Willows Lodge Care Home

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective - this means we looked for evidence that people's care, treatment, and support achieved good outcomes and promoted a good quality of life, based on best available evidence. We assessed a total of 4 quality statements from this key question. We have combined the scores for these areas with scores based on the rating from the last inspection, which was requires improvement. At this assessment this key question has remained requires improvement. This meant the effectiveness of people's care, treatment and support did not always achieve good outcomes or was inconsistent.

This service scored 46 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Most relatives we spoke to felt involved in the planning of their relative’s care and support needs. However, not all relatives had seen their relatives care plan. A relative told us, “Yes seen the care plan in the past going back a while ago but couldn’t tell you what’s on it’s at the moment. They are in the ward to be picked up, if need be, I think. I have never been invited to a review.” Another relative told us, “I don’t think [relative] has seen the care plan to be honest. I haven’t been invited for a review.” Another relative told us, “I haven’t seen what’s written about [relative] in their care plan, they’ve never asked me or shown it to me.”

The registered manager told us they carried out a full assessment of people’s needs before they came to the service to ensure their needs could be met. This involved meeting people and getting feedback from health professionals involved in the person’s care. However, our assessment found elements of assessing needs did not meet the expected standards.

Not all care plans and risk assessments were personalised, and support was not always in line with people’s care plan. Records we looked at failed to demonstrate people’s needs were being regularly reviewed through assessment to ensure their support plans continued to reflect their needs.

We did not look at How staff, teams and services work together during this assessment. The score for this quality statement is based on the previous rating for Effective.

People were supported to access healthcare but this was not always updated in their daily notes and care plans. For example, one person no longer required catheter care but their care plans did not reflect this change. People told us they had access to healthcare professionals when needed. One person told us, “I regularly get to see the chiropodist, doctor and nurses."

People's care plans and risk assessments were not always personalised and support was not always in line with people's care plan guidance. There was a lack of clear guidance and key information in care plans to enable staff to deliver the right and consistent support people needed when distressed. Improvements were required to ensure completed care plans and risk assessments were person centred and included how risks to people were to be mitigated and reduced. Some information was generic and not personalised to the individual people using the service. There was no system in place to ensure people's care plans and risk assessments were reviewed regularly and updated in line with regulatory requirements.

A person told us, "I drink 4 jugs of water a day, I like water, I fill it up myself and there is a machine in the dining room where I have my meals, and take my walker and fill up the jug, the food is alright." However, a relative told us, the choices were limited and there was little variety. Another relative told us, they felt individual preferences and nutritional needs were not being met. During our assessment people were not always supported to eat and drink in a safe and timely manner. For example, a person's care plan stated they were at high risk of malnutrition and dehydration and staff should assist at mealtimes with prompting and encouragement. However, we observed staff had left the person's food on a table and when the person refused, staff took away their food. The person did not eat their food.

Staff knew people well and how they wished to be supported with food and drink. People were given options at mealtimes and were able to choose what they wanted to eat. People discussed menu’s at their monthly meetings and changes they wished to make to the menu. However, staff were not always recording people’s fluid intake accurately and people’s fluid targets were often not being met.

The providers processes for monitoring and improving people’s outcomes was not always robust. The service did not sufficiently monitor or manage the risks associated with poor hydration. Record of people’s fluid intake were incomplete which meant we were not assured people were meeting their fluid intake target. For people who were on a specific fluid regime, a chart was completed with a daily fluid target. However, we found, there was inconsistent recording. This meant staff are not recording fluids accurately and this had not been picked up by senior staff as part of their daily monitoring. Therefore, people were at risk of receiving unsafe care and support Peoples care plans and risk assessments were not always personalised, and support was not always in line with people’s care plan. Records we looked at failed to demonstrate people’s needs were reviewed through assessment to ensure their support plans continued to reflect their needs. The registered manager carried out a care plan audit and identified concerns but these had not been addressed.

Consent to care and treatment was not always sought in line with legislation and guidance. Some people we spoke with told us they were able to make some informed choices. For example, the times they like to get up in the morning and go to bed, what clothes they like to wear, choice of meals and drinks and whether or not they choose to participate in social activities. One person told us, “There are times where I want to stay in my room and nobody forces me to come out.” However, some people felt they had limited choices and did not often receive the support they needed.

Staff understood the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Staff understood the need to gain consent from people for care and to encourage people to make decisions for themselves. Staff told us, “I have recently completed my training and I understand the importance of gaining consent from the people I support.” However, not all staff had completed their Mental Capacity Act training as per the training matrix.

Ensuring consent to care and treatment in line with law and guidance The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The MCA requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the Mental Capacity Act (MCA). In care homes, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS). We checked whether the service was working within the principles of the MCA, whether appropriate legal authorisations were in place when needed to deprive a person of their liberty, and whether any conditions relating to those authorisations were being met. Staff had variable levels of understanding of the Mental Capacity Act 2005, including Deprivation of Liberty Standards. Some staff were unable to define the Mental Capacity Act and its importance. Staff were observed during the assessment to uphold people's rights to make decisions and choices.