The Willows Care Home provided residential and nursing care for older people. It is registered to accommodate up to 124 people. The home consists of 2 detached properties. The first detached property known as 'The Willows' provided residential and general nursing care across two floors. The second property known as 'Blue Bell Court' provided residential care on its first floor unit and nursing care on its ground floor for people with dementia/mental health conditions. At the time of our visit, there were 46 people resident at 'The Willows' and 58 people resident at 'Bluebell Court'.At the time of our inspection, a new manager had just been appointed and had been in post since March 2014. The Manager identified the home as being a work in progress and advised that they were closely collaborating with the provider to agree a manageable and sustainable way forward to improve the quality of service provided to people who used the service. We were told the service was being reorganised in respect of staffing roles and responsibilities within both units, and practices and procedures, including documentation was being reviewed.
During our visit we spoke with four people who used the service, 25 relatives and friends, three visiting health care professionals. We also spoke with eight members of staff during our visit.
Our inspection team was made up of an inspector, an expert by experience and a specialist advisor in relation to nursing people with dementia. They helped answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?
Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who used the service, their relatives, the staff supporting them and from looking at records.
If you want to see the evidence supporting our summary please read the full report.
Is the service safe?
We found people were treated with respect and dignity by the staff. People told us they felt safe. One person who used the service told us; 'Its ok here, the nurses go out of their way to help you." Another person who used the service said "I feel very safe at night here. When you go to bed you feel safe and they look after you.' One relative told us; 'X seems happy and content which speaks volumes for the care he is getting. X is safe here, no concerns.' Another relative said 'I feel X is safe here.'
Safeguarding procedures were in place and staff understood how to safeguard the people they supported.
It was not always clear to us what systems were in place to make sure that managers and staff learnt from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This would have reduced the risks to people and helped the service to continually improve.
The home had appropriate policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards. The new manager had extensive experience and understood when an application should be made, and how to submit one. Most staff we spoke with had limited knowledge of Mental Capacity Act.
On the day of our visit, the service was safe, clean and hygienic. Equipment was maintained and serviced regularly, therefore people were not put at unnecessary risk.
The manager sets staff rotas and used a dependency assessment to ensure people's care needs were taken into account when making decisions about the numbers, qualifications, skills and experience of staff required. We found there were adequate numbers of staff on duty on the day of our visit and staff reported staffing levels had improved. Overall, relatives we spoke with considered that there were adequate numbers staff on duty most of the time. This helped to ensure that people's needs were always met.
Recruitment practice was safe. Policies and procedures were in place to make sure that unsafe practice was identified and people are protected.
We found people were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines.
People were also at risk because accurate and appropriate records were not always maintained.
We have asked the provider to tell us how they will make improvements and meet the requirements of the law in relation to managing medication and record keeping.
Is the service effective?
From speaking with people who used the service or their relatives, it was not clear that people's health and care needs were assessed with them. We found they were not always involved in writing their plans of care. People also told us that they had not always been consulted during reviews about the changing needs of their relatives who received care.
Specialist dietary, mobility and equipment needs had been identified in care plans where required.
People's needs were taken into account with signage and the layout of the service enabling people to move around freely and safely, however there was only basic signposting to support people with dementia.
Visitors confirmed they were able to see people in private and that visiting times were flexible.
Is the service caring?
People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. People commented, 'Staff are good and all very caring, we have a very positive experience of the home, our X was looked after very well here.' 'The regular staff are very kind and my X is looked after really well.' 'Staff here seem fine and appear to care for our X well.'
People who used the service, their relatives and friends completed a satisfaction survey. Where shortfalls or concerns were raised it was not always clear to us how the service addressed those concerns.
People's preferences, interests, aspirations and diverse needs had not always been fully recorded, and it was not always clear to us that care and support had been provided in accordance with people's wishes.
Is the service responsive?
The service had recently recruited a marketing coordinator to oversee organised activities in both the Willows and Bluebell Court. We saw evidence of a range of activities in and outside the service in some areas of the home, however in other areas, families complained to us about the limited availability of organised activities for people who used the service.
People knew how to make a complaint if they were unhappy.
Is the service well-led?
We found the manager and provider were currently reviewing the management arrangements for each home with the intention of introducing clinical and residential leads for both units. In respect of the nursing unit within Bluebell Court we were told that a registered mental health nurse would be recruited as clinical lead to meet the needs of people who used the service.
The service worked well with other agencies and services to make sure people received their care in a joined up way. A visiting health care professional told us; 'No concerns the staff are very responsive. They are very good at following instructions, I feel they are very professional and always welcoming.' Another health care professional said 'The staff follow any plans we put in place, we have no major concerns.'
The service had some quality assurance systems, however it was not always clear to us that any shortfalls identified were always addressed promptly.
Staff told us they were clear about their roles and responsibilities.