The inspection was undertaken on 29 August 2018 and was unannounced this meant that the service did not know we were coming. We previously undertook a comprehensive inspection on 10 April 2017 where it was rated as requires improvement in the areas of safe, effective and well led and good in the areas of caring and responsive. This meant that the service was requires improvement overall. At that inspection we found that the provider had not always safeguarded people who used the service from abuse and improper treatment, because they had failed to report a serious incident of alleged abuse on behalf of a person who used the service. This was in breach of regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider had also not always obtained formal consent in relation to the provision of care and treatment. This was in breach of regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also made recommendations in relation to nutritional risk assessments, personal emergency evacuation plans and submitting statutory notifications to the Care Quality Commission (CQC).

Following the last inspection, we asked the provider to complete an action plan to show us what they would do and by when to improve the key questions of safe, effective, caring and well led to at least good. During this inspection, we found the service was meeting the requirements of the current legislation.

Willowbank Rest Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Willowbank Rest Home accommodates up to 19 people in one building. It provides accommodation for persons who require personal care. All bedrooms were of single occupancy with separate bathing facilities, lounges, dining room and outside gardens areas and car parking. At the time of our inspection 17 people were living in the home.

The service had a registered manager in post at the time of our inspection. 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 was run.

All people we spoke with told us they felt safe in the home. Staff were able to discuss what actions they would take to deal with allegations of abuse. Records we looked at confirmed staff had received safeguarding training. Risk assessments had been completed for the environment and people’s individual needs.

Systems that ensured only suitable people were employed to work in the home was in place. Duty rotas were completed and staff we spoke with said there was generally enough staff to deliver people’s care. Staff received up to date and relevant training that supported them to deliver their role effectively.

Medicines were administered and stored safely, however we noted a controlled drug record did not match the quantity of medicine in the controlled drugs cupboard, the registered manager investigated this and confirmed this was a recording issue and stock levels were correct.

Improvements were noted in relation to the way the service recorded people’s formal consent. Best interest’s meetings had been held and capacity assessments had been completed where it was required. People were supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible; the policies and systems in the service did not support this practice.

The food people were served looked appetising and nutritious. People told us they were happy with the meals in the home.

We saw positive, caring and meaningful interactions taking place bet

This comprehensive inspection was unannounced, which meant the provider did not know we were coming. It was conducted on 10 April 2017.

Willowbank Rest Home is registered to provide care and accommodation for up to 19 adults. The home is situated on the outskirts of Leyland in a quiet residential area and is within easy reach of Preston and Chorley. All accommodation is provided on a single room basis and there are a variety of communal areas for residents’ use. Bathrooms are located throughout the home. A range of amenities are available in the area and public transport links are nearby. There are ample car parking spaces adjacent to the premises.

At our last inspection on 17 March 2016 we found six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to person centred care, dignity and respect, the premises, infection control, medicines management, safeguarding service users from abuse and improper treatment, meeting nutritional and hydration needs and good governance The provider submitted a detailed action plan to show that all areas requiring improvement would be completed by 28 August 2016.

During this inspection we consulted the provider’s action plan and found that substantial improvements had been made since our previous inspection. We found that regulations 9, 10, 12, 13, 14 and 17 were no longer in breach, in relation to continuous shortfalls. However, we did identify other areas that were in need of attention. We found that the provider had not always safeguarded service users from abuse and improper treatment, because they had failed to report a serious incident of alleged abuse on behalf of a service user. This was in breach of regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider had not always obtained formal consent in relation to the provision of care and treatment. This was in breach of regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. A more detailed description of the breaches is contained within each relevant section of this report.

Although the nutritional plan of care for one person was very detailed in relation to choking risks, a separate risk assessment had not been developed on this occasion. We made a recommendation about this.

We observed that the dietary intake charts did not record any snacks taken during the day or night and some fluid balance charts had not been totalled. Therefore, it was not easy to determine if people were receiving sufficient fluid intake. We made a recommendation about this.

Personal Emergency Evacuation Plans [PEEPs} were in place for those who lived at Willowbank. However, not all relevant information was always recorded to support a safe evacuation, should this be required. We made a recommendation about this.

Records showed that people's views about the quality of service provided were sought in the form of surveys and meetings and complaints were managed well. The provider had forwarded the required notifications to CQC, as and when required. However, the management of safeguarding incidents had not been well managed, as an allegation of abuse had not been appropriately reported. We made a recommendation about this.

People who lived at Willowbank told us they felt safe being there and we found that the recruitment practices were robust, which helped to protect people from harm. There were sufficient staff on duty on the day of our inspection and it was observed that staff were always present in the communal areas of the home.

We noted that people were supported to mobilise, when help was needed and freedom of movement was evident within the home. We observed that call bells were answered in a timely manner.

The staff team were well supported by the management of the home, through the provision of information, induction programmes, supervision, appraisals and training modules. The staff members we spoke with h

This comprehensive inspection was unannounced, which meant the provider did not know we were coming. It was conducted on 17 March 2016.

Willowbank Rest Home is registered to provide care and accommodation for up to 19 adults. The home is situated on the outskirts of Leyland in a quiet residential area and is within easy reach of Preston and Chorley. All accommodation is provided on a single room basis and there are a variety of communal areas for residents’ use. Bathrooms are located throughout the home. A range of amenities are available in the area and public transport links are nearby. There are ample car parking spaces available adjacent to the premises.

This was the first inspection of this service since the change of ownership in November 2015. We identified some areas where improvements needed to be made These are detailed within each relevant section of the report.

People who lived at Willowbank told us they felt safe being there and we found that the recruitment practices were robust, which helped to protect people from harm. There were sufficient staff on duty on the day of our inspection and it was observed that staff were always present in the communal areas of the home.

The management of medicines could have been better and there were areas of the environment and external grounds, where improvements to safety were needed. The window restrictors were not robust and therefore the windows could have easily been forced open. The hot water temperatures were excessively high in some areas, which created a potential risk of scalding. The hoists had been serviced in accordance with recommended guidelines.

Some areas of the home could have been cleaner and more hygienic. Infection control practices could have been better. For example, the external clinical waste bin was unlocked, which potentially created a risk of cross infection.

We noted that people were supported to mobilise, when help was needed and freedom of movement was evident within the home. We observed that call bells were answered in a timely manner.

Care plans did not always reflect people’s assessed needs and some care records provided conflicting information. This did not give the staff team clear guidance about how individual needs were to be best met.

The provision of meals could have been better, although we saw people being supported with their meals in a sensitive manner.

Deprivation of Liberty Safeguard (DoLS) authorisations had not always been extended, in line with the requirements of the Mental Capacity Act.

Records showed that people’s mental capacity had been considered when developing the plans of care, but such assessments were generic and not decision specific. We made a recommendation about this.

We saw people being asked verbally for their consent before care and support was delivered and some consent forms were present in the care files we saw, but these were not always signed and the area of consent could have been extended to incorporate more areas of care and support. We made a recommendation about this.

The staff team were well supported by the management of the home, through the provision of information, induction programmes, supervision and appraisal. The majority of staff we spoke with had a good understanding of people in their care and were able to discuss their needs well.

Interaction by staff with those who lived at the home varied in quality. Some members of staff provided good, sensitive and caring approaches, whilst others failed to promote people’s dignity and respect.

The call bell system was noted to produce a loud, high pitched tone, which could have been quite disturbing for those who lived at the home. We made a recommendation about this.

Records we saw failed to demonstrate that those who lived at Willowbank had the opportunity to be assisted with regular bathing. We made a recommendation about this.

Social care profiles were in place in each person's care file, which reflected peoples' preferen