Willow Court is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. The home is registered to provide accommodation and nursing care for up to 54 people, including older people and people living with dementia, some of whom were supported in a separate unit called ‘The Kingfisher Unit’ which specialised in providing care to people living with dementia.

We inspected the home on 7 and 8 November 2017. The inspection was unannounced. There were 50 people living in the home at the time of our inspection.

The home had a registered manager in post. The registered manager was not available at the time of this inspection. A registered manager is a person who has registered with CQC to manage the service. Like registered providers (‘the provider’) 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. In this report when we speak both about the company the area director, the registered manager and the acting manager we refer to them as being, ‘The registered persons’.

People were supported by staff who knew how to recognise abuse and how to respond to concerns. Risks in relation to people’s daily life were assessed and planned for to protect them from harm. There was evidence of organisational learning from significant incidents and events. Any concerns or complaints were handled effectively.

We found there were sufficient care and nursing staff available to keep people safe and meet their care and support needs. Staff worked well together in a mutually supportive way and communicated effectively, internally and externally.

Training and supervision systems were in place to provide staff with the knowledge and skills they required to meet people’s needs effectively. Staff provided end of life care in a sensitive and person-centred way.

Staff were kind and attentive in their approach and there was a friendly, relaxed atmosphere around the home and. People were provided with food and drink that met their individual needs and preferences. The overall physical environment and facilities in the home generally reflected people’s requirements.

People’s medicines were managed safely and staff worked closely with local healthcare services to ensure people had access to any specialist support they required. Systems were in place to ensure effective infection prevention and control.

CQC is required by law to monitor the operation of the Mental Capacity Act, 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves. At the time of our inspection, 22 people living in the home were subject to a DoLS authorisation. Staff understood the principles of the MCA and demonstrated their awareness of the need to obtain consent before providing care or support to people.

People were involved in giving their views on how the service was run and there was a range of audit and review systems in place to help monitor and keep improving the quality of the services provided.

We inspected the service on 3 November 2015. The last inspection took place on 30 April 2014 and we found the provider was compliant with all of the outcomes we inspected.

Willow Court Nursing Home is situated in the village of Cherry Willingham, close to the city of Lincoln. The home provides residential and nursing care for up to 54 people. The home also has a separate unit located within it which provides support for people with memory loss associated with conditions such as dementia. There were 53 people living in the home at the time of our inspection.

The home did not have a registered manager. However, the registered provider had appointed a new manager in July 2015 and an application to register the new manager had been submitted to the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC to manage the home. 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.

CQC is required by law to monitor the operation of the Mental Capacity Act, 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, always to protect themselves. At the time of the inspection one person who used the home had their freedom restricted in order to keep them safe and the registered provider had acted in accordance with the MCA and DoLS.

People and their relatives were involved in planning the care and support provided by the home. Staff listened to people and understood and respected their needs. Staff also understood how to identify report and manage any concerns related to people’s safety and welfare.

Staff cared for people in a kind, friendly and respectful way. Staff reflected people’s wishes and preferences in the way they delivered care and understood how to meet each person’s individual choices, and preferences.

People were supported by staff to be able to access a range of external healthcare professionals when they required any additional specialist support. People’s medicines were managed in a safe way.

People had access to a range of nutritious meals and drinks in order to keep them healthy. People were supported to enjoy a wide range of activities and pursue their personal interests. This included people living with dementia.

People and their relatives could freely express their views, opinions and any concerns to the manager and staff. The registered provider, the manager and staff listened to what people had to say and took action to resolve any issues when they were raised with them. There were clear systems in place for handling and resolving any formal complaints. The manager reviewed and reflected on concerns or untoward incidents and took any additional actions needed to keep developing and improving practices for the future.

Staff were appropriately recruited to ensure they were suitable to work with vulnerable people. They had received training and support to deliver a good quality of care to people. A comprehensive training programme was in place to support staff to maintain and develop their skills.

The home was run in an open and inclusive way that encouraged staff to speak out if they had any concerns. The manager and the registered provider regularly assessed and monitored the quality of the service provided for people.

This inspection was carried out by one inspector. We met with twelve people who used the service and observed their experiences of care to support our inspection. We spoke with the registered manager, five care and nursing staff, five relatives and three health care professionals.

