The Willows

We found the following examples of good practice.

¿ The provider had identified a specific area within the home to ensure effective use of cohorting and zoning for people who were discharged from hospital with COVID-19. That meant people had rooms and facilities in a certain area of the home and were cared for by a dedicated staff team who only worked in that area. This reduced the potential for the infection to spread.

¿ The provider ensured supplies of personal protective equipment (PPE) were available. This included different levels of PPE equipment such as masks, aprons, gloves, gowns and eye protection. We observed staff using this appropriately in line with national guidance.

¿ There was a detailed process for people being admitted into the service. Visitors were admitted through the main entrance and everyone was temperature tested, completed hand disinfection and completed a declaration of health prior to entering the home.

¿ Staff received training and were observed washing their hands regularly by a nurse. This was to assess their competency and to ensure staff were washing their hands effectively, to reduce transfer of infection. Where hand washing facilities were not available, hand sanitising stations were located in areas of the service.

¿ The provider participated in regular COVID-19 testing for staff. That ensured action could be taken swiftly to reduce the potential spread of infection if a positive test was returned.

¿ There were increased cleaning schedules in place which meant higher risk areas were regularly disinfected.

We were assured that this service met good infection prevention and control guidelines as a designated care setting.

Further information is in the detailed findings below.

The Willows is a 60-bed nursing and residential home providing personal care to 41 people, some with mental health needs and with a learning disability. The care home supports people in a purpose-built residential property.

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

Risks had been assessed prior to people moving into the home. Medicines were stored and administered safely, people were supported their medicines in a safe way. People will be re-assessed for their ability to self-administer their own medicines. Recruitment checks had been carried out to ensure staff were suitable to work with people. Staffing levels were adequate to provide individual support and good overall levels of care, however staffing deployment could be improved.

We have made recommendations in the report around checking the environment for any necessary changes to infection controls.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. Training for staff was linked to people’s individual support needs. The staff team felt involved in the running of the home and felt supported by the provider, registered manager, nursing and senior staff. Staff had supervision to ensure they met people’s needs. Staff respond to and supported people’s health and care needs.

People were provided with a varied diet which met their individual cultural needs. Healthcare was supported by the staff and people were provided with treatment following consultations.

People were fully involved in making decisions about their care and their consent was obtained prior to offering care. People were supported by a staff team who were kind and caring and treated them in a considerate and respectful manner. Staff promoted people’s privacy and dignity.

Staff were knowledgeable about people’s individual needs informed by well detailed care and support plans. There was a complaints process in place which was managed effectively. People had complimented the staff on the care provided for people. Staff had considered people’s end of life choices and made reference to this in care plans.

There were systems in place to monitor the quality and safety of the service being provided. People’s views of the service were sought through regular meetings and surveys. The registered manager understood their roles and responsibilities as a registered person. They worked in partnership with other agencies to ensure people received care and support that was consistent with their assessed needs.

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

Why we inspected

This was a planned inspection based on our previous rating.

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.

The service provided residential and nursing care for up to 60 adults most of who were aged 65 years and over. At the time of our inspection there were 26 people using the service four of whom required nursing care.

The service had a registered 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.

There were enough numbers of staff on duty to meet people needs. Staff responded promptly when people requested support from them. We saw that staff were deployed effectively to meet people’s needs in a timely manner. We also found that the provider has safe recruitment practices. This assured them that staff were safe to support people before they commenced their employment with the service.

People’s medicines were managed in a safe manner. They were supported to have their medicines as prescribed by their doctor. There was sufficient stock of medicines that people required. Medicines were only administered by staff who were suitably trained to complete this task.

People were safe at the home because staff knew their responsibilities to keep people safe from avoidable harm and abuse. Staff knew how to use the provider’s policies to report any concerns that they had about people’s welfare.

Staff had the skills and experience to support people effectively. They had access to an induction when they started their role and had regular training as required. Nurses were supported to remain competent and maintain their qualifications.

We found that staff were not always aware of the needs of people living with advanced levels of dementia. The registered manager and managing director had plans to make improvements in this area.

People were supported in accordance with relevant legislation and guidance. Staff we spoke with demonstrated a good understanding of Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS). People’s liberty was not deprived unlawfully. This was because the provider had made applications to the local authority for DoLS authorisation for people that required this.

People received sufficient nutrition and hydration. They had access to a variety of meals, snacks and drinks. Their health needs were met. This is because staff supported them to access health care professionals promptly. Staff also worked with other professionals to monitor and meet people’s needs and support them to remain well.

Staff treated people with dignity and respect and supported them to be as independent as possible.

Staff treated people with kindness and compassion. People complimented the caring attitudes of staff. The registered manager created a culture which promoted kindness and appreciation. This encouraged staff to go the extra mile. People who were approaching the end of their life were supported to remain comfortable and pain free.

People had access to a variety of activities of their choice. This included group activities and spending individual time with staff. They were also support to maintain contact and spend quality time with their friends and family.

The registered manager maintained regular contact with people and their relatives and sought their feedback about the service. They acted on the feedback they received to improve people’s experience of the service. This included feedback from other professionals and stakeholders.

People spoke very positively about the improvements made at the home by the registered manager. They were confident that the home was well-managed. Staff felt supported by the registered manager to meet the standard expected of them. The registered manager and managing director were approachable and within easy access to staff and people. The registered manager had implemented systems to monitor the quality of the service. We saw that they used this to drive continuous improvement in the service.