We carried out an inspection of Willowbank Nursing Home on 26 and 27 April 2017. The first day was unannounced.

Willowbank Nursing Home provides accommodation and nursing and personal care for up to 53 people who are living with a dementia or mental ill health. There were 48 people accommodated in the home at the time of the inspection.

Willowbank Nursing Home is an extended detached older property which has retained a number of original features. The home is set in a quiet residential area approximately a mile from Burnley town centre with shops, a post office, public houses and a bus route nearby. The home is set in 1.5 acres of attractive gardens.

The service was managed by a registered manager. 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 2008 and associated Regulations about how the service is run.

At our last inspection on 12 and 13 November 2014 we found the service was meeting all the standards assessed. During this inspection, we found the service remained Good.

People told us they felt safe and staff were caring. Safeguarding adults' procedures were in place and staff understood how to safeguard people from abuse. The registered manager and staff were observed to have positive relationships with people living in the home. People were relaxed in the company of staff and there were no restrictions placed on visiting times for friends and relatives.

Appropriate Deprivation of Liberty Safeguard (DOLS) applications had been made to the local authority and people's mental capacity to make their own decisions had been assessed and recorded in line the requirements of the Mental Capacity Act 2005. People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Each person had a care plan that was sufficiently detailed to ensure they were at the centre of their care. People’s care and support was kept under review and, where appropriate, they were involved in decisions about their care. Risks to people’s health and safety had been identified, assessed and managed safely. Relevant health and social care professionals provided advice and support when people’s needs changed.

People considered there were enough suitably skilled staff to support them when they needed any help and they received support in a timely and unhurried way. The manager followed a robust recruitment procedure to ensure new staff were suitable to care for vulnerable people and arrangements were in place to make sure staff were trained and supervised.

Medicines were managed safely and people had their medicines when they needed them. Staff administering medicines had been trained and supervised to do this safely.

Appropriate aids and adaptations had been provided to help maintain people’s safety, independence and comfort. Some people had arranged their bedrooms as they wished and had brought personal possessions with them to maintain the homeliness.

Activities were appropriate to individual needs and people were happy to participate in activities both inside and outside the home. There were designated staff who were employed specifically for this role. People told us they enjoyed the meals and had been involved in developing the menu. They were provided with a nutritionally balanced diet that catered for their dietary needs and preferences.

People were encouraged to be involved in the running of the home and were kept up to date with any changes. People were aware of how to raise their concerns and were confident they would be listened to. Action had been taken to respond to people’s concerns and suggestions.

People considered the service was managed well. There were effective sy

On the day of our inspection we spoke with four people who lived at Willowbank and four staff. People told us they were happy with the care and support they received. Comments included, "It's very good here as I can do what I like; staff will help me if I need help" and "Staff look after me; I'm well looked after".

People were involved in discussions and decisions about the activities they would prefer and excursions and activities were arranged for small groups of people or on a one to one basis. Comments included, "I've been out in the garden; I enjoy the fresh air", "I like the entertainers", "I enjoy chatting to the staff" and "Staff take me to the shops". We found people's activities were tailored to their individual needs and preferences.

Most of the care staff had achieved a recognised qualification in care, which would help them to look after people properly. Staff were observed interacting with people in a kind, pleasant and friendly manner and being respectful of people's choices and opinions. People made positive comments about the staff team. Comments included, "They are good staff", "Staff are always kind" and "The staff are kind and caring". Staff told us they enjoyed working at the home.

The provider had an effective system to regularly assess and monitor the quality of service that people received and to identify, assess and manage risks to people's health, safety and welfare.

We received information that people's injuries and incidents were not being investigated or reported appropriately and that no action had been taken when staff raised their concerns about poor practice. We shared this information with the local authority safeguarding team and the police and following their initial investigation into the allegations we visited the service.

We found there was a system to report and record any incidents, accidents or injuries. However we found some of the incidents had not been recorded, investigated or reported in line with the procedures. We also found the system to monitor incidents had been ineffective.

