Willows Care Home

Willows Care Home is a residential care home providing nursing and personal care to people, some of whom may have dementia. The home can support up to 72 people and at the time of the inspection, 51 people were living in the home. It is an adapted building with three floors, each with separate facilities, including en-suite bathrooms.

People’s experience of using this service and what we found

We found the service continued to be safe and people were protected from the risk of avoidable harm and abuse. Medicines were managed safely and there were robust procedures in place for the administration, recording and storing of all medicines. Audits identified medicine errors and action was taken to investigate them and make improvements.

There were appropriate numbers of staff and they were recruited safely. The provider ensured infection control procedures were in place and there was guidance for people, staff and visitors during the Covid-19 pandemic to keep them safe. Risks to people were identified and managed. The premises, installations and equipment were serviced and maintained to ensure the home environment was safe.

The registered manager carried out audits and inspections to check correct procedures were being followed by staff. The provider was meeting regulatory requirements and notifications of incidents were submitted to us. People and relatives told us the service was well managed. People and relatives were given opportunities to provide feedback about the quality of the service. The provider had identified where improvements were needed in the home and had action plans in place to address them.

Staff were kind and compassionate towards people in the home. There was a positive and open culture and discussions were held with people and relatives to obtain their feedback. Team meetings with staff were held with the management team to discuss important topics and go through any issues. Staff felt able to voice their concerns to the management team. Staff worked well with health professionals and other agencies to ensure people’s health and wellbeing were maintained.

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

Rating at last inspection and update

The last rating for this service was Good (published 10 May 2019).

Why we inspected

We received concerns in relation to the management of the service, infection control procedures, medicine management, staffing levels and the culture of the home, which could put people at risk of unsafe care. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were received in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has remained Good. This is based on the findings at this inspection.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Willows Care Home is a residential care home registered to provide

accommodation and personal care to 72 people. At the time of the inspection, 54 people were living in the home.

People’s experience of using this service:

•People were safe in the home and there were procedures to protect them from abuse.

•Risks associated with people’s needs were assessed to mitigate them and keep people safe.

•People were provided their medicines as prescribed.

•People were supported with their nutritional needs and had choices with meals. People had access to health care professionals such as GPs when required.

•People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

•People received care from staff who were kind and compassionate. Staff treated people with dignity and respected their privacy. People’s independence was promoted.

•Staff had developed positive relationships with the people they supported. They understood people’s needs, preferences, and what was important to them.

•Care plans were person centred and detailed people’s support needs.

•People and relatives were supported with complaints they wished to make.

•Staff were recruited safely and were supported with the necessary training and development to increase their skills.

•Staff felt supported by the management team and told us there was a positive culture.

•There was a system in place to monitor the home and ensure consistent and good quality care was provided to people.

•The registered manager was committed to make continual improvements to the home.

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

Rating at last inspection:

At the last inspection on 15 February 2018 (report published 6 April 2018), the service was rated ‘Requires Improvement’ because the service was not always caring, responsive or well-led. At this inspection, we found these issues were addressed and the rating for the service has now improved to ‘Good’.

Why we inspected:

This was a planned inspection based on the rating of the last inspection.

Follow up:

We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care.

We looked into these concerns at this inspection and we have rated the service ‘Requires Improvement’.

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.

Willows Care Home accommodates up to 72 people across three separate units, each of which have separate adapted facilities. The units specialises in providing nursing care to people living with dementia.

One the day of our inspection, 52 people were living in the home.

The home had 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.

Each unit in the home was managed by a registered nurse who was supported by the registered manager and a deputy manager. The deputy manager was unavailable on the day of our inspection.

Risks to people were identified to ensure they remained safe. However, we noted that any risks relating to people's personal equipment which helped them remain comfortable was not always assessed by the provider. This was addressed by the registered manager during the inspection.

Medicines were stored, managed and administered by staff who were trained. We noted that staff had not appropriately followed procedures following a change to a person's medicine prescription.

