About the service:

The Willows is located in Woodthorpe near to the town of Staveley in Derbyshire. The service is registered to provide accommodation for up to 41 older people who require residential and nursing care, including those living with dementia.

People’s experience of using this service:

People were not always supported to follow their interests and take part in activities that were meaningful and socially relevant including accessing the wider community. People and their relatives told us they were bored and there was not enough for them to do. The manager told us they had purchased a wheelchair accessible mini bus that was currently in the process of being adapted. This would increase opportunities for people to go on trips outside the home. The activity coordinator also told us they were going to increase their hours to provide further activities provision.

People continued to receive safe care. Staff had been provided with safeguarding training to enable them to recognise signs and symptoms of abuse and how to report them. There were detailed risk management plans in place to protect and promote people’s safety. The provider followed thorough recruitment practices to ensure staff employed were suitable for their role.

People’s medicines were managed safely and in line with best practice guidelines. Systems were in place to ensure that people were protected by the prevention and control of infection. Accidents and incidents were analysed for lessons learnt and these were shared with the staff team to reduce further re-occurrence.

People’s needs and choices were assessed and their care provided in line with their preferences. Staff received an induction process when they first commenced work at the service and received on-going training to ensure they could provide care based on current practice when supporting people. People received enough to eat and drink and were supported to access health care appointments including opticians and doctors, to make sure they received continuing healthcare to meet their needs.

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 supported this practice. The principles of the Mental Capacity Act (MCA) were followed.

People continued to receive care from staff who were kind and caring. People were encouraged to make decisions about how their care was provided and their privacy and dignity were protected and promoted. People had developed positive relationships with staff who had a good understanding of their needs and preferences.

People’s needs were assessed and planned for with the involvement of the person and/or their relative where required. Care plans were personalised and provided staff with guidance about how to support people and respect their wishes. Information was made available in accessible formats to help people understand the care and support agreed.

The service continued to be well managed. People and staff were encouraged to provide feedback about the service and it was used to drive improvement. Staff felt well-supported and received supervision that gave them an opportunity to share ideas, and exchange information. Effective systems were in place to monitor and improve the quality of the service provided through a range of internal checks and audits. The manager was aware of their responsibility to report events that occurred within the service to the CQC and external agencies.

More information is in the Detailed Findings below

Rating at last inspection: Rating at last inspection: Good (report published 27 September 2016).

Why we inspected: This was a planned inspection based on the rating at the last inspection. The service remained rated Good overall.

Follow up: We will continue to monitor the service through the information we receive until we return to visit as per our re-inspection programme. If any concerning i

The Willows is registered to provide personal and nursing care for up to 41 older adults, which may include some people living with dementia. This inspection was unannounced and took place on 24 June 2016. At the time of our inspection there were 40 people living there.

There was a registered manager at this 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 our last inspection in January 2014 the provider was fully compliant in all areas inspected.

During our inspection visit we observed that staff were friendly and approachable. They spent time sitting with people to offer them comfort or stimulation. We observed staff delivering care which met people’s individual needs and which supported them in a respectful and appropriate way.

There were training and processes in place for staff to follow to keep people safe and staff followed these. People’s physical and mental health was promoted. Staff were trained to care for people living with dementia. Medicines were stored appropriately and were administered and recorded as prescribed.

We saw staff ensured people were comfortable and had an object that offered them comfort. We saw people were supported in a relaxed and unhurried manner. Staff were caring and communicated well with people. However lunch for people on the ground floor was more relaxed and more of an occasion than for those on the top floor.

Staff focused on people they were caring for rather that the task they were carrying out. Staff spoke in a positive manner about the people they cared for and had taken the time to get to know people’s preferences and wishes. Staff had a good understanding of people’s needs and this was demonstrated in their responses to people and recognition of when people required additional support.

People’s privacy was respected. People had their independence promoted. Where possible they were offered choice on how they wanted their care delivered and were given choices throughout the day. Staff responded to body language of people who were without verbal communication.

People were supported to maintain relationships with family and friends. Visitors were welcomed at any time and were invited to join their family member for meals so that family time could be enjoyed. Records we looked at were personalised and included decisions people had made about their care including their likes, dislikes and personal preferences. There was a varied activity programme for people based on individual and group preferences. Suitable occupation was offered to people living with dementia. This included reminiscence and other therapies. Activities also included one-to to-one time and outings, or time in pursuit of personal hobbies or interests

People, relatives and staff spoke very highly of the registered manager and felt the home was well-led.

The service was managed in an inclusive manner. People and staff had their wishes and knowledge respected. Staff were aware of their roles and responsibilities for people’s care. The registered manager had systems in place to review the service and to ensure the service responded to ongoing needs of people.

At our visit there were 41 people living at The Willows. This included 34 people receiving nursing care and seven people receiving personal care. We found that people’s care needs were met by staff who were suitably supported, qualified, trained and experienced

People told us they were happy with their care and support. One person told us, "The care is very good here, I can’t fault it.” Another person said, “The staff are fantastic and really helpful and the food is lovely; there’s always a good choice and plenty of drinks are offered.”

We found that the home was clean, safe and well maintained and there were systems in place to protect people from the risks of infection. People were also protected against the risks associated with unsafe medicines practice because the provider had appropriate arrangements in place to manage medicines.

We observed the care provided to people living in the home and found staff to be responsive to peoples' needs by helping them to eat at mealtime and engaging them in stimulating activities. We also spoke to relatives who told us they were pleased with the care provided. We observed that the environment in the home has improved addressing concerns identified in previous compliance inspection reports. We spoke to six people living in the home who told us they were happy with the care they received. Staff told us that improvements in the assessment process and the training they have received had enabled them to provide care for the people living in the home.

One person told us “I’m comfortable here”. A visiting relative said the person was “well looked after”.

One person told us the home was “always kept very clean”. Two relatives told us that the home was usually clean when they visited.

Two relatives told us they were pleased that the provider had listened to and acted on ideas suggested at meetings for relatives and people in the home.

One person told us they liked living in the home and said "they do their very best for you". Three relatives told us they were happy with the care provided.

Relatives of people in the home told us they were involved in planning and reviewing the care provided. One relative said they were consulted as the person had dementia and was unable to express their views. This relative said “they are very good to my husband” and told us they were reassured because “I know they look after him when I’m not here”.

One relative told us that there were usually enough staff available when needed. They said that staff came straightaway if the person in the home needed assistance. They commented that the staff working with people with dementia on the first floor of the home “have a lot to do”.

Relatives told us the staff were friendly and approachable and that they looked after people very well.