We looked at the safeguarding adults and whistleblowing (reporting poor practice) procedures. We spoke with four staff who were aware of the correct procedures and told us they would report any poor practice. We found evidence staff had reported their concerns. However the manager had not shared the information with the appropriate agencies. This could have placed people at risk of abuse and was not in line with local safeguarding procedures.

Following our visit we shared our findings with the provider and the local authority. The provider was asked to send us an action plan to advise how systems would be improved to ensure people were protected against the risk of abuse.

On the day of our inspection we spoke with four people who lived at Willowbank. They told us they were happy with the care and support they received. Comments included, “I get the help that I need; this is the best place” and “It's alright here; it’s not home but it’s as close as it can be”.

During our visit we observed staff treating people in a friendly and respectful way. We observed people being offered choices and being supported in a way that respected their privacy and encouraged their independence. People made positive comments about the staff team. They said, “Staff are lovely; they are very patient” and “Staff are alright”. We found all staff received a range of appropriate training to keep them up to date and to give them the necessary skills and knowledge to look after people safely and properly.

People told us they had no complaints about the service but would raise their concerns with the staff or managers. Comments included, “I would tell the staff if I was unhappy”, “I have no problems at all” and, “They listen to us, I know they would sort things out if I needed”.

At our last inspection visit on 14 July 2011 we were concerned that some of the essential standards of quality and safety were not being met. Following the visit we asked the service to send us a report that explained what action they intended to take to respond to our concerns.

The service recently sent us an up to date report or 'improvement plan' as part of this

review and prior to our visit. We found that the service had responded to our concerns and that improvements had been made.

During this inspection visit we found people were happy with the care and support they received. One person said, "They look after me properly". Comments from visitors included, "I am happy with the care and I am always kept up to date with any changes" and "They do everything they can to make her comfortable". Other comments included,

"I have only praise for the professional and personal care" and "The conduct of all the staff involved is something I will always remember".

Staff told us there were enough staff, they were provided with appropriate training and were able to attend regular meetings. They told us they were happy with the way the home was managed and were confident their opinions were valued.

Visitors told us there were enough staff to look after people properly. The staff team was described as 'caring', 'friendly', 'professional' and 'efficient'.

People who use the service told us they were able to make choices about how they spent their day. One person told us they were able to able to go in any area of the home and another said "I can suit myself".

We were told that there were "plenty of things going on".

One person told us they were not involved in their care plan but that staff talked to them about their care preferences.

Three people who lived at Willowbank told us they were happy with the care and support that they received; one person told us they were able to see their GP when they needed.

People said they enjoyed the meals; comments included "I enjoyed my lunch", "I enjoy the food", "the meals are good" and "we always get a choice".

The environmental health officer had raised concerns about the standards in the kitchen in December 2010. A further visit had taken place in May 2011 where improvements had been noted.

One person said "the staff are nice and they treat us well"; another said "they look after us".

One person told us that the home was always "tidy and clean" and another said they were happy with their room and "the lounges are very comfortable".

People who used the service told us there were enough staff. Comments included "they are nice", "staff are alright", "I'm looked after" and "I get help when I need".

We carried out an unannounced inspection of Willowbank on 12 and 13 November 2014. Willowbank is a care home which is registered to provide care for up to 53 people. It specialises in the care of people who have dementia or mental ill health. The service provides nursing care. At the time of the inspection there were 49 people accommodated in the home.

The home is set in a residential area approximately a mile from Burnley town centre with shops, a post office, public houses and a bus route nearby. The home is a detached three storey building with a purpose built extension set in 1.5 acres of gardens.

At the previous inspection on 16 July 2013 we found the service was meeting all standards assessed.

There is a registered manager in day to day charge 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 2008 and associated Regulations about how the service is run.

People made positive comments about the management arrangements. Staff told us, “There is a good atmosphere. The manager is easy to approach.” Comments from health and social care professionals included, “The manager is willing to listen and work with us” and “The manager is really good and has made changes that are beneficial to the home.”

People told us they felt safe and were looked after. One person said, “They (the staff) are very kind.” A relative told us, “I have not seen the staff do anything they shouldn’t.” Staff knew what to do if they witnessed or suspected any poor practice. Management and staff had responded promptly and appropriately to any incidents.

