We carried out a review of the data available to us about The Willows on 6 July 2023. 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 Willows, you can give feedback on this service.
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.
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; both were looked at during this inspection.
The Willows provides nursing and residential care for up to 124 older people. The home consists of two detached properties, one building named the Willows provides nursing and residential support and the second building known as Bluebell Court, is designated to provide care and support for people who experience dementia. The premises are situated in the area of Broughton, Salford. Each building has oversight by a registered manager.
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 Care Act 2008 and associated Regulations about how the service is run.
At last inspection carried out on the 13 December 2016 we found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was in relation to the management of pressure care. Following this inspection we asked the provider to complete an action plan to show what they would do and by when to improve the key question of Safe to at least good.
At this inspection we found the provider was no longer in breach of this regulation.
People were re-positioned two hourly when required and had care plans in place which contained relevant information and were reviewed monthly. People were prescribed their own pressure relieving equipment and were observed using them during the inspection; however we noted that in some cases mattress settings needed adjusting slightly to ensure they were being used in line with manufacturer’s guidance. Referrals to outside agencies such as GP’s and tissue viability nurses were promptly made and staff felt they were well supported from these professionals.
During this most recent inspection we found the service was in breach of one regulation of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the provider did not provide any training for nurses who worked at the service on an agency or self-employed basis and in addition did not carry out any formal supervision to ensure on-going competency of its registered manager.
Permanent staff employed by the service received adequate training and supervision support and were knowledgeable about the people they supported at the service. People using the service and their visitors felt staff were trained well and competent to carry out their caring role.
People’s care files provided evidence of professional referrals such as GP/dietician and contained detailed information in relation to dietary requirements, skin integrity, falls management and further perceived risks associated with daily living tasks.
Environmental risk assessments were in place for both internal and external areas and tradesmen were called upon to service gas and electrical appliances as well as manual lifting equipment. The provider also employed a maintenance team to oversee daily internal and external maintenance issues at both units.
Safeguarding policies and procedures were in place to ensure people, staff and visitors were aware how to raise concerns and what abusive practice looks like. Staff received training in this area and a record of safeguarding referrals was kept securely.
Safe recruitment procedures were followed and new staff received a period of induction before being assessed as competent in their new role.
Risk assessments were in place in each person’s file we looked at to manage identified risks associated with daily living and also recognise individual risk taking.
Business continuity plans were in place to offer information and guidance in the case of adverse weather or any other unforeseen circumstances which could affect the day to day running of the service. People had personal evacuation plans and fire audits were completed by both external agencies and internally by the maintenance person.
Medicines practice was managed well and people received their medicines in a safe way.
People’s care files contained person centred information. Each care file was written in a way which reflected the individual and only contained documents relevant to the person. People’s human rights and diverse needs were reflected within each plan and we received positive feedback during the inspection which evidenced people were being treated fairly and in line with their personal preferences.
Consent to areas of care and support were evident in people’s care files; however not all had been signed by the person or a representative when required.
We received mixed comments from people in relation to attending care file reviews. Some people told us they had been present at the reviews; however others told us they had not yet received an invite.
Staff interacted and engaged well with people. Staff were caring, respectful and understanding in their approach and treated people as individuals. They promoted privacy and dignity and supported people to maintain control over their lives. People’s opinions were routinely sought and acted upon by means of questionnaires and residents meetings and resident committee meetings. This enabled people to provide influence to the service they received.
Positive feedback was received from people who used the service and staff about the management structure. People told us they were able to ask for assistance from the management team when required. People felt able to raise complaints when required however they noted difficulty in contacting the units at the weekend when the administrator office was not open.
The Willows is registered to provide accommodation and personal care for up to 124 older people. The service consists of two detached properties. The Willows provides nursing and residential care whilst Bluebell Court is designated to provide care and support for people living with dementia. The premises are situated in a residential area of Broughton, Salford, close to major bus routes.
At the last comprehensive inspection on the 15 December 2014 breaches of legal requirements were found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements.
We then carried out an unannounced focused inspection on the 21 July 2015. This was to ensure that improvements had been implemented by the service. During this focused inspection we found that the service was now meeting the requirements of Regulations under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. However we could not improve the rating at that time because to do so required evidence of consistent good practice over time.
