The Willows

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

Governance systems, management and provider oversight had improved from the previous inspection but there continued to be further improvements required. The provider had introduced systems to help improve monitoring of the service. A number of improvements had been made as a result of these checks. However, the provider had not identified some of the concerns we found. This demonstrated the providers systems continued to require improvement.

People told us they felt safe, but there were occasions when people were placed at risk of unsafe care. Some of these risks were associated with inaccurate and unclear records for medicines and fire risks. Some care plans lacked the information that staff needed to provide personalised and safe care. 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. The prevention and control of infection was managed safely. There were enough staff to support people’s needs and recruitment checks had been managed safely in line with the providers policy.

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 16 March 2023) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations. This service has been rated requires improvement for the last 3 consecutive inspections.

This service had been in Special Measures since 16 February 2021. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures

Why we inspected

We undertook this focused inspection to check the provider had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has remained Requires Improvement. This is based on the findings at this inspection.

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.

You can see what action we have asked the provider to take at the end of this report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Willows on our website at www.cqc.org.uk.

Enforcement

We have identified a continued breach in relation to the management of the home.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The Willows provides accommodation with personal care for up to 32 older people, including people living with dementia. It does not provide nursing care. Accommodation is provided in one adapted building. During our inspection visit 23 people lived at the home.

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

Governance systems, management and provider oversight continued to be inadequate due to the number of improvements still required. A new manager was in the process of registering with the CQC at the time of our inspection visit. Systems and processes designed to identify areas of improvement continued to be ineffective. Conditions we had placed on the provider's registration following the last inspection had not been met. Audits and checks completed by the provider had not identified the concerns we found. This demonstrated the providers systems continued to require improvement. The care planning system was in the process of being changed which meant people's care plans did not always provide sufficient detail or information to support staff in delivering person centred care.

People told us they felt safe, but they did not always receive safe care or were placed at risk of unsafe care. Risks associated with people's care were identified, but care records remained unclear about how risks needed to be managed to demonstrate consistent and safe practice. There had been improvement of infection, prevention, and control practice. Action to improve the fire safety in the home was ongoing to enable the home to be fire safe.

Sufficient numbers of staff were on duty to meet people’s needs. Some staff training was in need of updating but staff had access to training to update their skills and competence to ensure they were able to provide safe care consistently. People and relatives gave mixed views of their experiences of care but were positive in comments about staff. Relatives felt people's basic needs were met. Medicine management remained in need of improvement to ensure people's healthcare needs were managed effectively.

People were supported to have some 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 did not always fully support this practice.

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 22 February 2022) and there were multiple breaches of the regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection not enough improvement had been made and the provider was still in breach of regulations.

We undertook this focused inspection to check the provider had followed their action plan and to confirm they met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained Requires Improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Willows on our website at www.cqc.org.uk.

Why we inspected

This inspection was a planned inspection based on the previous rating.

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.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified continued breaches in relation to risks associated with people's care, and management oversight of the service. The provider had not ensured systems and processes in place to monitor the quality and safety of the service were always effective to continually drive improvement. The conditions imposed on the providers registration at our previous inspection in relation to quality and safety have therefore remained in place.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is ‘Requires improvement’. However, we are placing the service in 'special measures'. We do this when services have been rated as 'Inadequate' in any Key Question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services 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, 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.

The Willows provides accommodation with personal care for up to 32 older people, including people living with dementia. It does not provide nursing care. Accommodation is provided in one adapted building. During our inspection visit 22 people lived at the home.

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

People told us they felt safe but did not always receive safe care. Risks associated with people's care were identified, but care records were not always clear about how those risks needed to be managed to demonstrate consistent and safe practice. Infection prevention and control practices continued to require improvement although some areas had been addressed following the last inspection. Action to improve the fire safety in the home was ongoing to enable the home to be fire safe.

Sufficient numbers of staff were on duty. Staff training records were not accurate which meant the provider was not able to demonstrate staff had completed all of the training required to support them in providing safe care. People at the home living with dementia were not able to share detailed information of their experiences of care. Relatives felt people's needs were met but spoke of some areas where improvements could be made. People's care plans did not always provide sufficient detail to demonstrate how person-centred care was planned and provided. Medicine management remained in need of improvement to ensure people's healthcare needs were managed effectively.

A new manager had been registered with the service since the last inspection. Governance systems, management and provider oversight, continued to be inadequate due to the number of improvements still required. Systems and processes designed to identify areas of improvement continued to be ineffective. The conditions we had placed on the provider’s registration following the last inspection had not been met. Audits and checks had not identified the concerns we found. This demonstrated lessons had not been learnt since our last inspection. The management of individual and environmental risks continued to require improvement.

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 Inadequate (published 13 July 2021) and there were multiple breaches of the regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

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.

We undertook this focused inspection to check they had followed their action plan from the last focused inspection and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well Led which contain those requirements. The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has improved from Inadequate to Requires Improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Willows on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified continued breaches in relation to risks associated with people's care, and management oversight of the service. The provider had not ensured systems and processes in place to monitor the quality and safety of the service were always effective to continually drive improvement. The conditions imposed on the providers registration at our previous inspection have therefore remained in place.

Please see the action we have told the provider to take at the end of this report.

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 meet 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’. However, the service remains in 'special measures'. We do this when services have been rated as 'Inadequate' in any Key Question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services 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, 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.

