This was an unannounced inspection carried out on 11 July 2017.

We last inspected Willowdene Care Home in April 2016. At that inspection we found the home was meeting all its legal requirements. However, we considered some improvements were required. At this inspection we found those improvements had been made.

Willowdene Care Home is registered to provide accommodation for personal and nursing care to a maximum of 52 older people, including people who live with dementia or a dementia related condition. There were 33 people who were using the service at the time of our inspecion.

A manager was in place who was in the process of applying to become 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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Due to their health conditions and complex needs not all people were able to share their views about the service they received. Those that could speak with us told us that care was provided with kindness and we observed that people’s privacy and dignity were respected. Staff knew the people they were supporting well.

People’s preferences in relation to their end of life care had been discussed and the service aimed to provide people with a home for the rest of their lives.

Some people told us they felt safe. However, staffing levels were not sufficient to ensure people's needs were managed safely. Staffing levels were increased immediately during the inspection. Risk assessments were in place and they accurately identified current risks to the person as well as ways for staff to minimise or appropriately manage those risks. People were protected as staff had received training about safeguarding and knew how to respond to any allegation of abuse. Staff received opportunities for training to meet peoples’ care needs and in a safe way. A system was in place for staff to receive supervision and appraisal and there were robust recruitment processes being used when staff were employed.

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 support this practice. Staff had a good understanding of the Mental Capacity Act 2005 and best interest decision making, when people were unable to make decisions themselves. People were able to make choices about aspects of their daily lives. People had access to health care professionals to make sure they received appropriate care and treatment. People received their medicines in a safe way.

The home was well-maintained and the environment encouraged the independence and orientation of people who lived with dementia. Menus were varied and a choice was offered at each mealtime. Staff supported people who required help to eat and drink and special diets were catered for.

A complaints procedure was available. Relatives and people told us they would feel confident to speak to staff about any concerns if they needed to. The provider undertook a range of audits to check on the quality of care provided. People had the opportunity to give their views about the service. There was regular consultation with people and/ or family members and their views were used to improve the service. People had access to an advocate if required.

Staff and relatives said the new manager and the management team were approachable. Communication was effective to ensure staff and relatives were kept up to date about any changes in people’s care and support needs and the running of the service.

Willowdene Care Home provides nursing care for older people, some of whom are living with dementia. It is registered to provide care for 52 people. At the time of our visit there were 39 people living at the home. This inspection took place on 31 March and 1 April 2016 and was unannounced on the first day. This meant the provider did not know we would be visiting.

We last inspected the service in August 2015. We found there was not enough staff deployed to ensure people’s needs were met. The provider did not ensure staff received appropriate training and development to enable them to carry out the duties they are employed to perform. People did not receive the appropriate support and encouragement to eat and drink. Staff did not treat people with dignity and respect at all times. The provider did not have effective quality assurance processes to monitor the quality and safety of the service provided and to ensure that people received appropriate care and support.

No registered manager was in place at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission (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.

The home had recently been decorated and had a fresh clean look and people’s rooms were homely and personalised.

The provider carried out regular health and safety checks including checks of gas safety, electrical safety, electrical appliances, fire safety and water safety.

Recruitment checks were conducted prior to an applicant’s start of employment. However recruitment records were not always updated to reflect this.

Risk assessments were completed individually for people using the service based upon their needs.

Medicines were managed safely. The provider had systems in place for the receipt, administration and disposal of medicines.

Accidents and incidents were recorded and collated however no analysis was conducted to identify any patterns or trends.

During the short period the new manager had been in place staff training had raised from 62% to 86% completed and a supervision and appraisals programme had been introduced.

At mealtimes staff were attentive and responded quickly to people’s needs. They encouraged people to be as independent as possible and were happy to support when they were required. However we did observed people on a specialist diet were made to wait for their meal.

Each person had an individual emergency evacuation plan detailing how to support them in the event of an emergency.

Staffing levels had been increased since our last inspection. The manager regularly reviewed staffing levels taking into account people’s needs.

