The inspection of Willow Bank Care Home took place on 30 May and 7 June 2018. We previously inspected the service between 6 December 2017 and 18 January 2018; at that time we found the registered provider was not meeting the regulations relating to person centred care, safe care and treatment, meeting nutrition and hydration needs, fit and proper persons employed and good governance. We rated them as inadequate and placed the home in special measures. A service is then allowed time to address the shortfalls we have identified before we re-inspect them. We brought the inspection date forward as we were concerned people were at risk harm. The purpose of this inspection was to ensure people were safe and to see if significant improvements had been made since the last inspection to the quality of the service currently being provided for people.

Willow Bank Care 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.

Willow Bank accommodates a maximum of 59 people. The home provides care and support to older people in two units, one of which (Elizabeth Wing) provides personal care for people living with dementia. There were 47 people living at the home at the time of the inspection.

The service had a manager in place but at the time of this inspection they were not yet registered with the Care Quality Commission. 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.

During this inspection, we identified a continuing breach of regulations related to dignity and respect, nutrition and hydration and good governance. We found the previous breaches to regulation relating to person centred care, safe care and treatment and fit and proper persons employed, had been addressed.

Improvements were needed to the management of fire safety. Fire training was not up to date and there was no equipment in place to enable staff to evacuate people in the event of an emergency.

There had been concern regarding the management of people’s skin integrity. We saw a number of actions had been implemented by the manager including staff training and taking steps to improve communications with the district nurse team,

Staff recruitment was safe. People told us there were sufficient staff but some relatives were concerned that recent changes to the allocation of staff at the home may impact upon people’s care. Additional staffing support had been provided to Elizabeth Wing since the last inspection.

Medicines were not always stored safely but action was taken at the time of the inspection to address this. Suitably trained staff administered medicines, in a kind and caring manner. Staff administered medicines as prescribed but we found the management of creams still needed to be improved.

People were mainly complimentary about the meals, although we found not everyone’s nutrition and hydration needs were met. Where staff recorded peoples diet and fluid intake, these records were not accurate.

Staff received an induction when they commenced employment at the home. Supervision was ongoing but we found staffs training was not up to date.

People were able to access other healthcare professionals as needed although the district nurses they said they were concerned communication within the home was effective.

Decision specific capacity assessments and best interest’s decisions were evident in people’s care plans, but people were not always supported to have maximum choice and control of their lives. There was a lack of evidence to suggest people and their families were involved in

This inspection took place on 6, 14 December 2017 and 18 January 2018 and all were unannounced.

When we inspected the service in December 2014 we identified one regulatory breach which related to staff training and support (Regulation 18). At this inspection we found the provider had made the necessary improvements in this area but identified further breaches of regulations.

Willow Bank Care 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.

Willow Bank Care Home can accommodate up to 59 people across two separate floors, each of which have separate adapted facilities. The service provides care and support to older people and people living with dementia. There were 53 people using the service when we inspected. The home was purpose built and provides single bedroom with en-suite toilet facilities. There are lounge and dining areas on the ground floor.

There was no registered manager in post. The Registered Manager was dismissed for their position in October 2017. 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.

Staff were not always being recruited safely although there were enough staff they were not always deployed in a way to keep people safe and to deliver person centred care. Whilst some staff were seen to deliver caring, kind and compassionate care, there were practices in the home which did not treat people with dignity and respect.

Staff were receiving appropriate training and they told us the training was good and relevant to their role. Staff said they felt supported by the manager and were receiving formal supervision where they could discuss their on-going development needs.

People’s care plans did not always provide accurate and up to date information about their current needs. Some information was contradictory. Risk assessments were being completed; however, these were not always being followed or had been completed incorrectly. This meant we were not confident action was being taken to mitigate risks to people using the service.

People’s healthcare needs were being met and medicines were being managed safely.

People who used the service made some positive comments about the meals; however, we found people’s nutritional and hydration needs were not always being met. We also found people’s mealtime experience was poor.

There were some activities on offer and trips out were being arranged. There were also some good links with the local community.

We found the service was working within the principles of the Mental Capacity Act and Deprivation of Liberty Safeguards. People were supported to have maximum choice and control of their lives and staff supported people in the least restrictive way possible; the policies and systems in the service did support this practice.

