We undertook an unannounced inspection at The Willows on 10 and 12 April 2018.

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.

The Willows accommodates 61 people across two separate units. One of the units specialises in providing care to people living with dementia. At the time of the inspection there were 50 people living at the home.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection. At this inspection we found the service remained good.

There was a registered manager in post. A registered manager is a person who has registered with CQC 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 and their relatives were very complimentary about the care they received.

People were protected from abuse and avoidable harm. Staff had completed safeguarding training and understood the provider's safeguarding policy. The culture was open and staff told us they felt able to report any concerns which would be acted upon by the management team.

There was enough staff to support people effectively. Throughout the inspection we saw staff supporting people, meeting their needs and spending time socialising with them. There was a recruitment plan in place, especially for night staff.

The provider had an effective recruitment and selection procedure in place and carried out relevant checks when they employed staff.

Appropriate arrangements were in place for the safe management and administration of medicines.

Staff assessed risks to people's safety and developed plans to manage and mitigate those risks. Risk assessments were regularly reviewed and in line with changes in people's health and/or support needs. The home was very clean and well maintained.

Staff were supported to provide care to people through regular training, supervision and appraisal.

People were offered appropriate support with eating and drinking. Overall people were satisfied with the food available although some comments received suggested that the food could be variable. People’s health needs were kept under review and referrals were made to health professionals where required.

Staff understood the importance in seeking people's consent. During the inspection we heard staff asking for people's consent before they assisted them with any support. Staff had received training in and understood the principles of The Mental Capacity Act 2005 (MCA).

The provider and staff team placed emphasis on the importance of people’s well-being. Throughout the inspection we observed staff who were friendly and caring in their approach. They knew people well and talked about things that were important and relevant to the person.

People told us that they were treated with dignity and respect. Staff had a good understanding of how to respect people's right to privacy.

There was a wide and varied range of activities available for people to take part in should they choose. There was a programme of activities, including music therapy and reflexology. People were supported to maintain their spiritual well –being and a chaplain was employed by the service. There was a “seize the day” initiative” which supported people to achieve specific goals.

Staff were responsive to people’s needs and provided support in an individualised

People who lived at The Willows were positive about their experiences and the comments received reflected this. One person living at the home stated, "There is nowhere other than my own home I'd rather be and I can't live there any more". Another person who lived at the home told us, "The home is very good, I feel safe here".

The premises were clean and tidy and the design, layout and security of the premises was fit for purpose to meet the needs of the residents.

We found evidence that there was an effective recruitment process in place and found policies to back the process up.

The provider had an effective system in place to identify, assess and manage risks to the health and safety of people using the service and others. This included an effective complaints policy and process.

We completed an unannounced inspection visit on 15 October 2012 to The Willows. During our inspection on 02 July 2012 we saw some gaps in records because some forms had not been completely filled in or not accurately completed. These included risk assessments and information about fluid and hydration in the daily records. When we inspected The Willows on 15 October 2012 we established that improvements had been made. We found the records we reviewed reflected the care and support staff provided to people who used the service.

We spoke with three people who used the service, three staff members including the chef and met the deputy manager during the course of our inspection.

As part of this review, we asked people who used the service to comment on the management of their records and about the care and support they received. The people we spoke with told us they had no concerns and told us they were happy living in The Willows. One person told us: The staff here are very helpful I have no complaints.” Another person told us: “I am very happy living here.”

At the time of our inspection visit, 55 people lived in the home. We spoke with five people who lived in The Willows and two family members as well as care workers, nurses and the registered manager, who for the purposes of this report we refer to as 'the manager'.

Limited information was obtained from some of the people who used the service due to their dementia care needs or communication difficulties. We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

We observed and heard staff talk to people who lived in the home in a respectful way, people were well dressed and their modesty and dignity preserved when assisted with personal care.

One person who used the service who said: "The staff are very friendly and respectful. They wouldn't just barge into your room unannounced; it's not like that here."

When asked about whether people were involved with their care planning one person told us: "They (the staff) do talk to us about the care, but I'm just not that interested in any of the paperwork, they do a good job and that is what's important."

People told us they were confident that staff cared for them properly. Their comments also included:

"This is a lovely place to live."

"The nurses are professional and the carers are all very nice."

The family members we spoke with told us that staff acted in a professional manner and found them to be professional and kind in their provision of care. Their comments also included: “I cannot fault them."

"The Willows is an excellent care home with wonderful, caring staff."

"We always visit unannounced, as do our friends; they are always the same, welcoming, friendly, supportive, the staff respect people and have time for them. They really care."

This inspection was unannounced and took place on the 27 October 2014. A second day of the inspection took place on the 28 October 2014 in order to gather additional information. The home was previously inspected in November 2013 when it was found to be meeting all the regulatory requirements which were inspected at that time.

The Willows is a purpose built two storey care home located in Mobberley. It offers permanent care for up to 61 people and specialises in nursing and dementia care for older people. At the time of our inspection the service was providing accommodation and care to fifty-nine people.

The nursing care accommodation is arranged over two floors, with communal areas such as the lounge and dining room found at ground floor level. The home has a passenger lift and stairway to access each floor. Dementia nursing care is provided in a separate wing of the home on the ground floor. This has a lounge and dining room area that leads onto an enclosed patio and garden area.

At the time of the inspection we were informed that the registered manager was in the process of applying to de-register from her role to take up a new post from November 2014. We noted that the provider (MHA) had appointed a new manager in September 2014 who was in the process of applying to register with the Care Quality Commission.

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.

During the two days of our inspection, people living at The Willows were observed to be relaxed in their home environment and in the company of the staff team. The relatives of people who lived at The Willows also told us that they felt that the people who lived there were safe and that they had no concerns about the way that their family members were treated. Staff were observed to be diligent and friendly as they went about their duties.

People living at The Willows that were spoken with during our visit spoke highly of the care provided in the home. Comments received from people using the service included: “I would recommend this home to other people”; “I feel free and easy here”; “I can’t say enough good about the home”; “The care has been phenomenal”; “It’s not home but it’s a good place to be”; “It’s pretty nice here and everybody here would say that” and “The girls are wonderful here.”

Likewise, relatives of the people who lived at The Willows also complimented the care provided. Comments included: “The staff are very kind”; “Residents are treated as individuals and with respect” and “I feel part of a family when I visit. I come at different times of the day and I am always welcome. I have no concerns whatsoever about the care provided.”

Examination of induction and training records and discussion with staff confirmed staff had received guidance on the principles of care such as providing personalised care and the importance of treating people with dignity, privacy and respect. Furthermore, staff had access to a range of induction, mandatory and other training that was relevant to individual roles and responsibilities.

Two activity coordinators were employed at The Willows to develop and provide a programme of activities for people living in the home. During the two days of our inspection we noted that a range of activities had taken place.

Systems were in place to audit, review, monitor and improve the quality of the service. This included seeking the views of people who used the service, their relatives and staff on the running of the service.

We saw that there were corporate policies and procedures in place relating to the Mental Capacity Act 2005 and the Deprivation of Liberties Safeguards (DoLS). This helped to safeguard the rights of the people using the service.