Willowbeck Health Care Limited

Willowbeck Health Care Limited is a nursing home providing personal and nursing care to up to 80 people with mental health or physical support needs. It comprises seven discrete units each with their own focus with communal facilities in each. At the time of the inspection one of the units was not in use and was being refurbished. There were 66 people living at the service.

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

Some environmental risks had not been identified which could have had an adverse affect on people’s safety. Staff were not given enough information about some risks to support them to keep people safe. Best practice guidance was not fully followed during the administration of people’s medicines. Lessons learnt were identified and shared, however these had not always been effective. People told us they felt safe and enjoyed living at the home. Staffing levels were sufficient to meet people’s needs.

People’s needs were assessed and support to meet those needs was planned however some people's support plans did not always contain enough information to support them safely. Staff were engaged with and received training. Compliance with this was high and well-monitored. People had a good choice of food and drink, which supported people’s preferences and cultural requirements. Regular handovers took place and systems were in place to make referrals to other professionals. People received and were encouraged to access ongoing healthcare support. People’s rooms were personalised. Staff were knowledgeable about people’s capacity and choices. 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.

There was a structured and detailed governance framework, however these systems had not identified the issues found during inspection nor some of the previous incidents which had occurred. There was a focus on continuous learning, however the effectiveness of this was not always evident. People and staff spoke highly about the home manager. Staff told us they were well-supported. People and their families were engaged with the home.

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

Rating at last inspection

The last rating for this service was good (published 10 May 2019).

Why we inspected

Prior to the inspection we received concerns in relation to the safety of people at the home and the management of medicines. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the safe and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Willowbeck Health Care Limited 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 monitor the service.

We have identified breaches in relation to the effectiveness of governance and management oversight at this inspection.

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.

People’s experience of using this service:

People told us they experienced very good outcomes and Willowbeck Health Care Limited. People we spoke with were positive about the care they received. One person told us: “The care is exceptional, staff know me well and know what I want to be doing; they help me to achieve what I want to.” A staff member said: “The whole point is to try to get people to be as independent as they can and make their own choices. That’s what motivates us all as a team, when we see people developing new skills.”

The provider had implemented imaginative and creative methods to enable people to be involved in their care and in the running of the home. People living at the home had been nominated as resident ambassadors, who coordinated meetings with other people using the service and gave feedback to senior staff, including the provider’s board of directors, about people’s views. People using the service were involved in recruitment and held various responsibilities around the home, including managing the post and operating a snack shop.

People received care which was highly tailored to their needs. People were involved in planning their care, and people we spoke with told us they understood their care plans and felt they had control over them. People told us they felt there were enough staff on duty at all times. One person said: “Whenever I need help, there’s always someone around

People experienced care which was delivered safely. Staff had received training in safeguarding and staff we spoke with demonstrated a good understanding of their responsibilities in this area. One person said: “I know I’m safe here because they look out for me and check on me so that I don’t come to any harm.” Managers had a good oversight of risks within the service and these were regularly reviewed to ensure they were managed appropriately.

People gave us positive feedback about food within the home. We spoke with a member of the catering team who had a good knowledge of people’s special diets and what steps they needed to take to meet such needs. People told us they enjoyed the food available. One person said: “I like the food, it’s always good.”

Managers were highly visible within the service and accessible to people using the service. People told us they knew the management team well and could speak with them whenever they wanted to. We saw that managers conducted a daily visit to every unit within the home which meant they had a good oversight of the service and regular contact with people using it. Staff told us they felt very supported by the management team, describing the home’s manager as “fantastic.”

People were supported in maintaining good health, and staff liaised with external healthcare providers where appropriate to ensure that care was provided in a way that met people’s needs.

Rating at last inspection: Good. The report was published in October 2016

Why we inspected: This was a scheduled inspection based on the previous rating.

Follow up: ongoing monitoring.

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

Willowbeck provides nursing and personal care for to 82 younger adults. The beds are divided into five individual units, catering for the needs of younger adults between the ages of 18-65 years old. Two units support people with complex physical disabilities, including critical care needs, and two units care for people with mental health problems, whose behaviours may challenge. At the time of our inspection the fifth unit was not operational. All bedrooms are single with ensuite toilets and are located across two floors. Lounge and dining areas are situated within each unit. The home has a garden area, a car park and is close to a bus stop.

The service did not have a registered manager in post at the time of our inspection. However, the deputy manager, with support from senior managers, was overseeing the day to day operation of the home. 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 and associated Regulations about how the service is run.

People who used the service, and the relative we spoke with, told us they were happy with how care and support was provided at the home. They spoke positively about the staff and the way the home was managed. Everyone we spoke with told us the staff were very good and they felt safe living at Willowbeck.

We saw there were systems in place to protect people from the risk of harm. Staff we spoke with were knowledgeable about safeguarding people and were able to explain the procedures to follow should an allegation of abuse be made. Assessments identified risks to people and management plans to reduce the risks were in place to ensure people’s safety.

We found the service to be meeting the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). The staff we spoke with had a good understanding and knowledge of this topic. People who used the service had been assessed to determine if a DoLS application was required.

Systems were in place to ensure people received their medications in a safe and timely way from staff who were appropriately trained. We found the majority of the time staff had followed the correct procedures. However, we identified some minor concerns in respect to recording and reviewing medication. These were resolved at the time of the inspection.

There was enough skilled and experienced staff on duty to meet people’s needs. Recruitment systems were robust, so helped the employer make safer recruitment decisions when employing new staff. New staff had received a comprehensive induction into how the home operated and their job role. This was followed by regular refresher and specialist training to meet the needs of the people using the service.

People were supported to eat and drink sufficient to maintain a balanced diet and adequate hydration.

People’s needs had been assessed before they moved to the home and we found they, and if required their relatives had been involved in the planning care. Care files checked reflected people’s care and support needs, choices and preferences. However, we found the care files on one unit were difficult to follow, due to the way they were organised and the amount of out of date information stored in the files.

People had access to a varied programme of activities which provided regular in-house stimulation, as well as trips out into the community. People said they enjoyed the activities they took part in.

A complaints policy was available to people using and visiting the service. The people we spoke with told us they had no complaints, but said they would feel comfortable speaking to staff if they had any concerns. We saw when concerns had been raised they had been investigated and resolved in a timely manner.

There were extensive systems in place to monitor and improve the quality of the service provided. However, these had not always identified areas that needed improvement. Therefore timely action had not been taken to address inconsistencies on the different units.

Where people did not have the capacity to consent, the provider acted in accordance with legal requirements. Where required, decisions were made in people's best interests in line with relevant legislation and evidenced in their care plans.

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. Comments included, 'I'm happy, it's my life now', 'They're good to me'spend time with me, know if I'm down, they ask me. They're great' and 'I wouldn't change anything, they look after me.'

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

People were cared for, or supported by, suitably qualified, skilled and experienced staff. The home had effective recruitment procedures in place to safeguard people who lived there.

Comments and complaints people made were responded to appropriately. People had opportunities to make their views known and said they knew how to complain.

There are two managers listed on this report however Rachel Lister was the sole manager of the home at the time of our inspection.