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Inspection carried out on 17 January 2020

During a routine inspection

About the service

The Willows is a residential care home providing personal care and accommodation for up to 25 people aged 65 and older. At the time of our inspection 22 people were living in the service.

People’s experience of using this service and what we found

People were happy living at The Willows and with the care they received. People felt safe and well-treated by staff. Staff were kind, considerate and treated people with respect and dignity.

People and relatives told us there were sufficient staff available to meet their needs in a timely manner. We received some mixed feedback from staff about this. We made a recommendation to the provider that they continue to monitor staffing levels closely. Some improvements were needed to the safe recruitment of new staff; however immediate action was taken by the registered manager to address this

Risk assessments were in place, providing guidance for staff in how to reduce risks and keep people safe from harm. People's medicines were administered as prescribed. Accidents, incidents and near misses were used as an opportunity to learn and make necessary improvements.

People were provided with a nutritious and varied diet and a choice of food to meet their preferences. Staff supported people to maintain their health and they sought timely advice from health professionals, when needed.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People, relatives and healthcare professionals were positive in their feedback about the leadership of the home and the quality of care delivered.

Systems were in place to ensure the service was monitored and the quality of care people received was maintained.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection: Good. (report published 29 September 2017).

Why we inspected: This was a planned inspection based on the rating at the last comprehensive inspection. At this inspection, the service remained Good.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

Inspection carried out on 18 July 2017

During a routine inspection

The Willows is a residential care home for older people. It can accommodate up to 25 people. The accommodation is a converted and extended farm house in a rural setting. All rooms have en-suite facilities.

At the last inspection on 06 November 2014, the service was rated Good. At this inspection we found the service remained Good.

We found a care home that was well run for the benefit of the people who lived there. The strongest element of this care home was the management in place. The registered manager had been in place for many years and performed her role well. She was passionate about giving good quality care to people that met their needs. Everyone was seen as a unique individual to be appropriately supported. This culture of this service came from the registered manager who strived to keep up to date and develop where they could. They had a comprehensive oversight of the service and balanced well their role of being visible and available to people, relatives and staff with ensuring their role as accountable manager was completed.

People spoke highly of the service offered and felt appropriately cared for. People experienced good care with on-going monitoring of health needs and prompt access to health services. Visiting health professionals told us that the service was caring and met the needs of people who lived here. There was varied, needs led social stimulation that people were consulted upon. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice. There was plenty for people to choose from each day of the week. People liked the variety and quality of food on offer. Mealtimes were a pleasant experience for everyone.

Staff told us that they had the training and support to carry out their roles effectively and confidently. Staff spoke highly of the management who they said were approachable and made positive changes when needed. Staff were happy and positive. People looked happy and there was a degree of calm and people had purpose to their day.

There were sufficient numbers of staff to meet people needs. People were able to develop caring and meaningful relationships with staff because staff were consistent and remained at the service for a long time. People were safeguarded from the potential of harm and their freedoms protected. Staff were provided with training in Safeguarding Adults from abuse, Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). The manager knew how to make a referral if required.

Medicines were safely managed. The manager had oversight and had thorough quality assurance processes in place that were fed up to and monitored by the provider. The manager was supported appropriately by the provider and spoke positively about developments and resources being available to them.

Further information is in the detailed findings below.

Inspection carried out on 06 November 2014

During a routine inspection

The inspection took place on 6th November 2014 and was unannounced.

The Willows is a 25 bed residential care home that provides long stay, short stay and respite care for older people, some of whom were living with dementia. There were 25 living in the home at the time of our inspection.

Our last inspection of this service was on 08 May 2014. We found that the provider was not meeting expectations in relation to seeking and confirming people’s consent around their financial affairs. We also found that there was not sufficient staff on duty and that improvements were required in how the provider assessed and monitored the quality of the service. At this inspection we found the provider had taken action to improve all of these areas.

There was a registered manager in post at 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 felt safe in the home and were confident that there were enough staff and they were caring and compassionate. Staff treated people with kindness and respected their individuality which was reflected in the person’s care plan. People found the staff approachable and could speak to them about any concerns they had or anything that worried them.

The staff had received training and had the skills and knowledge to provide support to the people they provided care to. The registered manager and staff understood the requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards and were clear about their roles and responsibilities to support people who may lack capacity to make their own decisions..

People had access to healthcare professionals when they became unwell and appointments for check-ups with dentists and opticians had been made when needed. People’s independence and choice of options, particularly regarding what food they chose to eat, were supported.

The staff were happy working at the service and felt that the management team and the provider were supportive. They were listened to and encouraged and supported to attend training and develop their care practice.

Inspection carried out on 8 May 2014

During a routine inspection

We spoke with six people who use the service, four relatives, four care staff, the deputy manager and the registered manager during this inspection. We looked at five people's care records and three staff records. Other records we reviewed included staff training and quality and monitoring records. We considered our inspection findings to answer questions we always ask; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?

This is the summary of what we found:

Is the service safe?

Care records were updated to ensure that people received the care they needed to keep them safe. The service worked with other healthcare professionals when they were concerned about someone�s safety. The falls prevention team had worked with the service to reduce the frequency and impact of falls for one person.

