About the service: Willow court is a care service that provides personal care and accommodation for up to 81 people, some of whom live with dementia. At the time of the inspection 67 people lived at the service. Most people lived there permanently, and there were two short stay respite rooms. The accommodation was arranged over two floors. There were four living areas which included two 25 bedded living areas and two smaller living areas one with 16 bedrooms and the other with15. Each area had multiple communal areas, a dining room and there was a central café which was accessible to all people.

People’s experience of using this service: There was a warm, welcoming and very friendly atmosphere. The registered manager had developed a person-centred culture. The care and support provided to people who lived with dementia was consistently excellent and staff worked hard to understand people's individual needs.

Staff were extremely responsive towards people’s needs and care requirements. People and relatives told us they were fully involved in the development and review of their care plans.

Staff showed exceptional care and compassion when caring for people at the end of their lives.

The service was committed to assisting people to pursue their interests which created a sense of belonging and purpose. A range of activities were on offer to ensure a variety of opportunities which reflected people’s interests and differing abilities.

The registered manager was passionate about providing person centred care and this was reflected in every aspect of the service. People and relatives were empowered to share ideas to help improve the service. People and family members were asked to provide feedback and the results were positive. People’s views were considered and had been used to make changes in various areas including the environment, menus and activities.

Partnerships had been developed with the community and with health and social care professionals.

A range of regular checks had been completed to review the quality of the care and any areas where improvements were required. Actions were in place to make continual improvements to the service.

People’s safety had been considered and risks had been assessed and measures put in place to reduce the risks. Staff had received training in relation to safeguarding and knew how to protect people from harm. Medicines were managed safely. The risk to any infection was reduced by the maintenance of high standards of hygiene.

People enjoyed the food and their nutritional needs were met. People enjoyed living at the service and told us staff were kind and respectful of their choices. There were sufficient staff to meet their needs and staff were recruited in accordance with the providers recruitment policy.

People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service supported this practice. People’s cultural and spiritual needs were met and information was available in different formats to support understanding. There was a registered manager at the service and the rating was displayed at the service and on their website. When required notifications had been completed to inform us of events and incidents, this helped us the monitor the action the provider had taken.

Rating at last inspection: Good (Published August 2016)

Why we inspected: This was a planned inspection based on the rating at the last inspection. At this inspection we found the service continued to be Good, and in one area had improved to Outstanding.

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 the the 12 July 2016 and was unannounced.

Willow Court is a residential home providing accommodation and personal care to up to 81 people. At the time of our inspection there were 71 people using the service.

During our previous inspection in March 2015, we had found that people did not experience safe and good quality care that appropriately met their individual needs. The provider needed to make improvements in all of the five key areas we inspected. We found that significant improvements had been made during this inspection and the provider met all the required standards.

There was 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 were kept safe and protected from avoidable risk of harm. People had enough to eat and drink and had their healthcare needs identified and monitored by the service. Each person had individualised care plans and risk assessments in place which detailed the care and support they required and were followed by staff. There was a programme of events and activities for people to take part in throughout the day. People were given opportunities to feedback their views and have their opinions heard.

Staff received a range of training which enabled them to support people effectively. Each member of staff was supported through on-going supervision and performance review. They understood people’s needs and demonstrated a kind, caring and compassionate attitude.

People, their relatives and staff were positive about the management and culture of the service. Questionnaires and surveys were sent out regularly to ask for feedback on the quality of the care and support being provided. Regular meetings took place to give people and staff an opportunity to share their views and keep abreast of issues in the service. There were robust quality monitoring systems in place to identify improvements that needed to be made.

During this inspection we set out to answer our five key questions; Is the service caring,

is the service responsive, is the service safe, is the service effective and is the service well led? The inspection was carried out by one inspector over one day.

Below is a summary of our findings.

Is the service safe?

We noted from the care plans that an assessment of needs had been carried out before people came to the home. We saw evidence from the care plans that risks had been assessed and instructions on how the risks should be managed by staff was provided so that people were safe.

