At our last inspection in January 2016, the service was rated 'Good'. At this inspection, the service continued to be good.

Willow Grange Care Home is a care home. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Willow Grange Care Home provides residential care to older people. The home has three floors accommodating up to 46 people. On the day of our inspection visit 40 people lived at the home.

We carried out this comprehensive unannounced inspection on 1 August 2018.

A requirement of the service's registration is that they 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. A registered manager was in post and had been for 17 years.

People felt safe and staff were available when people needed them. The provider's recruitment procedures minimised, as far as possible, the risks to people safety.

Procedures were in place to protect people from harm and staff knew how to manage risks associated with people’s care and support. Processes were in place to keep people safe in the event of an emergency such as, a fire. Accidents and incidents were monitored and action was taken to prevent them from happening again.

Medicines were handled safely and people received their medicines when they need them from trained staff. People received support and treatment from health professionals when needed.

The provider was working within the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). People were supported to have maximum choice and control of their lives and care workers supported them in the least restrictive way possible.

The home was clean and tidy and people's needs were met by the design of the building. Staff understand their responsibilities in relation to infection control which protected people from the risks of infection.

People enjoyed the food provided. Staff understood people’s dietary requirements and preferences.

New staff were provided with effective support when they started work at the home and people confirmed staff had the skills and knowledge they needed to provide their care and support.

People were treated as individuals and were encouraged to maintain relationships important to them. People's individual religious and spiritual needs were known and respected.

Peoples dignity and privacy was maintained and staff supported people to be as independent as they wished to be.

Staff were caring and the atmosphere at the home was warm and friendly. People planned and reviewed their care in partnership with the staff. Staff knew people well and people confirmed their care and support was personalised to their preferences.

People chose to take part in a variety of social activities which they enjoyed and people maintained positive links with their local community.

People knew how to make a complaint and felt comfortable doing so. No complaints had been received since our last inspection. People had opportunities to share their views on the service. The management team were responsive to people’s feedback which meant people were listened to.

Staff enjoyed working at the home and felt supported and valued by their managers. People spoke positively about the leadership at the home and the provider’s management team.

Effective systems to monitor and the review the quality of the home was in place.

We carried out this inspection on 14 January 2016. The inspection was unannounced.

The home provides accommodation and personal care for up to 46 people. At the time of our inspection there were 40 people living at the home, one person was receiving temporary respite care.

A requirement of the service’s registration is that they 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. A registered manager was in post and had been for 13 years.

Support was provided that met people’s individual needs and there were enough staff to care for people safely. People’s health and social care needs were reviewed regularly. Staff referred to other health professionals when needed, so people were supported to maintain their health and wellbeing. Risk assessments were completed and plans minimised risks associated with people’s care.

People told us they felt safe living at the service. Staff knew how to safeguard people and what to do if they suspected abuse. People were protected from harm as medicines were stored securely and systems ensured people received their medicines as prescribed. Checks were carried out prior to staff starting work at the service to make sure they were of good character and ensure their suitability for employment.

Staff understood the Mental Capacity Act 2005 (MCA), and Deprivation of Liberty Safeguards (DoLs) had been applied for where applicable. Staff gained consent from people before supporting them with care.

Staff received training to do their jobs effectively in order to meet people’s care and support needs. Staff were encouraged to continue to develop their skills in health and social care. Staff told us they felt supported by the management team to carry out their roles effectively.

People’s nutritional needs were met, choice was offered and special dietary needs were catered for. People took part in some organised activities and day trips, and told us there was enough for them to do. Social support was provided for people, on an individual basis if they did not wish to join in with group activities, or were not able to.

People told us they liked living at the service and that staff were polite and kind. People were cared for as individuals with their preferences and choices supported. Staff treated people with dignity and respect when supporting them and encouraged people to be independent. Relatives were encouraged to be involved in supporting their family members. People were offered a choice about the care they received.

People were positive about the management team and the running of the service. The registered manager was responsive to people’s feedback in developing the service, and making continued improvements. People knew how to complain if they wished to, and complaints were addressed to people’s satisfaction.

Systems and checks made sure the environment was safe and that people received the care and support they needed.

We visited Willow Grange Care Home to follow up on concerns we had identified at a previous inspection of the service in April 2014. These concerns related to record keeping within the home.

During our visit on 1 July 2014 we checked three people's care plans and looked at a selection of records and accident reports.

Processes had been introduced which had improved record keeping. We found care records now provided staff with sufficient information to support them in delivering safe and consistent care.

Accidents were recorded and monitored to identify any issues of concern or trends, so that appropriate action could be taken where necessary.

We inspected Willow Grange Care Home and spoke with the registered manager, the deputy manager and five staff about the support they gave to people who lived at the home. We also spoke with a director of the provider company which had taken over the running of the home seven weeks prior to our visit. Speaking with these people helped answer our five questions. Is the service safe? Is the service effective? Is the service caring? Is the service responsive and is the service well led?

Below is a summary of what we found. This summary is based on our observations and evidence we found during the inspection. We were able to speak with most people living at the home and five visiting relatives. The people we spoke with were able to tell us about their experiences of what it was like living at Willow Grange Care Home.

Is the service safe?

The service was safe, clean and hygienic and there were no unpleasant odours. Staff had received up to date training in infection control and there were regular infection control assessments of staff. A visiting healthcare professional to the home told us, "The standards of cleanliness and hygiene are pretty good."

Staffing levels were set by the manager and based on an assessment of the dependency levels of those people living in the home. There were sufficient numbers of care and support staff on duty to meet the needs of people. Comments from the people we spoke with about staff included: "The staff are unbelievably kind and patient" and "It is very well staffed, plenty of staff."

We looked at the care records for four people living in the home. We found there were areas of record keeping that needed improvement. Records did not always provide staff with the information they needed to safely manage people with specific needs such as diabetes or catheter care. Care records were not consistently updated which made it difficult to get a clear picture of people’s current needs to make sure they were receiving the right support.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to people’s care records.

Is the service effective?

People had an assessment of their needs prior to moving to the home. Care plans were developed from the assessment of needs and reviewed regularly. Specialist dietary needs had been identified in care plans where required. Staff supported people who required assistance to eat on an individual basis and ensured they received food at a pace which was right for them.

Staff received an induction to the home and benefited from regular training. Some staff required specialist training to support them in feeling confident to meet the specific needs of people living in the home. A director from the new provider told us they were committed to providing this training.

Relatives and friends arrived at the home throughout the day and confirmed they could visit whenever they wished to.

Is the service caring?

We saw warm and kindly interactions between people living in the home and staff. One person told us, “The staff are very good.” A visitor commented, “The staff have never shown any signs of irritation or impatience with any of them. They are endlessly patient and attentive.” We saw staff took time to sit and talk to people where possible. One relative told us, “There is always someone sitting with her.”

Care plans contained details of people’s preferences, likes and dislikes so their care and support needs could be met in a way they preferred.

Is the service responsive?

Records demonstrated that staff were responsive in contacting other health and social care professionals to meet people's changing health and social care needs. A visiting healthcare professional to the home confirmed that referrals by the service were both appropriate and timely and said, “If they are concerned if someone isn’t eating or their weight is falling off they ask for dietician referrals.”

Is the service well led?

We found there was a process in place that took into consideration the views of people who used the service. People were invited to complete questionnaires about the care and support they received. Relatives were invited to a manager’s surgery every Tuesday if they had any queries or concerns they wished to raise informally. There was also a similar surgery for staff. One staff member told us, "You can go into her every Friday if there is anything you want to discuss." Staff spoke positively about the support they received from the management team. The manager assessed the quality of care given to people through monthly audits.