This inspection took place on 30 November 2016 and was unannounced.

The Willows provides personal care and accommodation for up to 30 older people and people living with dementia. On the day of our inspection there were 28 people using the service.

The Willows is required to 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. At the time of our inspection a registered manager was in place.

During our previous inspection on 15 July 2015, we identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was in relation to care not always being provided or delivered to meet people’s needs and the provider had not notified us of safeguarding incidents.

During this inspection we checked to see whether improvements had been made. We found improvements had been made and this breaches in regulation had been met. People received care and support that was personalised to meet their individual needs. The provider had notified us appropriately of any safeguarding incidents as required. .

Staff were aware of their responsibilities to protect people from avoidable harm. Staff had received adult safeguarding training and had available the provider’s safeguarding policy and procedure.

Risks to people's individual needs and the environment had not always been assessed. Concerns were identified with risks associated to a fish pond close to a door exist. The registered manager took immediate action and completed a risk assessment. Risks associated to people’s healthcare needs had not always been appropriately assessed and recorded. However, staff were aware of how to manage these risks; the issue was that of recording. The registered manager completed appropriate care plan documentation and risks assessments and forwarded these to us after the inspection.

Accidents and incidents were recorded and falls were analysed to review themes and patterns. External healthcare professionals were contacted to provide further assessment and support when concerns were identified.

Safe recruitment practices meant as far as possible only suitable staff were employed. The provider was recruiting additional staff but the deployment of staff was not consistent. The provider took immediate action and reviewed how staff were deployed. Appropriate adjustments were made to ensure people received the level of support they required to keep them safe at all times.

People received their medicines safely but some improvements were required to ensure the management of medicines followed good practice guidelines. The temperature of the medicines fridge was taken daily but not the medicines room. People’s records did not include information about how they liked to take their medicines. Protocols were not in place for medicines prescribed to be taken as and when required. The systems in place to audit that medicines were administered and managed safely were infrequent. The registered manager took immediate action to make improvements and after the inspection forwarded us information to confirm what action they had taken.

Staff received an appropriate induction, training and appropriate support.

The manager applied the principles of the Mental Capacity Act 2005 (MCA) and Deprivations of Liberty Safeguards (DoLS), so that people's rights were protected. Where people lacked mental capacity to consent to specific decisions about their care and support, appropriate assessments had been completed but improvements were required to ensure best interest decisions were made in line with this legislation. Where there were concerns about restrictions on people’s freedom and liberty, the manager had appropriately app

The inspection took place on 15 July 2015 and was unannounced.

The Willows is in the village of Rippingale in Lincolnshire. It is registered to provide accommodation and personal care for up to 30 older people or people living with a dementia.

There was a registered manager in post when we visited. 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 Care Quality Commission is required by law to monitor how a provider applies the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way. This is usually to protect

themselves. The registered manager had assessed people’s abilities to make decisions and where people were unable to make decisions the systems in place ensured they were made in the person’s best interest. Where there was a risk someone was being deprived of their liberty the registered manager had made applications to the local authority for their needs to be assessed.

Care workers knew how to keep people safe and were happy to raise concerns with the registered manager. They also knew how to raise concerns with the local safeguarding authority. People had been assessed and risks to their health and welfare had been identified. There were systems in place which supported good ordering, storage and administration of medicine.

Staff were safe to work with the people living at the home and there were systems in place to calculate the amount of staff needed to meet people’s needs. Care workers received training and support which ensure they had the skills needed to meet people’s care needs.

People were supported to eat safely and where people were at risk of choking advice had been sought from healthcare professionals. People were offered a choice of food, however, choice around the midday meal was restricted.

There was a warm and caring relationship between care workers and people living at the home with lots of laughter. Care workers were aware of people’s individual communication needs and supported people to make choices. People were involved with planning there care and attended reviews of their care plan to ensure it met their needs.

While people’s needs were met with care and kindness, the registered manager had not always identified when the care provided was no longer adequate to support people. Care plans also did not fully identity people’s needs or support care workers with information on how to meet those needs. People were not supported to live meaningful lives as care workers did not always have time to maintain an acceptable level of activities.

People living at the home, visitors and staff said that the registered manager was approachable and would work to resolve any issues or concerns brought to their attention. There were systems in place to allow people to comment on the quality of the service and for actions to be taken. However, the registered manager did not audit risks to see if changes to care or the environment would reduce the risks people faced. Care plan audits had not identified that the plans did not fully meet people’s needs.

A person told us, “They are very good here; I wouldn’t like to be anywhere else.” We spent time observing care and saw people were treated with dignity and respect. Care was planned and delivered to meet people’s needs safely.

People told us they had a choice of food. Records showed people’s ability to eat independently was assessed. Appropriate equipment was used to help people maintain their independence.

The cleanliness of the home had improved since our last visit. We saw ongoing improvements to reduce the risk of infection were planned. One person told us, “They keep it clean, they are very orderly.”

We saw there were enough staff to meet people’s needs. One person told us, “The girls are quick to come when you press the bell.”

We saw the manager took account of complaints and identified actions needed to rectify issues.

The people we spoke with were happy with the care and support they got. One person told us, “The staff are all very good.” A relative we spoke with said, “The feedback is good from staff, any issues and they give you a call and let you know what’s going on.” We saw staff treated people with kindness and consideration.

We saw there were not enough care staff available to keep people safe. This meant the manager and other members of staff had been covering caring duties. This had a negative impact on other areas of the home. For example, cleaning staff told us they sometimes got behind with their work as they helped care for people.

When we visited there was an unpleasant smell in the entrance hall and atrium area and in some of the bedrooms. We saw some areas of the home were not as clean as they should be.

The people we spoke with said they were very happy with the care and support they received and felt the home was a safe place to live. They told us staff offered them choice and had respected their privacy and dignity while encouraging them to be as independent as they were able to be. One person told us, “I can’t say how kind they are (the staff) they give excellent TLC (tender loving care) to everyone here, nothing is too much trouble.”

People were complimentary about the meals provided. One person told us, “The food is very good, I don’t eat some food so they make sure I get food I can eat and enjoy.” A relative told us, “The food is homemade, I’ve had meals here and it’s lovely.” They also said that people were offered alternative meals and regular drinks.

People were complimentary about the staff and said they carried out their work competently. They told us they always asked them what they wanted and listened to what they had to say. One person told us, “They are always helpful and look after mum well.” Another person commented, “Nothing is too much trouble for them.”

People we spoke with said they felt comfortable raising any concerns they might have with the manager. When we asked them if there was anything they would like improving at the home they told us they could not think of anything. One person told us, “It’s a nice place to live.” A relative said they had looked round several homes but had chosen this one because it was “very homely”