The home offered a range of activities and encouraged involvement with families. Although we found no specific activities were available for people living with dementia.

The provider did not ensure people’s authorisations for Deprivation of Liberty Safeguards (DoLS) were monitored and we noted appropriate requests were not always made in a timely manner.

Staff demonstrated a general knowledge about the people they supported and their families.

The home ensured people received care and support from healthcare professionals including social workers, community psychiatric nurses, occupational therapists, and GPs.

Where people had no family or personal representative we saw the home provided information about advocacy services.

Staff told us they enjoyed working at Willowdene Care Home and they felt supported by the manager.

Feedback was encouraged from people and the manager acted on the comments received to continually improve the quality of the service.

We did not speak to people living at the care home during this visit. We spoke with staff who told us things were much improved since our last inspection. The appointment of a new manager had helped with this, staff said they had recruited more staff and made improvements to the premises.

We found the provider had systems in place to gain and review consent from people who used their services.

We found that people who used the service, including people who worked there or visited were in safe, accessible surroundings which promoted their wellbeing.

Some of the people using the service had complex needs which meant they were unable to tell us their views; because of this we used a number of different methods to help us understand their experiences. We undertook a SOFI exercise.

We spoke to five relatives on the day of our visit. The comments were all positive. One person said their relative had lived at the care home for six years and said “I have nothing but praise (for the staff)." Another person told us "Staff are great. They are busy but always have time for a chat."

Another relative said “There has been a lot of managers but staff are helpful" "My xx has put on weight since moving here. They look much better." Another person said "Any changes to my xx and they (staff) are straight on the phone to let me know."

We found that people were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines. We found that there were enough qualified, skilled and experienced staff to meet people’s needs.

We found that where people did not have the capacity to consent to their care and treatment there was no assessment of this. The provider could not be sure they were acting in accordance with their wishes. We found that people were not protected against unsuitable premises and the provider had not taken steps to provide care in an environment that is suitably designed and adequately maintained in relation to specific needs.

Some of the people using the service had complex needs which meant they were unable to tell us their views; because of this we used a number of different methods to help us understand their experiences. We undertook a Short Observational Framework for Inspection (SOFI) exercise. SOFI is designed to be used when inspecting services for people who had some difficulty in communicating their opinions on the services they receive.

We spoke to two relatives on the day of our visit. One person said that the care was “alright” and staff try to help wherever possible. Another relative said they were “quite happy” with the care their relative received. They felt the staff were “good” and treated their relative with dignity and tried to involve them in activities.

We saw that there were effective recruitment and selection processes in place on staff. The provider had an effective system to regularly assess and monitor the quality of service that people receive.

We found that people were not always asked for their consent to care or treatment. Where people did not have the capacity to consent, there was no assessment of this. We also found that people were not protected against the risks associated with medicines. The provider could not demonstrate there were enough qualified, skilled and experienced staff to respond to people’s needs.

Due to the physical and mental health needs of the people living in the home it was not possible to get some peoples views, however we used a number of different methods to help us understand the experiences of people using the service.

All of the people living in the home who could speak to us told us that they were happy with the service provided. A relative told us that they were confident that their family member was being looked after and they said that the staff were “really good with him”, another said that they “were happy with the care”.

During the inspection staff were talking to people and asking them about day to day care issues such as what they would like to drink or if they needed anything. The people we observed were relaxed and comfortable with the staff, some of the people were communicating with staff verbally and others were happy to spend time walking along with them on request or were looking toward staff for reassurance. Staff exchanged pleasantries with the people living in the service and their visiting relatives. Throughout the inspection visit we saw that there was generally a good rapport between the people and the staff.

We, the Care Quality Commission, have undertaken two compliance reviews at the Willlowdene Care Home. The visit for the first review was carried out on 8 September 2011, and we found that improvements were needed. The visit for the second review was carried out on 29 February 2012 and this report describes our findings.

Due to the physical and mental health needs of the people living in the home it was not possible to get some peoples views.

