Willows Care Home

Updated 10 February 2024

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

This inspection was carried out by 3 inspectors and a nurse specialist advisor.

Service and service type

Willows Care 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. Willows Care 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 not a registered manager in post for 12 months. A new manager had been in post since September 2023 and had submitted an application to register.

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 and professionals who work with the service. 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 spoke with 8 people who used the service and 4 family members about their experience of the care provided. We also observed interactions between staff and people who used the service.

We spoke with 9 members of staff including the home manager, compliance manager, nurses, carers and kitchen staff. We reviewed a range of records. This included 10 people's care records and other records relating to people care who lived in The Willows. We looked at 5 staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.

Updated 10 February 2024

About the service

Willows Care Home is a residential care home providing personal and nursing care to up to 73 people. The service provides support to older people, a number of whom live with dementia. At the time of our inspection there were 40 people using the service.

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

Refurbishment improvements were required across communal areas and bedrooms. At our last inspection the provider shared ongoing refurbishment and redecoration of the home was planned and ongoing. However, at this inspection we saw limited improvements had been made and a deterioration of the management of infection control due to this.

We identified improvements were required to the staff deployment across the home to ensure staff were available to provide care to people promptly. During the inspection we observed long periods where people were left in communal lounges with no staff present to provide support promptly, which left people at risk.

We observed a lack of engagement and activities in communal areas and for people nursed or remained in bed. At our last inspection this was an area of improvement we identified the provider required to make; at this inspection a new activity co-ordinator had been recently employed. While we saw some evidence of actions taken recently, this had not been embedded to enable sustained improvement.

Medication was administered safety; however, improvements were required to ensure that medication stock is managed effectively.

Care plans required further improvements to prompt staff on actions to complete when providing bespoke care and supporting people’s welfare.

Audits and checks the provider made were inconsistent and some actions identified were not always completed. This meant people were receiving inconsistent care and there was a failure to ensure consistent effective monitoring of risk and quality of the home.

People spoke positively regarding the care they received from staff at Willows Care Home. While we received some mixed responses from relatives regarding the home, overall relatives we spoke to were positive regarding staff and care their loved ones received.

Staff spoke positively about working at Willows Care Home, acknowledging area of improvements they wished to see the provider make. Some staff spoke about the regular changes of management within Willows Care Home and the challenges this creates providing consistent care to people.

There had been recent changes to the management team since our last inspection. The manager was open and transparent to any queries of concerns we raised during the inspection.

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.

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 8 March 2023). 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 regarding the quality care for people. A decision was made for us to inspect and examine those risks and review 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.

Enforcement and Recommendations

We have identified repeated breaches in relation to a lack of planned activities within the home for people to participate in and inconsistent oversight of the quality of care at the service.

We identified a breach in relation to safety or premises and ability to ensure effective infection control measure are maintained due to the on-going refurbishment requirements at the home.

We have also made recommendations relating to safe deployment of staff across the home and dementia friendliness of the home in line with best practice. We also recommended the provider reviewed care plans to ensure they provide information to prompt staff in areas of care for people.

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

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.