This unannounced inspection took place on 21 November 2016 and we returned the following day to complete the inspection process. Willow Court is a residential care home situated in North Shields. The home has two floors and all bedrooms have en-suite facilities. It provides accommodation, personal and nursing care for up to 48 people with physical and mental health related conditions. At the time of our inspection 42 people lived at the service.
There was a registered manager in post who has been employed to manage the service since September 2014 and was registered with the Care Quality Commission (CQC) to provide regulated activities in June 2015. A registered manager is a person who has registered with the CQC 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 service has historical non-compliance which related to safeguarding, infection control, cleanliness and medicines management; however we found the provider was complying with these regulations when we last inspected the service on 28 May 2015. At the inspection in 2015 the service still required some improvement, particularly with regards to safety and responsiveness.
The registered manager carried out daily, weekly and monthly checks on the safety and quality of the service using an electronic audit system. This automatically presented information and gave oversight to the registered manager and the provider. Although these processes were in place, they were not always effective enough to identify the issues we raised during the inspection with regards to compliance with statutory regulations. After the inspection, we discussed this with the registered manager who told us action would be taken to address the shortfalls in the service.
There was a medicines policy and associated procedures in place; however medicines were managed inconsistently throughout the home and not always in line with company policy. We found issues with the storage, administration, stock control and recording of medicines which meant medicines were not managed safely.
People we spoke with told us they felt safe living at Willow Court. Relatives confirmed this. Staff had been trained with regards to safeguarding of vulnerable adults and demonstrated awareness of their responsibilities towards protecting people from harm. Policies, procedures and systems were in place to support staff with the delivery of the service. Individual risks which people faced in their daily lives had been assessed (with the exception of some risks associated with medicine administration) and control measures were in place to reduce the possibility of an incident or accident occurring.
Incidents and accidents were recorded electronically; there was evidence of an investigation by the registered manager and these were monitored by the provider. Action plans were implemented to reduce the likelihood of a repeat event. The registered manager had reported all incidents to external bodies as required and had written letters of apology to people and relatives if necessary.
Routine safety checks were carried out around the premises; we observed the handyman completing these checks during the inspection and a practice fire drill took place. We also found the provider had suitable emergency contingency plans in place should these be required to be activated by staff.
There was a strong malodour throughout the corridors and in some communal areas. We have made a recommendation about this. We found the design of the home had elements of best practice with regards to dementia care. Walls and floors contrasted and doors were brightly coloured with appropriate signage. The décor in people’s bedrooms and communal areas was homely and objects of memorabilia were used to stimulate memories and conversation.
People and relatives told us they felt there was enough staff employed at the service. We observed staff responded quickly to people when called upon. Care workers told us they did not feel hurried in their duties and felt they were able to meet people’s needs. Staff had been recruited safely. They had completed training in topics relevant to their role, however refresher training was not routinely carried out. Staff competencies were not always checked in a timely manner and not all staff had completed a robust induction.
The Care Quality Commission (CQC) is required by law to monitor the operations of the Mental Capacity Act 2005 (MCA) including the Deprivation of Liberty Safeguards (DoLS), and to report on what we find. MCA is a law that protects and supports people who do not have the ability to make their own decisions and to ensure decisions are made in their ‘best interests’. It also ensures unlawful restrictions are not placed on people in care homes and hospitals. In England, the local authority authorises applications to deprive people of their liberty. We found the provider was complying with their legal requirements.
The staff offered people a choice of meals and alternatives were provided if people preferred something else. The food looked nutritious, well-balanced and appetising. Special diets were catered for and the kitchen staff were familiar with people’s dietary needs. People appeared to enjoy their meals; however the dining rooms were very crowded, lacked the atmosphere of a homely environment and didn’t provide much of an opportunity for socialisation.
All staff displayed kind and caring attitudes and people told us the staff were nice to them. We saw care workers treated people with dignity and respect whilst assisting with personal care and we saw positive interactions with people throughout the inspection. People appeared to enjoy a friendly relationship with the staff and it was apparent the staff knew people well.
We examined six individual care records in-depth and found 9with the exception of medicine records) they were person-centred, detailed and had been regularly updated and evaluated. Individual people’s needs were assessed and the records contained personalised information.
There was an activities coordinator employed at the service. We saw information on display about forthcoming events and we observed people engaging in activities during the inspection. Interesting and meaningful stimulation was provided on a one-to-one and group basis.
There was a complaints procedure in place and we saw information about it displayed in communal areas. We reviewed four response letters to complaints made about the service and saw evidence of internal investigations into the issues raised had taken place. Complainants had received a response in line with company policy. An electronic quality assurance system was in place to gather immediate feedback from people, relatives, visitors and staff. Nobody we spoke with raised any complaints, however one relative was not satisfied with the response to their complaint and this was on-going.
Staff told us they felt supported by the registered manager and had received regular supervision and appraisal. Staff meetings had taken place and there was good communication throughout the departments within the home.
We have identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, relating to safe care and treatment and good governance. You can see what action we told the provider to take at the back of the full version of the report.