Willowbrook provides accommodation and nursing care for up to 75 people. People living in the service may have dementia and or enduring mental health conditions.

The service comprises of two buildings; Aldridge House, which has accommodation for 45 people diagnosed as living with dementia, and Alexander House, which has a 15 bed wing for people with mental ill health and 15 beds for people living with dementia.

At the last rating inspection in June 2016, the service was rated Good. At this inspection we found the service had developed further and was now Outstanding.

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 kept safe and secure from risk of harm. Potential risks to people had been assessed and managed appropriately by the provider. People received their medicines safely and as prescribed and were supported by sufficient numbers of staff to ensure that risk of harm was minimised. The provider had introduced enhanced systems to ensure people remained safe within the home.

The provider and their staff had continued to show a high level of compassion and kindness when caring for people, demonstrating a dedicated person centred approach to supporting their care and well-being. Feedback from people, relatives and healthcare professionals were extremely positive and complimentary, all providing glowing endorsements of how caring and compassionate staff were towards their loved ones.

People’s rights to privacy were respected by the staff and their dignity was maintained and upheld at all times. People were supported to express their views and be actively involved in making decisions about their care and support needs, by a provider who valued their input. Staff consistently sought people’s consent before providing care and support.

The provider demonstrated a high level of responsiveness to people’s individual care and support needs. They knew people well and understood how to help people live a happy and content life. We saw that activities and events were tailored specifically in response to people living with dementia. Staff demonstrated that they understood the importance and benefits of providing person centred care

The provider led by example and there was a strong ethos for quality care which ran throughout the location. All stakeholders had input into the running of the home, their feedback was valued and used to drive forward quality service provision. People, relatives and staff were proud of being part of the home and its positive and uplifting culture. Systems and processes were extremely robust and effective ensuring that quality standards were met and exceeded. The provider was proactive in working with external stakeholders, sharing information and examples of good practice, to develop the service and support external service provision.

People using the service, their relatives and staff were confident about approaching the registered manager if they needed to. They were extremely complimentary about the provider, registered manager and the whole workforce. They recognised that their views were valued and respected by the provider who consistently used their feedback to support quality service development.

Our inspection took place over two days on 15 and 16 June 2016 was unannounced on the first day.

At our last inspection in February 2014 they met all the regulations we assessed.

The service is registered to provide specialist support for people with dementia and mental health problems who need personal or nursing care on a long term basis. The service is split into two areas; Keswick suite for people with mental health needs and Aldridge suite for people with dementia. It is registered to care for up to 45 people. At the time of our inspection 45 people lived at the service.

There was a registered manager in post and they were present during our inspection. 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.

The leadership culture and ethos of the service was to provide a high quality service to people. Staff were well trained and supported to provide the best possible care to people.

People and their relatives were consistently complimentary about the kindness of staff. Relatives told us that staff often went over and above their role to care for their relative and they felt fully involved in their family members care.

People felt safe using the service and they were protected from the risk of abuse because the provider had systems in place to minimise the risk of abuse.

People were supported by staff that were kind, caring and respectful and knew them well. People were treated with dignity and respect. Staff understood people’s needs well. Staff received the training and support they needed to carry out their role and meet people’s individualised needs. There were innovative systems in place to encourage communication and interaction with people.

Staff had a good understanding of risks associated with people’s care needs and knew how to support them. There were enough staff to support people safely. Recruitment procedures ensured that only staff of a suitable character to care for people were employed.

Medicines were stored and administered safely, and people received their medicines as prescribed. People were supported to have their healthcare needs met.

People were supported to eat and drink food that met their dietary requirements and that they enjoyed eating.

There was a system in place which showed that when complaints were raised these were listened to.

There were robust and effective systems in place to ensure that the service was assessed and the quality of care provided to people was monitored.

On the day of our unannounced visit 45 people were living at this nursing home. We subsequently spoke to six people who lived there, eight relatives, five members of staff and the manager of the home.

People were complimentary about the care staff who supported them and their living environment. Comments included, “I have no complaints to make about the staff, they are all very good.”

We spoke to relatives of people who lived at the home. Comments included, “I wouldn’t have my relative in any home but this one.”

We examined care plans and found that people’s needs were properly assessed and that care and support was planned and delivered appropriately. From our observations it was apparent that care staff were attentive, polite and sought consent before providing care and support.

People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

We found that care was provided in an environment that was safe, accessible and suitably designed and adequately maintained. People were safe and their health and welfare needs were being met because there were sufficient numbers of staff on duty who had appropriate skills and experience.

We concluded that Willowbrook Nursing Home was a comfortable, well maintained home that was safe, caring and well led.

There were 42 people living at the home when we visited. No one knew we would be visiting that day. We spoke with the provider, manager, met with twelve people living there, one relative and four staff.

We inspected the home in August 2012 and found that staff were often spending their time reacting to incidents taking place in the home and acting to keep people safe from the actions of other people living there rather than taking a proactive approach. Staff had not received all the training they needed to meet the needs of people and records were not always well maintained so care needs may not be met.

At this inspection we looked at the improvements that had been made in relation to these issues. The home was more welcoming and people looked relaxed. Staff were supporting people in a way that met their needs. Staff spoke positively about their work and they told us they were getting the training and support they needed to do their job.

There were 42 people living at the home on the day of our visit. No one knew we would be visiting. We spoke to ten people who lived at the home, one care professional, eight members of staff and the provider.

We found some progress had been made on compliance actions made following a previous visit to the home. However we made new compliance actions following this inspection.

The majority of people living in the home were unable to tell us about the care they were receiving. We spent time watching how people were cared for so we could understand their experiences of care. We saw that staff were caring towards people living there and we saw people enjoyed some of the activities they took part in and the time they spent with staff. However staff's time was often spent reacting to the incidents taking place, offering reassurance to people and acting to keep people safe from the actions of other people living in the home.

Systems were in place to keep people safe from harm and abuse however they were not robust so people were not fully protected.

Improvements had been made to medication management so people received the medication they needed.

The home was clean and well maintained so providing a comfortable place for people to spend their time. People had comfortable and spacious bedrooms. The garden was well maintained and secure so people were safe.

Staff did not have all the training they needed to meet the needs of the people living there. They were not supervised and appraised to decide if they had been competent to meet people's needs.

Systems were in place for the gathering and evaluating of information about safety and quality however they were not always effective or timely.

The majority of people living in Willowbrook were unable to tell us about the care they were receiving. We spent time watching how people were cared for. We spoke to relatives and health professionals.

We were told that people living in the home had complicated histories and needs. Care workers were knowledgeable about the needs of people they cared for. There was always enough staff on duty for health workers to be able to talk to staff about people's care.

Relatives told us that care workers treated people: "Kindly" and had: "Compassion and understanding." People were: "...never dressed in clothes with food on them." Relatives told us that care workers and managers cared for them and understood how worried they got.

We saw that people who posed risks to themselves and other people at times were observed. Care workers intervened when they needed to in a calm way.