started working at the service.

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. Systems were in place to safeguard people from abuse and control infection.

Services were not planned in a way that met people's needs. Care plans were not person-centred and did not always guide staff on people's current care needs. People’s preferences around end of life care were not known although the service did work closely with palliative care specialists to make sure people had a pain-free and comfortable death. Staff interacted with people in a kind and caring way. They described staff as ‘very caring’, ‘good’ and ‘courteous’.

There were widespread and significant shortfalls in the way the service was led. Complaints were not dealt with in an open and transparent way. Systems to assess, monitor and improve the service were not effective. The service had failed to respond to organisational risk such as fire safety concerns. There was a lack of effective leadership and management by both the provider and registered manager. The service had a range of systems which gave people opportunities to share their views and receive information. The service worked in partnership with health and social care professionals.

The provider was responsive to the inspection findings and sent information to show they were taking action to address the areas of risk identified at the inspection.

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 9 February 2021).

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 the provider remained in breach of regulations.

Why we inspected

The inspection was prompted in part due to concerns received about the management of risks to people who used the service, medicines, staffing and complaints. A decision was made for us to inspect and examine those risks.

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.

You can see what action we have asked the provider to take at the end of this full report.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to inadequate. 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 Willowbank Nursing Home on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to risk management, staffing, responding to complaints, person-centred care, recruitment of workers, medicines management and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

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 work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

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.