The Willows Nursing Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question requires improvement. At this assessment the rating has changed to good. This meant people were safe and protected from avoidable harm.

This service scored 72 (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 had systems in place to learn when things went wrong, and lessons were learnt to continually identify and embed good practice. The registered manager told us about the electronic system analysis and the additional analysis they completed. They used this to check for any changes and how learning was shared with staff through the system and written information shared. Staff confirmed they received lessons learned information and were updated when things changed following an incident. Records confirmed what we were told. When accidents and incidents happened, these were logged on an electronic system and regular checks were completed to look for any patterns, trends or learning which could be applied. For example, the location of falls, time of day, whether they were witnessed and unwitnessed were considered and learning was drawn for the service alongside changes to individual risk assessments and care plans.

The provider had developed and maintained safe systems of care. The provider had systems in place to ensure they received information about people prior to admission to the service from other agencies. This was used to form an assessment and care plan and identify any risks to people’s safety ahead of their admission. Checks were done following admission to ensure peoples care was in place. Where people needed referrals to other agencies, these were identified and completed promptly to ensure people had the support they needed. Staff told us the assessment and care plan which people had in place guided them on how to meet people’s needs. We saw where people required support from other professionals, such as therapists,’ referrals were completed and advice was sought and included in peoples care plans.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately. People and their relatives told us they had no concerns about safety at the service. A person told us, “The staff are very good. I feel safe with them all. I think they all know me well.” Relatives told us people were safe with staff. Staff told us they had received training in how to recognise abuse and understood how to report any concerns. Records showed any concerns were documented into the system. The registered manager told us they reported any concerns to the appropriate body and records supported this. We saw systems were in place to monitor the outcomes of safeguarding investigations and share learning with staff to make improvements to peoples care when things went wrong.

People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. In care homes, this can be done through a procedure called the Deprivation of Liberty Safeguards (DoLS), which is part of the Mental Capacity Act 2005 (MCA). We checked whether the service was working within the principles of the MCA and how they managed DoLS within the service. We found the provider had systems in place which ensured they worked within the principles of the MCA and where needed applications had been made for DoLS to the authorising body. A system was in place to monitor the application of DoLS to ensure updates were requested as required.

The provider worked with people to understand and manage risks to their safety. People and their relatives told us staff supported people to manage risks to their safety and could give examples. A person told us, “The staff hoist me. They make sure I’m safe in the hoist. There are always 2 staff available.” A relative told us, “[Person’s name] is very safe here. They have bed rails to prevent them from falling out of bed.” Staff told us they had information in peoples risk assessments and management plans which guided them to keep people safe. For example, they could describe how they supported people to manage risks associated with their diet and their skin integrity. Staff were aware of the plans in place to prevent incidents such as falls. The registered manager told us risks were reviewed monthly or more frequently if needed and updates were done to peoples care plans to help keep them safe. Documents we saw supported this. We observed staff using peoples risk assessments throughout the day. For example, we saw staff supporting people to transfer from a wheelchair to a lounge chair. Staff offered reassurance to the person and completed the transfer safely following the guidance which was in the persons care plan.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. The provider had systems in place to check on the safety of the environment. For example, regular checks were in place on equipment such as beds, mattresses and locking mechanisms for windows. The registered manager told us they had audits in place to ensure the environment was safe and the electronic records system had an environmental risk assessment in place to support staff with keeping people safe. Records we saw supported this. The home was well maintained and staff understood how to report any concerns. People and their relatives raised no concerns with the maintenance of a safe home environment.

The provider did not always ensure there were enough staff available to support people at the time of their choosing. People and their relatives told us they felt there were times when there were not enough staff. One person told us, “Sometimes they are short of staff. There was only 3 on the other day because of the weather. It happens occasionally. You don’t go short of anything though; they are just a bit more rushed with you.” Relatives felt there were times when staff were rushed, but confirmed people did not wait excessively for their support. Staff told us it was a busy home, and some days were better than others. Staff told us people were being cared for in their bedrooms due to being unwell and this meant people were waiting longer for their needs to be met. Observations showed some people had to wait for their support. For example, to have support with their meals and have call bells answered promptly. We saw staff were rushed and this impacted on the time they could spend with people; however, everyone had their needs met and there was no impact on safety. The registered manager increased staffing levels immediately after the inspection as they recognised the current staffing levels had not fully considered the additional needs of people whilst being cared for in bed and they told us this would remain under review. Staff were recruited safely as the provider had a recruitment policy in place which ensured safe recruitment practice. Staff told us they had an induction into their role and received regular updates to their training; records we saw supported this.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly. People and their relatives raised no concerns about infection prevention control. A person told us, “The staff clean my room regularly so it’s always clean.” Staff were observed following infection prevention control procedures and could describe how they prevented the risk of cross infection. The provider had systems in place to ensure staff received training and information about infection prevention control. There were regular checks and audits to ensure these processes were followed. We saw processes were followed to report any infections to the appropriate body and steps were taken to address any infections present and prevent the spread of infection.

The provider had systems in place to ensure people received their medicines as prescribed from trained staff. Staff ensured medicines were stored and administered safely and records were completed accurately. People and their relatives told us medicines were administered safely. A person told us, “The nurse gives me my tablets, and I get them on time every day.” A relative told us the doctor regularly reviewed their relatives’ medicines and staff followed the instructions of the doctor when administering medicines. We saw nurses administered medicines, seeking consent and following safe administration procedures. Medicines were stored safely; checks were in place to ensure medicines were stored at the correct temperature. Competency assessments were in place for staff administering medicines and staff completed regular updates to their medicines training. Medicines administration records were in place and were accurately completed. Stock checks were done to ensure people had enough medicines in stock. Risk assessments and care plans were in place to identify the support people needed and where people received medicines which were on an ‘as required’ basis, there was clear guidance in place for staff on when these should be administered.