This inspection took place on 18 April 2018 and was unannounced. At our previous inspection in February 2016 we had no concerns in the quality of the service and had rated the service as good. At this inspection we found that the service was not consistently safe, effective, caring, responsive or well led. We found one breach of regulation of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have taken at the back of this report.

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. At the time of the inspection 10 people were using the service.

There was a registered manager in post. 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.

People were not always receiving care that was safe and that met their assessed needs. Staffing levels had not been reviewed to ensure they met people's current care needs.

People's assessed needs were not always being met. Staff had not received all the training they required to be able to fulfil their roles effectively and health care advice and support was not always gained in a timely manner.

People did not always receive dignified care and their right to privacy was not always respected and prompt action had not been taken to ensure that people were cared for in a safe way.

The registered manager knew the local safeguarding procedures and new staff were employed using safe recruitment procedures.

People's medicines were stored and administered safely and people were protected from the spread of infection.

People were supported to eat and drink sufficient amounts to remain healthy.

The principles of the Mental Capacity Act were followed to ensure that people who lacked mental capacity were consenting to their care and support.

The environment had been adapted to meet the needs of people who used the service and people where able were able to make choices about their daily routines.

There was a complaints procedure and people felt able to raise concerns and people's end of life wishes were gained.

The registered manager and provider demonstrated a caring attitude towards people they cared for and there were quality monitoring systems in place.

This inspection took place on the 11 February 2016 and was unannounced. At our previous inspection in August 2013 there were no concerns in the areas we inspected.

The Willows Care home provides accommodation and personal care for up to 12 people. There were 11 people using the service when we inspected. People who used the service had dementia and associated needs.

There is a registered manager in post. 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.

People who used the service were safe. The registered manager and staff knew what constituted abuse and what to do if they suspected a person had been abused. Safeguarding referrals and investigations had taken place following allegations of abuse.

Risks to people had been individually assessed and plans were in place to minimise the risk of harm.

There were sufficient staff, kept under constant review to ensure that people's needs were met safely.

People's medicines were stored and administered safely by trained staff.

Staff were supported and trained to fulfil their role effectively. Training was on going and relevant to the needs of the people who used the service.

The provider and registered manager followed the principles of the Mental Capacity Act (MCA) 2005 to ensure that people consented or were supported to consent to their care and support.

People's health care needs were met, through the support of health care professionals. People were supported to maintain a healthy diet and their nutritional needs were met.

People were treated with dignity and respect and their privacy was respected.

People received care that was personalised and met their individual needs and preferences. People's needs were kept under review and care being provided reflected people's current care needs.

The provider had a complaints procedure and people were confident in approaching the registered manager if they had any concerns.

The provider and registered manager had systems in place to gain people's views and monitor and improve the quality of the service.

This inspection was unannounced which meant the provider and the staff did not know we were coming. At our last inspection on 29 May 2013 we made one compliance action regarding capacity and consent. This meant the provider had to make improvements and demonstrate they were fully protecting people using their service in this area.

We found that suitable and sufficient improvements had been made where we had identified concerns. We saw the provider had put right what was required. This meant the home could demonstrate how arrangements to seek people’s consent to care, support or treatment had been agreed in the person’s best interests.

We carried out this inspection to check on the care and welfare of people using this service. The inspection was unannounced which meant the provider and the staff did not know we were coming. There were 11 people residing in the home. We spoke with five people using the service, three staff, two visitors and the registered manager.

The staff provided sensitive support and people using the service were treated with respect. People told us they were very happy with the support provided. One person said, “You are looked after here I can assure you of that.”

We saw information regarding capacity and consent was not always in place. This meant the home could not always demonstrate how arrangements to seek people’s consent to care or treatment had been agreed in the person’s best interests.

We found people using the service received appropriate nutrition. People told us they enjoyed the meals provided. One person said, “The food is lovely and there is always a good choice, I never go hungry.”

We looked at the cleanliness and suitability of the environment to ensure people lived in a safe home where the décor and infection control standards were appropriate. We found the home was clean, safe and well maintained.

We checked records were stored correctly and found systems were as required. This ensured people’s confidential information was stored appropriately.

People told us they were happy with the care and support offered in the home. They said the staff were always available and responded promptly to any areas of concern. One relative told us, “The staff here are lovely, very caring and attentive.” We saw the staff provided sensitive support to people, and people were treated with respect. We saw the staff discussed any care or support required sensitively and discreetly. People using the service offered positive feedback one person told us, “It’s wonderful here.”

We were able to see that people received care and support that met their individual needs. Their care records included pictures and photographs to support understanding.

Staff ensured people were able to continue to go out and do the things they enjoyed. People told us, “We choose where we want to go and how to spend our time.” A visitor confirmed the staff ensured people were stimulated and encouraged to participate in activities on a daily basis.

We checked to ensure medication was stored and administered in a safe way and found medication was well managed.

We looked at the recruitment, training and supervision procedures for staff and found that overall suitable systems were in place to protect people using the service.

We looked at ways in which the home assessed its own quality and safety and saw good, clear and well recorded systems were in place.