During this inspection visit we found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to a failure to implement all reasonable steps to mitigate the risk of pressure areas. You can see what action we told the registered provider to take at the back of the full version of the report.
We have also made a recommendation about the frequency and significance of activities.
There was a manager in post both at The Willows and Bluebell Court. Both managers had applied to the Commission to register and their applications were on-going. 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 Operations Director told us he had taken the decision to have a registered manager in both units although this was not a legal requirement.
People expressed satisfaction with the service provided. People told us they felt safe and were confident the care received was delivered by professional and caring staff.
The provider ensured processes were in place to maintain a safe and appropriate environment for the people, relatives/visitors and staff members. A suitable amount of training was offered to all staff, to ensure they were equipped with the correct skills and knowledge to effectively support people in an informed, confident and self-assured manner. Staff felt confident with recognising the signs of abuse and demonstrated they could appropriately and confidently respond to any safeguarding concerns and notify the relevant authorities when required.
The service conformed to the requirements of fire safety regulations by ensuring fire audits were up to date and relevant checks were carried out on a weekly basis to fire equipment and lighting. People using the service had personal evacuation risk assessments in place and an additional contingency plan provided direction about what to do in the case of an emergency or failure in utility services or equipment.
The service had a sufficient number of staff to support the operation of the service and provide people with safe and personalised care. People told us they never felt rushed and staff were responsive to their needs.
Recruitment processes were robust and designed to protect people using the service by ensuring appropriate steps were taken to verify a new employee’s character and fitness to work. Robust systems were also in place to monitor nurse revalidation. These ensured nurses were maintaining their registration within the required time frame.
Processes were in place for appropriate and safe administration of medicines. Staff were adequately trained in medicines administration. Medicines were stored safely and in line with current guidance. People had been consulted about their dietary requirements and preferences and we saw choice was given at every mealtime.
We received mixed feedback in relation to the quality of food. One person stated meals at times were, “Sloppy”, however on the whole people were generally happy. We saw appropriate referrals had been made to dieticians and instructions were followed in cases where people had known dietary requirements.
Staff displayed an awareness of the Mental Capacity Act 2005 and had completed appropriate training. Necessary referrals had been submitted to the local authority by the home's manager and a good audit trail was seen.
The service had considered and implemented adequate documentation to support the development of the care planning process and support the delivery of care. This was done by providing a detailed plan covering essential information care staff needed to follow; each plan was individual to the person’s need and was kept under regular review. Effective systems were implemented to maintain people's independence with daily living skills. However, we noted that in some cases pressure relief for people assessed at high risk of pressure areas was not applied.
Staff interacted and engaged well with people. Staff were caring, respectful and understanding in their approach and treated people as individuals. They promoted privacy and dignity and supported people to maintain control over their lives. People were given information about their care on a daily basis and provided with a ‘hand book’ to help make informed decisions about the care and environment they received. Their opinions were routinely sought and acted upon by means of questionnaires. This enabled people to influence the service they received. Feedback we received from people during the inspection supported these observations.
Positive feedback was received from people using the service, visitors, and staff about the management structure. People described the management as, “Nice” and “Approachable”. Staff informed us they felt well supported and they could approach either manager with any concerns.
We undertook an unannounced focused inspection at The Willows on 21 July 2015. This inspection was undertaken to ensure that improvements that were required to meet legal requirements had been implemented by the service following our last inspection on 15 December 2014. During this inspection we found that the service was now meeting the requirements of Regulations under The Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.
We visited the home on 06 May 2014 and identified concerns about safe handling of medicines. This was a breach of Regulation 13 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, in relation to the management of medicines. We undertook a follow-up inspection on the 22 September 2014 to see how the service had addressed the regulatory breach. We found that people were still not protected against the risks associated with the unsafe use and management of medicines.
We issued a ‘Warning Notice’ to the provider to ensure that improvements were made to ensure people were safe. This required the service to become compliant with Regulation 13 of the Regulated Activities Regulation 2010 regarding the management of medicines by the 01 November 2014. We visited the home on 15 December 2014 to check if improvement had been made in medicines handling to ensure people were protected against the risks associated with the unsafe use and management of medicines. We found that some improvements had been made, however overall insufficient progress had been made to protect people and we found that medicines were still not handled safely.
