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Review carried out on 8 July 2021

During a monthly review of our data

We carried out a review of the data available to us about The Willow on 8 July 2021. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.

This could change at any time if we receive new information. We will continue to monitor data about this service.

If you have concerns about The Willow, you can give feedback on this service.

Inspection carried out on 4 September 2019

During a routine inspection

About the service

The Willow is a residential care home providing personal care for up to 11 people aged 65 and over. At the time of the inspection 11 people were living at the home.

The care home is located in a large detached house, within a residential area of the small town of Chesham, Buckinghamshire. People had access to three seated areas on the ground floor and extensive well-maintained garden.

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

People benefited from a service which was exceptionally person-centred, individualised and responsive. People were valued as individuals and encouraged to maintain a role in society and take part in local community events. The registered manager had forged many links with local services and had developed a local club called ‘The Willow Club’. There was an emphasis on reducing social isolation and increasing integration.

People and their relatives told us the service was well-led. The provider had policies and procedures in place. However, they did not always reflect best practice guidelines. We have made a recommendation about this in the report.

People were supported by staff who routinely promoted privacy and dignity. Staff had a good understanding of people, their likes and dislikes.

People were supported by staff who had a good knowledge of how to protect them from abuse and harm. People were encouraged to live as they wanted to. Staff encouraged independence in people.

People who required end life care were supported by staff who demonstrated kindness, compassion and supported the person’s family.

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.

Rating at last inspection

The last rating for this service was Good (published 21 March 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

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

Inspection carried out on 27 February 2017

During a routine inspection

We undertook an unannounced inspection of The Willow 27 February 2017.

The Willow is a family run care home registered to provide care and accommodation for up to eleven people who are elderly and physically frail. At the time of the inspection The Willow had no vacancies. The home is located in Chesham.

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 l Care Act 2008 and associated Regulations about how the service is run.

At the last inspection on 11 August 2015 the provider was in breach of one regulation. We asked the provider to take action and make improvements in relation to the Mental Capacity Act 2005 as they were not adhering to the principles of the act. The provider sent us an action plan outlining the actions they were going to take. At this inspection we found improvements had been made and the provider had completed these actions.

People and their families told us they felt safe at The Willow. Staff understood their responsibilities in relation to safeguarding people. Staff received regular training to make sure they stayed up to date with recognising and reporting safety concerns. The service had systems in place to notify the authorities where concerns were identified. People received their medicine as prescribed.

People benefitted from caring relationships with the staff. People and their relatives were involved in their care and people’s independence was actively promoted. Relatives and staff told us people’s dignity was promoted.

Where risks to people had been identified, risk assessments were in place and action had been taken to manage these risks. Staff sought people’s consent and involved them in their care where possible.

There were sufficient staff to meet people’s needs. Staff rotas confirmed planned staffing levels were maintained. The service had safe recruitment procedures and conducted background checks to ensure staff were suitable to undertake their care role.

People and their families told us people had enough to eat and drink. People were given a choice of meals and their preferences were respected. Where people had specific nutritional needs, staff were aware of, and ensured these needs were met.

Relatives and people told us they were confident they would be listened to and action would be taken if they raised a concern. The service had systems to assess the quality of the service provided. Learning needs of staff were identified and training was in place which promoted people’s safety and quality of life. Systems were in place that ensured people were protected against the risks of unsafe or inappropriate care.

Staff spoke positively about the support they received from the Registered Manager and all of the team at the home. Staff supervision and other meetings were scheduled as were annual appraisals. People, their relatives and staff told us all of the management team were approachable and there was a good level of communication within the service.

People and their relatives told us the service was very friendly, responsive and very well managed. Comments received included “I would not want to be anywhere else”; “We are like a family” and “Amazing boss and support is very good”. The service sought people’s views and opinions and acted on them.

The management teams’ ethos was echoed by staff and embedded within the culture of the service.

Inspection carried out on 11 August 2015

During a routine inspection

The Willow is a care home located in Chesham. It provides care and accommodation for up to eleven people who are elderly and physically frail. It does not provide nursing care. At the time of our inspection 10 people were receiving a service and one person was in hospital.

