We undertook this unannounced inspection on 15 June 2017. Willesden Court is a care home registered to provide nursing and personal care for 60 older people. It is a purpose built home with three floors. The ground floor accommodates 18 people living with dementia who do not require nursing care. The first floor accommodates 21 people with general nursing needs, and the top floor accommodates 21 people living with dementia who also have nursing needs.

At our previous comprehensive inspection on 18 November 2014 we rated the service as “Good”. We found one breach of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The breach was in respect of Regulation 12 HSCA RA Regulations 2014 in relation to safe care and treatment. The registered provider had not ensured that the administration of medicines was recorded accurately to show that people received their prescribed medicines safely. At this inspection the service demonstrated that they had taken action to comply and the required checks and documented evidence was in place. The arrangements for the recording, storage, administration and disposal of medicines were satisfactory. Audit arrangements were in place and people confirmed that they had been given their medicines.

People informed us that they were satisfied with the care and services provided. They had been treated with respect and felt safe living in the home. There was a very positive atmosphere within the home. The welfare of people was at the centre of the service. Management and staff worked well together to ensure people had a meaningful and enjoyable life. There was a safeguarding adult's policy and appropriate arrangements for safeguarding people. Safeguarding allegations were taken seriously and reported promptly. The service co-operated fully with investigations by the local safeguarding team. The home had a safeguarding folder with full details of action taken following each safeguarding allegation.

People’s care needs and potential risks to them were assessed and care workers were aware of these risks. Personal emergency and evacuation plans (PEEP) were prepared for people to ensure their safety in an emergency. Care workers prepared appropriate and up to date care plans which involved people and their representatives. People’s healthcare needs were carefully monitored and attended to. The home had a varied activities programme to ensure that people could participate in social and therapeutic activities. There were several examples of good practice where people had made significant improvements in their well-being. Two people who previously required a high level of care had improved to such an extent that they were able to return home.

The premises were kept clean and tidy to a high standard. No unpleasant odours were detected anywhere in the building. Infection control measures were in place. There was a record of essential inspections and maintenance carried out. There were arrangements for fire safety which included alarm checks, drills, training and a fire equipment contract. Fire drills had been arranged.

The CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLS ensures that an individual being deprived of their liberty is monitored and the reasons why they are being restricted are regularly reviewed to make sure it is still in the person’s best interests. We noted that the home had suitable arrangements in place to comply with the MCA and DoLS.

The dietary needs and preferences of people were met. Most people informed us that they were satisfied with the meals provided. There was a varied and innovative activities programme which was arranged to meet the needs and choices of people. This included the needs of people with dementia and promoting the independence of people. there were outdoor movies in the garden and outings to places people had requested.

Careful thought had been given to ens

We inspected Willesden Court on 17 November 2014. This was an unannounced inspection. Willesden Court is a care home with nursing and provides care and support to 60 older people. It is a purpose built home with three floors. The ground floor accommodates 18 people living with dementia who do not require nursing care. The first floor accommodates 21 people with general nursing needs, and the top floor accommodates 21 people living with dementia who also have nursing needs. There were 60 people using the service at the time of our inspection.

At our last inspection in October 2013 the service was meeting the regulations we inspected.

There was a registered manager at the time of our inspection. 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 that they felt safe and staff were caring and treated them with respect. One person said, “I have to be here because I don’t get around very well. This is the best place for me now.” Another person told us, “This is a good place.”

Risk assessments were in place for each person for health risks, such as the risk of falls, pressure sores and malnutrition. However we did not see assessments of how to manage risks to individuals, such as the risks from smoking, and for the need to use bed rails. We have made a recommendation for the provider to address this. Procedures were in place for managing and administering medicines. However we found that recording of medicines did not accurately show that they were safely administered. This was in breach of regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 which corresponds to regulation 12 of the Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

Procedures were in place to maintain the safety and welfare of people using the service. Staff were aware of the actions they should take to safeguard people from abuse. There were sufficient staff to meet people’s needs. People told us that there were always staff available to help them when needed. Staff told us that they were able to meet people’s care needs and to have time to talk to individuals and spend time with them.

Staff were aware of people’s rights to be involved in decisions and to make choices about their care and treatment. Care plans showed these preferences. Staff showed that they understood how to communicate with people and to understand and meet their needs. We observed activities during the day on all floors. Activities organisers provided individual activities such as manicures and supported people with craft activities. Care staff encouraged people to be involved and active throughout the day, for example with singing and dancing while they served morning drinks.

Staff treated people with respect for their dignity and privacy. We observed one staff member encouraging a person to go with them to their room to change their clothes. They managed this in a very positive and dignified way that did not draw attention to the person’s continence needs.

People told us that they would be able to talk to any member of staff if they had a complaint or concern. The complaints record showed that complaints had been investigated and responded to appropriately.

The atmosphere in the home was open and inclusive. Staff said the manager spent time walking around the home and he was always available if they wished to speak to them. People who use the service, their representatives and staff were asked for their views about their care and treatment and they were acted on.

People who we spoke with told us that they were very happy at Willesden Court. One person said, “They take good care of me.” Another person told us, “My family went to three other homes before I moved here. I have been here more than a year and I am happy.”

We spent some time observing the interactions between staff and people who had complex needs which meant they were not able to tell us their experiences. Staff gave each person individual attention and encouraged them to be alert and aware of their surroundings.

Accurate records were maintained of the care provided for each person, and of how specific needs were met.

Everyone in the home was assessed regularly for the risk of malnutrition. The assessments included records of weight to assess if people were losing weight and therefore not receiving appropriate nutrition to maintain their health.

People were provided with a choice of suitable and nutritious food and drink.

Several people told us that they really enjoyed the food, and one person said, “It’s like I am in my own home.”

Medicines were handled appropriately and were safely administered. People we spoke with told us that the staff managed their medicines properly, and that they received them on time.

The staff who we spoke with told us that they received support and training that supported them to meet the needs of the people in the home.

We were unable to get views from most people because of different levels of complex needs, which meant some were not able to tell us their experience. However, we also sought views from families through discussions and their routinely collected feedback of the service through surveys. We also observed and spoke to staff and examined the records kept at the home.

A few people we spoke to commented positively about the support they received from staff. They told us “Staff are very pleasant” and that they were treated with respect. A person told us “They ask me what I want to eat.” We observed that staff asked people what they wanted to drink before bringing drinks that were tailored to people’s choice. This meant staff respected and acted on people’s choices. We spoke to relatives of three people, who also made positive comments about the service. One told us “As far as I am concerned, my sister is treated well. I don’t know any difference.” Another commented, “Staff are always pleasant and helpful.”

We read minutes of relatives meeting and three out of five who were present expressed concerns about insufficient staffing. One of the relatives’ comments read “I still feel there are not enough staff” and another enquired, “Why doesn’t the home take any volunteers.” None of the people who used the service expressed any concerns.

People and their families did not raise any concerns around the quality of the service. A relative of one of the people told us, “I can’t find any fault with the service.”

We observed that staff treated people with respect and dignity. We saw that people were appropriately dressed and well cared for. People using the service were encouraged to make choices regarding their food, drinks and activities. We noted that staff were pleasant to people who used the service, and spoke to them respectfully. This ensured people using the service were treated with respect and their rights upheld.