Willows Care Southern Limited

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• 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. This is the first assessment for this service following a change of provider. This key question has been rated good. This meant people were safe and protected from avoidable harm. Potential risks to people’s health and welfare had been assessed and there was guidance for staff to mitigate risk. Accidents and incidents were used for learning, safeguarding concerns had been reported and investigated. There were enough staff to meet people’s needs, staff had received training appropriate to their role. Staff received their medicines as prescribed. The service was clean and odour free, the building and equipment had been checked to make sure they were safe.

This service scored 75 (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 a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice. Accidents and incidents were recorded by staff, these were then reviewed by the manager and each record will be signed off. When immediate action was required, this had been done. Monthly audits were completed to identify any patterns and trends. For example, a person had a pattern of falls, they were seen by the acute response team (ART) for guidance, this included more support in bed. The person had also fallen from their bed, staff reviewed their support, and it was decided the least restrictive option was to use bedrails, which were effective. Records showed all accidents and incidents had been reviewed and action taken to reduce the risk of them happening again. Staff told us they were kept informed of changes to people’s support following accidents.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services. There were clear processes in place to make sure people’s information moved with them including to the hospital and other care homes. The manager told us how they supported people to be assessed by other care homes, it their needs changed, or the person wanted to move. People’s care plans and anticipatory treatment plans were provided to the hospital when people were admitted. When people were being admitted as an emergency, a staff member would go with them, if a relative was not available, especially as people may not have capacity to make decisions.

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. Staff described to us how they would recognise signs of abuse and discrimination and the action they would take. Staff were confident to raise concerns with the management team and that action would be taken. The manager understood their responsibility to report concerns to the local authority and to work with them to reduce the risk of the situation happening again. Records showed concerns had been reported to the local authority as needed. People’s care records showed staff had promoted people’s rights when they were unable to do so, to ensure they were not discriminated against. For example, making sure people received antibiotics when they were on the end of life pathway, to treat a short term infection.

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them. Relatives told us, staff involved people to understand and manage risk. Comments include, “(Relative) is involved in the possible risks to their health, they talk to them about needing to use a frame,” and “Yes they include them in conversations about their safety with eating and using a frame.” Relatives told us staff knew how to respond and calm their relatives when they were distressed or anxious. Potential risks to people’s health and welfare had been assessed and there was clear guidance for staff to mitigate these risks. For example, staff understood how to support people living with diabetes, they knew how to recognise when they were unwell and the action to take. Some people were living with a catheter, to drain urine from their bladder, staff knew how to reduce the risk of urinary infection.

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 management team kept the environment in which people spent their time as safe as possible. Checks on equipment which staff and people used were checked regularly to make sure they were safe. The windows had restrictors on them so they could not be opened wide, and doors were locked where chemicals were stored. The fire safety system was maintained and checked regularly, fire drills had been completed.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs. Relatives told us there were enough staff to support people and they thought they were well trained. A relative told us, “When I am there, there seems to be sufficient staff. I would say that they know what they are doing, my hat goes off to them, they pay attention to what is going on.” Staff told us they thought there were sufficient staff, including “I’m happy with the number of staff on duty. We plan shifts and get on well.” There were processes in place to recruit staff safely, these included checking previous employment and criminal records. Staff had received an induction when they started at the service, including shadowing more experienced staff. Staff received training appropriate to their role and their competencies had been checked to make sure they were safe to support people.

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. The service was clean and odour free during our assessment. There were infection prevention and control (IPC) procedures in place including audits and cleaning schedules. There were hand washing facilities throughout the service, furniture and equipment were wipeable and easy to clean. There was personal protective equipment (PPE) available on each floor. We observed staff wearing PPE appropriately and disposing of it correctly. When people were unwell or had an infection, relatives were asked to wear PPE in line with best practice guidance. The manager understood their responsibility to report any outbreaks of infection such as Covid or diarrhoea and vomiting to the public health teams. There were systems in place including colour coded equipment to reduce the risk of cross contamination and ensure waste was correctly disposed of.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Medicines were managed safely, there were systems and processes in place to make sure people received their medicines as prescribed. Relatives told us people received their medicines as prescribed, and they were kept informed of any changes. Staff had received training and had their competency checked before they administered medicines. Some senior staff had been trained to give insulin, their competency was checked yearly by the district nurse. Staff confirmed they had received training and had been observed while completing a medicines round. When people were prescribed medicines on a ‘when required’ basis such as pain relief or to relieve anxiety, there was clear guidance in place. This included when to give the medicines, how much, how often and what to do if the medicine was not effective. Some medicines had specific storage and administration requirements, which staff followed.