The Willows

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 requires improvement. At this assessment the rating has remained requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

The service remained in breach of legal regulation in relation to safe care and treatment.

This service scored 53 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not always have a proactive and positive culture of safety. Lessons were not always learnt to continually identify and embed good practice.

Lessons had not been learnt from previous inspections particularly in relation to fire safety and environmental concerns, and the use of audits to identify issues. Although the provider had taken some steps to improve, such as commissioning an external company to carry out a fire risk assessment, day-to-day oversight required strengthening. The concerns identified during this inspection indicated that existing systems were not effective in recognising issues or driving sustained improvement.

Improvements had been made to the recording and reporting of accidents and incidents, and staff were supported to improve their understanding in this area which was evidenced in team meeting minutes.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

Processes were in place to assess people’s needs before they moved into the service. This information was then used to create the person’s care plan. Relatives expressed satisfaction with the referral process when their loved one moved into the home. One relative told us, “Everything was dealt with well,” and another said, “We experienced no issues.”

In the event of someone needing to go to hospital, information regarding their care needs was printed off and sent with the person alongside their medication administration records (MAR) and any other important records.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

People told us they felt safe living at The Willows, and their relatives shared the same view. One relative told us, “I feel [person] is safe there now.”

Staff understood their safeguarding responsibilities. One staff member told us, “If I had a safeguarding concern, I would make sure the resident is OK and everything is OK. I will inform the senior in charge, and make sure management is aware.”

The manager understood their responsibility to make safeguarding referrals and when this would be required.

People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. In care homes this can be done through a procedure called the Deprivation of Liberty Safeguards (DoLS), which is part of the Mental Capacity Act 2005 (MCA). We checked whether the service was working within the principles of the MCA and how they managed DoLS within the service. We found that appropriate legal authorisations had been sought in relation to any restrictions imposed on people. The manager understood their responsibility to ensure that any restriction on a resident's liberty is necessary, proportionate, and lawfully authorised.

The provider did not always work well with people to understand and manage risks. Staff did not always provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Further improvement was needed in the management of risk. For example, records indicated 1 person on a modified diet had been given food unsuitable for their swallowing capabilities on several occasions such as toast and bacon, increasing the risk of choking. The provider told us their subsequent investigation alluded to this being as a result of errors in recording. However, this error had not been identified in care plan checks, therefore no action had been taken to ensure the person was indeed being supported with their nutrition needs safely.

However, people’s individual risks were assessed and care records contained information staff needed to manage identified risks and reduce the risks of harm or injury to people. These were updated regularly or when required.

The provider did not always detect and control potential risks in the care environment. They did not make sure that equipment, facilities and technology supported the delivery of safe care.

Not all areas of the environment were well maintained to keep people safe. We found fire safety concerns, for example, the area beyond a fire door was cluttered, making escape during a fire unsafe, and a boiler cupboard was also filled with combustible items. The provider told us this was due to unforeseen circumstances and was not usual practice. We found a window restrictor in 1 person’s bedroom was unlocked, enabling the window to be opened fully, placing the person at risk of harm.

Opened food in the fridge was not appropriately labelled, with only the opening date recorded and no use-by or discard date. This meant staff could not determine whether the food was safe to use, contrary to food hygiene guidance which requires clear labelling of opened products to ensure safe storage and use.

Some generic risk assessments for the environment had their original dates and review dates crossed out, making it unclear when they were due for review.

The provider did not always make sure there were qualified, skilled and experienced staff. They did not always make sure staff received effective supervision. They did not always work together well to provide safe care that met people’s individual needs.

The provider could not be assured staff had the skills and knowledge to carry out their role. There was no current system in place to assess and record staff’s competencies, specifically in relation to medication and moving and handling. Although staff had completed training in these areas, providers must make sure staff can apply this in practice. This means checking and monitoring competency, rather than relying on attendance at training alone.

Staff had not always received the most appropriate training needed to safely support the people in their care. For example, although staff had completed online training on distressed behaviours, this had not equipped them with the practical skills required to manage incidents of physical aggression, particularly where some people presented a risk of harm to others. In addition, staff involved in preparing and supporting people with meals had not received training in dysphagia (swallowing difficulties). This meant people were at increased risk of unsafe or inappropriate support.

The provider had already arranged a train-the-trainer medication course, enabling management to assess staff competency in safely administering medication. They further addressed this concern by sourcing training to support staff in managing distressed behaviours and dysphagia.

Recruitment processes ensured staff were recruited safely and people told us there were enough staff to meet the needs of residents.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

Improvements had been made to the environment since the last inspection; it was clean and free from odours. Audits were completed and staff were observed completing hand hygiene.

Relatives told us they saw staff wearing PPE (personal protective equipment) and noted the improvements that had been made. One relative told us, “The standard of cleanliness has improved greatly.”

Cleaning rotas showed regular cleaning took place which included daily cleaning and deep cleaning.

The provider did not make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. People were not involved in planning.

Guidance for staff when people may need as required (PRN) medication was not always available or had incorrect medication listed. This meant staff did not always have access to clear and up-to-date information to support them in identifying when PRN medication may be required, leaving people at risk of inadequately managed symptoms.

We observed medication being crushed and mixed into a drink, which was then left with the person. The medication administration record (MAR) was signed to confirm administration; however, the staff member did not witness the resident taking the medication and therefore could not be assured it had been consumed. There was a risk people who this medication had not been intended for could have consumed the medicine. There was no clear guidance for staff to administer this medicine covertly. NICE guidance requires a clear plan for covert administration, explaining how medicines should be given safely, with instructions for each medication, as not all medicines can be safely altered or administered in the same way.

One person received paracetamol before the required 4-hour interval had elapsed on at least 3 occasions within the same week. This created a risk of unintended overdose and suggested medicines were not always being given in line with guidance.

There wasn’t always clear information about where or when prescribed creams should be applied, increasing the risk of creams being applied incorrectly or inconsistently. Administration records were in place for creams, but recording was variable. This had been identified in a recent medication audit.