In this report the name of a registered manager appears who was not managing the regulatory activities at this location at the time of the inspection. Thier name appears because they were still a registered manager on our register at the time.

We considered our inspection findings to answer questions we always ask:-

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well-led?

Below is a summary of what we found. If you want to see the evidence that supports our summary, please read the full report.

Is the service safe?

People were cared for in an environment that was clean and hygienic. People told us that they were happy living at the home and were supported to remain independent as safely as possible. They also told us that their needs were met because staff supported them to do the things they wanted to do.

Appropriate risk assessments were in place, and the registered manager had suitable arrangements to safeguard people from foreseeable emergencies.

People told us that they felt safe living at the home and their relatives confirmed this. We saw safeguarding procedures were in place and that staff understood how to safeguard the people that they supported. People were protected against the use of unlawful or excessive control or restraint because the provider had made suitable arrangements.

There were regular inspections and audits completed to make sure that the building and procedures were maintained and further improved and provided a safe environment for people to live in.

Is the service effective?

All of the people we spoke with and their relatives or carers, told us that they were happy with the care that was delivered and their needs were met. It was clear from our observations and from speaking with staff that they (staff) had a good understanding of people’s care and support needs and that they knew them well, which meant that people received an effective service. Staff had received training to meet the needs of the people who lived at the home.

The provider had recently implemented a new dementia quality monitoring tool to check the effectiveness of staff and procedures when working with people who had dementia. The service obtained a score of four out of six which was above average in the overall grade. This meant that the provider had tailored a particular audit to support them in providing a further improved service for people with dementia who lived at the home.

Is the service caring?

We asked twelve people if they had any concerns about the care provided by the home and they told us that were happy with the care provided and that the staff were caring. One relative told us, “I could not find a better home.”

Observations during the visit showed staff were compassionate and caring to the people they supported. The home was busy during the day with many visitors attending and we found positive interactions taking place and staff responding in a thoughtful and kind manner to people who lived at the home and also to visitors.

Is the service responsive?

Information was collected by the service with regard to the person’s ability and level of independence. Regular reviews were carried out with the person who used the service and their representative to make sure the person’s care and support needs had not changed. This helped ensure staff supplied the correct amount of care and support.

Information collected by the service also gave staff an insight into the interests, likes and dislikes and areas of importance to the people in their care. This meant that it helped staff to provide social activities that people could choose to be involved with.

Regular meetings took place with staff to discuss the running of the service and to ensure the service was responsive in meeting the changing needs of people who used the service.

People who lived at the home held regular meetings with staff to discuss their views on living at the home. This meant that people were involved in communications about the running of the home and staff listened and took action. People we spoke with confirmed they felt that they were listened to and knew who to contact if they had a problem.

Is the service well-led?

People who used the service had regular contact from the registered manager and other senior staff to check their wellbeing. The quality of service provided by care givers was monitored and this was done through quality audits and also through meetings arranged with the people who used the service.

Staff were knowledgeable about the support needs of people and the services ethos of maintaining safe independence and involvement of the person whatever their level of need.

One relative told us that they were kept regularly updated by the staff team if any changes occurred. The relative told us, “Staff ring me if I need to be made aware of anything, they are very good.”

Prior to our inspection we reviewed all the information we had received from the provider about the home.

As part of our inspection we spoke with four people who used the service and a visiting relative about their view of the home. We also spoke with six staff members and the registered manager.

One person said, “I can’t find fault with the manager, the staff or the home. If you ask a question you get an answer.” A visiting relative told us, “They are consistent at what they do and they listen to you if you have a point to make.”

Care records provided staff with enough information to enable them to deliver the level of care each person needed. We observed staff were caring and were responsive in the way they gave support to people.

We reviewed procedures for infection control and found these were in line with national guidance. We also looked at the statement of purpose and found this reflected the current service provision.

Overall we found the service was well led and there were effective systems in place for supporting staff to provide care and to audit and monitor the services provided.

We spoke with two people who use the service and one relative. They told us that staff were caring, thoughtful and kind. One person told us, "The staff are brilliant, they'll do anything for me". Another said, "I only came here for three weeks and I have ended up staying a long time because I love it". People told us that the activity programme in particular was excellent. One person said, "The activities are what make this place".