The Willows

Updated 6 February 2019

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

The inspection took place on 08 and 09 January 2019 and was conducted by two adult social care inspectors from Care Quality Commission (CQC), a Nurse specialist advisor (SPA) with specialist knowledge of pressure care, and an expert by experience (ExE). An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service. The expert who attended this inspection had experience in dementia care.

The inspection was prompted in part by some concerns we had received in relation to pressure care. We also wanted to see if the home had made the improvements, identified in their action plan, since our last inspection in January 2018.

Prior to the inspection we reviewed information we held about the home in the form of notifications received from the service, including statutory notifications and any safeguarding referrals submitted by the service.

We did not request a Provider Information Return. This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make.

We looked at a selection of records the home maintained including; policies and procedures, the recruitment records of six staff two of whom had been employed since the last inspection, the care records of ten people, supervision and training records, staff rotas and other records relating to quality and audit checks completed by the service. We spoke with, seven people who lived in the home, one of their relatives and ten members of staff which included nurses, care workers both on days and night shifts, the deputy manager and the registered manager for the sister home, Bluebell Court, who is overseeing The Willows due to there not being a registered manager in post. We spoke with one visiting professional. We also contacted the local safeguarding team who had no specific concerns to raise.

We used the Short Observational Framework for Inspection (SOFI), which is a way of observing care to help us understand the experience of people who could not talk with us. We observed four lunch and two breakfast services. We spent time in communal areas observing how care was provided.

Updated 6 February 2019

This inspection took place on 08 and 09 January 2019. The inspection was unannounced which meant the home did not know we were coming. We informed the home we would be returning on the second day to complete our inspection. We last inspected The Willows in January 2018, when we identified a breach of the Health and Social Care Act (Regulated Activities) Regulations 2014 in relation to staffing. This was because the provider had not provided training for nurses who worked at the service from an agency or on a self-employed basis. We rated the home as requires improvement in the effective and well led domains. We asked the home to provide an action plan to show what they would do and by when to improve these key questions to at least good. We reviewed the action taken during the inspection and found all the nursing staff were receiving training and competency assessments. The home was no longer in breach of this regulation.

There had been a change to the home's registration since our last inspection which meant Bluebell Court was now registered separately. The Willows provided residential and nursing care to up to 50 older people, some of whom were also living with dementia.

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.

Currently there is no registered manager in post, the home is managed by a deputy manager who is supported by the registered manager for Bluebell Court which is on the same site. 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.

We found people continued to be protected from the risk of harm and abuse by staff who were knowledgeable about safeguarding concerns and how to raise them.

Risk assessments were thorough and addressed all areas of a person's needs and activities. Risk management plans had been reviewed and evaluated to a good standard on a regular basis.

Staffing levels were calculated using a system based on the needs of the people who used the service. Staff appeared to be very busy and reported they felt more staff would be better but felt able to provide care and support safely.

The home continued to manage medicines safely. Regular competency checks were completed to maintain staff skills and knowledge.

Infection control policies and practices were effective in keeping people safe from the risks associated with infection and cross contamination.

Prior to admission people's needs were fully assessed and care plans had been developed which were thorough and reflected good practice.

Staff told us they received enough training to support people effectively, and had access to regular training. The home would benefit from having a clear record of all training done and the date including the date of renewal in one place. Records were kept in different places. We have asked the home to provide us with an up to date training matrix which will review at our next inspection. The nursing staff had received some training in relation to key areas with further training planned.

Staff received supervision to support them in their roles. Staff spoken with felt they were part of a good team and could rely on each other's skills and knowledge. We saw evidence of working with other professionals in people's care plans.

Records had been kept of all food and drink taken by those assessed as at risk nutritionally. The staff and kitchen were clear about who needed modified/enriched diets and ensured they received this and recorded it. People were supported to maintain their nutritional needs and referred to appropriate health professionals when needed.

People had been supported to live healthier lives and had access to health professionals and support to attend appointments.

There had been some adaptation of the premises which reflected good practice for people living with dementia.

We checked whether the service was working within the principles of the Mental Capacity Act 2005 (MCA), and whether any restrictions on people’s liberty had been authorised and whether any conditions on such authorisations were being met. We found they were.

The home continued to support people in kind and caring ways. We observed staff throughout the inspection and saw they took their time to respond to people and reassure them.

People had thorough care plans which were person centred and ensured people received care based around their needs and preferences. Care plans were evaluated to a high standard in response to any changes in people’s needs.

The home ensured people knew how to raise any concerns. People reported feeling able to raise any concerns they had.

The home provided support to people at the end of their life following good practice principles. The home ensured people had been supported to consider their end of life preferences which had been recorded in their care plan.

There were clear shared values within the team who were committed to achieving positive outcomes for people. The manager promoted good practice and encouraged staff to understand and follow policies.

An effective governance framework was in place and there was evidence that where issues were identified they had been addressed. Roles and responsibilities were clear.

The home had supported people to engage through surveys, questionnaires and meetings.

The deputy manager had worked with partnership organisations to share skills and knowledge and best practice learning which were then implemented in the home.