The Willow had 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 care provided was personalised to meet people’s individual needs. Staff understood the needs of the people living in the home and provided care and support with kindness and compassion.

Risks to people using the service were identified and incorporated into their care plans to enable staff to manage any such risks appropriately and keep people safe.

The registered manager assessed people’s dependency levels regularly to ensure there were enough staff on duty to meet people’s needs appropriately both during the day and night. People we spoke with told us they felt there was always enough staff to meet their needs appropriately.

Staff understood the needs of the people living in the home and were knowledgeable about how to keep them safe. Staff knew how to identify any suspected abuse and how to escalate it further to the correct people.People told us they felt safe in the home and staff knew who to speak to if they had any concerns.

There was a varied choice of activities people could take part in if they wished to. These included activities arranged both within the home and within the wider community

The service maintained good links with health professionals such as Doctors, District Nurses, Dietitians and Chiropodists and referrals were made when required to ensure people remained healthy and well.

Whilst staff had received medication training and there was a policy and procedure in place, we found one occasion where the providers medication policy was not followed. This was rectified and the person was not placed at risk.

The registered manager and the management team were not following the principles of the Mental capacity Act 2005: Code of Practice. They had misinterpreted and misapplied the statutory principles of the Act and failed to assume people had capacity, which did not work in people’s best interests.

Staff told us they were provided with a good level of training to assist them in their roles and felt well supported. They received regular supervision and an annual appraisal which enabled them to discuss their work with their line manager, raise any areas of concern and discuss any personal development needs.

The registered manager and the management team were committed to provide a high quality of care in which people’s needs and preferences remained the focus on care delivery. They had an open door policy and were available to meet with people and/or relatives and staff when they required.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of the report.

Inspection carried out on 22 October 2013

During a routine inspection

The Willow provided a warm and welcoming environment for the care of its eleven residents. People we spoke with told us how happy they were to live there. They said it was clean and comfortable, and the food was described as excellent. Three people told us it was "Proper old fashioned English cooking."

A relative and some people who lived there said the care staff were thoughtful, kind and considerate. One person told us they wished there were more "active" activities, but most people said they were happy socialising and going out with family and friends. We heard that the local church held services in the home from time to time, and that people liked this.

We looked at the complaints folder for the year since our last inspection; no complaints had been made.

Inspection carried out on 5 December 2012

During a routine inspection

We spoke to service users and relatives. One person told us that they "were so happy to live here, I am treated like royalty", another told us " The food is wonderful, the staff will do anything for us, and the other people who live here are very nice; we have a very good time here".

A relative told us that the food was excellent, and that "the cook went to great trouble to ensure people had what they wanted, even if it meant more work for her". People who used the service told us they had many choices in their activities, their food, when they rise and go to bed.

There was evidence that people who use the service's opinions were listened to and acted upon, in the Resident meeting minutes. One person told us "The staff are always helpful, and so kind; they really care about us". We found that the people who lived in the Home were keen to tell us how good it was to live there. One healthcare professional told us that "The staff are always available and helpful; there is a calm atmosphere here".

The provider had systems in place to assess and monitor the quality of the service offered, and had identified and managed risks relating to the care and welfare of their service users.

Inspection carried out on 21 October 2011

During a routine inspection

People said that staff respected their privacy and dignity. Personal care was provided in the privacy of their bedroom. They were able to choose what clothes they wished to wear, what time to rise and retire and what activities they wished to take part in.

People told us that they had a care plan. They said that their care needs were reflected in the care plan.

People said that they were registered with a general practitioner (GP) who visited the home as and when needed. They said that they had access to other health care professionals such as the optician, chiropodist and the district nurse.

People told us that the quality of the food was �excellent�. They said that they were consulted about their food preferences.

People said that they felt safe in the home. They told us that they were aware of whom to speak to if something was worrying them.

People told us that staff approach was �excellent� and staff spoke to them in a calm and respectful manner.

People said that regular residents meetings took place. They said that yearly surveys were sent out to obtain their views on how the home was run.

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