We carried out an inspection of Willowbank Nursing Home on the 15 and 22 June 2018. The first day was unannounced and the second day the registered provider was aware of our intention to visit.

Willowbank nursing home accommodates 37 people in one building and supports them with nursing or personal care support needs. At the time of our visit, 31 people were living at the service.

Willowbank Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service did not have a registered manager in place. The last registered manager deregistered on 6 June 2018. 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. The provider’s peripatetic manager was present during the days of our visit. We will refer to the peripatetic manager in this report as the ‘manager’.

We previously carried out an unannounced comprehensive inspection of this service on 3 November 2015. At that inspection we rated the service as good. No breaches in regulations were identified at our last visit.

Staff were aware of safeguarding procedures and how to raise concerns. They had received training in this and outlined the types of abuse that could occur.

A range of audits were carried out by the registered provider to check on the quality of the service provided. These included 'walkarounds' undertaken by senior staff. These had not always been effective given that. For example, issues with the safety of the building had not always been identified.

Assessments for those coming to live at Willowbank Nursing Home covered all their main needs. Care plans were person centred indicating people’s personal preferences. Care records lacked specific detail about how people liked their support and contradictions in the support they received.

Staff had not always received supervision to support them in their role. Supervision records showed most staff had not received the number of supervisions as required by the providers policy. The temporary manager was aware of this and had made changes to the supervision system. We made a recommendation about the supervision process.

The premises was safe. Cleaning storage cupboards were kept locked and the environment was clean and tidy. Redecoration was taking place during the inspection to update some areas. The service had its electrical systems monitored and serviced for safe usage. The heating system ran on a bio fuel which was also serviced appropriately. Firefighting equipment was stored around the service for use in an emergency and a nurse call system was available in people’s rooms and communal areas.

People told us that they felt safe and that there was always staff around to attend to their needs. We observed staff had a constant presence in the communal areas of the service and people had their call bells answered and not left unattended.

New staff coming to work at Willowbank Nursing Home were recruited robustly with checks carried out to ensure that they were suitable to work with vulnerable adults.

Risk assessments were in place outlining the hazards faced by people from the environment. For example, risks faced in the support they received as well as risks faced by malnutrition or pressure ulcers. Emergency plans to aid the safe evacuation of people in an emergency were in place and reviewed regularly.

Medicines were robustly managed. Audits were in place to ensure that stocks never ran out and that people received the medicines they required. Staff had received training in medication administration. Medication was given to p

The inspection took place on 03 November 2015 and was unannounced.

Our last inspection took place on 20 August 2014, at that time; we found the service was meeting the regulations we looked at.

Willowbank Nursing Home offers long term and respite care, and has 28 single and four double bedrooms, all with en-suite facilities. The home had two lounges and a large kitchen area. The home has well maintained gardens throughout.

At the time of this inspection there was a registered manager in post. 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 and their relatives told us they or their family member felt safe at the home. There were effective systems in place to ensure people’s safety at the home, whilst encouraging and promoting their independence. Staff could describe the procedures in place to safeguard people from abuse and unnecessary harm. Recruitment practices were robust and thorough.

People received their prescribed medication when they needed it and appropriate arrangements were in place for the storage and disposal of medicines. Staff were trained in medicines management.

People were cared for by sufficient numbers of suitably trained staff. Staff spoke of their training and said this supported them well in their role.

People’s needs were assessed and care and support was planned and delivered in line with their individual care needs and preferences. People had detailed, care plans in place which described all aspects of their care and support needs.

Staff were trained in the principles of the Mental Capacity Act (2005), and could describe how people were supported to make decisions to enhance their capacity and where people did not have the capacity to make decisions these were made in their best interests.

Health, care and support needs were assessed and met by regular contact with health professionals. People were supported by staff who treated them with kindness and were respectful of their privacy and dignity. People were provided with a choice of suitable healthy food and drink which ensured their nutritional needs were met.

People participated in a range of activities both in the home and in the community and received the support they needed to help them stay in contact with family and friends. However activities were not always being evidenced in the activities files, there were some gaps in the paperwork to support what people had done within the home.

Staff had good relationships with the people living at the home. Staff were aware of how to support people to raise concerns and complaints and we saw the provider learnt from complaints and suggestions and made improvements to the service.

There were effective systems in place to monitor and improve the quality of the service provided.

People who used the service and staff spoke highly of the support they received from the registered manager. Staff said that the registered manager was lovely and that if they had any concerns they would speak to the registered manager. People told us that the registered manager of the home was approachable.

What we saw

The inspection was carried out by an individual inspector. We looked at five specific questions; Was the service safe? Was the service effective? Was the service caring? Was the service responsive? Was the service well led?

