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Inspection carried out on 30 July 2019

During a routine inspection

About the service

Willowcroft is a residential care home providing personal care to 60 people at the time of the inspection. 58 people were living at the service at the time of the inspection.

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

Care plans and risk assessments for when people experienced behaviours that challenged needed more detail to help ensure staff provided consistent care.

Other risks regarding people’s health care needs, such as falls and risks from the general environment were assessed and managed. Actions were taken to ensure people were protected from abuse and avoidable harm. Medicines were managed in line with nationally recognised guidance for safe medicines management. The service was clean, and actions were taken to help prevent and control infections. The registered manager looked to identify any improvements and to learn from when things had gone wrong.

Enough staff were available to ensure people received timely care to meet their needs. The provider completed checks on staff as they were recruited to ensure they were suitable to work at the service.

People’s needs were assessed before they went to live at the service. Assessments covered all aspects of people’s health, care and well-being and reflected the requirements of the Equalities Act. Staff had been trained in areas relevant to people’s needs and their competence was checked. People received food and drink to meet their nutrition and hydration needs. Staff worked with other healthcare professionals to ensure their care needs were met effectively, including support for when people were required to attend hospital appointments. The building met people’s needs and had design features that helped people living with dementia. People’s own bedrooms were personalised to their own tastes.

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

Staff had developed warm and caring relationships with people. Staff respected people’s equality and diversity needs. People were supported to be as independent as they could be; staff actively worked with people to promote their independence. People were cared for by staff who respected their privacy and dignity. People and their relatives were involved in expressing views about their care and treatment and the development of the service. These views were respected and listened to.

Staff knew people well and understood how to meet their needs and preferences. People enjoyed how they spent their times at the service and had a variety of activities to be involved in. People’s communication needs were assessed, and information was in care plans on how best to communicate with people. Procedures were in place to ensure any complaints would be investigated and managed. When people required care at the end of their lives, this was planned and personalised.

The registered manager was clear on her role and steps had been identified to strengthen the management support in the service. People, relatives and staff all found the registered manager to be approachable and fair. Audits and checks on the quality and safety of services were in place to help ensure people received quality care. Regular meetings were held so that people and their relatives could contribute their views to the development and running of the service. The service worked well with other professionals and looked to identify learning to contribute towards improving care for people.

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

Rating at last inspection

The last rating for this service was Good (published 15 December 2016).

Why we inspected

This was a planned inspection based on the previous rating.

We have found evidence that the provider needs to make some improvements. Please see the safe section

Inspection carried out on 15 September 2016

During a routine inspection

Willowcroft is registered to provide personal care for up to 60 older adults, which may include some people living with dementia. This inspection was unannounced and took place on 15 September 2016. At the time of our inspection there were 59 people living there.

There was a registered manager at this service. 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. At our last inspection in January 2014 the provider was fully compliant in all areas inspected.

At our last inspection carried out in January 2015 we found three breaches in relation to Regulations. At this inspection we found these had been addressed.

During our inspection visit we observed that staff were friendly and approachable. They spent time sitting with people to offer them comfort or stimulation. We observed staff delivering care which met people’s individual needs and which supported them in a respectful and appropriate way.

There were training and processes in place for staff to follow to keep people safe and staff followed these. People’s physical and mental health was promoted. Staff were trained to care for people living with dementia. Medicines were stored appropriately and were administered and recorded as prescribed.

We saw staff ensured people were comfortable. We saw people were supported in a relaxed and unhurried manner. Staff were caring and communicated well with people. Lunch was the highlight of the day and care was taken to ensure people had time to socialise and to enjoy their food.

Staff focused on people they were caring for rather that the task they were carrying out. Staff spoke in a positive manner about the people they cared for and had taken the time to get to know people’s preferences and wishes. Staff had a good understanding of people’s needs and this was demonstrated in their responses to people and recognition of when people required additional support.

People’s privacy was respected. People had their independence promoted. Where possible they were offered choice on how they wanted their care delivered and were given choices throughout the day. Staff responded to body language of people who were without verbal communication.

People were supported to maintain relationships with family and friends. Visitors were welcomed at any time. Records we looked at were personalised and included decisions people had made about their care including their likes, dislikes and personal preferences. There was a varied activity programme for people based on individual and group preferences. Suitable occupation was offered to people living with dementia. This included reminiscence and other therapies. Activities also included one-to to-one time and outings, or time in pursuit of personal hobbies or interests.

People, relatives and staff spoke very highly of the registered manager and felt the home was well-led.

The service was managed in an inclusive manner. People and staff had their wishes and knowledge respected. Staff were aware of their roles and responsibilities for people’s care. The registered manager had systems in place to review the service and to ensure the service responded to ongoing needs of people.

