Willow Gardens is a residential and nursing care service which offers support for older adults. It is a spacious purpose-built facility set over two floors. The service also supports some people under the age of 65 with physical disabilities. There is a large dining area situated on the ground floor and a spacious lounge on each floor. Outside is a large garden and patio area. The service is conveniently situated near to local amenities and transport links. At the time our inspection there were 39 people living at the service.

Willow Gardens is a ‘care home’. People in ‘care homes’ receive accommodation and nursing or personal care as a 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 service had a manager in post who was in the process of applying to CQC to become registered. A registered manager is a person who has registered with CQC 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.

This was an unannounced inspection which took place on 11 and 12 February 2019. The last inspection was in July 2016 when the service was rated as ‘Good’. At this inspection we found the evidence continued to support the rating of ‘Good’. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

People told us they felt safe living at Willow Gardens. People’s care records contained detailed information about their healthcare needs and risk assessments which helped to keep them safe.

Appropriate arrangements were in place for checking the environment was safe. For example, health and safety audits were completed on a regular basis and accidents and incidents were reported and recorded appropriately.

Medication was managed safely and was administered by staff who were competent to do so. People told us they received their medicines on time.

We found that staff’s suitability to work with vulnerable adults at the service had been checked prior to employment. For instance, previous employer references had been sought and a criminal conviction check undertaken.

People told us they felt staff cared for and supported them well. Staff had received training which equipped them with the knowledge and skills to ensure people received adequate support. Most staff had completed National Vocation Qualifications (NVQs).

Staff sought consent from people before providing support. Staff spoken to understood the principles of the Mental Capacity Act 2005 (MCA) to ensure people consented to the care they received. The MCA is legislation which protects the rights of people to make their own decisions.

People were involved in their care and there was evidence in their care records to show that they had been consulted about decisions. Care records contained information about people's preferences in relation to their care. People were referred to external health professionals appropriately, this helped to promote people's well-being.

There was no set daily routine at the service and people had a choice in what activities they participated in each day. We saw evidence that people’s hobbies and interests were recorded and catered for. The service had its own mini bus and people had a say in the places they wished to visit.

Quality assurance processes were in place to seek the views of people using the service and their relatives. People were involved in how the service was run.

We asked people about how they thought the service was managed and their feedback was positive.

This inspection took place on 27 May 2016 and was unannounced.

Willow Gardens is a residential care home in the Bootle area of Liverpool. The service offers care and support for up to 46 people. The property offers accommodation over two floors with lift access. The upper floor is equipped to support adults with disabilities. The ground floor provides accommodation for older people. Car parking is available at the front of the building. There are gardens to the rear and side of the building.

During the inspection there were 42 people living in the home.

A registered manager was 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 we spoke with told us they felt safe living in Willow Gardens. Staff were knowledgeable regarding safeguarding procedures and how to raise concerns. We found that appropriate safeguarding referrals had been made. We looked at how the home was staffed and found that there were sufficient numbers of staff on duty during the inspection.

We found that effective processes were in place to recruit staff and ensure they were suitable to work with vulnerable people.

We found that medicines were not always stored securely and there were some gaps in the recording of administered medicines. A medicine policy was in place and staff had completed medicine training.

The care files we looked at showed staff had completed risk assessments to assess and monitor people’s health and safety. Care plans included personal emergency evacuation plans (PEEPs), which provided information to staff on how to support the person to safety in the event of an emergency, but did not advise how people would be supported to fully evacuate the home should this be necessary.

We found that accidents were recorded appropriately. Internal and external checks were made to ensure the environment and equipment remained safe.

Staff sought people’s consent before providing support and care records reflected this. When people were unable to provide consent, mental capacity assessments were completed. No Deprivation of Liberty Safeguards authorisations were in place at the time of the inspection.

Staff were supported in their role through induction, supervisions and appraisal and staff told us they were well supported. Training was available to staff and records showed that courses the service considered mandatory had been completed by all staff. People told us they felt staff were well trained.

People at the home were supported by the staff and external health care professionals to maintain their health and wellbeing. People told us the staff supported them to access the GP and escorted them to hospital appointments when needed.

People told us they enjoyed the meals prepared for them and that they had choice. The registered manager arranged taster sessions to enable people to make try foods and decide whether they should be included within the menu. Records we viewed showed that people were regularly asked for their feedback regarding meals.

People living at the home told us staff were kind and caring and treated them with respect and that their dignity and privacy was maintained. Interactions between staff and people living in the home were warm and genuine.

Care files were stored securely in order to maintain people’s confidentiality.

