The Willows Nursing Home

The Willows Nursing Home is a care home for up to 28 older people. At the time of our inspection 27 people were living at the service. The home is a converted house in a residential area and accommodates people across two floors. The Willows Nursing Home is part of St Dominic's Limited, a private company under the Aster Healthcare Ltd brand which has other care homes in England.

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

People received their medicines safely and as prescribed. There were suitable systems for checking medicines were being safely managed.

The risks people were exposed to had been assessed and planned for. People lived in a safe environment.

The environment was clean and there were systems to help prevent and control infection.

People were able to contribute their views about the service and the provider worked with others to make sure the staff followed best practice.

There were systems for managing the service including dealing with incidents, accidents, complaints, safeguarding alerts and other adverse events. There were regular audits and checks to help make sure quality was monitored and improved.

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 20 December 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 improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

At our last inspection we found breaches of regulations relating to safe care and treatment and good governance. We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

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 good. 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 The Willows Nursing Home on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The Willows Nursing Home is a care home providing nursing, personal care and accommodation to 28 people at the time of the inspection. The service can support up to 28 people and is registered to provide care to older people and people living with dementia. The home is a converted house in a residential area and accommodates people across two floors. The Willows Nursing Home is part of St Dominic's Limited, a private company under the Aster Healthcare Ltd brand which has other care homes in England.

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

Some improvements had been made in the way medicines were managed and administered but further improvements were required as issues were identified. The provider had made improvements in relation to infection prevention and control.

The provider identified risks relating to the people’s health and wellbeing and guidance was provided for nurses and care workers on how to mitigate these risks. Relatives felt their family members were safe when they received care. The provider had a robust recruitment process so they could identify if new staff had the appropriate skills and knowledge.

The provider had made improvements to their quality assurance processes but the medicines audit system was still not robust enough to identify issues in relation to the administration of medicines.

Relatives were happy with the support their family members received. The provider worked in partnership with a range of healthcare professional and other organisations. Staff felt they were supported by the senior staff.

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 3 August 2021). At this inspection some improvements had been made but the provider was still in breach of regulations in relation to the management of medicines and good governance. The service remains rated requires improvement.

Why we inspected

We carried out an unannounced focused inspection of this service on 16 February and 17 February 2021. Breaches of legal requirements were found. We issued Warning Notices in relation to Regulation 12 and Regulation 17 with the provider required to comply with the regulations by 30 April 2021.

We undertook this focused inspection to check they had followed undertaken improvements to check if they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those breaches. Some improvements had been made but further improvements in relation to the management of medicines was still required.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has remained as requires improvement. 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 The Willows Nursing Home on our website at www.cqc.org.uk.

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 continued breaches in relation to safe care and treatment 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 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 re-inspection programme. If we receive any concerning information we may inspect sooner.

The Willows Nursing Home is a care home providing nursing, personal care and accommodation to 27 people at the time of the inspection. The service can support up to 28 people and is registered to provide care to older people and people living with dementia. The home is a converted house in a residential area and accommodates people across two floors. The Willows Nursing Home is part of St Dominic's Limited, a private company under the Aster Healthcare Ltd brand which has other care homes in England.

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

During the inspection we found multiple concerns around the administration and storage of medicines. The provider’s management of medicines was ineffective as such poor practice and shortfalls had not been identified or addressed.

Whilst the provider had infection control protocols in place, we found the cleaning of some areas was not to a good standard and on one occasion government pandemic restrictions had not been adhered too. This had placed both staff and people at risk of harm.

People had person centred plans which gave staff guidance about how they wanted their care provided. This included people’s diverse support needs and preferences. Staff involved people with meaningful activities. The lounge and dining area had been refurbished to support people to be sociable and mix with others whilst remaining socially distanced or enjoy quieter spaces to relax.

The provider and registered manager had completed audits and checks but they had not identified all the concerns found at inspection.

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

Rating at last inspection

The last rating for this service was requires improvement when inspected 21 March 2019 (Published 23 May 2019)

Why we inspected

We undertook this unannounced focussed inspection to check whether the provider had made improvements in relation to breaches of the regulations which we identified at the last inspection.

The provider completed an action plan after the last inspection to show what they would do by 31 July 2019 to make improvements in relation to safe care and treatment, person centred care and good governance.

This report only covers our findings in relation to the key questions safe, responsive and well-led which contain those requirements. The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service remains requires improvement. This is based on the findings at this inspection.

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 coronavirus and other infection outbreaks effectively.

Enforcement

At the previous inspection the service was in breach of regulations 9, 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

At this inspection we found that the provider had met the requirements of regulation 9 person centred care but not fully met the requirements for regulations 12 safe care and treatment and 17 good governance.

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.

