Willow Grange Nursing Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

People felt safe at the service and staff were knowledgeable of the risks to people’s safety. Individual risk management plans were available in people’s care records. However, we found at the time of our site visit that some environmental risks were not adequately mitigated. The provider acted after our site visit to address this risk. There were sufficient staff to meet people’s needs. Staff recruitment processes were in place. Staff completed regular training to ensure they had the knowledge and skills to undertake their duties. They received regular supervision and felt well supported in their role. However, some people felt that staffing levels were short, and they had to wait for assistance. Staff confirmed that previously there were some staffing challenges, but they had recently recruited more staff, in particular more male staff to support the preference of some of the male residents at the service. Safe medicines management processes were in place and people confirmed they received their medicines as prescribed. Staff were trained and knowledgeable about how to store and administer medicines safely in line with people’s prescriptions. Accurate medicines administration records were completed. We assessed 3 quality statements in the safe key question and found areas of good practice. The scores for these areas have been combined with scores based on the rating from the last inspection, which was good. The assessment of these areas indicated areas of good practice, our rating for the key question has remained good.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safeguarding during this assessment. The score for this quality statement is based on the previous rating for Safe.

Staff knew the risks to people they were supporting, including what coping strategies to apply when people experienced emotional distress. Staff told us they, “Talk to and listen to [people]. Offer reassurance. Ask [people] what they want to do. Some residents clash which can cause distress to others, so we are careful to manage this and provide a distraction where needed”, “We read their care plans and there’s a handover at the beginning of every shift. We know the residents really well,” and “We know what to look for if someone is deteriorating. We have really good communication between staff, nurses and the manager.”

People felt involved in managing their own risks and felt staff had the necessary skills and knowledge to support them safely. People’s comments included, “[Staff] have to deal with a lot of different people in here and I think they handle things well, on the whole” and “[Staff] are quite well-trained. I do a lot for myself, so they don’t have to do much for me but, from what I see, they know what they are doing.”

We observed staff supporting people safely with their care needs. Staff were attentive to people's requests for assistance. They interacted with people in a kind and patient manner when assisting them. We saw moving and handling equipment being used safely.

People’s care plans included a range of risk assessments on how to support people safely. Risk assessments provided clear guidance for staff to follow in relation to people's nutrition, management of challenging behaviour, mobility, and health needs. People who were at risk of developing pressure ulcers were assessed and the home implemented measures to manage this risk such as special equipment or regular repositioning. Risk assessments were in place to review the health and safety of the environment. However, these risk assessments did not sufficiently address how risks relating to the use of a steep staircase, which was accessible to all, were to be mitigated. This was discussed with the management team who took immediate actions to address this concern.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

Safe recruitment practices were in place. Pre-employment checks included records of employment history, references from previous employers and Disclosure and Barring Service (DBS) checks. DBS checks provide information including details about convictions and cautions held on the Police national computer. The information helps employers make safer recruitment decisions. Staff received the necessary support in their role. This included regular supervision. Staff had completed mandatory training such as moving and handling, safeguarding and dementia care to help them continuously apply best practice. Staff rotas showed that regular staffing levels were maintained in line with people’s assessed needs. Records viewed showed that call bells were mostly answered in a reasonable time. However, call bell response times were not regularly analysed by the management team making sure people's care needs were attended to in good time. This was discussed with the management team who promptly put an action plan in place to address this concern and ensure people received prompt support.

People told us that staffing levels provided were safe but that they had not always met their support needs as necessary. Comments included, “It does vary how long it takes for help to arrive. [Staff] just say that they are busy if it is a long time. They are under-staffed most of the time,” and “[Staff] don’t have time to talk because they are busy. That’s the only thing I would like that they spent more time with you.”

Staff told us the numbers of staff matched the needs of people using the service. Comments included, “There are enough care staff now but there hasn’t always been. We met with the manager to talk about this, and things have improved since” and “We work together as a team and they’re enough staff. Now we have more male staff on duty. Some male residents prefer male staff to support them which we now have and there wasn't enough before.” Staffing levels were monitored by the provider. The manager told us they continued recruiting but that the service was well-staffed. Agency staff was only used to cover leave and sickness. Staffing levels were reviewed regularly and when people were admitted to the service.

We observed staffing levels during our visit and felt there was enough staff to meet people’s care needs in a timely manner. Staff were attentive to people’s requests for assistance. Call bells were answered in a reasonable time when people required staff's support.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

People received support from staff to take their medicines as prescribed. People’s comments included, “We have nurses here for the medication and it is normally done well. I do know what I take” and “It’s all given on time. If I’m not feeling well, [staff] will get a prescription from the doctor.”

Systems and processes were in place to ensure safe management of people's medicines. This includes the safe storage, administration, recording and disposal of medicines. Medicine administration records (MAR) were appropriately completed to monitor the medicines being taken by people. Protocols were in place for medicines prescribed as needed.

People were supported by staff who followed national practice to administer medicines safely. Nursing staff were able to tell us about people’s medicines and what processes they followed to ensure safe medicines practices. This included what processes to follow should a person refuse their medicines in line with their rights under the Mental Capacity Act 2005. A staff member told us, “It’s a team working. We have a resident who sometimes refuses to take medication from nurses, but she might take it from [another staff member] so we help, with the nurse watching.”