About the service: The Willows is a care home that provides personal and nursing care for up to 57 people. There were 41 people aged 65 and over at the time of the inspection, some of whom were living with dementia.

People’s experience of using this service:

¿ People received kind and caring support from staff. We observed staff talking kindly to people and treating them with respect.

¿ Care staff kept people safe whilst supporting them.

¿ People were supported with their dietary needs. People were positive about the choice of food though some said they would like more variety.

¿ People had personalised plans of care which care staff read to develop their knowledge about people’s needs and preferences.

¿ There were enough staff to be able to support people safely.

¿ Care staff assessed, reviewed and managed risks associated with people’s care needs.

¿ People were supported to take their medicines safely, and to access healthcare in a timely manner.

¿ People were cared for by staff who were appropriately trained to support them with their needs in line with national guidance and legislation.

¿ 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.

¿ People had the choice to engage with a variety of activities, including activities with local nursery school children.

¿ People and relatives told us that management were approachable and that any concerns raised would be dealt with effectively.

¿The registered manager had quality monitoring systems in place. They were aware of their responsibilities and worked in partnership with others to ensure people received safe care and support.

¿The registered manager had a plan in place for the refurbishment or replacement of some of the older furnishings and décor.

More information can be found in the detailed findings below.

Rating at last inspection: Good: Report published 20 September 2016

Why we inspected: This was a planned inspection based on the previous rating.

Follow up: We will continue to monitor the service through the information we receive.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

This was an unannounced comprehensive inspection that took place on 1 August 2016.

The Willows Nursing and Residential Home provides both care and nursing for up to 57 people with a range of needs. These include younger adults, people who are aged over 65, who are living with Dementia, who have a physical disability or a sensory impairment. The service is located on three floors. Each person had their own room. There were a number of communal lounges, kitchens and dining rooms where people could spend time together. At the time of inspection there were 43 people using the service.

The service had 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.

People’s medicines were not always handled safely. We found that staff had not always signed when they had administered medicines. We also found that the area where medicines were stored was consistently recorded as being at a temperature that was above the recommended storage temperature for medicines. This meant that the medicines could have reduced effectiveness. Staff competency to administer medicine had been checked but had not been recorded. Where someone had a medicine that was taken as and when needed, there was no guidance in place to tell staff when this could be taken.

People were protected from the risk of harm at the service because staff had undertaken training to recognise and respond to safeguarding concerns. They had a good understanding about what safeguarding meant and how to report it.

There were effective systems in place to manage risks and this helped staff to know how to support people safely. The provider dealt with accidents and incidents appropriately.

Checks and risk assessments to make sure the building was safe had been completed. Evacuation plans were in place for people to help support them safely in the event of an emergency. We found that one person did not have an evacuation plan in place. People’s equipment was regularly checked and there were plans to keep people safe during significant events, such as a fire.

There were enough staff to meet people’s needs. They were recruited using robust procedures to make sure people were supported by staff with the right skills and attributes. Staff received appropriate support through a structured induction and regular supervision. There was an on-going training programme to provide and update staff on safe ways of working.

People were supported to maintain a balanced diet and guidance from health professionals in relation to eating and drinking was followed. We saw that people were able to choose their meals and were involved in making them.

People were supported to make their own decisions. The registered manager had an understanding of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). We found that assessments of mental capacity had been completed; however they needed to be for a specific decision. Applications for DoLS had been made where these were needed. Staff told us that they sought people’s consent before delivering their support.

People were involved in decisions about their support. They told us that staff treated them with respect. People knew how to make a complaint. There was a complaints policy in place that was displayed in the home.

People received care and support that was responsive to their needs and preferences. Care plans provided detailed information about people so staff knew what people liked and what they enjoyed. People were encouraged to maintain and develop their independence. People took part in some activities that they enjoyed. People were offered the chance to be involved in reviewing their care plan each month.

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At our inspection we asked five questions; is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records.

Is the service safe?

We observed that people were treated kindly and respectfully by staff. Staff were attentive to people’s needs and offered people choice. People we spoke with felt safe. Staff had a good understanding about safeguarding people from abuse. They knew the correct procedures to follow in the event of suspected abuse and about who to inform.

There was evidence that learning from incidents / investigations took place and appropriate changes were implemented. The manager carried out a weekly falls analyses so that changes could be made to reduce further risk.

People were cared for in a clean and hygienic environment. Since our last inspection the provider had made significant improvements in this area. We saw that the

environment was clean and well maintained.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. This means that when people have their liberty deprived in order to keep them safe, this was only done following a best interest assessment carried out by the local authority DoLS team. At the time of our visit there was nobody using the service who required a DoLS authorisation. All staff had received training about DoLS.

Staff recruitment and selection procedures were robust. This meant that appropriate checks were carried out and only people who were suitable were employed.

People we spoke with told us that staffing levels were good and they did not have to wait for staff to attend to them.

Is the service effective?

People told us that they were happy with the care that had been delivered and their needs had been met. It was clear from our observations and from speaking with staff that they had a good understanding of people's care and support needs. One person told us "I get on really well with staff”. Another person said "I like the staff, we have a laugh”.

Staff had received appropriate training to meet the needs of the people living at the home.

Is the service caring?

People were supported by kind and attentive staff. We saw that staff showed patience and gave encouragement when supporting people. People who used the service appeared relaxed and at ease with the staff supporting them.

People's health and care needs were assessed before they moved in. Each person had a care plan in place for each identified need. People's relatives told us they were always made welcome. One person told us that staff enabled them to maintain as much independence as possible. A relative told us “They treat my relative as if they were one of their own.”

Is the service responsive?

People had access to activities that were important to them and had been supported to maintain relationships with their friends and relatives.

People completed a range of activities in and outside the service. Appropriate activities were available to suit the needs of people with cognitive impairment.

People knew how to make a complaint if they were unhappy. People told us that staff

would listen to them and take appropriate action.

Residents meetings were held and people were asked for feedback about their experience of care, treatment and support.

Is the service well-led?

Staff had a good understanding of the ethos of the home and quality assurance processes were in place. The registered manager and other members of the management team were approachable and accessible to people who used the service, their relatives and to staff.

We spoke with fourteen people who used the service. People told us they liked the staff and received the care and support they required. One person said " I like it here, I get on well with the staff". Another person said " I like it here, they look after me".

We saw that staff usually gave people choice about the care and support they received. People said they liked the food. It was evident that people were given a choice of meal and if they changed their mind, an alternative was provided.

There was a range of recreational and social activities on offer. Some people said they would like more opportunities to go out. People had their medicines managed safely and effectively. We looked at cleanliness and infection control. While the majority of areas were clean and tidy, some areas required attention. Staff spoken with had a good knowledge of how to prevent the spread of infection.

We spoke with three people who used the service. They told us they received the care, treatment and support that met their needs. One person said 'the staff are very nice'. We spoke with two visiting relatives. They told us their relative had recently moved in and they were very happy with the care they received. We observed staff interacting with people who used the service in a helpful, friendly and appropriate way.

People told us they were satisfied with the cleanliness of the home.

People told us that staff were respectful and maintained their privacy and dignity. Staff were competent and there were enough staff on duty so that people were not left waiting for the support they needed.

One person said the food was very good and there was always a choice.