The registered manager and provider completed some actions by the second day of our inspection and have informed us they will send an action plan to tell us how they planned to address other concerns.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Willows Nursing Home on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our reinspection programme. We will work alongside the provider and local authority to monitor progress. If we receive any concerning information we may inspect sooner.

Raj Nursing Home is a care home that is registered to provide personal and nursing care for up to 28 older people, some of whom are living with dementia. At the time of the inspection 24 people were using the service.

People’s experience of using this service:

At our last inspection we found a breach of the regulations relating to safe care and treatment. This was because some aspects of the environment were not kept in a safe manner. At this inspection we found safety in those areas that previously had been a cause for concern had been improved. During this inspection we still found some areas that might pose a risk to people, that had not been identified or addressed by the provider.

During our inspection people told us they received their medicines in a timely manner. Whilst medicines administration records were completed by the nursing staff appropriately, some information had not been updated to reflect people’s current medicines regimes.

At this inspection we also found that care plans were not person centred because they did not contain background information relevant to the person and did not always contain what support people required with their diverse needs. Care plans did not state what activities people might enjoy and we found a lack of meaningful activities in the service.

There had been no registered manager in post since August 2018 and there had been several changes in manager since our last inspection. The current manager had applied to register with the CQC. The provider ensured they were present in the service to support the manager to make identified changes, but difficulties recruiting staff, in particular nursing staff had impeded this process. Therefore, whilst the provider had undertaken checks and audits and had in place a comprehensive action plan there was a delay in making some planned changes to the service provision.

The manager had assessed staffing needs in the home and put in place additional staff if someone had a higher support need. Notwithstanding this, most people and relatives told us staff were often very busy and said there was sometimes a delay in call bells being answered at key times in the service.

At our last inspection we found a breach of the regulations about the need for consent. At this inspection we found this had been addressed and care plans we reviewed were signed by the person or their legal representative to show they had agreed with their care plan. We saw also that the manager had applied for Deprivation of Liberty Safeguards on behalf of people who were assessed as not having capacity to consent to their care and treatment.

People described staff as caring and friendly and said despite them being busy they made time to talk with them. We saw staff were respectful towards people and asked their permission before supporting them. People said staff maintained their privacy and dignity.

People told us they liked the meals provided and there was a picture menu to choose from and alternative meals were offered. People with dietary needs were supported and staff encouraged all people to have enough to drink. The provider ensured people had access to health and social care professionals to maintain their well-being.

Rating at last inspection: At the last inspection on 10 May 2018 we undertook a focused inspection for the key questions safe, effective and well-led and rated these requires improvement and therefore the overall the rating was requires improvement.

Why we inspected: We brought the inspection forward because a Healthwatch visit on 8 January 2019 had identified concerns about staffing levels and support for them, the lack of a menu and activities for people on the day of their visit.

Improvement action we have told the provider to take: Please see the actions we have told the provider to take section towards the end of the report.

Follow up: We will ask for an action plan from the provider to address the areas where improvement is required. We will continue to monitor the service and will re-inspect based on the rating of requires improvement. We may re-inspect earlier if we receive concerns about the service.

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

For this inspection the team inspected the service against three of the five questions we ask about services: ‘Is the service safe?’, ‘Is the service effective?’ and ‘Is the service well led?’ No risks, concerns or significant improvement were identified in the remaining Key Questions through our ongoing monitoring or during our inspection activity so we did not inspect them. The ratings from the previous comprehensive inspection for these Key Questions were included in calculating the overall rating in this inspection. During this inspection, we rated the service ‘Requires improvement’ in each key question inspected and overall.

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

The care home accommodates up to 28 people in one adapted building consisting of two floors. They offer a nursing care service to older people, some of whom may be living with dementia. At the time of our inspection there were 20 people living at the home.

There was no registered manager in post as they had left employment at the home and deregistered prior to our inspection. A registered manager is a person who has registered with the Care Quality Commission 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 2008 and associated Regulations about how the service is run. The provider was in the process of recruiting for a manager.

The provider had not adequately assessed the risks to people using the service. The areas of concern included stairs access not being assessed, a tripping hazard not removed, uncovered radiators and unlocked boiler and electric cupboards and sluice room. There was also a lack of review around some manual handling risk assessments to accurately describe the equipment needed to move people or when people’s needs had changed.

People in their bedrooms did not always have access to their call bell and were therefore unable to call for staff support should they need to do so.

We found that infection prevention and control procedures were not always followed robustly by staff to help prevent the spread of infection.

We found a few concerns around medicines management which could put people at risk of not receiving their medicines safely. These concerns had not been picked up by the various checks in the home so they could be addressed.

