The inspection of Willow House took place on the 23 November 2017. The inspection was unannounced and undertaken by one adult social care inspector. At the last inspection, in August 2015, the service was rated Good overall and Requires Improvement in the safe domain as we could not always reconcile medication stocks with records. At this inspection we found the service had improved where required and has been rated Good in all five domains.

Willow House provides accommodation and personal care for up to 30 older people, some of who were living with dementia. There were 29 people living there at the time of our inspection.

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 protected from the risks of harm, because staff understood their responsibilities to protect people from harm and to share any concerns with the registered manager. The registered manager checked staff's suitability for their role before they started working at the home and made sure there were enough suitably skilled staff to support people safely and effectively.

Risks to people's individual health and wellbeing were identified and care was planned to minimise the risks. Medicines were stored, administered and managed safely and the registered manager regularly checked the premises and equipment were safe for people to use.

People told us they were happy with the variety and choice of meals available to them. We saw regular snacks and drinks were provided between meals to ensure people received adequate nutrition and hydration.

The registered manager and staff understood their responsibilities in relation to the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. Staff worked within the principles of the Mental Capacity Act 2005 because people were encouraged to be as independent as possible and empowered to take responsibility for their own lives and make their own decisions.

People were treated with dignity and respect by staff who demonstrated a caring, kind and compassionate approach. Staff understood the needs of people and people and their relatives were involved in the planning of care and support. A variety of opportunities were provided for people to enable them to enjoy meaningful social interaction and reduce potential risks of social isolation. Care was planned to meet people's individual needs, abilities and preferences. Care plans were regularly reviewed and updated when people's needs changed.

The service had an open and inclusive culture and people, their relatives and staff were positive about the way it was managed. The provider and registered manager had established quality assurance systems and regular audits were being completed. Issues identified were addressed in a timely manner. People's feedback was sought in order to improve the service.

The inspection took place on 25 August 2015 and was unannounced. We also visited on 4 September 2015 and this inspection was announced. The service was last inspected on 24 January 2014 and at that inspection we found records were not kept securely and could not be located promptly when required. At this inspection we checked that improvements had been made and sustained in this area.

Willow House provides accommodation and personal care for up to 30 people. It also offers respite care for people living with early to mid-stage dementia. There were 29 people living there at the time of our inspection including one person on respite care.

There is 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 told us they felt safe at Willow House and relatives who spoke on behalf of people who were unable to tell us how safe they felt said they had confidence their relations were safe. Staff could confidently describe the signs of abuse and what to do if they suspected abuse had occurred.

Risks were assessed and managed appropriately and we saw risk assessments had been completed regarding falls and skin integrity

As part of our inspection we carried out a random sample of medicines dispensed in individual boxes. This revealed some shortfalls in the management of individually boxed medicines as a result of non-adherence to the home’s policy.

People were supported to eat their meals by care staff appropriately and sensitively and people told us how much they enjoyed their meals. People’s nutritional and hydration needs were met and people were encouraged to drink throughout the day.

Staff received an induction and training to ensure they had the skills to meet the needs of the people who lived there. Staff were supported to continually develop by obtaining nationally recognised qualifications and by on-going supervision.

People told us staff were caring and kind and we observed this during our inspection. People told us staff treated them with respect and we saw staff protecting people’s dignity and privacy.

People were encouraged to remain independent in activities of daily life such as with personal care tasks and staff recognised the importance of independence in the wellbeing of the people who lived at Willow House.

Care provision was personalised and support plans were reviewed regularly to ensure they were relevant to the people who lived there.

Complaints were handled appropriately and people were happy that any concerns raised had been acted upon.

The home was well led and the management team encouraged an open and transparent culture where people were able to make suggestions for change and improve the quality of the service.

The management team were monitoring the quality of the service and had evidence to support they were continuously improving.

On the day of our inspection we arrived at the home at 9.30am and met with the manager. They told us care was provided to people over the two floors of the home. They also told us the service only offered a service to women. We spoke with six people who lived at the home and they all told us they were very happy there. One person told us "I've lived here a long time and the staff are lovely. They do their best and that's good enough for me." Another person told us "The food is lovely. There is always plenty to eat and we have lots of choice." We also spoke with one person's relative who told us "They are a very good home. The staff have always been good with my relative."

We looked at how people's privacy and dignity were maintained by the staff at the home. We saw people were spoken to with respect and received assistance as soon as they requested it.

We looked at five people's care records and saw people’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan.

When we looked at how the home met people's nutritional needs we found the menu system in place offered people healthy, well balanced meals on a daily basis.

During our inspection we looked at the recruitment procedures in place for the service. These showed staff were being properly checked to make sure they were suitable and safe to work with vulnerable people.

We looked at how the service managed record keeping. This included the storage and archiving of care records and other records relevant to the management of the service. We found records were not kept securely and could not be located promptly when required.

On the day of our visit there were 27 people living at Willow House Residential Home. During our visit we observed positive interactions between people living at the home and care staff in the lounge areas. We spoke with the registered manager, deputy manager, care coordinator, a care assistant, the cook and two people living at the home. During our visit we saw people laughing, singing and dancing with an entertainer in one of the lounge areas.

The two staff we spoke with said they felt care at the home was good and they felt well-supported by the management team. One of them told us “We work well as a team” and the other said “If there are any problems the managers are quick to sort them out”.

Care assistants received appropriate training for their role and understood the importance of their role to safeguard people using the service

One resident told us "We have our ups and downs, but I like living here.” and another said “The staff are lovely and the food is good; we get plenty of choice”.

When we asked people living at the home about making complaints and raising concerns one said “They always deal with any concerns I have” and the other person told us “I can’t think of any improvements which are needed here”

From what we saw and heard during our visit we felt people who lived at the home and their relatives would be able to raise concerns and know they would be listened to, and that actions would be taken to resolve any problems.

We spoke with seven people who live in the home. They told us that they were happy about the care they receive. Also that they are encouraged to make their decisions about their daily lifestyles and that staff talk with them about their care. People said they liked the new menu and food.

No one spoken with had any concerns and said that if they did they felt they could speak to the staff.Their comments included. " I can't fault it . I am happy here"

"We get good food. Its homely here"

"The staff are great they are very helpful".

A relative who was visiting said " It's homely here and the staff are lovely with people"

None of the people in the home nor the relative or visiting professional had any concerns over staffing levels.

People said that they understood their care and the support they needed but had not seen written care plans explaining how this was to be done. They told us that they are encouraged to make their decisions about their daily lifestyles. People explained that staff talk to them about their care and are given questionnaires to complete so that they can make comments about different aspects of the home. One person did say, “We could have more choice at mealtimes.”

All the people we spoke with were complimentary about the care they receive. One person told us “The staff are lovely. Whenever I need support it is given in a nice way and I never feel embarrassed or uncomfortable.” Another person said, “Staff are excellent. They are friendly and you can have a laugh with them.” People said they took part in activities and exercises. One person liked to have a cigarette and said they could go outside and have one whenever they wanted to.

People said they feel safe living at Willow House. All the people spoken with said they would feel confident that any concerns would be dealt with properly. People made comments that staff treat them with kindness.

Overall people did feel well cared for. One person told us “It is like being on holiday, nothing could be better.” Another person said, “The support you need is given in a nice way.” However, one person commented that staffing levels could be better.

People said that staff knew what kind of support they needed and were competent in providing this safely.

People told us that they are asked to complete questionnaires to give their views and opinions about different aspects of the home.