The Willows provides accommodation with personal care for up to 32 older people, including people living with dementia. It does not provide nursing care. Accommodation is provided in one adapted building. During the first day of our inspection visits, 22 people lived at the home and one person was in hospital. On the second day of our visits, 20 people lived at the home.

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

People did not receive safe care. Staff had not completed all the training they needed to provide safe care and their competency had not been assessed following training to confirm their learning. People’s care plans did not always contain accurate information to help staff support people safely.

Risks associated with people's care were not promptly identified and managed. Infection prevention and control was not safe. Medicines were not always managed safely in line with best practice guidance to ensure people’s healthcare needs were managed effectively.

Governance systems, and management and provider oversight of the service, were inadequate. Systems and processes designed to identify areas of improvement continued to be ineffective. Systems to identify and manage potential abuse were not effective. The providers policies and procedures did not always provide staff with the guidance they needed. Audits and checks had not identified the concerns we found. This demonstrated lessons had not been learnt since our last inspection.

The management of individual and environmental risks continued to require improvement.

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 25 February 2020) and there were two breaches of the regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had not been made and the provider continued to be in breach of the regulations.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 21 January 2020 where breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do, and by when, to improve safe care and treatment, and good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. We also had received complaints and concerns prior to our inspection visit in relation to the management of risks at the home and how people’s needs were met. As a result, we undertook a focused inspection to review the key questions of Safe and Well Led only.

This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions that were not looked at on this occasion, were used in calculating the overall rating at this inspection. The overall rating for the service has changed from Requires Improvement to Inadequate. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Willows on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We identified breaches in relation to risks associated with people’s care and management oversight of the service. The provider had not ensured effective systems and processes were in place to monitor the quality and safety of the service and drive improvement.

Please see the action we have told the provider to take at the end of this report.

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 meet 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.

Special Measures:

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 six 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.

People’s experience of using this service:

We found there continued to be a lack of effective governance, management and provider oversight. Systems and processes designed to identify shortfalls, and to drive improvement continued to be ineffective. The providers policies and procedures did not always provide staff with the guidance they needed. Completed audits and checks had not identified the concerns we found. This demonstrated lessons had not been learnt since our last inspection.

The management of individual and environmental risks continued to require improvement. Medicines were not always managed safely in line with best practice guidance. Despite this people felt safe living at The Willows. Staff were recruited safely and there were enough staff available at the times people needed them.

People received care and support from staff who were polite and friendly. People’s privacy and dignity was upheld, and their independence promoted. Staff understood the needs of the people they supported and staff practice demonstrated their commitment to providing good care. People were supported to maintain important relationships and had access to a health and social care professionals when needed.

People's care and support was based on their individual needs and choices. Most care plans were detailed and personalised, through some had not been reviewed. Action was taken to address this. People and relatives were satisfied with the service and had no concerns but understood who to speak to if they wanted to make a complaint. People were supported to maintain important relationships and had some opportunities to take part in individual or group activities.

Staff received the training they needed to be effective in their roles. 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 did not support this practice. The home’s environment continued to be in need of upgrading and development to ensure it was dementia friendly Plans were in placed to address this.

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 8 February 2019) and there was a breach of the regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations.

This is the second consecutive time the service has been rated ‘Requires Improvement’.

Why we inspected: This was a planned inspection based on the previous rating.

Enforcement:

Please see the action we have told the provider to take at the end of this report.

Follow up:

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and 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.

This was the first time The Willows had been inspected under its current registration. The home had previously been registered under a different provider and had a different registered manager.

The Willows is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The home provides accommodation with personal care for up to 32 older people, including people living with dementia. It does not provide nursing care. At the time of our visit 24 people lived at the home. Accommodation is provided in a two-storey adapted building. The home is located in Coventry, in the West Midlands.

This is the first time the service has been rated Requires Improvement.

The service did not have 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. The provider had appointed a manager who had applied to register with the Care Quality Commission (CQC). They had been in post since October 2018.

People and relatives spoke highly of staff who they felt were kind and had a positive attitude towards their work. Staff felt valued and supported by the manager. People, relatives and staff felt listened to because they had opportunities to provide feedback about the service.

People felt safe living at The Willows and staff were available when people needed them. The manager and staff understood how to protect people from the risk of abuse and their responsibilities to raise any concerns. Medicines were mostly managed and administered safely.

Some care plans did not contain accurate, detailed or up to date information. Action was being taken to address this. Relatives were involved in care planning and were confident staff had the skills and knowledge needed to meet their family members needs safely.

The provider’s recruitment procedures ensured staff were of a suitable character to provide care and support to people who lived at the home. Staff received an induction when they started working. A programme of on-going training supported staff to meet people's needs effectively. Complaints were managed in line with the provider’s procedure.

People were supported to maintain important relationships and their visitors were welcomed at the home. People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible.

The provider’s systems to check, monitor and improve the quality and safety of the service provided, including the management of risk were not always effective. People and relatives spoke positively about the way the home was managed and the service people received.

People received the support they needed to meet their nutritional needs and had access to health care services when needed. The manager and staff worked in partnership with other health professionals to support people to maintain their health and well-being.

People’s right to privacy and dignity were respected by staff and their independence, where possible, promoted. Staff knew the people they supported well. Some activities were available which people could choose to take part in. However, improvement was needed to ensure activities were meaningful and reflected peoples interests.

We found a breach of 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 the report.