We looked at entries made in the medication administration record (MAR) charts and we found on occasions there were no signatures against medicines that had been administered. We also found discrepancies in the management of medicines. This meant that people could potentially be put at risk due to medicine errors.

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The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We noted capacity assessments and best interest had been completed. We saw one completed DoLS ‘Standard Authorisation’. There had been other applications made for DoLS.

Is the service effective?

The care plans had risk assessments in place to ensure the safe moving and handling of people, the use of bedrails and prevention of falls. The care plans were reviewed regularly to ensure that people’s changing needs were reflected. This meant that staff had up to date information about people so that their needs were met. One relative said, “There are great carers on the Rosebriar dementia care unit. I am happy that my relative’s health and care needs are met.”

Is the service caring?

During our inspection, we observed that staff were respectful of people’s privacy and dignity. For example, we noted that staff knocked on the door and waited before entering people’s room. We observed people were cared for by staff in a respectful way.

We looked at five care plans and found that these were detailed and centred on each person’s needs. The care plans provided up to date information to staff so that they were aware of people’s needs when providing care and support in meeting the needs. The care plans had risk assessments to ensure that people received appropriate and safe care.

Is the service responsive?

We noted that the care plans had been written from the person’s perspective and were centred on their needs. Care plans were reviewed on a regular basis. One member of staff we spoke with said," The residents are the most important people, that’s what we are here for.”

We saw the provider had a complaints procedure in place. We looked at the complaints log and saw that complaints were looked at in line with home’s policy.

Is the service well-led?

We saw there were systems in place to assess and monitor the quality of service. We saw that an action plan that had been compiled from internal audits dated May 2014. There were regular residents and staff meetings where they discussed issues relating to the day to day running of the home. This meant that people's views and opinions were being sought and taken into account.

At our last inspection in August 2013, we found that the provider was compliant with the five standards that we inspected. The provider was found non-compliant in four out of the five standards looked at in our inspection in May 1013. We inspected to ensure that improvements made since August 2013 had been maintained.

People looked well groomed, were dressed appropriately and looked happy. One person said that "I am very happy here, the food is good and the people are good. Everything is nice. They are very kind here".

There were systems in place to ensure that people received their medicines regularly and on time. The provider recently changed pharmacist, which had improved the medication delivery.. The pharmacist had provided an extra medication trolley. This ensured that the medication rounds were carried out more effectively.

There were sufficient numbers of staff on duty to meet the needs of people and the rotas confirmed that staffing numbers had been increased. We saw that the service used less agency staff and there were more permanent staff employed.

There was a system to assess and monitor the quality of service provision. We reviewed the records relating to the day to day management of the service and found that these had been kept up to date and had been stored safely and securely.

At our last inspection in May 2013, we had found that the provider was not compliant with four of the five standards we had inspected. We carried out this follow up inspection to check that the provider had made the required improvements. We found that the provider had made the necessary improvements and was now compliant.

People looked well groomed and were dressed appropriately. There were various activities being provided in different areas within the home. We observed people being assisted to eat and drink enough, and noted that processes had been put in place to monitor fluid intake for those people who were at risk of dehydration.

We observed people having their lunch time meal and noted that the quality and variety of food served to people during lunch time was below the standard that would be expected. The manager was in the process of addressing this issue with the relevant staff.

There were systems in place to ensure that people received their medicines regularly and on time. However, we found that there were still minor concerns which we brought to the attention of the manager, who told us that there were plans in place to address these concerns.

There were sufficient numbers of staff on duty to meet the needs of people and the rotas confirmed that staffing numbers had been increased since our last visit.

There was a system to assess and monitor the quality of service. We reviewed the records relating to different aspects of the day to day management of the service and found that these had been kept up to date and had been stored safely and securely.

People told us that they were well cared for at Willow Court. However when we asked what that meant and asked if they could expand on this, people we spoke to were unable to describe the care and support they received in detail. People did not necessarily understand that their assessment of needs should be reflected in their individual care plan, which could indicate that they had not been involved in agreeing and developing their care plan. We did not see any activities being provided, although there were planned activities these were not delivered as arranged. On the day of our visit the activities room was being used for training.