People we spoke with told us they had been involved in care planning, though records we looked at did not all reflect this involvement clearly. Relatives told us they had been involved in creating personal profiles for their family members and records showed people were involved in decisions regarding the home, such as decoration and menu choices.

We observed relatives visiting during the i

This unannounced inspection involved following up on two areas of non-compliance identified at our previous inspection in January 2014. The inspection also set out to answer our five questions:

• 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. The summary is based on our observations during the inspection, discussions with people who lived at the home, their relatives, staff providing support and looking at records.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

The people we spoke with told us staff were caring and treated them with kindness and respect. People told us they felt safe and well cared for at Willow Gardens Nursing Home.

The home was clean, hygienic and odour free.

Measures were in place to ensure the environment was safe and suitable for the people who were living there.

The manager set the staff rotas; they took people’s care needs into account when making decisions about the numbers of staff required. This helped to ensure that people’s needs were always met. People we spoke with confirmed this.

The home protected the rights and welfare of the people in accordance with the Mental Capacity Act (2005). At the time of the inspection there was a Deprivation of Liberty Safeguard in place to keep a person safe. DoLS is part of the Mental Capacity Act (2005) and aims to ensure people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom.

Is the service effective?

People’s health and care needs were assessed with them and/or with a family member. People and family members told us staff communicated well about care needs and any changes were discussed with them. Specialist dietary, mobility and equipment needs had been identified in care plans where required. People’s care plans reflected their current needs.

Where specialist support was needed, for example, with a person’s nutrition, mobility and use of equipment, this had been sought in a timely manner to help improve people’s health, well-being and independence.

A variety of activities were arranged in the home and in the community which provided stimulation and social interaction. People we spoke with were very enthusiastic about the activities they took part in and the places they had the opportunity to visit.

Is the service caring?

The people we spoke with told us the staff were kind and helpful. People’s comments included, “The staff support me with whatever I need help with” and “They (staff) are always walking past my room and ask if I need anything.”

Throughout the day we observed staff prompting and encouraging people, in a kind and respectful way. Care and support was given when people requested and needed it. The staff ensured people’s comfort and dignity at all times.

Staff had a good knowledge about people’s care needs and how they wish to be treated. This included people's dietary preferences. Meals served were according to people's individual wishes and requirement.

People who lived at the home and their relatives had the opportunity to participate in and regular satisfaction surveys and could also provide feedback via the residents' and relatives' forum.

Is the service responsive?

Following our last inspection in January 2014 we had made a compliance action (requirement to improve) that the service needed to respond to and address. We found that these had been addressed and the improvements made.

From our discussions with staff and looking at a number of care records we could see that people’s plan of care was revised to meet any change in need. For example, deterioration in a person’s medical condition. Care documents showed medical intervention had been sought at the appropriate time.

Is the service well-led?

The home had systems in place to regularly monitor the quality and safety of the service provided. Records we looked at demonstrated that action plans were developed to address identified shortfalls in a timely way.

The service worked in partnership with key organisations, including the local authority and safeguarding teams to support the care provision and service development. This was evidenced through looking at a number of records and talking with the manager and staff.

The home did not have a Registered Manager in place at the time of our inspection. We informed the manager of the importance of being registered with the Care Quality Commission [CQC]. They agreed to submit the application as soon as they were able to do so.

We inspected this outcome to follow up on non-compliance found at previous inspections in February 2013 and June 2013. At the time of the last inspection, people were not protected from the risks of unsafe or inappropriate care and treatment because accurate records were not maintained. Records could not be located promptly when required.

At this inspection, we found good progress had been made in reviewing and maintaining staff records. However, work remained outstanding on addressing the accuracy of information held within people’s care records. We found the provider had not effectively monitored the transfer of people’s care records to new documentation.

The purpose of this inspection was to follow up a number of concerns we had identified at a previous inspection in February 2013. We found that good progress had been made, although further work was required to ensure accurate records were maintained and could be located promptly. A new manager and administrator had been appointed and the provider had taken steps to strengthen its quality assurance arrangements within the home.

We spoke with five people who were living in the home. All were able to tell us about their views and experiences of Willow Gardens. People told us they were satisfied with the care and support provided to them and that they were treated with dignity and respect. One person said, “The staff are wonderful and always take time to have a chat with you.” Another person said “The staff all treat us very well.”

We spent time with people in the dining room while lunch was being served. The dining room had recently been redecorated. We found it provided a pleasant and welcoming environment for people to enjoy their meals. The food being served looked appetising and people told us they had enjoyed their lunch. We were told the chef comes round every morning to ask what food they would like to eat that day. One person said, “He [the chef] always makes sure there is something you will like.” We observed that people were appropriately supported by staff over the lunch time period.