OSJCT Willowcroft provides accommodation and personal care for up to 42 people. On the day of the inspection there were 39 people living at the service.

The home was last inspected in December 2013 and was found to be meeting all of the standards assessed.

This inspection took place on 10 and 11 January 2017 and was unannounced.

There was a registered manager in post at the service. 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.

At the time of the inspection an activities coordinator was not employed by the service. There were two volunteers who regularly visited the service and provided a range of activities for people to participate. Although we saw some people enjoying these activities there was a lack of stimulation for people on an individual basis. Some people we spoke with told us they were often bored and frustrated at not having more to occupy their time and although they spoke highly of staff, they told us since the activities coordinator had left; the level of activities had significantly decreased. Having points of interest and objects of reference to pick up and handle can bring comfort to people living with dementia however, there was a lack of objects of interest for people to pick up and interact with.

People who used the service were positive about the care they received and their relatives about the service their family members received. They praised the quality and kindness of the staff and management. Staff spoke fondly of the people they supported. Most interactions observed between staff and people were positive particularly during mealtimes. We saw staff assist people to make menu choices and some staff joined people and ate their meals together. However, there were occasions when people were not always asked what they would like to do and their permission was not always sought prior to support being given.

People were very complimentary about the food. Snack stations were available throughout the home where people were able to help themselves to sweet and savoury snacks and drinks when they chose to have them.

People told us they felt safe when receiving care. Individual risk assessments were in place and staff we spoke with knew what to do if they were concerned about the safety and well-being of people using the service. Risk assessments were completed and where risks identified, care plans had been written which detailed the guidance for staff to follow to help mitigate these risks. Observations made during the inspection and our conversations with staff confirmed they knew how to support people in line with this guidance.

Medicines were managed safely and administered by trained staff. People were also well supported to with their ongoing health care needs and to access health care services.

Staff told us they had received training to help them deliver care and support to people effectively. Newly recruited staff completed an induction programme which included completion of the Care Certificate. This is an identified set of standards that care workers use in their daily work to enable them to provide compassionate, safe and high quality care and support. Staff demonstrated a good understanding of their roles and responsibilities as well as the values of the service. Staff were also supported to carry out their role through regular supervisions and training.

The provider regularly assessed and monitored the quality of care provided. Feedback from people and their relatives was encouraged and was used to make improvements to the service. People’s views about their care and support was listened to and acted upon and there was an effective complaints procedure in place.

We started this inspection in the early morning. The people we met with who were already up and dressed all confirmed this was because they chose to be, not because staff told them to. We observed care workers being polite and respectful to people during the night and day shifts. People were supported in choosing how they spent their days. One member of staff told us warmly “all of them are individuals.”

People were positive about the care they received. One person told us “very helpful they are here.” A person told us they experienced falls. They said staff came “straight away” when they fell. We saw staff supported people who were living with dementia in a kindly way. They also involved external healthcare professionals in their care when relevant. People had clear care plans to direct staff on how to meet their individual needs. This included people who needed support with changing their position regularly. We saw care workers followed these care plans.

People were complementary about staff. One person told us about the “very good staff.” Staff reported on the training programmes to develop their skills in meeting the needs of people. One newly appointed member of staff told us the provider’s induction programme “makes you reflect.” Staff said they were supported in their roles. One member of staff told us they had “very regular” supervision meetings. They said they could bring up issues, such as further training they felt they needed.

We performed this inspection because we had issued a Warning Notice and made a compliance action at the home’s previous inspection on 11 November 2012. We found the provider had taken action and the home was now fully compliant.

We talked with people about the service they received. People we spoke with were appreciative of the care provided. One person described the “marvellous” care and another described staff as being “very particular” about meeting their needs. A person told us “they keep us going” about the staff. People told us there were enough staff to meet their needs. One person told us “there’s always someone about” and another “there’s a nice lot of staff”.

We observed staff supported people in an appropriate manner. Care workers helped people to take their medication when they needed assistance. Care workers followed the provider’s policy on administering medicines. Medicines were stored safely. Medicines administration records were fully completed.

We saw the home had made many improvements in record-keeping. What people described, what we observed and staff told us about was fully documented in people’s records. Staff told us the revised records supported them in giving care, for example where people were prescribed a range of different topical creams.

People told us that staff were “wonderful” and another person told us “it’s as good as it gets” about the home. A relative described the care workers as “very, very good”.

We observed care workers helped people appropriately, including people who had dementia and disability needs. The home stored medicines safely and made accurate records of the medicines they gave to people. Care workers supported frail people in the way they needed when they gave them their medication.

The home did not always ensure all medications were secured in accordance with their own policies and procedures. Records relating to medicines which were prescribed and administered by care workers on an “as required” basis did not follow the provider’s own medicines policy.

Records of care and treatment did not show care was being given in accordance with people’s care plans. Some relevant information about people was not documented and other information was not recorded accurately to show people were having the care and treatment they needed.

People told us they could choose about how they spent their days and they liked living in the home. One person told us “it’s a very nice place here” and another “the carers are very good”. We observed care workers offering people a choice of where they sat during the day. People told us they felt safe in the home. One person said us “I feel safe, all the carers are very good”. One person commented about staff “anyone can look after me”.

Staff said they were trained in their role. A care worker described one of their training sessions as “fantastic” and another “one of the most beneficial training I’ve been on”. One member of staff said if they had any concerns they would “report it, report it at once”.

People’s care and treatment was not consistently planned and delivered in a way that met their needs and professional advice was not consistently sought when needed. The home’s record keeping systems did not fully protect people from the risks of inappropriate care. People were not protected against the risks associated with medicines because the medicines trolley was left unsecured in an area where people could access it.