The Willow

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.

This is the first assessment for this newly registered service. This key question has been rated Good. This meant people were safe and protected from avoidable harm.

This service scored 69 (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 reported safety events where necessary, investigations were undertaken to establish cause, and identified lessons learnt to prevent incidents from occurring again. Where medication errors had been made, it was identified staff were tired or distracted. As a result, shift lengths were changed and the procedure to administer medication was altered. No further errors had been made since this change.

The service was open and transparent, and outcomes of safety events were shared with residents and their representatives. Safety events shared with staff at handover meetings were handed over to ensure learning was embedded. People’s representatives told us that they would “raise any safety fears with the manager” and “[the registered manager] seem to be very approachable.” Partners told us that they felt that the service worked with them and took appropriate action when things went wrong.

This meant the service was able to continually identify and embed good practises, and people using the service were kept safe.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored.

People’s representatives were involved in the admission process and helped to provide information about people’s life history. People were able to bring in items from their own home such as ornaments, photos and pictures. We observed staff getting to know people and supporting them to settle into the home, providing gentle encouragement to join in with activities or eating at the dinner table with other residents.

People had hospital passports which were shared with medical professionals to support them to access health services. This meant people experienced safe continuity of care when moving between different services.

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 were supported to understand what keeping safe means and were encouraged to raise any concerns. We observed staff encouraging people to protect themselves from self-neglect and continued to support people when they made choices that appeared to others as “unwise”. Staff had up-to-date safeguarding training and access to safeguarding policies and procedures. Staff knew how to report concerns. This meant that people were protected from the risk of harm and neglect.

People’s representatives told us “[they have] lived all [their] life with issues, and [their needs] makes [them] more vulnerable. Anyway, [they are] settled here and I know [they are] in a safe place.”

The provider worked well with the local authority, and safeguarding referrals were made appropriately. Management had a clear understanding of the requirements of the Mental Capacity Act 2005 (MCA) and applied for DOLs (Deprivation of Liberty Safeguards) as necessary. Staff had all completed MCA training but were not always able to tell us who had DOLs and associated conditions in place. Staff had access to this information when needed. Management told us they worked with people and their representatives to make decisions in people’s best interests, for example, the use of bed rails. This meant that people were protected from unnecessary restrictive practises.

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.

We observed staff acting appropriately to reduce risk; by asking people to wait so staff were able to provide the person’s walking aid to them before they mobilised. We observed staff using safe moving and handling practises. Staff completed appropriate training specific to their roles to reduce risks to people, including falls, hydration and nutrition, and positive behaviour support.

People and their representatives were involved in care planning and risk management; however, risk assessments were not always robust, individualised, and did not document written strategies to mitigate risks of falls, behaviour that communicated distress, or moving and handling. This meant staff did not always have appropriate documented guidance to manage risk.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. Equipment used by people to support care was regularly serviced.

Health and safety checks of the premises were completed on a weekly basis. There was a building risk assessment in place. The provider showed us what action has been taken to rectify high or low water temperatures. There were no risk assessments in place to protect people from scalding. We gave feedback to the provider and action was taken to put these in place. However, risk assessments did not contain documented processes for staff to ensure water was an appropriate temperature to use. Risk assessments did not address the risk of scalding to staff. This meant people and staff were at risk of burns.

Fire drills were regularly evidenced, and practise scenarios had been thought out carefully to assess people’s reactions to fire situations. Fire equipment was regularly serviced and worked properly. Management and staff were able to tell us who would need support to evacuate from the home and the strategy to do so. The use of coloured stickers on bedroom doors meant that the fire service knew who needed support to evacuate in an emergency.

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.

We observed a mix of qualified and skilled staff working on the day of inspection. Rotas were appropriately put together and the management team cover day and night shifts where there was a need. People told us “Staff are around if I shout or if I press my button”. Relatives told us “There’s always staff in and around the lounge” and “there always seems to be plenty of staff around, [I’ve] never found it hard to find someone to speak to”.

The service had a designated activity coordinator supported by volunteers, domestic staff and a cook. We saw evidence of recruitment checks, competency checks in medication administration and homely remedies, regular supervision with management, and records of all completed training. This meant people were safely cared for by a well-trained team.

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.

We observed staff wearing appropriate Personal Protective Equipment (PPE) and safe disposal mechanisms were in place. Staff washed hands regularly in between care for people, with hand sanitiser readily available for their use. The environment appeared clean and free from odours. Food was prepared on site and correctly stored in fridges with labels stating when items had been opened and when they needed to be used by. We observed foods defrosting in a safe way. The provider had an in-date Infection Prevention and Control (IPC) policy in place that staff had access to on their mobile phones and on site. There was an IPC lead in the service who carried out audits regularly. This meant that IPC was a focus for staff and protected people from the risk of infection.

The service told us that people had experienced a recent delay in receiving their flu jabs. The management team had taken quick action to work with healthcare providers to ensure this was rectified to avoid an outbreak of flu.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened.

We observed staff administering medication safely and discreetly. Staff asked people if they would like to take their PRN (as needed) medication at appropriate times. Staff were trained and assessed to be competent in medication administration.

Staff followed national guidance, and records were complete, clear and contemporaneous. Medication was stored appropriately with temperature checks taking place and staff used safe disposal practises for medication that was no longer needed. Information posters about anticoagulants and associated risks were present in staff’s sight. We gave feedback to the provider regarding the use of PRN pain relief and prescribed pain relief, to ensure staff follow protocol and avoid potential errors in administration.