Staff did not receive all the training they needed to carry out their roles safely. We found that fire training for some staff members was overdue and two members of staff had not received fire training since joining the service.

Relatives told us they trusted the staff and felt that the service was safe. One relative told us, �My (relative) is looked after and safe�.

We looked at rotas and were concerned that sometimes there were not enough staff on duty.

We found that the service was aware of its responsibilities under the Mental Capacity Act 2005 Deprivation of Liberty Safeguards (MCA DoLS) and had recently made multiple DoLS referrals to the local authority in relation to its practice of locking the external doors.

Is the service effective?

People�s health and care needs were assessed in consultation with the people who use the service or their relatives. People�s care plans reflected their healthcare needs and the service worked in conjunction with support from outside professionals to meet them.

People who use the service and their relatives told us they were happy with the care provided. One relative told us, �However under pressure the staff are, nothing is too much trouble�.

One person who uses the service told us, �The staff here are really and truly good. I get my pills on time and they come if I call them. I have no problems�.

We found that some care records were incomplete for one person whose care plan we looked at.

Is the service caring?

People were supported by staff who were kind, caring and respectful. We observed staff supporting people with genuine affection and concern.

People told us they were happy and felt well cared for. A relative told us, �The care here is 200%�.

People who use the service and relatives told us that the manager was very caring. One person said �(The manager) is very kind. I have been here four years and I am very happy�. One relative commented on the atmosphere and culture of the service. They told us, �You feel like you are coming into somebody�s house�.

Is the service responsive?

People's care records showed that where concerns about an individual�s wellbeing had been identified, staff had taken appropriate action to ensure that people were provided with the support they needed. This included seeking support and guidance promptly from other health care professionals about a person's high blood sugar levels and frequent falls.

People�s preferences and choices had been recorded in their care plans and we observed that care and support was delivered in accordance with people�s wishes. We saw that where people had asked to be supported by a person of a particular gender this had been respected.

Is the service well led?

The service did not have an effective quality assurance system in place. We found that some audits were taking place but that strategies to deal with issues highlighted by the audits were not always put in place.

The service did not have effective systems to deal with the current low staffing levels.

We found that some important staff training was overdue and this could have placed people at risk.

Staff we spoke with were positive about the leadership of the service and said that they felt well supported.

Inspection carried out on 12 September 2013

During a routine inspection

We found that people living at the Willows were respected, had choices and were well cared for. One person said, �Yes, I am happy here. There is nothing I dislike�. Another said, �We have different activities most mornings.� Families and friends we talked with also spoke positively. One relative told us, �I am over the moon with the care here�.

Staff told us that they were well trained and felt supported. However, it was not clear that supervision meetings were regularly recorded and there were some gaps in the training records we viewed. The provider told us that improvements were in hand.

A new care record system had recently been introduced at the Willows. Care plans we reviewed were person centred, relevant and up to date. Staff told us they liked the new care plans. One member of staff told us, "The new care planning system is much better. Information is more structured and it is easier to find what you want". During our inspection we reviewed a wide variety of records. Overall, we found that they were accurate, accessible and held securely.

Inspection carried out on 8 January 2013

During an inspection looking at part of the service

This was a follow up inspection to check compliance on the safe management of medication. Our previous inspection on 4 November 2012 found that systems in place did not protect people. At this inspection we found matters much improved. This meant people were protected from unsafe practices relating to medication management.

Inspection carried out on 4 November 2012

During a routine inspection

We spoke with two relatives and two people who live at this service. All were very pleased with the service on offer. One relative said "My relative has lived here for eight years. I have had no issues in that time. I'm confident in the care they give and would recommend this home.�

We found that care plans were adequate and made observations for improvement. The provider immediately wrote to use and confirmed all care plans were to be revised and updated.

We have made a compliance action with regards the management of medication as we found current practice at the service was placing people at potential risk.

There were enough qualified, skilled and experienced staff to meet people�s needs. People at the service spoke of how kind, caring and helpful the staff were. One person said "I'm nicely looked after. I just need to ask and the staff help me".

Inspection carried out on 3 July 2012

During an inspection looking at part of the service

We spoke with two people who used the service. People told us that they were involved with their care, support and treatment. One person told us �I�m very happy here. I can just ask for anything I want and they sort it out�. They received the appropriate care to meet their needs.

People told us that if they had any concerns they would speak to the manager. They felt confident matters would be resolved. A typical comment was �I feel happy and safe living here. I�m confident that the manager would sort out and problem, but I do not have any�.

Inspection carried out on 6 January 2012

During a routine inspection

During our review we spoke directly to six people living in the home. People told us that they felt �happy� living in The Willows and that they had �no complaints�. Each person we spoke with commented that they enjoyed the food and were happy with the choice of meals.

However, one person told us that they sometimes �felt bored� and another told us that they didn�t get to go out and there was �not much going on outdoors, even in the summer�.

We also spent some time observing the care being provided and our findings indicated that people were disengaged from their surroundings and that there were limited positive interactions from members of staff

Reports under our old system of regulation (including those from before CQC was created)