We carried out a review of the data available to us about Willow Tree House on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Willow Tree House, you can give feedback on this service.
Willow Tree House is a residential care home providing personal care for up to 60 people aged 65 and over. At the time of the inspection there were 24 people using the service some of whom were living with dementia. People are cared for over two floors with various communal areas being provided on the ground floor.
People’s experience of using this service and what we found
Risks were managed, and care plans had been updated to detail current risks and individual needs. Medicines were managed safely, and the service had implemented robust infection control measures. Staff were recruited safely and there were enough trained staff to meet people’s needs safely.
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. People and their relatives were involved in the planning and reviewing of their care. Records in place and our observations demonstrated people were supported to maintain a balanced diet.
People and their relatives told us they were involved in planning their care, records we reviewed supported this. Staff demonstrated kind, compassionate and caring attitudes and actively encouraged people to make their own choices.
Care plans we reviewed were person centred and detailed individual needs and preferences. Where concerns had been raised these had been acknowledged and responded to appropriately. People were supported to maintain relationships with their loved ones and a safe visiting process was in place.
The registered manager and senior management team had implemented a number of changes in order to improve the quality of care provided. Quality monitoring processes and actions following incidents had improved significantly. People and staff told us they felt management communicated well, listened and acted up on any issues they raised.
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 requires improvement (published 26 August 2021) and there were multiple breaches of regulation. The provider completed monthly action plans after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.
This service has been in Special Measures since 13 July 2021. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate in any of the key questions. Therefore, this service is no longer in Special Measures.
Why we inspected
This inspection was carried out to follow up on action we told the provider to take at the last inspection. We also received concerns in relation to management of people’s continence needs, supporting people to make personal choice and safety of the service at night. As a result, we undertook a comprehensive inspection which we carried out during the night to examine those risks and follow up on previous action we told the provider to take.
We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.
The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.
We found no evidence during this inspection that people were at risk of harm from the concerns raised. Please see the safe, responsive, caring and well-led sections of this full report.
Follow up
We will meet with the provider following this report being published to discuss how they will sustain the changes they have made and maintain their rating of good. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
Willow Tree House is a care home providing personal care for up to 60 people aged 65 and over. At the time of the inspection there were 32 people using the service. The service is provided over two floors, with communal facilities being provided on the ground floor.
People’s experience of using this service and what we found
Risk assessments were not up to date or accurate for staff to support people safely, this put people at risk of choking and falls.
People were kept safe from abuse and avoidable harm. Improvements had been made and staff were knowledgeable about safeguarding.
We found that management of pressure care had improved, and regular checks were being carried out on people’s skin integrity.
Infection prevention and control had improved since our last inspection and we saw domestic staff cleaning all areas. However, personal protective equipment (PPE) was still not being worn as per government guidelines and we saw that not all staff were changing, handwashing or sanitising between different tasks.
There was still insufficient staffing to ensure that people’s needs were met, there was no accurate and up to date dependency assessment in order to calculate staffing levels in ratio to people’s needs.
Medicines administration was not always safe and medicines policies were out of date.
The provider had made some improvements and begun to develop tools to assess and monitor the service, they were also developing effective systems to gather and analyse information. This would give better management oversight when they were effectively implemented. There was improved engagement with people living at the service and health care professionals.
Staff were recruited safely.
Rating at last inspection and update
The last rating for this service was inadequate (published 20 February 2021) and there were multiple breaches of regulation. The provider completed monthly action plans after the last inspection to show what they would do and by when to improve. At this inspection the rating had improved to requires improvement. However, they remain in breach of Regulation 12 (Safe Care and Treatment) Regulation 18 (Staffing) and Regulation 17 (Good Governance). We found that improvements had been made to keeping people safe from abuse and avoidable harm and they were no longer in breach of regulation 13 (Safeguarding).
You can see what action we have asked the provider to take at the end of this full report. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Willow Tree House on our website at www.cqc.org.uk.
Why we inspected
This inspection was carried out to follow up on action we told the provider to take at the last inspection.
Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.
Follow up
We will be in contact with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
The overall rating for this service is ‘Requires Improvement'’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.
If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.
For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it, and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.
Willow Tree House is a care home providing personal care for up to 60 people aged 65 and over. At the time of the inspection there were 39 people using the service, at our two other visits there were 37. The service is provided over two floors, with communal facilities being provided on the ground floor.
People’s experience of using this service and what we found
The provider had not developed effective system in place to assess and monitor the service, nor were there effective systems to gather and analyse information. This has restricted the overall monitoring of the service and ineffective governance meant there was a lack of management oversight of the service.
We found that management of pressure care was inadequate. Skin integrity was not regularly checked and recorded and so there was no oversight of improvement or further deterioration.
Infection prevention and control was poor and there was no oversight with regard to the cleanliness of the premises or equipment. PPE was not always worn effectively and appropriately, and we did not see good hand hygiene practises even though government guidance is clear and has been throughout the pandemic.
Staff were not kept up to date with training, that meant that they were not receiving information on changing practises with regard to delivering care. There was insufficient staffing to ensure that people’s needs were met, there was no accurate and up to date dependency assessment in order to calculate staffing levels in ratio to people’s needs.