During this visit we also found that the service could not demonstrate they had consistent arrangements in place for the recording of people’s consent. This was a breach of Regulation 20 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, because the service had failed to maintain accurate records of people who used the service.
On the 24 June 2015, we interviewed the Managing Director of Unity Homes who was also the nominated individual for the service. They were interviewed under caution and admitted that the home had been in breach of regulation with regard to medication. They also told us that improvements had been made and systems had been implemented to ensure medicines were handled safely and people were no longer at risk from unsafe medication practices.
As part of this focused inspection, which took place on the 21 July 2015, we checked to see that improvements had been implemented by the service in order to meet legal requirements. This report covers our findings in relation to those requirements and additional concerns we received regarding the fire safety arrangements at the home. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for 'The Willows' on our website at www.cqc.org.uk.
We found systems were in place to ensure medicines were handled safely and people’s health was protected. We looked at the records about medicines for the previous and current medication cycles and saw that robust arrangement were in place for obtaining medicines in a timely manner.
We saw that medicines were stored safely. We saw that the medicines fridges were now locked and that waste medication and creams were now stored securely.
We saw that people who were prescribed medicines to be given ‘when required’ had information recorded to guide staff as to how to recognise if people, especially those people who found communication difficult, needed their medication.
We found that there was clear information recorded to guide staff as to where to apply creams to ensure people were given the correct treatment. We saw that accurate records were made, which showed that creams were applied properly.
We saw that some people needed to be given their medicines covertly, secretly. There was adequate information available to guide staff as to the best way to hide their medicines so that they were given safely.
We saw that audits of medication were being carried out on a regular basis and the managers were aware of any shortfalls in medication handling and had taken effective actions to address them and prevent them from happing again.
When we visited the home on 15 December 2014, we found the service could not clearly demonstrate they had consistent arrangements in place for the recording of people’s consent. This was a breach of Regulation 20 of the Health and social Care Act 2008 (Regulated Activities) Regulations 2010.
During this inspection we found the provider was now meeting the requirements of the regulation. We found that records were accurate, fit for purpose, were held securely and remained confidential. We looked at 15 care files of people who used the service. We found that consent records were now accurately completed and included dates and signatures of the person who used the service or their representative.
Before we undertook this inspection, we had also received information of concern regarding the fire safety arrangements at the home. As part of this inspection visit, we checked to see what arrangements existed and whether they protected people in the event of a fire. We found that suitable arrangements were in place to protect people in the event of an emergency.
The Willows provides residential and nursing care for older people. It is registered to accommodate up to 124 people. The home consists of two detached properties at the same address. The first detached property known as ‘The Willows,’ provides mixed residential and general nursing care across two floors. The second property known as ‘Bluebell Court,’ provides residential care on its first floor unit and nursing care on its ground floor unit for people with dementia/mental health conditions. At the time of our visit, there were 45 people resident at ‘The Willows’ and 49 people resident at ‘Bluebell Court’.
We undertook a scheduled inspection of the service on 06 May 2014, when we found the service was non-compliant with regulations in respect of the management of medicines and record keeping. We undertook a follow-up inspection on the 22 September 2014 to see how the service had addressed the regulatory non-compliance. We found the service was now compliant with regulations in respect of record keeping. However, it remained non-compliant with the management of medicines. We also found it non-compliant with regulations in respect of the care and welfare of people who used the service.
Because of our concerns for the safety of people that used the service, regarding the continued non-compliance with the management of medicines, we served a warning notice on the provider. This required the service to become compliant with Regulation 13 of the Regulated Activities Regulation 2010 regarding the management of medicines by the 01 November 2014. The service then wrote to inform us that improvements would be made by assessing the competency of the nurses who would be checking records at the end of their shifts and that an external consultancy firm would audit medicines each month. They told us better systems would be in place for ordering medicines and creams and that protocols would be put in place to make sure people were given their ‘when required’ medicines safely.
There was no registered manager in place at The Willows (including Bluebell Court) when we undertook our inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law. The home had been without a permanent registered manager for over 18 months, though efforts had been made to recruit a registered manger during that period, whilst a temporary manager in post. Shortly before we undertook this inspection, the provider was able to confirm that a new manager had now been appointed and was scheduled to take up their post early in 2015.