The Mental Capacity Act 2005 (MCA) sets out what must be done to make sure the rights of people who may lack capacity to make safe decisions are protected. The Deprivation of Liberty Safeguards (DoLS) provides a legal framework to protect people who need to be deprived of their liberty to ensure they receive the care and treatment they need. We found staff had varied levels of understanding of the MCA and DoLS processes. However, the registered manager had made appropriate referrals to ensure people were safe and their best interests were considered.

We observed people being offered choices and, where possible, consenting to care and treatment. Staff had a good understanding of people’s abilities to make safe decisions and choices for themselves which should help make sure restrictions on their freedom were no more than was necessary.

People were able to take risks as part of their daily lifestyle which meant their independence, rights and lifestyle choices were respected. One person said, “I tend to do my own thing. I tell them when I leave and when I get back; they like to know to make sure I am safe.” Some people living in the home behaved in a way that could place themselves and others at risk of harm. Staff had received training to help them respond appropriately and keep themselves and others safe.

A safe and fair recruitment process had been followed which should help protect people from unsuitable staff. We found the arrangements for managing people’s medicines were safe.

There were sufficient nursing, care and ancillary staff to meet people's needs. A health and social care professional told us, “The staffing ratio is good.” A person living in the home said, “There always seems to be staff around if you need them.” A relative said, “I have always seen plenty of staff and never seen anyone having to wait a long time for anything.” During our visit we observed staff in attendance in all areas of the home and people's calls for assistance were promptly responded to.

Staff received appropriate supervision, training and induction to give them the necessary skills and knowledge to look after people properly. We observed staff being kind, friendly and respectful of people's choices and opinions. People living in the home told us they were happy with the staff and information from the recent customer satisfaction survey was very positive. One person said, “All the staff are very kind and friendly.”

There were strong odours in some areas of the home. The registered manager was aware of the problem and described the action taken to date and further plans to resolve the issue. The registered manager was confident the issue would be resolved within a short timescale. Following the inspection we were told new flooring would be fitted in December 2014.

People's nutritional needs had been assessed which helped determine whether they were at risk of dehydration or malnutrition and staff were able to provide specialist diets as needed. People told us they enjoyed the food and were offered choices. A visitor said, “The food seems good, I have eaten here and my relative has put weight on.” We observed the lunch time meal in both dining areas and saw people were given support and encouragement as needed. In the ‘quiet’ dining room there was very little conversation between staff and people living in the home and people chose to sit alone. The main dining room was very busy with lots of chatter and encouraging words from staff. However, there was little room to move around once everyone was seated. We noted people were provided with plastic plates and cups when there appeared to be no reason for this. The registered manager suggested how people’s dining experience could be improved.

Care plans were well presented and contained information about people’s likes and dislikes and any risks to their well-being as well as their care and support needs. A visitor confirmed they had been involved in developing the care plan and consulted about their relative’s care needs.

There were opportunities for involvement in a range of suitable activities both inside and outside the home. Activities included aromatherapy massage, garden parties, themed parties, visits from local entertainers, tea dances, crafts, bingo and clothing parties. People were able to discuss the activities they would prefer which should help make sure activities were tailored to each individual.

The complaints procedure was displayed in each person’s room and around the home. People told us they knew who to complain to if they were unhappy about any aspect of their care. One person said, “I will tell the staff if I am unhappy about anything.”  People were encouraged to discuss any concerns during regular ‘chit chat’ meetings, during day to day discussions with staff and management and also as part of the annual satisfaction survey.

There were systems in place to assess and monitor the quality of the service with evidence these systems had identified a number of shortfalls and improvements had been made. However, the registered manager was currently reviewing the audit tools.

During the inspection we found the service was meeting the required legal obligations and conditions of registrations. The registered manager had notified the commission of any notifiable incidents in the home in line with the current regulations. There were effective systems to ensure any accidents and incidents were recorded and analysed to identify any patterns or areas requiring improvement.