The Willows is a residential care home for older people. It can accommodate up to 25 people. The accommodation is a converted and extended farm house in a rural setting. All rooms have en-suite facilities.

At the last inspection on 06 November 2014, the service was rated Good. At this inspection we found the service remained Good.

We found a care home that was well run for the benefit of the people who lived there. The strongest element of this care home was the management in place. The registered manager had been in place for many years and performed her role well. She was passionate about giving good quality care to people that met their needs. Everyone was seen as a unique individual to be appropriately supported. This culture of this service came from the registered manager who strived to keep up to date and develop where they could. They had a comprehensive oversight of the service and balanced well their role of being visible and available to people, relatives and staff with ensuring their role as accountable manager was completed.

People spoke highly of the service offered and felt appropriately cared for. People experienced good care with on-going monitoring of health needs and prompt access to health services. Visiting health professionals told us that the service was caring and met the needs of people who lived here. There was varied, needs led social stimulation that people were consulted upon. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice. There was plenty for people to choose from each day of the week. People liked the variety and quality of food on offer. Mealtimes were a pleasant experience for everyone.

Staff told us that they had the training and support to carry out their roles effectively and confidently. Staff spoke highly of the management who they said were approachable and made positive changes when needed. Staff were happy and positive. People looked happy and there was a degree of calm and people had purpose to their day.

There were sufficient numbers of staff to meet people needs. People were able to develop caring and meaningful relationships with staff because staff were consistent and remained at the service for a long time. People were safeguarded from the potential of harm and their freedoms protected. Staff were provided with training in Safeguarding Adults from abuse, Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). The manager knew how to make a referral if required.

Medicines were safely managed. The manager had oversight and had thorough quality assurance processes in place that were fed up to and monitored by the provider. The manager was supported appropriately by the provider and spoke positively about developments and resources being available to them.

Further information is in the detailed findings below.

The Willows is a residential care home for older people. It can accommodate up to 25 people. The accommodation is a converted and extended farm house in a rural setting. All rooms have en-suite facilities.

At the last inspection on 06 November 2014, the service was rated Good. At this inspection we found the service remained Good.

We found a care home that was well run for the benefit of the people who lived there. The strongest element of this care home was the management in place. The registered manager had been in place for many years and performed her role well. She was passionate about giving good quality care to people that met their needs. Everyone was seen as a unique individual to be appropriately supported. This culture of this service came from the registered manager who strived to keep up to date and develop where they could. They had a comprehensive oversight of the service and balanced well their role of being visible and available to people, relatives and staff with ensuring their role as accountable manager was completed.

People spoke highly of the service offered and felt appropriately cared for. People experienced good care with on-going monitoring of health needs and prompt access to health services. Visiting health professionals told us that the service was caring and met the needs of people who lived here. There was varied, needs led social stimulation that people were consulted upon. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice. There was plenty for people to choose from each day of the week. People liked the variety and quality of food on offer. Mealtimes were a pleasant experience for everyone.

Staff told us that they had the training and support to carry out their roles effectively and confidently. Staff spoke highly of the management who they said were approachable and made positive changes when needed. Staff were happy and positive. People looked happy and there was a degree of calm and people had purpose to their day.

There were sufficient numbers of staff to meet people needs. People were able to develop caring and meaningful relationships with staff because staff were consistent and remained at the service for a long time. People were safeguarded from the potential of harm and their freedoms protected. Staff were provided with training in Safeguarding Adults from abuse, Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). The manager knew how to make a referral if required.

Medicines were safely managed. The manager had oversight and had thorough quality assurance processes in place that were fed up to and monitored by the provider. The manager was supported appropriately by the provider and spoke positively about developments and resources being available to them.

Further information is in the detailed findings below.

We spoke with six people who use the service, four relatives, four care staff, the deputy manager and the registered manager during this inspection. We looked at five people's care records and three staff records. Other records we reviewed included staff training and quality and monitoring records. We considered our inspection findings to answer questions we always ask; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?

This is the summary of what we found:

Is the service safe?

Care records were updated to ensure that people received the care they needed to keep them safe. The service worked with other healthcare professionals when they were concerned about someone’s safety. The falls prevention team had worked with the service to reduce the frequency and impact of falls for one person.

Staff did not receive all the training they needed to carry out their roles safely. We found that fire training for some staff members was overdue and two members of staff had not received fire training since joining the service.

Relatives told us they trusted the staff and felt that the service was safe. One relative told us, “My (relative) is looked after and safe”.

