About the service:

The Willows is a nursing home that provides personal and nursing care for up to 48 older people some who maybe living with dementia. At the time of the inspection 45 people were living at the service.

People’s experience of using this service:

People told us they felt safe: however, we found potential risks to people’s health and welfare had not always been assessed and detailed guidance was not available for staff to refer to. Not all staff had received sufficient training to deliver effective care. Although there were sufficient numbers of staff the deployment of staff required improvement. Safe recruitment processes were in place. Staff had access to equipment and clothing that protected people from cross infection.

Although people received their medicines as prescribed; improvements were required in the storage and disposal of medicines. Systems to monitor on line medicine training required improvement.

People’s needs were not always adequately assessed. Food choices were limited. Staff sought people’s consent before providing care. People’s health needs were met and people had access to healthcare services.

People’s dignity was not always respected. People’s choices and preferences were not always met because staff were often focussed on tasks. People’s independence was promoted. People and their relatives knew how to complain about the service and felt confident their concerns would be addressed.

People, their relatives and staff found the management team open and approachable. Although the audits completed had not always identified the shortfalls found at the inspection; the registered manager had begun to implement new systems to assess, identify and improve the quality of service people received.

More information is in the detailed findings below.

Rating at last inspection:

Rated Requires Improvement overall (report published 19 December 2017).

Why we inspected:

This was a planned inspection based on the rating at the last inspection. At this inspection we found the rating remained as required improvement.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

This inspection took place on 9 October 2017 and was unannounced. The Willows Nursing Home is a care home with nursing for up to 48 people. At the time of our inspection 40 people were using the service.

We last inspected this service in November 2016 when we rated the service ‘Good’ overall. We identified however that staff did not always respond promptly to people’s care needs and records did not confirm how much a person was required to drink in order to stay hydrated. This put people at risk of harm. We found the provider had taken action to address these issues.

There was no registered manager in place during our inspection visit. The registered manager had deregistered in September 2016 and a new manager who was intending to apply to become the registered manager left the service in September 2017. We were however accompanied during our inspection visit by the acting manager who was also a registered manager from another of the provider’s locations. 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. Failure to ensure a registered manager was in place is a breach of Regulation 5, Care Quality Commission (Registration) Regulations 2009. You can see what action we have asked the provider to take at the back of the report. A breach of regulation limits the highest overall rating the service can be awarded to ‘Requires Improvement’.

Staff we spoke with knew how to keep people safe from the risks associated with their specific conditions however people were not always supported in line with their care plans. Appropriate checks had been carried out to ensure people were supported by suitable staff.

People received their medicines as prescribed however further improvement was required to ensure people’s thickening powder and creams were managed safely. People told us that they felt safe in the home and staff demonstrated that they were aware of signs which may indicate that someone was being abused and the action to take.

Prior to our inspection visit we received information that people were being supported by a high number of inconsistent agency staff who did not know their care needs. We found however the acting manager had taken action so people were supported by consistent staff who had the skills and knowledge to meet their needs. Staff asked people’s opinions and respected their wishes. Assessments were undertaken when people were felt to lack mental capacity to make decisions about their care which were in their best interests. Protocols had been introduced since our last inspection to assess and protect people who were at risk of malnutrition and dehydration. People were supported with accessing other professionals to meet their needs such as a GP or optician.

People told us that the staff were caring. Staff spoke fondly about the people who used the service and how they enjoyed supporting them to engage in things they liked. People were supported to express their views about the care they received. People were able to develop and maintain social relationships that were important to them. People were supported by staff who respected their privacy.

People were supported to follow their interests and hobbies and had regular reviews with staff about how they wanted to be supported. Care records had recently been reviewed and updated so they reflected how each person wished to receive their care and support. People were encouraged to express their views of the service and assured that the acting manager would respond to concerns raised.

Prior to our inspection we had received concerns that the manager had not been effective in retaining and developing staff or monitoring the quality of the service. We found the manager no longer worked at the service and the acting

This was unannounced inspection took place on 16 November 2016.

The Willows is a nursing home providing accommodation and personal care for up to 48 older people. At the time of our inspection 41 people lived at the home.

As part of its conditions of registration, this provider is required to have 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. There was no registered manager in place as they had left the providers employment in June 2016. The provider had made arrangements to make sure there was a management structure in place by way of an interim manager pending recruitment of a manager.

At our previous inspection improvements were required to staffing arrangements to make sure people’s needs were met in a timely way. At this inspection the interim manager had assessed staffing levels and was increasing staffing levels to ensure people’s wellbeing and safety were consistently met in a timely manner. However changes in staffing arrangements were in their infancy at the time of this inspection and needed time to be embedded into practice and assessed for their effectiveness.

Staff were aware of how to reduce risks to people’s safety. We saw they used specialist equipment to ensure people’s needs were met and the risks of injuries were reduced. The information for staff to follow when monitoring people’s needs required strengthening. This was to make sure staff had sufficient information to guide their daily practices when supporting people to consistently reduce risks to their wellbeing.