The provider was not always working according to code of practice of the Mental Capacity Act 2005. This was because we found that relatives signed consent forms when it was not confirmed they had a lasting power of attorney, giving them the right to make decisions on their family member’s behalf. In addition, when applications under the Deprivation of Liberty Safeguards had been authorised, the provider had not requested for a re-assessment in a timely manner where these authorisations have expired.

The service was not always well-led as although the management team carried out audits and checks, the above concerns were not identified so the necessary improvements could be made. We also found that records were not always being maintained accurately and stored safely.

We found three breaches of Regulations. These were in relation to safe care and treatment, need for consent and good governance. You can see what action we have asked the provider to take at the back of the report.

Relatives were encouraged to visit the home to see their family members. They had not been kept up to date with developments in the home and the management team agreed to address this by arranging meetings for them.

There were enough staff on duty to meet people’s needs. The recruitment policy was mostly followed with the exception of one staff member’s references that were not from a previous employer. This meant their full employment history could not be confirmed.

Staff demonstrated they could recognise the signs of abuse and knew how to report safeguarding concerns appropriately to help protect people from the risk of abuse.

Staff had not received recent supervision because the registered manager had not been working in the service since January 2018. However, they said they felt well supported by management and the operations manager had held weekly staff meetings so staff had the opportunity to raise and share concerns.

Staff encouraged people to eat and drink healthily and there was a good menu choice. People, who required care and support to eat and drink received this as needed and were referred to relevant healthcare professionals according to their needs.

The provider and staff worked in partnership with health and social care professionals to ensure people received effective health care. We have made a recommendation for the provider to seek advice about the monitoring of people’s vital signs when they are not well.

Raj Nursing Home is a care home, which provides accommodation, nursing and personal care for up to twenty eight adults, some of whom have dementia. The home accommodates people from different cultural backgrounds. At the time of the inspection the majority of people living at the service were from an Asian background. There were twenty three people using the service at the time of our visit. The accommodation is laid out over two floors. The first floor can be accessed by a lift. Each person had their own bedroom and could access the communal facilities such as a lounge, dining area and garden.

There was a registered manager in place at the time of the inspection. A registered manager is a person who has registered with the Care Quality Commission 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 2008 and associated Regulations about how the service is run.

The provider had systems in place to keep people safe. There were policies and procedures guiding staff on how to protect people from harm and abuse. Staff we spoke with knew what to do if they thought somebody was at risk of harm. Risks to people’s health and wellbeing were assessed and staff had guidelines telling them how to minimise and managed these risks. People received their medicines as prescribed and staff were appropriately trained to support people with taking of their medicines.

The provider had effective staff recruitment procedures to ensure that staff were safe to work with the people using the service. There were sufficient numbers of staff deployed to support people safely and effectively.

People were supported by staff who received appropriate induction to their role and duties and were sufficiently trained and skilled. Staff received regular support and supervisions from the registered manager to ensure that they provided the care that was safe and responsive to people’s needs and preferences.

The CQC monitors the operation of the DoLS (Deprivation of Liberty Safeguards) which applies to care homes and hospitals. The registered manager had submitted applications under DoLS where people might have been deprived of their liberty and they followed up on these applications to check if these had been authorised. Staff were knowledgeable about the Mental Capacity Act 2005 (MCA) and decisions about people’s care were made in their best interests.

Staff supported people to maintain good physical and mental health and have a balanced and nutritious diet that reflected people’s health needs and personal preferences. Staff had made appropriate referrals to relevant healthcare professionals to ensure changes in people’s care and health needs were addressed in a timely manner.

People told us they liked staff who supported them and they were happy with the care provided. We saw that staff were gentle and kind when caring for people and had taken the time to support people and make them feel they mattered. Staff respected and maintained people’s right to dignity and privacy and they managed end of life care with sensitivity and compassion.

Each person using the service had an individual care plan that was personalised and contained specific information on their care needs and preferences. People had access to activities in the home and were supported in maintaining relationships with friends and family members.

People and their relatives were asked about their opinions on how the service was managed and provided. The registered manager responded to any suggestions and complaints appropriately and in a timely manner.

Staff told us they felt supported by the registered manager and they were happy to work at the home.The registered manager had numerous systems in place to audit and monitor the service and was able to effectively maintain required standards of practice and take action if the home was not meeting these standards.

People appeared well cared for and staff responded to people's care needs in a timely manner. One person told us 'they always explain everything to me before they carry out any care'. A relative commented 'you feel at home here, they are like family. I am happy'.

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. Relatives we spoke with confirmed they had been involved in the development and review of care for their family member.

The provider had arrangements to ensure medicines were appropriately managed and ensured that people received their medicines as prescribed.

Appropriate checks were carried out on staff before they started work to safeguard people using the service.

The service had a complaints procedure in place and people and visitors said they felt confident about raising any issues and said that they would be addressed.