People were involved in the planning of their care and received care and support to ensure their individual needs were met. Care plans were person centred and contained information on people’s backgrounds and preferences, including for end of life care.

Staff ensured people had access to appropriate healthcare when needed and their nutritional needs were met. People were provided with a choice of meals, although some people told us they were not always happy with the variety and the presentation of their meals. We have made a recommendation for the provider to look into maintaining good quality catering standards.

Feedback was received from people and relatives in the form of questionnaires and surveys to help drive quality improvements. People and relatives were able to make complaints and have them investigated by the registered manager. However, we have made a recommendation about ensuring all types of complaint are responded to and followed up because some people did not feel they were always listened to or shown enough respect.

The registered manager was committed to developing the service, although further improvements were required to ensure people continued to receive a caring and responsive service.

The premises were clean and regularly maintained. The environment was suitable for people who had specific needs such as dementia.

Infection control procedures were followed after a recent outbreak, which affected people in the home.

Records of accidents and serious incidents showed that the provider learned from mistakes to prevent reoccurrence.

Staff had received training on how to keep people safe. They were able to describe the actions they would take if they had any concerns about people’s safety. The provider also had a whistleblowing policy, which staff were aware of and they knew how to report concerns both internally and to external organisations.

The provider had safe recruitment procedures in place and carried out checks on new employees. There were enough staff on duty to ensure people's needs were met and staff rotas were planned in advance so that staff cover could be arranged when required.

Staff were supported with regular training, meetings and supervision. Staff performance was reviewed on a yearly basis and they were encouraged to develop their skills.

The provider had systems in place to support people who lacked capacity to make decisions for themselves. Staff had received training on the Mental Capacity Act 2005.They were knowledgeable of the processes involved in assessing people’s capacity.

Staff were aware of people’s preferences, likes and dislikes. They also had an awareness of equality and diversity and challenged any discrimination they encountered.

People were encouraged to participate in activities and remain as independent as possible. Their choices were respected.

Staff were able to communicate with people in order to understand their needs.

Staff felt supported by the management team, who reminded staff of their responsibilities and requirements when providing care.

At our previous inspection on 7 August 2015 we found that the provider was not meeting legal requirements. This was because medicines were not always administered safely, infection control guidelines were not always followed and people were not always cared for by staff who had the skills and competence to care for people on oxygen or to follow guidelines already in place. People's dignity was not always respected as there were instances where staff had walked in on people without knocking. People's records such as observation charts, fluid and food records and daily records were not always completed correctly. The inconsistent leadership found at our last inspection meant that some aspects of the systems in place for monitoring the quality of care were not effective.

The service did not have a registered manager in place in August 2015, however, a new manager had been in post since September 2015 and had applied to CQC to manage the service. A registered manager is a person who has registered with CQC 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. Additionally a new deputy manager was appointed in December 2015.

During this visit we found that a more stable and consistent staff team were in place and reliance on agency staff had decreased. The registered manager had a system in place to ensure there were enough staff to meet people's needs safely and in a timely manner. People's health care needs were met and the provider had recently contracted with a new GP surgery who was also undertaking a medicines review for each person.

People told us they felt safe and cared for. Staff told us what steps they would take to keep people safe and how they offer people choices. Staff explained that people could make decisions about some things even when they might lack capacity to make more complex decisions. Where people lacked capacity to make some decisions, best interests decisions were made in line with legislation. Applications had been made for authorisations where necessary to deprive people of their liberty for their own safety.

Safer recruitment practices were followed and a training and quality lead had been appointed with responsibility for ensuring all new staff completed a mandatory induction, including agency staff.

People's needs were assessed and risks relating to their support were also assessed. We saw evidence that these assessments and care plans were regularly reviewed.

People told us that they enjoyed the activities that took place, joining in when they wanted. There was use of a minibus to take people outside of the care home environment. There was an activities room and activities also took place in the communal lounges and in people's rooms.

People told us they liked the food, were given choices and could make requests for foods they liked. Visitors told us they felt welcomed and that they felt improvements had been made by the new manager and staff.