During this inspection we found two breaches of regulations under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.
During our visit we checked to see if improvements had been made in the way the service handled medicines to ensure people were protected against the risks associated with the unsafe use and management of medicines. We found that though some improvements had been made since our last visit in September 2014, overall insufficient progress had been made. We found that medicines were still not handled safely.
This is a breach of Regulation 13 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, because the service did not protect people against the risk associated with the unsafe use and management of medicines.
We are currently considering what action to take against the service in respect of the continued failure to meet regulations in respect of medication.
During our inspection we looked at five care files on the Bluebell Court Unit. We found that none of the care planning agreement forms, consent for photograph forms and consent to access service user’s note by other agencies had been signed and dated by the person who used the service or their representative. The service could therefore not clearly demonstrate they had consistent arrangements in place for the recording of people’s consent.
This is a breach of Regulation 20 of the Health and social Care Act 2008 (Regulated Activities) Regulations 2010, because the service had failed to maintain accurate records of people who used the service.
People from across the home told us they felt safe at home.
Staff we spoke to were able to confirm they had received training in safeguarding adults, which we verified by looking at training records. They were able to describe to us what action they would take if they had any concerns and were aware of the service’s whistleblowing policy.
We looked at how the service ensured there were sufficient numbers of suitably qualified staff on duty to meet people’s needs. On the day of our visit we found there were sufficient numbers of staff on duty across the three units to meet the needs of people who used the service. We received a mixed response from people regarding staffing levels. We spoke to the provider about the staffing concerns raised by relatives. They acknowledged that there had been difficulties with recruitment and continuity of staff. However, they stated that following recent recruitment, reliance on agency staff had reduced and consistency of staff and staffing levels had improved and that staffing levels were being monitored on a daily basis.
We found care plans reflected the current health needs of each person and provided clear instructions to staff regarding the level of care and treatment required. Staff we spoke to were able to demonstrate a good understanding of each person’s needs and the care and support required.
It was apparent the service worked well with other health care services to ensure people who used the service had their individual needs met.
Improvements were required to ensure signage was better suited to meet the needs of people suffering with dementia. We recommend the service explores the relevant guidance on how to make environments used by people with dementia more ‘dementia friendly’.
We looked at training records to ensure staff were fully supported and qualified to undertake their roles. Staff explained that they have had a comprehensive induction followed up by a set of mandatory training. Staff were able to tell us that they received regular supervision and felt supported in their role.
We found that individual nutritional needs were assessed and planned for by the home.
Throughout the inspection, we observed staff treating people with respect and dignity. We saw staff supporting people in a sensitive, respectful and considerate manner. We observed good humoured interactions between staff and people in the lounges.
From looking at care files we tracked choices, like and dislikes within care plans of people who used the service. We spoke to staff who were able to speak knowledgeably about the people they cared for. We observed staffing knocking on bedroom doors before entering. Staff were patient, friendly, supportive and used people’s name when speaking to them.
The home undertook an initial assessment prior to admission involving the person and their family to determine what the person’s individual care and treatment needs. We found people’s needs were assessed and care and support was planned and delivered in accordance with people’s wishes.
We observed one person becoming very agitated and aggressive towards staff at one stage during our visit in the Bluebell Court Unit. We saw staff dealt with the situation professionally, calmly and effectively whilst ensuring the safety of other people who used the service.
We found no set activity programme in the Blue Bell Court on the day of our inspection and observed very little in the way of mental or physical stimulation was available for people. We observed people sitting in one of the lounges, the TV was on but no one was watching it. Improvements were required to ensure greater consistency and continuity across the home to ensure people had opportunities to take part in activities they enjoyed and met their personal preferences.
Concerns were expressed about communication between families and management. Relatives were concerned that no recent resident and family meetings had taken place. Improvements were required to ensure the service effectively engaged with relatives to ensure they were kept fully informed and updated about any developments within the home, which impacted on the care their loved ones received.
Both people who used the service, their families and staff were able to confirm that the provider maintained a visible presence throughout the home and was always available to deal with any issues.
We found the home currently had separate Investors in People recognition for both The Willows and Blue Bell Court.