Was the service safe?

Systems were in place to make sure that managers and staff learned from events such as accidents,incidents and complaints. This reduced the risk to people and helped the service to continuously improve.

When people were identified as being at risk, their care plans showed the actions that would be required to manage these risks. These included the provision of specialist equipment such as pressure relieving mattresses, hoists and wheelchairs.

The service had policies and procedures in place in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). Staff received safeguarding and Mental Capacity Act training. This meant staff were aware of how to safeguard people as required.

There were sufficient care staff to respond to people's health and welfare needs.

Is the service effective?

People's health and care needs were assessed either with them or with their relative. From speaking with staff they were able to demonstrate a good understanding of people’s care and support needs.

Suitable arrangements were in place for staff to receive updated training to ensure they had the skills, knowledge and experience to meet the needs of people who used the service. This ensured that the outcomes for people would continue to improve.

There was a resident’s and relatives meeting at the home. This gave people the opportunity to discuss things that affected the running of the home.

Is the service caring?

We saw staff were attentive and respectful when speaking with or supporting people. The home had a relaxed and comfortable atmosphere. We saw that there was some good humoured banter between several people living at the home and staff. One person said, “They (staff) are all wonderful.”

People looked well cared for and spoke highly of the care they received. We observed the lunchtime experience and saw that staff were calm and unhurried and they spent time with people.

Relatives we spoke with felt that overall the care and treatment provided was good. They told us they felt involved in their relatives care but felt that sometimes communication between staff wasn’t very good. One relative told us, “I tell staff something and it doesn’t get passed on to staff on the next shift.”

Is the service responsive?

People’s needs were assessed and records we looked at showed they received specialist equipment or aids that they needed.

People’s preferences and interests had been recorded and care and support had been provided in accordance with people’s wishes.

People we spoke with knew how to make a complaint if they were unhappy.

The service carried out an annual satisfaction survey. Results were collated and analysed and action plans were agreed and actioned. The results if the survey had been made available for people who used the service and visitors to the home to read.

Is the service well-led?

The service had a quality assurance system, and records showed that identified problems and opportunities to change things for the better had been addressed promptly. As a result we could see that the quality of the service was continuously improving.

Staff we spoke with were clear about their roles and responsibilities. This helped to ensure that people received a good quality service. They told us the manager and deputy manager were very approachable and supportive.

Effective management systems were in place to promote and safeguard people's safety and welfare. Such as health and safety records and peoples care records were up to date and had been reviewed regularly.

Relatives we spoke with told us they thought that overall the service ran well. One relative said “Some of the staff here are very good.” Another relative felt able to talk to the staff about any concerns they had.

People we spoke with said they were happy and content. One person said, “Staff do show me respect, they ask my opinion on what I would like to do and they are very pleasant.” Another person said, “I am happy, the staff are really nice, kind and are pleasant; I have choice.” We spoke with two relatives of people who lived at the home. One relative said, “I have no complaints they are really good, they always knock on her door and ask if she wants anything or if she is ok.”

Staff were seen to interact well with people and knew them by their first name. There was choice in what people wanted to do and the privacy and dignity of residents was respected as we observed care interventions being carried out. Staff spoke to people in a very pleasant and dignified manner.

People said their rooms were clean and they were happy with the systems in place for their laundry. We found there were systems in place to reduce and protect people from the risks of infection. There were processes in place to promote the prevention and control of infections. One relative said, “The place is always clean when I come.”

We saw on the day of our visit, there were enough qualified, skilled and experienced staff to meet people’s needs.

The provider had a system for checking the quality and safety of the service and records were maintained and held securely.

People who used the service said they were happy living at the home and they were well looked after. People’s comments included:

“We are treated very well.”

“This is a nice place, everything is nice and the meals are very good.”

“I am very happy here; they do a good job for us.”

People we spoke with or their relatives said they understood their care and support plans and that staff had explained things well to them. People looked well cared for and supported and were responded to promptly when they asked for any support or assistance. We saw staff interacting with people in a respectful and caring manner. They showed warmth and patience when giving support to people.

People said their rooms were clean and they were happy with the systems in place for their laundry. However, we found the systems in place for the management of infection prevention did not always adequately protect people from the risks of infection. The processes in place did not always promote the prevention and control of infections.

People who used the service were very complimentary about the staff. Their comments included:

“I like them all, they are all so good to us.”

“Staff are very decent, very polite, that’s what I like.”

People who used the service or their relatives said they were aware of how to make a complaint if they needed to do so. People said they felt confident to speak to the staff about any concerns they may have.

People who were able to talk with us, were asked about how they felt about living at the home and if they were happy with the care they received. The majority were complimentary and made positive comments about the staff and about the care provided.