Willow Court Nursing Home

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

The service was in breach of legal regulations in relation to consent to care and treatment.

Consent processes were not consistently followed. Mental capacity assessments, best interest’s decisions, and decision-making records were missing or incomplete for several people. Where restrictions or significant care interventions were in place, documentation did not consistently demonstrate how people’s rights or preferences had been considered.

This service scored 54 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not make sure people’s care and treatment was effective because they did not check and discuss people’s health, care, wellbeing and communication needs with them.

A person who could sometimes become distressed when being supported with personal care, did not have a care plan to guide staff on how to support them in a way that reduced/minimised distress. Another person with anxiety and depression did not have a care plan detailing support for their mental health needs.

Records indicated that some care plan updates were completed during early hours of the morning, limiting opportunities for people and their relatives to be involved in care decisions.

People and families gave mixed feedback about involvement. One person said, “I’ve never seen a care plan or had it discussed. I didn’t realise until recently that I had a care plan”. A relative added, “I did see a care plan a while ago. My meetings with staff tend to be on an ‘on demand basis and I’m quite happy with that”. These responses show that people and their families did not consistently have opportunities to engage with or understand care plans, which could affect shared decision-making and individualised care.

Care plan audits were completed, but did not consistently identify missing or misleading information, leaving staff without reliable guidance to deliver care that met people’s needs effectively.

The provider responded by creating and updating care plans, reviewing records, and involving staff in training to reinforce accurate documentation. Auditing processes were enhanced, and closer oversight was implemented to ensure care plans reflected current needs and were regularly reviewed with people and their families.

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them. Care and treatment were not consistently delivered in line with evidence-based guidance or best practice, placing people at potential risk of harm.

The provider used nationally recognised tools to assess people’s risk of malnutrition and pressure injuries. However, this information was not always used to inform risk management and care planning. For example, 1 person identified as at high risk of developing pressure injuries did not have a risk assessment or care plan to guide staff on how to reduce the likelihood of pressure sores developing. Similarly, a person at risk of malnutrition had no risk assessment or care plan, leaving their nutritional needs unaddressed. This meant actions were not always taken to reduce the identified risks and exposed people to the risk of avoidable harm.

During the inspection, the provider reviewed and updated care plans to ensure that assessment outcomes were linked to personalised interventions. The provider scheduled workshops with staff to reinforce the importance of translating risk assessments into actionable care plans, and monitoring processes were strengthened to ensure ongoing compliance with evidence-based practice.

The provider worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

People and their relatives told us staff worked well with other services, such as community mental health teams, occupational therapists, social workers and GPs, to ensure people received the care they needed. Health and social care professionals were positive about the way the service worked with them to meet people’s needs.

One professional told us: “We have weekly MDTs, and a monthly forum with other social work teams and short-term service providers to share best practice and learn from one another about how we might be able to get better outcomes for people accessing the service”. Another professional told us, “The staff engage with the assessment process and referrals are clear. We can then prioritise the referrals effectively.

Although the provider’s processes were inconsistent and at times ineffective, staff supported people to manage their health and wellbeing to maximise their independence, choice, and control.

People told us that staff actively encouraged them to live healthier lives and, where possible, reduce their future needs for care and support. One person said, “I’ve recovered very well, and I shouldn’t really be here now but I’m waiting for my flat to be ready”.

Relatives also described staff going above and beyond to support both physical and cognitive wellbeing. One relative said, “Since my relative has been here their cognitive ability has improved, their speech has massively improved. Definitely an amazing place and the improvement in my relative is down to the staff.” Another relative told us, “The staff use a hoist to take my relative to the lounge so that they can get a bit of company and get out of their room, which is really helpful for my relative’s mental wellbeing.”

People told us they benefitted from proactive support for their health and wellbeing, particularly through assistance with mobility, personal care, and engagement in activities when these were available. People and relatives confirmed that staff were attentive, responsive, and committed to promoting wellbeing.

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

Records showed that pain management and nutritional monitoring were not always appropriately followed up. For example, a person’s Abbey Pain Scale records indicated a mild pain score of 3, yet pain relief was declined, and no follow-up was recorded until the next day — over 8 hours later. When pain relief was subsequently accepted, again no follow-up was recorded until the following day, reducing timely oversight of ongoing discomfort.

Similarly, a person identified at risk of malnutrition had lost 6 KG in one month. Despite the GP’s advice to have their weight monitored twice a month, records showed the person had only been weighed once. Limited monitoring meant that emerging risks, such as deterioration in nutrition or unrelieved pain, could go unaddressed for extended periods, placing people at avoidable risk of harm. The lack of systematic tracking and timely review also limited opportunities to adjust care plans promptly or involve people and their families in decisions about interventions.

Despite these shortfalls, relatives told us care in key areas was reliable and effective. One relative said, “I believe that the care my relative is getting is medically exceptional. The staff are all very good at dressing my relative’s ulcers, which are cleaned and dressed every day without fail.” Another commented, “The staff have to work in pairs when moving/dressing my relative. I have to say that the staff are very good at regularly moving my relative, who stays in bed all the time, as my relative has not had any ulcers or bed sores.”

During the inspection, the provider responded by reviewing monitoring processes, reinforcing staff training on timely documentation and follow-up, and updating protocols to ensure pain, nutrition, and other key outcomes were regularly recorded and acted upon. Enhanced auditing procedures were introduced to identify gaps promptly and improve oversight.

The provider did not tell people about their rights around consent or respect these when delivering care and treatment. People’s rights were not always recognised, explained, or respected, and the provider’s processes were not lawful.

One person had a consent form for care and support which stated, “Staff have talked to me about my care and support needs, wishes and preferences and have involved me when writing my care plans”. The same person told us they had never seen their care plan. This meant the provider could not demonstrate that consent was informed.

We reviewed the records of 2 people living with Dementia. For 1 person, the provider had not applied for a Deprivation of Liberty Safeguards (DoLS) authorisation, despite the person being at the service for over a month and staff and staff recording incidents where the person resisted personal care and hit out at staff. Additionally, these 2 people had Mental Capacity Assessments (MCAs) and Best Interests (BI) decisions, but these were not decision specific. The provider had completed a general MCA and BI decision covering care and treatment, and a separate MCA/BI for bed rails. No MCA or BI decisions existed for other key aspects of care, including modified diets, administration and handling of medicines, regular checks, or hoisting. This meant, important decisions were made without legal safeguards, and the service could not evidence that people or their legal representatives were involved in decision-specific decisions.

People with capacity who could communicate told us staff asked for consent and treated them considerately. They said they were happy with the care they received. However, some people lacked capacity or had speech impairments and could not provide this assurance.

The provider’s internal processes did not align with the MCA 2005. On admission, staff completed a single MCA and BI decision covering all aspects of care, without showing how each decision was assessed or what information was shared. The manager told us that separate MCAs are completed only for bed rails, sensor mats, high/low beds, and crash mats. While this reflected provider-wide practice, it did not meet the legal requirement for decision-specific assessments and Best Interests decisions.

Although people reported positive experiences and staff sought consent during daily care, the lack of decision-specific documentation and incomplete DoLS processes meant the provider could not demonstrate that all decisions were lawful or that people’s rights were consistently protected under the MCA 2005.