This inspection was unannounced and took place on the 27, 28 and 29 September 2016. Willow Court provides nursing, short term respite and residential care for up to 66 older people. The home accommodates people with a range of needs, including those living with dementia, epilepsy and diabetes. At the time of our inspection 63 people were living in the home.
Willow Court is a purpose built nursing home situated in the grounds of Andover War Memorial Hospital. The home comprises of single occupancy bedrooms with ensuite toilet and hand washing facilities. The home is over two storeys with the first floor accessible to those with mobility needs via a lift. Willow Court is divided into seven distinct living areas, Acacia, Juniper, Saffron, Rosemary, Jasmine, Primrose and Lavender with appropriate signage to make it easier for those with dementia to navigate independently. The building is situated around a secure garden which is accessible to people and visitors by double opening doors on the ground floor.
There was a registered manager at this location. 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 HSCA and associated Regulations about how the service is run.
We make recommendations to signpost providers to potential action they can consider to help them improve the quality of the service they provide to people who use it. We follow up recommendations at our next inspection. At our last inspection on 19 and 23 January 2015 we made two recommendations where the provider could take action. These concerned the documentation and practice regarding ‘as required’ medicines and pain assessments and ensuring that activities were offered which meet the needs and wishes of the people using the service.
During this inspection we saw that appropriate documentation was in place to provide guidance to staff in peoples care plans about the use of as required medicines. We saw that people were encouraged to participate in activities which better suited their needs. However we saw activities staff were also completing other functions within the home. We have made a recommendation that the role of the activities coordinator is reviewed to ensure they remain dedicated and able to complete the role they are employed to fulfil.
The provider did not always ensure that effective quality assurance and auditing systems were in place in order to drive improvements in the quality of the service people received. Action was not always taken to rectify where shortfalls in service provision were found.
There were sufficient numbers of staff deployed to meet people’s individual needs. Processes were in place to regularly review the required level of staff to ensure this remained appropriate.
The home provided both long term and short term care for people including those living with dementia and the environment was designed and decorated in a way to support people to move around the home safely enabling them to remain independent. Corridors were wide and well lit with contrasting different coloured handrails to aide people who were able to walk. Appropriate signage helped people to orientate themselves around the home.
Relatives of people using the service told us they felt their family members were cared for safely. Staff understood and followed the provider’s guidance to enable them to recognise and address any safeguarding concerns about people.
People’s safety was promoted because risks that may cause them harm had been identified and guidance provided to manage these appropriately. People were assisted by staff who encouraged them to remain independent. Appropriate risk assessments were in place and regularly reviewed to keep people safe.
Thorough recruitment procedures were completed to ensure people were protected from the employment of unsuitable staff. Induction training for new staff included a period of time working with experienced colleagues. This ensured staff had the skills and confidence to support people safely. Staff were happy to raise any concerns with their colleagues and senior staff and received regular supervisions. Staff told us they felt supported as a result.
Contingency plans were in place to ensure the safe delivery of care in the event of adverse situations such as a loss of accommodation as a result of fire or flooding. Fire drills were documented and practiced to ensure people were kept safe.
People were protected from the unsafe administration of medicines. Nurses responsible for administering medicines had received detailed training and were subject to competency assessments to ensure people’s medicines were administered, stored and disposed of correctly.
People received sufficient food and drink to maintain their health and wellbeing. Snacks and drinks were encouraged between meals to support good nutrition and ensure people remained hydrated. People assessed as requiring a specialised diet, for example a pureed and diabetic diet, received these.
People were supported by staff to make their own decisions. Staff demonstrated that they complied with the requirements of the Mental Capacity Act 2005 when supporting people. This involved making decisions on behalf of people who lacked the capacity to make a specific decision for themselves. Documentation showed people’s decisions to receive care had been appropriately assessed, respected and documented.
The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Appropriate applications had been submitted to the supervisory body to ensure that people were not being unlawfully restricted.
The staff and manager promptly engaged with other healthcare agencies and professionals to ensure people’s safety and wellbeing.
Staff demonstrated they knew and understood the needs of the people they were supporting and people told us they were happy with the care provided. The manager and staff were able to identify and discuss the importance of maintaining people’s respect and privacy at all times.
People had care plans which were personalised to their needs and wishes. They contained detailed information to assist staff to provide care in a manner that respected each person’s individual requirements. Relatives told us they were encouraged to be involved at the care planning stage, during regular reviews and when their family members’ health needs changed.
People told us they knew how to complain and would be confident that the registered manager would take the appropriate action to deal with their concerns. Procedures were in place for the registered manager to monitor, investigate and respond to complaints in an effective way. People and relatives were encouraged to provide feedback on the quality of the service during regular care plan meetings and resident and relative meetings.
The provider’s values were displayed within the home. We could see these standards were evidenced in the way care was delivered.
The registered manager and staff promoted a culture which focused on providing care in the way that staff would wish to provide to their family members. The registered manager provided strong leadership and had fulfilled the requirements of their role as a registered manager. The registered manager had informed the CQC of notifiable incidents which occurred at the service allowing the CQC to monitor that appropriate action was taken to keep people safe.
We found a breach of the Health and Social Care Act 2008 (Regulated Activities) 2014. You can see what action we asked the provider to take at the back of the full version of this report.