The service undertook a range of audits of the service to ensure different aspects of the service were meeting the required standards. We found that regular reviews of care files and care plans were undertaken. We looked at monthly infection control audits that were undertaken. However, improvements were required to ensure auditing processes remained effective specifically in relation to medication and obtaining formal written consent from people who used the service.
Providers are required by law to notify CQC of certain events in the service such as serious injuries and deaths. Records we looked at confirmed that CQC had received all the required notifications in a timely way from the service.
Our inspection was co-ordinated and carried out by an inspector and a pharmacy inspector from the Care Quality Commission, together with an expert by experience. As part of the inspection we spoke to three people who used the service, 12 relatives and nine members of staff.
The atmosphere throughout the home was calm, friendly and people appeared at ease with staff.
We spoke to visiting relatives who on the whole spoke favourably about the quality of care their loved one's received. Comments included; 'The care is excellent and the food is prepared well. The cleanliness is good and there are no smells.' 'They take what I say very seriously each time I visit and I go at very different times. I always get a good response and they are polite and get things done.'
There were a range of risk assessments in place which covered pressure sores, moving and handling, continence, falls, bed rails and nutrition. Where people were identified as 'at risk' staff were required to refer to the main care plan section which contained guidance to follow about how to keep people safe.
We found care and treatment was not always delivered in a way that was intended to meet people's needs.
We found people were not protected from the risks associated with medicines because the provider did not have effective processes in place to make sure medicines were managed safely.
We looked at medication records for 14 people who lived in the Bluebell Unit on the day of our visit. We found there were some concerns about medication or records relating to medicines for all but one of those people.
The Care Quality Commission has a duty to monitor activity under the Deprivation of Liberty Safeguards (DoLS) to ensure vulnerable people over the age of 18 have their human and civil rights upheld. We saw there was a suitable policy and procedures in place which provided clear guidance to staff on the legislation and when DoLS application should be made.
We found people were now protected against the risks of unsafe or inappropriate care arising from poor and inadequate record keeping.
On the whole, documentation was arranged in chronological order and was up to date and accurately reflected peoples' current needs.
At the time of our inspection, a new manager had just been appointed and had been in post since March 2014. The Manager identified the home as being a work in progress and advised that they were closely collaborating with the provider to agree a manageable and sustainable way forward to improve the quality of service provided to people who used the service. We were told the service was being reorganised in respect of staffing roles and responsibilities within both units, and practices and procedures, including documentation was being reviewed.
During our visit we spoke with four people who used the service, 25 relatives and friends, three visiting health care professionals. We also spoke with eight members of staff during our visit.
Our inspection team was made up of an inspector, an expert by experience and a specialist advisor in relation to nursing people with dementia. They helped answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?
Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who used the service, their relatives, the staff supporting them and from looking at records.
If you want to see the evidence supporting our summary please read the full report.
Is the service safe?
We found people were treated with respect and dignity by the staff. People told us they felt safe. One person who used the service told us; 'Its ok here, the nurses go out of their way to help you." Another person who used the service said "I feel very safe at night here. When you go to bed you feel safe and they look after you.' One relative told us; 'X seems happy and content which speaks volumes for the care he is getting. X is safe here, no concerns.' Another relative said 'I feel X is safe here.'
Safeguarding procedures were in place and staff understood how to safeguard the people they supported.
It was not always clear to us what systems were in place to make sure that managers and staff learnt from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This would have reduced the risks to people and helped the service to continually improve.
The home had appropriate policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards. The new manager had extensive experience and understood when an application should be made, and how to submit one. Most staff we spoke with had limited knowledge of Mental Capacity Act.
On the day of our visit, the service was safe, clean and hygienic. Equipment was maintained and serviced regularly, therefore people were not put at unnecessary risk.
The manager sets staff rotas and used a dependency assessment to ensure people's care needs were taken into account when making decisions about the numbers, qualifications, skills and experience of staff required. We found there were adequate numbers of staff on duty on the day of our visit and staff reported staffing levels had improved. Overall, relatives we spoke with considered that there were adequate numbers staff on duty most of the time. This helped to ensure that people's needs were always met.
Recruitment practice was safe. Policies and procedures were in place to make sure that unsafe practice was identified and people are protected.
We found people were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines.