We looked at rotas and were concerned that sometimes there were not enough staff on duty.

We found that the service was aware of its responsibilities under the Mental Capacity Act 2005 Deprivation of Liberty Safeguards (MCA DoLS) and had recently made multiple DoLS referrals to the local authority in relation to its practice of locking the external doors.

Is the service effective?

People’s health and care needs were assessed in consultation with the people who use the service or their relatives. People’s care plans reflected their healthcare needs and the service worked in conjunction with support from outside professionals to meet them.

People who use the service and their relatives told us they were happy with the care provided. One relative told us, “However under pressure the staff are, nothing is too much trouble”.

One person who uses the service told us, “The staff here are really and truly good. I get my pills on time and they come if I call them. I have no problems”.

We found that some care records were incomplete for one person whose care plan we looked at.

Is the service caring?

People were supported by staff who were kind, caring and respectful. We observed staff supporting people with genuine affection and concern.

People told us they were happy and felt well cared for. A relative told us, “The care here is 200%”.

People who use the service and relatives told us that the manager was very caring. One person said “(The manager) is very kind. I have been here four years and I am very happy”. One relative commented on the atmosphere and culture of the service. They told us, “You feel like you are coming into somebody’s house”.

Is the service responsive?

People's care records showed that where concerns about an individual’s wellbeing had been identified, staff had taken appropriate action to ensure that people were provided with the support they needed. This included seeking support and guidance promptly from other health care professionals about a person's high blood sugar levels and frequent falls.

People’s preferences and choices had been recorded in their care plans and we observed that care and support was delivered in accordance with people’s wishes. We saw that where people had asked to be supported by a person of a particular gender this had been respected.

Is the service well led?

The service did not have an effective quality assurance system in place. We found that some audits were taking place but that strategies to deal with issues highlighted by the audits were not always put in place.

The service did not have effective systems to deal with the current low staffing levels.

We found that some important staff training was overdue and this could have placed people at risk.

Staff we spoke with were positive about the leadership of the service and said that they felt well supported.

We found that people living at the Willows were respected, had choices and were well cared for. One person said, “Yes, I am happy here. There is nothing I dislike”. Another said, “We have different activities most mornings.” Families and friends we talked with also spoke positively. One relative told us, “I am over the moon with the care here”.

Staff told us that they were well trained and felt supported. However, it was not clear that supervision meetings were regularly recorded and there were some gaps in the training records we viewed. The provider told us that improvements were in hand.

A new care record system had recently been introduced at the Willows. Care plans we reviewed were person centred, relevant and up to date. Staff told us they liked the new care plans. One member of staff told us, "The new care planning system is much better. Information is more structured and it is easier to find what you want". During our inspection we reviewed a wide variety of records. Overall, we found that they were accurate, accessible and held securely.

This was a follow up inspection to check compliance on the safe management of medication. Our previous inspection on 4 November 2012 found that systems in place did not protect people. At this inspection we found matters much improved. This meant people were protected from unsafe practices relating to medication management.

We spoke with two relatives and two people who live at this service. All were very pleased with the service on offer. One relative said "My relative has lived here for eight years. I have had no issues in that time. I'm confident in the care they give and would recommend this home.”

We found that care plans were adequate and made observations for improvement. The provider immediately wrote to use and confirmed all care plans were to be revised and updated.

We have made a compliance action with regards the management of medication as we found current practice at the service was placing people at potential risk.

There were enough qualified, skilled and experienced staff to meet people’s needs. People at the service spoke of how kind, caring and helpful the staff were. One person said "I'm nicely looked after. I just need to ask and the staff help me".

We spoke with two people who used the service. People told us that they were involved with their care, support and treatment. One person told us “I’m very happy here. I can just ask for anything I want and they sort it out”. They received the appropriate care to meet their needs.

People told us that if they had any concerns they would speak to the manager. They felt confident matters would be resolved. A typical comment was “I feel happy and safe living here. I’m confident that the manager would sort out and problem, but I do not have any”.

During our review we spoke directly to six people living in the home. People told us that they felt “happy” living in The Willows and that they had “no complaints”. Each person we spoke with commented that they enjoyed the food and were happy with the choice of meals.

However, one person told us that they sometimes “felt bored” and another told us that they didn’t get to go out and there was “not much going on outdoors, even in the summer”.

We also spent some time observing the care being provided and our findings indicated that people were disengaged from their surroundings and that there were limited positive interactions from members of staff