People were supported by staff who knew how to recognise and report any concerns so people were kept safe from harm. People were helped to take their medicines by staff who knew how to manage these in line with safe principles of practice and were continually supported by the interim manager who regularly sampled medicine administration records.

Staff were appropriately recruited to ensure they were suitable to work with people who lived at the home. They were receiving on-going training and support to deliver a good quality of care to people and more practical style of training was being organised as staff felt this would enhance their learning experiences further.

Staff respected people's rights to make their own decisions and choices about their care and treatment. People's permission was sought by staff before they helped them with anything. Staff made sure people understood what was being said to them by using a range of communication methods. These included gestures, short phrases or words. When people did not have the capacity to make their own specific decisions these were made in their best interests by people who knew them well and were authorised to do this.

Staff met people's care and support needs in the least restrictive way. Where it was felt people received care and support to keep them safe and well which may be restricting their liberty applications had been made to the local authority for authorisation purposes. These actions alongside the interim manager’s improvements in having an organised system in relation to DoLS made sure people's liberty was not being unlawfully restricted.

Staff had been supported to assist people in the right way which included helping people to eat and drink enough to stay healthy and well. People had been assessed for any risks associated with eating and drinking and care plans had been created and were being updated for those people who were identified as being at risk. People were supported to access health and social care services to maintain and promote their health and well-being.

Staff cared for people in a kind and friendly way. Staff promoted what people could do and s

We carried out this visit to review the care of people who used the service. The last inspection of the home was 29 November 2012 when concerns had been raised by the local authority following a quality monitoring visit. At our visit in 2012 we found improvements to the service were required. The provider sent us an action plan on how improvements were to be made. We reviewed this as part of this inspection.

There were nine people living at the home which was registered to provide nursing care. All of the people living at home had been assessed as requiring residential care, with no nursing requirements. The local authority had temporarily stopped new placements of people to the home.

We involve people in our inspections that have experience of social care services; we call them experts by experience. With the expert by experience we spoke to the provider, the manager (who had been in post for one week), two staff members, five people who used the service and two visitors.

We saw that people had care plans and risk assessment in place these gave staff the necessary information to deliver care. People living at the home had the opportunity to be involved in their care delivery. One person told us, “Staff let me do what I can for myself, they are lovely people”. Staff had received training appropriate to their role this included safeguarding vulnerable adults.

Systems were being further developed to monitor the quality of the service provided at The Willows.

We carried out this review to check on the care and welfare of people using this service. The visit was unannounced which meant the provider and the staff at The Willows did not know we were coming.

We had received concerns about the service provided at the home. These concerns had been raised by the local authority following an infection control audit and quality monitoring visits. At the time of our visit the local authority had stopped new placements of people in this home.

In this report the name of a registered manager appears. They were not managing this service at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time. The provider told us that recruitment to the manager post was underway.

We observed that staff were courteous and polite and treated people with dignity and respect. The staff we spoke with were knowledgeable about the care requirements for people. Plans of care for people were available and the information was reviewed monthly.

We asked staff about their understanding of safeguarding (protecting vulnerable adults). The staff gave examples of abuse and told us they were confident to report concerns to a senior staff member. There had been omissions reporting to external agencies.

Staff working within the home did not have regular one to one meetings or appraisals.

There was no process in place for the provider to monitor the quality of the service at the home.

This unannounced inspection took place on 7 and 8 October 2015. At our last inspection on 28 May 2013 we found the provider was meeting the requirements of the regulations we inspected.

The Willows is a nursing home providing accommodation and personal care for up to 48 older people. At the time of our inspection 35 people were living at the home. The home had 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 told us they felt safe in the home. Staff we spoke with were aware of their responsibilities to report any concerns of potential abuse. There were occasions when there were not enough staff available to support people with their care needs. The provider had safe processes in place to recruit new staff and carried out appropriate pre-employment checks.

Risks to people’s health and welfare were assessed and appropriate equipment was available for staff to use. People received their medicines at the correct time and as prescribed. People were supported to make their own decisions about their care and support needs. Staff obtained consent from people before they provided care however some staff were not sure how to obtain consent from people who could not verbalise. Not all staff were aware of people living at the home who were subject to a Deprivation of Liberty Safeguards (DoLS) arrangement.

People were offered a choice of what they would like to eat and drink. People’s health and care needs were assessed and care was planned and delivered to meet those needs. People had access to other healthcare professionals to ensure that their health needs were met.

People and their relatives told us staff were kind and caring. People felt comfortable to approach staff for support. Staff understood people’s choices and respected their dignity and privacy when providing care and support. People were encouraged to be as independent as possible.

People were supported to maintain relationships and relatives we spoke with said that they were made to feel welcome when they visited the home. People and their relatives told us they felt comfortable raising concerns with the registered manager or staff members. The provider had a system in place to respond to people’s complaints and concerns.

People considered the home to be well managed. The provider did not have effective quality audits systems in place to identify issues or trends. These could be used to improve the quality of care provided to people.