People were also at risk because accurate and appropriate records were not always maintained.
We have asked the provider to tell us how they will make improvements and meet the requirements of the law in relation to managing medication and record keeping.
Is the service effective?
From speaking with people who used the service or their relatives, it was not clear that people's health and care needs were assessed with them. We found they were not always involved in writing their plans of care. People also told us that they had not always been consulted during reviews about the changing needs of their relatives who received care.
Specialist dietary, mobility and equipment needs had been identified in care plans where required.
People's needs were taken into account with signage and the layout of the service enabling people to move around freely and safely, however there was only basic signposting to support people with dementia.
Visitors confirmed they were able to see people in private and that visiting times were flexible.
Is the service caring?
People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. People commented, 'Staff are good and all very caring, we have a very positive experience of the home, our X was looked after very well here.' 'The regular staff are very kind and my X is looked after really well.' 'Staff here seem fine and appear to care for our X well.'
People who used the service, their relatives and friends completed a satisfaction survey. Where shortfalls or concerns were raised it was not always clear to us how the service addressed those concerns.
People's preferences, interests, aspirations and diverse needs had not always been fully recorded, and it was not always clear to us that care and support had been provided in accordance with people's wishes.
Is the service responsive?
The service had recently recruited a marketing coordinator to oversee organised activities in both the Willows and Bluebell Court. We saw evidence of a range of activities in and outside the service in some areas of the home, however in other areas, families complained to us about the limited availability of organised activities for people who used the service.
People knew how to make a complaint if they were unhappy.
Is the service well-led?
We found the manager and provider were currently reviewing the management arrangements for each home with the intention of introducing clinical and residential leads for both units. In respect of the nursing unit within Bluebell Court we were told that a registered mental health nurse would be recruited as clinical lead to meet the needs of people who used the service.
The service worked well with other agencies and services to make sure people received their care in a joined up way. A visiting health care professional told us; 'No concerns the staff are very responsive. They are very good at following instructions, I feel they are very professional and always welcoming.' Another health care professional said 'The staff follow any plans we put in place, we have no major concerns.'
The service had some quality assurance systems, however it was not always clear to us that any shortfalls identified were always addressed promptly.
Staff told us they were clear about their roles and responsibilities.
We found that care was planned and delivered in a way that was intended to ensure people's safety and welfare.
The relative of one person who used the service told us: 'I don't have any concerns. I leave here and feel confident that they are looking after X'. Another relative said 'They do a good job I am happy with the care.'
We found medicines were safely administered and people who used the service received their medicines in the way that had been prescribed for them.
We saw staff files contained records which demonstrated that staff had been safely and effectively recruited.
We found there were sufficient numbers of appropriately trained staff to meet the needs of people who used the service.
The provider had effective systems in place to monitor the quality of the service provided.
We found the provider had effective systems in place to record, respond and investigate any complaints made about the service.
Staff we spoke with were aware of their roles and responsibilities to protect people and report bad practice.
We spoke with one person living at the home, four relatives a chef, three members of staff, the provider and a healthcare professional visiting the home.
We also used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.
We spoke with four relatives of people living at the home. They told us that their loved ones were looked after well, treated with respect and encouraged to take part in activities.
Comments from relatives included: 'They look after us as well.' 'X is happy and staff know how to deal with him.' 'They have lots of activities they have a mini bus and take people out.' 'There is always a member of staff in the lounge.'
We looked at a sample of six people's care plans to assess how people were involved in planning their care. We saw that the care plans were person centred and there was evidence that people or their representatives had been involved in making decisions about how their care was delivered.
We observed interactions between staff and people living at the home and saw that staff approached people with respect.
People said they had been provided with details about the home, staffing levels and the services provided before admission.
We also spoke with five relatives of the people living in the home. They told us that they felt people were treated with the utmost respect. One person said that staff were aware of people's holistic needs and made sure they retained their dignity at all times. All relatives spoken with felt the manager had an open door policy and said they could approach staff members to discuss any issues knowing they would get a good response.
We asked a relative of a person who lives in the home whether they thought they were safe and they replied 'I could not have chosen a better place. The staff care for and protect everyone living here'. They further said that care workers were kind and respectful to visitors as well and the home manager was admired and respected by all who knew her.