Rating at last inspection
The last rating for this service was requires improvement (published 31 December 2019)
Why we inspected
The inspection was prompted in part due to concerns received about pressure care, infection control and nutrition and hydration. A decision was made for us to inspect and examine those risks.
Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.
Follow up
We will be in contact with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.
If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.
For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.
About the service: Willow Tree House is a residential care home with a supported living facility registered at the same address, this is known as The Willows Care Village. The residential care home (Willow Tree House) is purpose built residential home and can provide accommodation and personal care for up to 60 people. At the time of the inspection there were 41 people living there.
In September 2018 the regulated activity of personal care was added to the providers registration. The supported living facility is an adapted property providing 40 self-contained flats.
Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided. There were thirty people resident in the home at least five of these required personal care
People’s experience of using this service: Willow Tree House (Residential Care).
People told us they felt safe living at Willow Tree House.
The risks to people had been assessed and people and where appropriate their relatives had been involved in compiling care plans. Staff were knowledgeable about the range of needs people had. People were supported with their medicines in a safe way.
Appropriate recruitment checks had been carried out to ensure staff were suitable to work at the service. Training relevant to people’s support had been undertaken by staff. The staff team felt involved in the running of the home and were supported by the registered manager.
People accessed healthcare services when they needed them, and they were supported to eat and drink enough to remain healthy.
People were involved in making decisions about their care and support. Staff obtained people’s consent before commencing with care and support. People were supported by a staff team who were kind and caring and treated them in a considerate and respectful manner.
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, surveys and informal chats. A complaints procedure was in place and people knew what to do if they had a concern of any kind.
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.
People’s experience of using this service: The Willows Care Village (Supported Living).
People told us they felt safe living at The Willows Care Village.
The risks to people had been assessed and people had been involved in compiling care plans. However, assessments were not updated and so care plans did not fully reflect the level of personal care people were assisted with. Staff are not employed in numbers to assist people with their personal care needs.
People’s views of the service were sought through regular meetings. Concerns about the meal provision in the home had been raised by people and the registered manager had attempted, unsuccessfully to remedy the situation.
Staff were knowledgeable about the range of needs people had. People were supported with their medicines in a safe way, though people who required assistance with their medicines had them held in the office.
Appropriate recruitment checks had been carried out to ensure staff were suitable to work at the service. Training relevant to people’s support had been undertaken by staff.
People accessed healthcare services when they needed them, and they were supported to eat and drink enough to remain healthy.
People were involved in making decisions about their care and support. Staff obtained people’s consent before commencing with care and support. People were supported by a staff team who were kind and caring and treated them in a considerate and respectful manner.
There were systems in place to monitor the quality and safety of the service being provided. A complaints procedure was in place and people knew what to do if they had a concern of any kind.
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.
More information can be found in the detailed findings below.
Rating at last inspection: The residential home was rated Good at the last inspection in 2016.
This is the first inspection of the Supported living service.
Why we inspected: The inspection was prompted in part by notification of a specific incident. This incident is subject to a continuing safeguarding investigation by the local authority.
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.
We inspected Willow Tree House on 28 September 2016. The inspection was unannounced.
Willow Tree House is situated in Mansfield, a town in North Nottinghamshire. The service is registered to provide accommodation for people who require nursing or personal care for up to 110 people, although nursing care was no longer being provided. There are two separate buildings on the site of the service, although one building was not in use at the time of our inspection. People were supported with a variety of physical health needs as well as dementia related care. At the time of our inspection 37 people were living at Willow Tree House.
The service had a registered manager in place at the time of our visit. 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.
People told us they felt safe at Willow Tree House and did not have any concerns about the care they received. Staff knew how to protect people from harm and referrals were made to the appropriate authority when concerns were raised.
Risks to people’s safety were identified and managed and assessments were carried out to minimise the risk of harm. For example in relation to falls or environmental risks. The building was well maintained and regular safety checks were carried out.
People received care and support in a timely way and there were sufficient numbers of suitably qualified and experienced staff employed. Appropriate pre-employment checks were carried out before staff began to work at Willow Tree House.
People received their prescribed medicines when required and these were stored and administered safely. People who chose to administer their own medicines were supported by staff to do so safely.
People received effective care from staff who received training and support to ensure they could meet people’s needs. On going training and assessment for care staff was scheduled to help maintain their knowledge.
People provided consent to any care and treatment provided. Where they did not have capacity to offer informed consent their best interests and rights were protected under the Mental Capacity Act (2005). People’s wishes regarding their care and treatment were respected by staff.
People told us they enjoyed the food offered and we saw they had sufficient quantities of food and drink to help them maintain healthy nutrition and hydration. People had access to healthcare professionals when required and staff followed their guidance to ensure people maintained good health.
People were treated with dignity and respect and their privacy was protected. We observed positive, caring relationships between staff and people who used the service. Where possible people were involved in making decisions about their care and daily activities.
Staff understood people’s support needs and ensured they received personalised responsive care. People had the opportunity to take part in enjoyable, constructive activities. They knew how to raise an issue and were confident these would be listened to and acted on.
There was an open and transparent culture at the service. People, their relatives and staff were encouraged to have their say on their experience of care and their comments were acted on. Quality monitoring systems were in place to identify areas for improvement and ensure these were acted on.