All of the people living in the home who were spoken to said that they were very happy with the service provided by the staff. A relative told us that they were confident that their family member was being looked after and they said that the staff were “brilliant” and another said that they “were are happy with the care”.

One person told us that they were very happy with their bedroom and that it was warm and comfortable.

The people in the service and the visitors who were spoken to during the visit were complimentary about the way that the home is managed.

A person living in Willowdene care home told us that they were “happy” and felt “well cared for” and another said “things are getting better” since the new manager had started.

One relative spoken to said that they had been “involved in the decision making process” and that they were “happy with the care”. Another said that they thought the staff were "helpful" and that the staff were considerate to the relatives of people living in the home. One visitor told us that she was particularly impressed that the staff always knew what was happening” and that their relative “thought the world of the staff”.

The people in the service and the visitors who were spoken to during the visit were complimentary about the way that the home is managed.

A person living in Willowdene care home told us that they were “happy” and felt “well cared for” and another said “things are getting better” since the new manager had started.

Willowdene Care Home provides nursing care for older people, some of whom are living with dementia. It is registered to provide care for 52 people. At the time of our visit there were 39 people living at the home, with one person currently in hospital.

This inspection took place on 12 August 2015 and was unannounced. This meant the provider did not know we would be visiting. A second day of the inspection took place on 13 August 2015 and was announced. We last inspected the service in October 2013 and found the provider was meeting all legal requirements we inspected against.

No registered manager was in place at the time of 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.

During this inspection we found the provider had breached a number of regulations. We noted there was not enough staff deployed to ensure people’s needs were met. The provider did not ensure staff received appropriate training and development to enable them to carry out the duties they are employed to perform. We witnessed people did not receive the appropriate support and encouragement to eat and drink. We saw people were not supported to maintain their independence in line with their needs. We also found that the provider did not have effective quality assurance processes to monitor the quality and safety of the service provided and to ensure that people received appropriate care and support. We observed a number of issues which demonstrated staff did not always consider a person’s dignity. For example wiping a person’s mouth without asking and not assisting people immediately when required.

You can see what action we told the provider to take at the back of the full version of the report.

One family member told us, “I think there is a lack of staff here. The management need to pay more attention to the staff.” Another said, “There has never been enough staff” and “The main thing that could be improved was the staffing”.

On the ground floor we noted the lounge was left without care staff for repeated periods. During lunch we noted not all people who needed support with eating received assistance. We witnessed meals standing for 45 minutes before a member of staff was free to assist.

The home did not have an up to date emergency evacuation plan in place.

Medicines records were up to date and accurate. This included records for the receipt, return, administration and disposal of medicines.

The provider completed reference checks and a Disclosure and Barring Service (DBS) check prior to employees starting work. However no further DBS checks were conducted throughout their employment.

The provider conducted health and safety checks included checks of gas safety, electrical safety, electrical appliances, fire safety and water safety

We saw the manager had recently carried out supervisions with staff. Staff confirmed that appraisals were conducted annually and supervisions monthly.

We saw evidence of MCA assessments and ‘best interests’ decisions being carried out for people who lacked capacity to make decisions for themselves.

We saw evidence in care records of cooperation between care staff and healthcare professionals including social workers, dietetics, pharmacy, community psychiatric nurses, occupational therapists, physiotherapy, and GPs to ensure people received effective care. Where people had no family or personal representative we saw the home provided information about advocacy services.

People did not receive sufficient engagement or stimulation. No activities were available for people using the service.

Staff interacted with people during the delivery of care. We noted staff were busy with other duties and therefore did not have a great deal of time to ensure people had meaningful engagement.

Care plans we looked at contained personalised information about the person, a brief social history and their preferences.

People who used the service and their family members had the opportunity to give their views about the service.

One family member told us, “[My relative] has been here five years and we have seen eleven managers in that time. There is something not right about that”.

The manager has notified the Care Quality Commission of all significant events which have occurred in line with their legal responsibilities. They have submitted an application to become a registered manager.