The Willows

The Willows is a residential care home providing regulated personal care to up to 30 people. The service provides support to older people, some of whom may be living with dementia. At the time of our inspection there were 27 people using the service. The service is in a two-story house.

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

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.

The home was not staffed to the level identified by the registered manager. While people’s needs were met, at times people had to wait for care. Additionally, staff were not always able to support people living with dementia when they were distressed. Furthermore, staff did not have time to support people to take part in meaningful activities.

Staff had received training in how to care for people safely. However, training records were not up to date.

People’s ability to eat and drink safely were identified, and care plans reflected those needs. However fluid intake was not completely recorded.

The home was clean, however some practices did not support good infection control.

There were audits in place to monitor the quality of care provided. They had not fully identified the concerns in the home.

We raised all these issues with the registered manager. They took immediate action to resolve our concerns.

People’s medicines were administered safely and risks to people were assessed using good practice guidelines. Staff were confident to raise safeguarding concerns and the registered manager worked with the local authority to investigate concerns.

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 24 August 2019).

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. The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

Follow up

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

We found the following examples of good practice.

The provider was checking the vaccination status of professionals who visited the home.

The environment was clean and hygenic.

Staff and people living at the home had received their COVID-19 vaccinations and took part in a testing programme.

The Willows is a care home in the village of Rippingale. It is registered to provide support to 30 older people, some of whom may be living with dementia. At the time of our inspection, 25 people lived at the service.

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

People’s medicines were not always managed safely. Staff were trained in the safe administration of medicines, though we found problems with recording processes and a lack of guidance for staff. Risks to people’s safety and wellbeing had not always been identified or recorded, though staff understood how to manage the risks.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. We have made a recommendation about consent and recording decisions.

People’s health needs were met, and staff were knowledgeable about the support people needed. However, care plans did not always reflect people’s needs or provide staff with important information, including how they wanted to be cared for at the end of their life. Daily records did not show the care and treatment people had received.

Quality assurance systems were not always in place. When they were in place, they had been unable to maintain a high-quality service as they had not identified problems with medicines, risk management and care records. The registered manager had started to make improvements and implement new quality assurance systems.

Staff were kind and caring though they sometimes missed opportunities to engage people in meaningful conversations. People were encouraged to participate in activities and maintain their relationships with family and friends.

The registered manager was working to improve the service and included people and staff with this. The registered manager promoted a positive culture and staff were confident in their ability to develop the service.

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 Good (published 19 December 2016).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to the management of medicines and risks, the assessing, monitoring and addressing of quality shortfalls and maintaining complete and accurate records. Please see the action we have told the provider to take at the end of this report.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The Willows provides personal care and accommodation for up to 30 older people and people living with dementia. On the day of our inspection there were 28 people using the service.

The Willows is required to have a registered manager. 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. At the time of our inspection a registered manager was in place.

During our previous inspection on 15 July 2015, we identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was in relation to care not always being provided or delivered to meet people’s needs and the provider had not notified us of safeguarding incidents.

During this inspection we checked to see whether improvements had been made. We found improvements had been made and this breaches in regulation had been met. People received care and support that was personalised to meet their individual needs. The provider had notified us appropriately of any safeguarding incidents as required. .

Staff were aware of their responsibilities to protect people from avoidable harm. Staff had received adult safeguarding training and had available the provider’s safeguarding policy and procedure.

Risks to people's individual needs and the environment had not always been assessed. Concerns were identified with risks associated to a fish pond close to a door exist. The registered manager took immediate action and completed a risk assessment. Risks associated to people’s healthcare needs had not always been appropriately assessed and recorded. However, staff were aware of how to manage these risks; the issue was that of recording. The registered manager completed appropriate care plan documentation and risks assessments and forwarded these to us after the inspection.

Accidents and incidents were recorded and falls were analysed to review themes and patterns. External healthcare professionals were contacted to provide further assessment and support when concerns were identified.

Safe recruitment practices meant as far as possible only suitable staff were employed. The provider was recruiting additional staff but the deployment of staff was not consistent. The provider took immediate action and reviewed how staff were deployed. Appropriate adjustments were made to ensure people received the level of support they required to keep them safe at all times.

People received their medicines safely but some improvements were required to ensure the management of medicines followed good practice guidelines. The temperature of the medicines fridge was taken daily but not the medicines room. People’s records did not include information about how they liked to take their medicines. Protocols were not in place for medicines prescribed to be taken as and when required. The systems in place to audit that medicines were administered and managed safely were infrequent. The registered manager took immediate action to make improvements and after the inspection forwarded us information to confirm what action they had taken.

Staff received an appropriate induction, training and appropriate support.

The manager applied the principles of the Mental Capacity Act 2005 (MCA) and Deprivations of Liberty Safeguards (DoLS), so that people's rights were protected. Where people lacked mental capacity to consent to specific decisions about their care and support, appropriate assessments had been completed but improvements were required to ensure best interest decisions were made in line with this legislation. Where there were concerns about restrictions on people’s freedom and liberty, the manager had appropriately applied to the supervisory body for further assessment.

People received sufficient to eat and drink and their nutritional needs had been assessed and planned for. The menu showed that alternatives were available to the main meal option if required. People’s independence was promoted as fully as possible.

People's healthcare needs had been assessed and were regularly monitored. The provider worked with healthcare professionals to ensure they provided an effective and responsive service. External healthcare professionals were positive about how the service met people’s individual needs.

Staff were kind, caring and respectful towards the people they supported. They had a clear understanding of people's individual needs, routines and what was important to them.

The provider enabled people who used the service and their relatives or representatives to share their experience about the service provided.

People were involved as fully as possible in their care and support. The provider’s complaint policy and procedure and information about independent advocacy information was not on display for people. However, the registered manager took immediate action and forwarded us this information after our inspection to confirm this had been displayed for people.

People received limited opportunities to participate in activities, interests and hobbies of their choice. Staff provided activities daily when they could.

The provider had checks in place that monitored the quality and safety of the service. These included daily, weekly and monthly audits. Whilst the provider visited the service weekly, their checks on quality and safety and how they ensured the service was continually improving were informal. The provider assured us that they would develop formal systems and processes.

People told us they had a choice of food. Records showed people's ability to eat independently was assessed. Appropriate equipment was used to help people maintain their independence.

The cleanliness of the home had improved since our last visit. We saw ongoing improvements to reduce the risk of infection were planned. One person told us, 'They keep it clean, they are very orderly.'

We saw there were enough staff to meet people's needs. One person told us, 'The girls are quick to come when you press the bell.'

We saw the manager took account of complaints and identified actions needed to rectify issues.

We saw there were not enough care staff available to keep people safe. This meant the manager and other members of staff had been covering caring duties. This had a negative impact on other areas of the home. For example, cleaning staff told us they sometimes got behind with their work as they helped care for people.

When we visited there was an unpleasant smell in the entrance hall and atrium area and in some of the bedrooms. We saw some areas of the home were not as clean as they should be.