Staff knew how to recognise and report concerns about people’s safety and welfare.

The home was generally clean, tidy and odour free. However, we did note there was an odour of stale urine in one of the lounges.

There was a complaints procedure in place and formal complaints had been investigated.

There was a lack of leadership and direction for staff, with no oversight of key issues for people's care and support. Systems and processes for monitoring the quality of the care provision were weak and there was no robust management of the service. At the time of the inspection a new management structure had recently been introduced, but it was too soon to be able to assess how effective these changes would be.

The overall rating for this service is ‘Inad

On the 17 December 2014 we inspected Willow Bank Care Home. This was an unannounced inspection. Willow Bank is a purpose built care home providing personal care for up to 59 older people and people living with dementia. The accommodation is provided on two floors in single rooms with en-suite facilities. There are a number of communal rooms on the ground floor and communal bathrooms/showers and toilets are located throughout the home. There is ample car parking on site.

There was a registered manager in place. 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 home had a safeguarding policy in place. Staff told us they were aware what safeguarding was and how they would report it. Staff described different types of abuse and possible warning signs of abuse. This showed us people were protected from abuse.

We looked at five staff files and saw supervisions and appraisals were not taking place frequently. The registered manager acknowledged our concern and told us supervisions should be at least four a year. The training matrix indicated that a large proportion of staff were not up to date with mandatory training. This showed us that all staff did not receive appropriate support and training to complete their duties.

People that used the service told us the staff were nice and they had their dignity respected. They told us staff used their preferred names and knocked on the door before entering. We saw staff asking for permission before supporting them.

The home had an activities coordinator. The coordinator would have different activities each day. The coordinator told us they can change activities depending on the weather and what people want to do. We saw people being asked and encouraged if they wanted to join in with dominos.

Medicines were administered in a safe way. Medicines were dispensed one person at a time by staff who had received training. Some as and when required medicines did not have a record of why they were given and did not have protocols in place for staff to follow.

We saw staffing rotas reflected sufficient numbers of staff to keep people safe. During the inspection we saw people were not left wanting for periods of time. We observed staff did not rush people and people told us they were not left for long periods.

The Care Quality Commission (CQC) monitors the operation of the DoLS (Deprivation of Liberty Safeguards) which applies to care homes. We did not see any restrictions on people’s liberty which could constitute an unlawful deprivation of their liberty. The home had made some DoLS referrals in agreement with the DoLS team. One referral had been authorised but the paperwork had not arrived yet. We had seen a confirmation e-mail regarding this.

We saw that accidents and incidents were recorded and analysed for trends. Accidents and incidents had been discussed at managers meetings and changes made where appropriate. This showed us that accidents and incidents were monitored effectively.

A complaints policy and procedure was in place. Staff and relatives we spoke with had confidence any concerns and complaints would be appropriately dealt with. We saw complaints had been actioned and followed the procedure. This showed us the complaints policy was effective and staff followed the correct procedure.

The registered manager ensured a robust programme of quality assurance was in place. We saw regular quality audits fed information into an action plan. The action plan was followed through to make changes.

We identified a breach of Regulation 18 of the Health and Social Care Act 2008 (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.

We spoke with five people who used the service. Everyone told us they were satisfied with the level of care received at the home. People told us they thought other residents were also well cared for and that they hadn’t seen anything of concern. People’s comments included:

“Very good, plenty to eat, great staff, I would recommend."

“I am well cared for. Those with higher needs than myself also seem well cared for.”

We also spoke with two relatives and they also told us they were pleased with the care, treatment and support their relative's received at the home. They said the manager and staff were quick to inform them of any significant changes in their relative's general health and they were always made to feel very welcome when they visited.

We found people were able to make decisions in relation to their daily lives. Where people did not have capacity to make decisions for themselves, systems were in place to ensure decisions made were in their best interests.

We found care was planned and people’s needs assessed so appropriate care could be delivered.

The home was clean and effective infection control procedures were in place.

We found staffing levels were adequate.

An effective complaints system was in place.

People told us the staff were kind and treated them well. They said they were satisfied with the care and support provided at Willow Bank. People were very complimentary about the activities organiser and said there was always plenty for them to do. People said they felt safe. People told us the home was clean, warm and comfortable. People told us they were not very happy with the food and said they had talked to the manager about this.