This unannounced inspection took place on 7 June 2018. Willowbank is a 'care home' for up to 18 older people, including people living with dementia. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. At the time of our inspection there were 16 people living there. There were three communal areas that people could choose to sit in and an accessible garden that people could go out to at any time.

At our last inspection we rated the service good, with an outstanding rating in responsive. At this inspection we found the evidence continued to support the rating of good in three domains and outstanding for responsive and caring. There was no evidence or information from our inspection and ongoing monitoring that demonstrated risks or concerns.

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. They provided leadership to the home to ensure that the values of respecting each individual and providing exceptional care was embedded.

Staff provided sensitive, compassionate care and responded very promptly to people’s needs. They understood each individual’s diverse requirements and ensured they met them. This included adaptations to maintain and encourage their independence. They worked in partnership with people’s families to ensure that their personal histories were understood. The staff also adopted different communication methods to ensure that they could assist everyone to make choices about their care.

People continued to receive outstanding personalised care and support which was built on their preferences. There was close collaboration with other professionals to get the best outcomes for people to maintain their health and wellbeing. The outcomes of careful assessment with the professionals and with families led to extremely detailed care plans. All staff had an excellent knowledge about people’s needs and ensured that they were met and regularly reviewed. They also used this knowledge to plan activities and interaction which promoted people’s mental and physical wellbeing. This included developing community partnerships and employing specialists.

The staff team were well trained and supported to have the skills to achieve good outcomes for people. This included in delivering end of life care and families we spoke with told us they were exceptional in supporting people through this time. They also were trained to develop their skills in clinical observations so that they could work in partnership with other professionals to respond swiftly to changes in people’s health. This included detailed analysis of any accidents or incidents to ensure that appropriate actions and referrals were made.

People continued to receive safe care. There were enough staff to support them and they were recruited to ensure that they were safe to work with people. Staffing levels were planned around individual need to keep people safe from harm. People were protected from the risk of harm because staff understood how to support them safely including using equipment. Medicines were administered to each person in an individualised way. They were recorded, stored and disposed of safely. The risk of infection was controlled because the home was clean and hygienic.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. They had enough to eat and drink and staff were extremely attentiv

The inspection was carried out on 12 November 2015 and was unannounced. At the time of our inspection the service was providing care and support to 18 people. The service provides care and support for older people, with a range of medical and age related conditions, including mobility issues, diabetes and dementia

The service had a registered manager who was also the owner. 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.

There were enough staff to meet people’s needs. Staff provided people with support and assistance in an unhurried and considerate manner.

Staff protected and promoted people’s dignity and privacy. All interactions between staff and people were caring and respectful; staff were consistently caring, kind and compassionate. Staff understood how to support people living with dementia.

Conversations and records with the provider, people and relatives showed that people were listened to. People were included in developing the service and regular meetings took place to monitor the service and this gave people the opportunity to voice their opinions and feel valued. There was a clear complaints procedure which was available for people and their relatives.

The provider ensured that staff fully understood people’s care needs and had the knowledge and skills to meet their needs. There were opportunities for additional training specific to the needs of the people, such as end of life care and the care of people with dementia. Training records were kept up to date and showed the staff attended training. Staff had regular one-to-one supervisions and appraisals.

Staff had received training in the Mental Capacity Act 2005 (MCA) to ensure they understood how to promote and protect people’s rights. People were asked for their consent before staff provided people with support. Staff were able to explain to us how they maintained people’s safety and protected their rights. Staff had also been provided with training in respect of Deprivation of Liberty Safeguards (DoLS) and safeguarding.

The provider demonstrated a clear commitment to providing people with a service that was based on strong values and a passion to implement best practice through research and knowledge. Staff were motivated and proud of the service they provided.

The provider used effective systems to continually monitor and evaluate the quality of the service being provided. There were plans for on-going and continuous improvement. The provider collected information about people’s, relatives and staff’s experience and used the information to sustain and improve the service.

