The Willows

People’s experience of using this service:

• The provider had taken action to make improvements and comply with the breaches of regulations identified at the last inspection visit. This ensured people received safe care.

• People felt safe living at the home and staff knew how to safeguard them from the risk of potential abuse.

• The potential risk to people was assessed and minimised to protect them from harm.

• People were cared for by sufficient numbers of staff who had been recruited safely.

• People were supported by trained staff to take their prescribed medicines.

• Appropriate systems and staff’s practices helped to reduce the risk of cross infection.

• Accidents were monitored and action taken to avoid a reoccurrence.

• People’s involvement in their assessments ensured they received a service the way they liked.

• People were cared for by skilled staff who received regular one to one support from the registered manager.

• People were supported by staff to eat and drink sufficient amounts to ensure their health was maintained.

• Access to relevant healthcare services promoted people’s physical and mental health.

• The environment was adapted to meet people’s needs.

• People were encouraged and supported by staff to make their own decisions.

• People were involved in planning their care, which was delivered by staff who were kind and respected their right to privacy and dignity.

• People received care and support specific to their needs and were supported by staff to engage in social activities of their choice.

• Complaints were listened to and acted on.

• At the time of the inspection no one was receiving end of life care.

•There was a clear management structure in place and people were encouraged to be involved in running the home.

•The provider’s governance was effective in monitoring the quality of the service and to drive improvements.

•The provider worked in partnership with other agencies to ensure people received appropriate care.

Rating at last inspection: The service was rated Requires Improvement at the last inspection in January 2018.

Why we inspected: This was a scheduled inspection based on the previous rating.

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.

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

The Willows 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 Willow accommodates eight people who have a brain acquired injury. On the days of our inspection the home was fully occupied. The home is situated on two floors, providing a passage lift to the first floor.

At the previous inspection in January 2015, the service was rated Good. At this inspection we found the provider was not meeting the regulations. The provider’s governance was ineffective in promoting quality standards to ensure people received a safe and effective service. Potential risk to people was not managed sufficiently to protect them from harm and people's liberty had been unlawfully deprived. You can see what action we told the provider to take at the back of the full version of the report.

The home had a registered manager who was present on the second day of our inspection visit. 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 was not consistently well led; insufficient staffing levels meant people’s aspirations were not always supported. Although the registered manager was experienced they had not maintained their knowledge in relation areas relating to good practices.

People’s risk was not managed effectively to reduce the risk of potential harm. Inadequate staffing levels compromised the quality of care and support provided to people. However, the provider’s recruitment procedure ensured appropriate safety checks were carried out before people were employed.

People could not be confident that all the staff were skilled because systems and practices were ineffective in monitoring staff training and to ensure skills learnt were put into practice. Equality, diversity and human rights were not incorporated in the assessment and care planning to ensure people were not discriminated against. The principles of the mental capacity act and the deprivation of liberty safeguards were not adhered to and people’s liberty was unlawfully deprived.

People’s specific dietary needs were not known by all staff and this placed their health at risk. However, people told us they had access to a choice of meals and drinks were available at all times.

People’s right to privacy and dignity was not always respected. However, one staff member demonstrated their understanding of good practices to ensure people’s privacy and dignity were maintained. People may not always receive the necessary support because of staff’s lack of understanding of their care needs. People were involved in their care planning and were supported by staff who they described as kind and friendly.

Appropriate equipment was in place to support people’s mobility and where necessary referrals were made to review suitable aids and adaptations for the individual.

People were supported by staff who had received an induction into their role and who had received supervision. People’s care needs had been assessed by relevant professionals and they had access to healthcare services to promote their physical and mental health.

People’s interests were recognised by staff who supported them to do the things they liked where possible. People were supported by staff to maintain contact with people important to them. People could be confident their complaints would be listened to and acted on.

People felt safe living in the home and staff were aware of their responsibility of protecting them from the risk of potential abuse. Medication practices were safe and people were supported appropriately to take their prescribed medicines. Systems and practices in the home promoted good hygiene standards to reduce the risk of cross infection.

The provider was able to demonstrate the involvement of other key healthcare professionals to support people.

We observed the staff provide personal care and support. The people and the staff team were relaxed and the staff understood the people's needs. We were told how the staff asked everyone what they wanted from the lunch menu. We observed lunch being prepared. Everyone sat together talking and enjoying their meal. We saw how the people were supported to undertake tasks related to lunch preparation and clearing up the kitchen area.

We were invited to go to people's rooms and saw they were well furnished and people had thier own things. We were told everyone was encouraged to keep their rooms clean and tidy. We were shown around the rest of the building which was well kept and clean.

We were told by the staff and the registered manager how the staff team work with the people to promote independence as far as possible. We saw how they supported and encouraged people to undertake daily tasks. The daily tasks included house work, meal preparation, medication and money management.

We saw people going out on activities supported by staff. One person was able to go out alone but they telephoned the home when they arrived at their destination and when they were about to leave.

We spoke to staff on duty about their work and their training. They were able to tell us about how they supported the people. They also told us how they were supported by the management and their colleagues.