Archived: Willow Grange Care Limited

Updated 12 October 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection was prompted in part because of information we received from the local authority of the Royal Borough of Kingston-upon-Thames who were concerned about the quality and safety of the care and support people living at Willow Grange were receiving. In response to these concerns the provider has been working closely with the local authority and in August 2018 voluntarily agreed to self-impose an embargo on the service accepting any new admissions to the care home until further notice. The information shared with the CQC indicated potential concerns about the way this care home was being managed.

The inspection was conducted over two days on 29 August and 4 September 2018. The first day of our inspection was unannounced and we told the provider we would be returning on the second day. The inspection team on the first day consisted of a lead inspector, a specialist advisor who was a registered nurse and an expert-by-experience. The expert-by-experience had personal experience of caring for someone who lived with dementia. Only the lead inspector returned to the service on the second day.

Before the inspection, we reviewed all the information we held about this service. This included previous inspection reports and notifications the provider is required by law to send us about events that happen within the service. We used information the provider sent us in the Provider Information Return. This is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make.

During the inspection we spoke in-person with seven people who lived at the home, eight visiting relatives/friends, an independent care consultant and a local authority placement reviewing officer. We also talked with various managers and staff who worked for the provider including, the registered manager, the area manager, two registered nurses, six health care workers, an activities coordinator, two cooks and the maintenance person. In addition, we received written feedback about the service from two relatives and a local authority commissioning officer.

Throughout our inspection we observed the way staff interacted with people living in the home and performed their roles and responsibilities. We also used the Short Observational Framework for Inspection (SOFI) to observe lunchtime meals being served throughout the home on both days of our inspection. SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

Records we looked at included ten people’s care plans, five staff files and a range of other documents that related to the overall management of the service.

Updated 12 October 2018

This was an unannounced comprehensive inspection which took place on 29 August and 4 September 2018.

People living at Willow Grange (formerly known as Coombe Hill and Blenheim Lodge Nursing home) receive accommodation and personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

The care home can accommodate up to 44 people living across three floors in one adapted building. Most people living in the home were older people living with dementia and/or who had nursing needs. The service also specialises in supporting people with mental ill health problems, learning disabilities or autistic spectrum disorders, acquired brain injuries or sensory loss. At the time of our inspection 37 people resided at Willow Grange.

The service continues to have the same registered manager who has been in post since 2016. A registered manager is a person who has registered with the CQC. Registered managers like registered providers 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 last inspection, which we carried out in April 2017, we rated the service ‘Requires Improvement’ overall and for the three key questions, ‘Is the service effective, caring and well-led?’ This was because we found staff did not always given sufficient opportunities by their managers to reflect on their working practices and develop their knowledge and skills, some staff did not always respect people’s privacy and governance systems were not always effective.

At this comprehensive inspection, we found the provider had taken appropriate steps to address the issues we identified at their last inspection. This included ensuring care staff were now suitably trained and supported, staff always respected people’s privacy and more effective management oversight and scrutiny arrangements were established to help monitor the quality and safety of the service people received. This included the appointment of new clinical nurse lead and an independent care consultant and the introduction of a new electronic care planning system.

However, we also identified a number of new issues at this inspection where the provider still needed to take further action to improve and meet the essential standards and regulations. The service has therefore been rated ‘Requires Improvement’ overall for the third consecutive time and for all five key questions.

This was because we found some staff did not always ensure people were treated with kindness and respect. Although we saw most staff interacted with people in a kind and compassionate manner, we observed several instances of poor practice including one incident when a member of staff used inappropriate language and gestures to ‘encourage’ an individual to eat their lunch and other staff not engaging well with the people they were assisting to have their lunch.

Furthermore, people did not always receive care and support which met their individual needs and reflected their preferences. Half the relatives we spoke with expressed being concerned that staff did not always follow their family members wishes or guidance in their care plan. Examples given included several incidents of people’s family members being left in bed too long or being assisted to go to bed too early by staff contrary to guidance in their care plan about their preferred daily routines.

These shortfalls represent two breaches of the HSCA (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

The home was adequately staffed on both days of our inspection. However, it was evident from most of the comments we received from people living in the home, their relatives and staff we spoke with that they felt there were sometimes issues with the way staff were deployed in the care home. We discussed this issue with the registered manager at the time of our inspection who told us they had recently reviewed current staffing levels and were in the process of recruiting new staff to increase the number of staff that were on duty at night. Progress made by the provider to achieve this stated aim will be assessed at their next inspection.

In addition, although care staff were suitably trained to effectively carry out their roles and responsibilities; we found not all nursing staff had completed the specialist training they needed to effectively meet peoples more complex health care needs and use specialist medical equipment safely. We discussed this issue with the registered manager who showed us a time specific action plan they had developed to ensure all nursing staff completed up to date training in the safe use of syringe drivers, Percutaneous Endoscopic Gastrostomy (PEG) feeding tubes, catheters and pressure sore care within the next three months.

People also did not always have sufficient opportunities to participate in meaningful activities that reflected their social interests. We recommended the provider seek advice and guidance from a reputable source, about developing a programme of social activities that met the needs and social interests of people living with dementia.

Finally, although we found the provider had made some progress to improve their governance systems, further improvements were still required because of the number of new issues described above that we identified during this inspection.

These negative comments notwithstanding, we found the provider continued to have robust procedures in place to safeguard people from harm and abuse. Staff were familiar with how to recognise and report abuse and neglect. Appropriate recruitment checks took place before staff were permitted to commence working at the home. The environment was kept hygienically clean and safe. People received their medicines as prescribed.

People were supported to eat and drink enough to meet their dietary needs and preferences. Managers were aware of their duties under the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Staff sought people's consent before providing any care and support and followed legal requirements when people did not have the capacity to do so. They also received the support they needed to stay healthy and to access health care services.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. When people were nearing the end of their life, they received compassionate and supportive care.

People had new electronic personalised care plan, which set out how their care and support needs should be met by staff. The provider had suitable arrangements in place to appropriately deal with people’s concerns and complaints.