Medicines were managed safely and in line with current legislation and guidance. There were systems in place to ensure medicines were safely stored, administered and disposed of. Staff who administered medicines received training to ensure their practice was safe.

People’s nutritional needs were assessed and records maintained to make sure people were protected from potential risks associated with eating and drinking. Referrals were made to the relevant professionals where risks and changes had been identified.

On this routine inspection we spoke with two people who lived at Willowbank, one visiting relative, four members of staff and the deputy manager.

We considered all the evidence we had gathered under the outcomes we inspected.

This is a summary of what we found.

Is the service safe?

We observed people were treated with respect and dignity by the staff. One person living

at the home told us, "They do their best for me here." People told us that they felt safe and were reassured by staff if they were concerned about anything. Procedures were in place to protect people from abuse or neglect. People had been cared for in an environment that was safe, clean and hygienic. There were effective systems in place to reduce the risk and spread of infection. People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

Systems were in place to monitor the quality of care people received and record any incidents and accidents. This helped reduce risks to people and helped the service to continually improve. We found special equipment was provided for people and checks were completed to ensure it was safe. A plan was in place for dealing with emergencies so that people were not put at risk. The medication system in place was safe. Enough staff were mostly provided to meet people's care needs. A plan was in place for responding to unexpected events that could affect the running of the service, for example fire or loss of the power or water supply.

Is the service effective?

We found people's needs were assessed and care files included information about any diagnosed health conditions. Care plans were reviewed regularly to ensure their needs were being met. People's health and care needs were assessed with them. They were involved in writing and agreeing their plans. Where people did not have the capacity to consent to their care, relatives were involved to ensure their best interests were followed.

Is the service caring?

People told us they were happy with the care they received at the service. We observed that staff communicated well with people and were keen to involve them in activities if they chose to do this. Care planning took account of people's wishes, preferences and background which helped ensure staff could provide personalised care that met their needs.

Is the service responsive?

Systems were in place for obtaining people's views about the service provided. People told us they knew how to make a complaint if they were unhappy. They also told us staff responded well if they had any concerns. We saw the provider assessed the quality of care people received and that action was taken where improvements were needed. People were aware how to make a complaint. There were clear procedures stating how complaints would be handled. No complaints had been received since our last inspection.

Is the service well-led?

Checks and audits of medication, infection control systems and other aspects of safety and practice were in place at the home. People using the service, their relatives and other people involved with the service completed an annual satisfaction survey and records showed action was taken where any improvements were required . Meetings were held with people living at the home and also relatives and friends to discuss what was going well and any concerns. As a result, the managers were able to plan any improvements that were needed to the way people's care was delivered and the service was provided.

People told us that care at Willowbank was good. One person said, "This is a really good, caring place to be. You feel welcomed and respected."

We found that people's needs were assessed and their care planned and delivered appropriately at Willowbank. We observed people receving personalised care that ensured their welfare and safety.

We saw that people's consent was obtained for their care, and that proper procedures were used if they could not make their own decisions, for example due to dementia.

We saw that staff received training to meet people's needs and that they were well supported by the manager.

We saw that procedures were in place to ensure complaints and comments about the service were responded to appropriately by the manager.

At the time of our inspection there were eighteen people living at the home.

During our visit we spoke to eight people who lived at the home, the relatives of two people and three visiting professionals. We also spoke to three members of staff.

One person living at the home told us ''I am very happy here, it's a wonderful place. Another person told us ''I like it here, if I didn't I wouldn't stay.'' Relatives of one person told us ''She loves it here. I am very happy with the her care. She enjoys the food.''

A visiting professional told us ''It's very good here, the staff are excellent. I have been coming here for years, the people are always well looked after.'' One member of staff said ''I enjoy working here, it is a lovely place. It's sometimes busy. I know how to report any abuse and I am confident that the manager would deal with any issue I raised.''