Archived: Willow Court

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. At our last assessment we rated this key question good. At this assessment the rating has remained 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 service had a positive approach to learning and improvement. Staff and managers reviewed concerns and made changes to prevent issues happening again. Relatives told us the service listened when feedback was given and took action to improve communication and support. One relative said, “Yes, I have [made a complaint], I did one recently. I was unhappy with the level of care for my [family member] and I spoke to [staff member]. She was apologetic. She agreed someone would call me once a week. They are now doing that and notifying me when they have had a doctor out to see my [family member].” Records showed lessons from incidents and concerns were shared with staff so practice could be strengthened. This helped ensure learning was acted on and that any identified issues led to changes in how care was delivered.

The service had clear systems and pathways in place to support people to access care safely and consistently. Staff understood assessment, referral and escalation processes and followed these appropriately when people’s needs changed. People and relatives told us communication was effective and they knew how to contact the service if support was needed. Records showed staff worked well with external professionals to ensure timely responses and coordinated care.

Safeguarding processes in place were effective, and people were protected from abuse. Deprivation of Liberty Safeguards (DoLS) were applied for when necessary to ensure people who lacked capacity were lawfully supported. Staff understood their responsibilities and knew how to report concerns. Relatives told us they felt their family members were safe and well cared for. One relative said, “They do treat them well and they are safe.” Records showed concerns were shared with external agencies when required and staff took appropriate action when people’s health or wellbeing changed. Training supported staff to recognise risks and respond promptly.

Staff understood people’s risks and how to support them, but involvement in managing those risks was not consistent. Some relatives told us they were kept informed when there were changes in health while others were unclear about how risks were being monitored. One relative said the management of risks linked to their family member’s mobility had been ineffective after they experienced falls. The manager told us sensor mats had been introduced to reduce the risk, but this had not been discussed with the relative, so they were aware of or involved in the decision. Records also showed people and relatives had not always been included in discussions about risk. This meant involvement varied and was not fully embedded across the service. However, there were plans to meet with people and their relatives to review risk assessments and care plans so that decisions about risk were clearly recorded and reflected people’s current needs.

The environment was clean and staff ensured communal areas were tidy and suitable for people to use safely. Relatives told us they were satisfied with the condition of the home and had seen improvements being made. One relative said, “Yep, all good there. Never felt the place looked dirty. They have also bought new furniture too.” Some areas required further maintenance and refurbishment, but there were clear action plans in place and work was underway to support ongoing improvement of the environment.

Staffing levels were generally safe, and care was delivered by a consistent team who understood people’s needs. Rotas showed shifts were covered and staff told us they worked well together to support people safely. Relatives also commented positively on staffing and the stability of the team. One relative said, “Yes, very. This is something I like there, that there is not a high turnover of staff. This is good for my [family member] and me and experience of staff counts for a lot.” Although staff were mostly positive, some staff told us staffing levels could feel more pressured at times, which made it harder to meet people’s needs promptly. A staff member told us, “Currently we do have a lot of [people] that require [the] use of hoist and if someone wants to get up and there are only 2 carers this can be difficult. We aim to get [people] up when they request but [with] only 2 carers [it] can be hard to manage.” Training records showed staff had received training that supported them in their roles and helped them develop the skills needed to meet people’s needs. Supervision and oversight supported staff to work safely and effectively. Staff explained that managers checked in with them and supported development opportunities which helped create a positive working environment.

The service followed safe infection prevention and control practices. The environment was clean and staff maintained regular cleaning routines throughout the day. Relatives told us cleaning standards were consistently high. One relative said, “It is spotless. Every time I go there, there are always cleaners working.” Staff understood how to prevent the spread of infection and used personal protective equipment (PPE) appropriately. Records showed checks were completed to monitor cleanliness and identify any areas that needed attention. These measures helped keep people safe from the risk of infection.

The service had systems in place to safely store, administer and record medicines. Medication administration records checked on the day of inspection showed no missed doses and stock levels were correct. Instructions were available for medicines that needed to be given at specific times. Where people were prescribed medicines applied via patches there was a system in place to record the site of application to make sure the patch was rotated safely. Guidance for medicines prescribed 'as and when' required (PRN) was clear and specific to each person.

People told us they received their medicines when they needed them. One person said, “I always get my tablets on time.” Records showed thickeners used for swallowing difficulties were recorded when used and topical creams were documented on body maps to guide staff. Temperature checks for medicine storage were completed in line with national guidance. Controlled drugs were managed safely, and regular balance checks were completed. Staff told us they had completed medicines training, and their competencies were assessed regularly. Audits completed by managers and trained staff showed procedures were followed.