Inspection carried out on 19 & 21 January 2015

During a routine inspection

This inspection took place on 19 January 2015 and was unannounced.

Willowcroft is a care home without nursing for up to 60 older people. There are four wings over two floors; each floor has a dementia care and residential care wing. At the time of this inspection there were 56 people using the service, some of whom are living with dementia. The service is located in Spondon in Derby which has amenities and good transport links.

A registered manager was in post, however this person was currently on leave and the position was being covered by an acting manager. 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.

At our last inspection on 16 November 2013, we asked the provider to take action to make improvements. This was because some care records we looked at were not always kept up to date to ensure people’s needs were being met. Improvements were needed in the storage of care records so that people’s personal information was kept securely. We found that not all of the people at the service had personal emergency evacuation plans (PEEP’s) in place. The provider sent us an action plan outlining how they would make improvements. At this inspection we saw that the provider had made improvements in these areas.

People who self-medicated were not always protected against the risks associated with poor medicines management.

Some people using the service and staff felt that the current staffing levels did not ensure that there were sufficient staff available to meet people’s individual needs.

Risks to people’s nutrition was not effective. People were not always supported to maintain their hydration and nutrition. People using the service told us they felt safe and were happy living at the home. The acting manager and staff understood their responsibilities to protect people from harm.

Arrangements were in place to assess and monitor the quality of the service. However further improvement was needed to ensure these systems were effective.

Risk assessments were in place to ensure measures were in place to minimise the identified risks. Staff had a good understanding of people’s needs and abilities because they were involved in handover meetings.

Recruitment procedures ensured suitable staff were employed to work with people who used the service.

Staff received health and safety training which related to the needs of the people receiving support. Staff were supported through regular supervision.

People told us they liked the staff and were supported by staff to make their own decisions about their care and support. Our observations showed that staff offered people a choice in how they spent their day.

People told us they saw the GP, dentists and opticians when they needed to.

People told us they enjoyed using the service and received the right support. Relatives we spoke with told us that staff were caring and reliable. People were supported to take part in activities which suited their interest and hobbies.

There was a complaints procedure and we saw that complaints had been managed appropriately.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which correspond with the Health and Social Care Act 2008. (Regulated Activities) Regulations 2014.You can see what action we told the provider to take at the back of the full version of this report.

Inspection carried out on 16 November 2013

During a routine inspection

During our inspection we spoke with 10 people who used the service and the relatives of four people. We also spoke with nine members of staff, the deputy manager and a visiting health professional. People who used the service and their relatives told us they were happy with the care. One person said, “Its first class here”. Another person said, “On the whole all the staff are pretty good”. One person’s relative told us, “We are very happy with the care. It’s very person centred and we are always kept informed”.

People told us they were involved in making choices about their care, and we observed staff responding to and respecting people’s choices.

We observed staff interacting with people who used the service in a caring and positive manner, but we saw that people’s support plans were not always followed. This meant that some people were placed at risk of harm.

We saw there were systems in place to ensure staff were suitably trained and supported to meet people’s needs.

We found that the safety of the premises were adequately monitored and maintained and the care environment was suitable to meet people’s needs and keep people safe.

We saw that people’s care records contained information about their preferences and interests, but some care records were not always kept up to date. This meant people were at risk of receiving inconsistent or unsafe care. Care records were not stored securely which meant that people’s personal information was not kept safely.

During a check to make sure that the improvements required had been made

We followed up one area of non-compliance identified in a previous inspection. We reviewed evidence that demonstrated the provider's compliance in this area.

Inspection carried out on 1 October 2012

During a routine inspection

We found evidence that people’s views and experiences were taken into account in the way the service was provided. People we spoke with told us that they enjoyed living at the home and felt safe living there. They told us that the home provided a range of interesting and stimulating activities, whilst encouraging people’s independence. One person told us "I'd give it five stars, I think it’s excellent". Another person told us “I can’t fault the place, to me it's what I would do if I was at home, the staff are most helpful".

Relatives we spoke with were also positive about the experiences of their family members and felt fully involved in their care planning.

We found that the home had a quality audit system in place. However,we found that there were incidences where systems and policies in relation to medication management were not followed. This meant that people were not always protected against the risks associated with poor medicines management.

Inspection carried out on 7 February 2012

During a routine inspection

We saw people taking part in activities. The activity co-ordinator told us they worked on all four units within the service. Some people were doing jigsaws and the activity co-ordinator was manicuring people’s nails.

We also spoke to some people who were using the service at the time of our visit. We were told “I am happy here and the staff are nice.” and “It is lovely here, the staff treat me well. We get a good choice of food and things to do.”

We spoke to some people who were using the service at the time of our visit. We were told “I am fine here, the staff are nice and I am happy, there are no concerns.” and “I feel safe here, I’ve not seen anything untoward happen.”