Care plans were in place for most of the people using the service but not all were reviewed or in use. On one unit the care plans were inaccessible at the back of the medicines trolley which could suggest that they were not used to guide staff in the provision of personalised care.

We observed staff respond to requests from the people for assistance and when asked what information regarding the person was included in the care plan most staff referred to the daily communication notes. This indicated that care was task led and not person centred. The manager told us that all care plans were currently being reviewed and updated.

There appeared to be enough staff in the home initially but throughout the day we observed staff being moved to other units to assist with various tasks, in particular at times of peak demand over lunch time. We observed people being assisted with lunch but the people we observed eating, ate very little.

When we visited Willow Court on 25 September 2012, people looked well cared for and at ease with the staff. Willow Court had recently expanded; two units primarily for people with high dependency needs had increased to 25 beds each from 15, giving a total capacity for 81 people over four units. The manager at the home had also recently changed. The new manager had been recruiting permanent staff to assist running the enlarged units and had also increased staffing on one dementia unit. People told us they were happy living and Willow Court and felt safe. One relative said the staff were exceptionally good and another person said all the staff were very helpful. However, several people said they thought staff were very busy, particularly on the high dependency units. Several members of staff had transferred from a neighbouring property run by the provider. The manager had recruited a number of new permanent staff who were due to commence work from the following week. A quality assurance programme was ensuring that standards are being maintained or improved at Willow Court following the period of expansion and change.

The people who were living at Willow Court when we visited on 29 April 2012, had varied levels of verbal communication, however they were all able to demonstrate through speech, facial expressions and gestures that they were satisfied with the care and support they received. One person said ‘’They are very good carers on this unit’’ and ‘’The girls are all very good’’. Another said ‘‘It’s very good here’’. A third said ‘’They are very nice and obliging if you want something doing. Very caring.’’

People looked clean and well cared for, and where people needed support or assistance with personal care this was done in the privacy of their room, or discretely if not requiring privacy, to protect their dignity.

People had access to a wealth of information relating to the home which was displayed on notice boards both in the individual units and in the communal areas of the home. This included information about people’s rights and how to make a complaint and safeguarding contact information. There were a number of different activities arranged, including outings, and this information was also made available to families to ensure everyone could participate if they wish.

This inspection took place on 15 and 18 April 2015 and was unannounced. When the service was last inspected in June 2014 we found that the provider was not meeting the required standards in relation to the management of medicines and record keeping. At this inspection we found that the service had taken action to address the issues in relation to medicines and had addressed the specific issues in relation to record keeping and was making good progress towards meeting this standard overall.

The home provides accommodation for up to 81 older people, some of whom are living with a diagnosis of dementia. This number included up to seven beds for people to stay on a short term enablement basis. Enablement is support that is planned and structured to support people to regain their independence and confidence to enable them to go home following a hospital admission or a period of ill-health. At the time of this inspection there were 70 people living at the home.

The home 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.

Staff were aware of the safeguarding process. Personalised risk assessments were in place to reduce the risk of harm to people, as were risk assessments connected to the running of the home and these were reviewed regularly. Accidents and incidents were recorded and the causes of these analysed so that preventative action could be taken to reduce the number of occurrences. There were effective processes in place to manage people’s medicines.

The necessary recruitment and selection processes were in place and the provider had taken steps to ensure that staff were suitable to work with people who lived at the home. However, people’s needs were not always met because there were not enough staff deployed in some areas of the home. We have made a recommendation about staff deployment to meet the needs of people living with dementia.

People had been involved in determining their care needs and the way in which their care was to be delivered. Their consent was gained before any care was provided and the requirements of the Mental Capacity Act 2005 and associated Deprivation of Liberty Safeguards were met.

We have made a recommendation about staff training on the subject of dementia.

Staff were kind and caring. They treated people with respect and encouraged people to be as independent as possible. However, some people’s dignity was not maintained.

Information was available to people about the services provided at the home and how they could make a complaint should they need to. People were assisted to access other healthcare professionals to maintain their health and well-being.

There was an effective quality assurance system in place. However, the management arrangements for the service were not made clear to people, their relatives and staff.