About the service: Willowdene Care Home is a care home which can provide nursing and personal care to 47 older people, some of whom are living with dementia. At the time of this inspection there were 43 people living at the service.

At our last inspection we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014. This related to Safe care and treatment and Good governance. There were shortfalls in the safe management of medicines, record keeping, assessment of risks and the provider’s quality assurance audits. At this inspection we found improvements had been made and the service was no longer in breach of regulations.

People’s experience of using this service: Medicines were well managed and people received their medicine as prescribed. However, some medicine audits and checks were not always fully detailed or clearly completed. The environment and equipment was safe and well maintained. Arrangements were in place to protect people from risks to their safety and welfare. Staff understood how to keep people safe and used information following accidents and incidents to reduce the likelihood of future harm. Effective recruitment procedures were in place and people received care in a timely way. Arrangements were in place to protect people from the risks associated with the spread of infection.

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. People were supported to eat and drink enough to maintain their health and welfare. Staff received appropriate training and supervision to maintain and develop their skills and knowledge to care for people in a person-centred way. People's health was well managed and staff worked closely with other professionals to provide effective care.

Staff had developed caring relationships with people and respected their privacy and dignity. People’s independence was promoted and staff ensured people maintained links with their friends and family.

People’s care was based on detailed assessments and person-centred care plans. A range of activities were available. People felt confident raising concerns and complaints had been dealt with effectively. Staff were aware of good practice and guidance in end of life care, and respected people's religious beliefs and preferences.

Management systems were in place to monitor the quality of the care provided and feedback was used to make continuous improvements to the service. The registered manager worked well to lead the staff team in their roles and ensure people received a good service.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection: Requires Improvement (report published 20 June 2018).

Why we inspected: This was a comprehensive inspection brought forward in response to information of risk or concern about people’s health and wellbeing. We found the concerns to be unsubstantiated.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

This inspection took place on 22 May 2018 and was unannounced.

Willowdene is a ‘care home’. 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. The service is registered for 47 people and at the time of inspection there were 39 people living at the service. The service had three units, nursing which had 17 people living there, residential which had 11 people and a unit which specialised in care for people living with dementia, which had 9 nine people.

A registered manager was in post at the time of the inspection visit. They were registered with the Care Quality Commission on the 15 May 2018. 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 service was last inspected in December 2015 and received a rating of Good. At this inspection we found the service was now rated requires improvement.

We identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These concerns related to the safety of people using the service and the lack of oversight of the service. You can see what action we told the registered provider to take at the back of the full version of the report.

We found concerns with the safe administration and storage of medicines.

Plans were not in place to minimise all risks to people who used the service. For example, where a person was an insulin dependent diabetic or where a person was at risk of choking.

We saw evidence of fire drills that had taken place, however at each one it was recorded that staff were not taking them seriously or ignoring the alarm. No action had been taken regarding the appropriateness of this. No full evacuation or practice simulated evacuation had ever taken place.

Audits were taking place; however, due to a high turnover of manager’s in the last year, until now no one had been consistently accountable or had full oversight of the service.

Staff training was up to date, however staff felt the e learning now provided was not substantial enough. Supervisions were now starting to take place but due to changes in management had been lacking so far, this year.

The provider had sought peoples feedback via a questionnaire, however individual views for Willowdene were not fully provided and not action plan was in place to address any concerns.

Through observation we found there were sufficient staff employed to support people with their assessed needs on the day of inspection. However, relatives and staff said they could be short staffed at times. An anonymous concern was raised prior to the inspection to say staffing levels were dangerously low. The service was using agency staff to cover the nursing unit. They had recently had a high turnover of staff. The registered manager agreed to review staffing levels.

We received mixed views from people on the food provided. There was no information in the satellite kitchens to provide staff with information on each person’s dietary needs.

We have made a recommendation stating that all dietary information should be available in the satellite kitchens to reflect people’s current needs.

People were supported to continue with their preferred religious needs.

People who lived at the service were safeguarded from abuse. People told us that they felt safe at the service and that they trusted staff. Staff had received training in the safeguarding of vulnerable adults and said they would not hesitate to report concerns.

A number of recruitment checks were carried out before staff were employed to ensure they were suitable to work with vulnerable

This inspection took place on 3 December 2015 and was unannounced. This meant the staff and the provider did not know we would be visiting. At the time of our inspection there was a new manager in post who was applying to become registered with CQC. A registered manager is a person who has registered with 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.

On 31 October 2014 and 3 November 2014 we completed an inspection at Willowdene Care Home and informed the registered provider they were in breach of a number of regulations including staffing and records and required improvements to make the service safe and responsive. Whilst completing this inspection we reviewed the action the provider had taken to address the above breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. We found that the provider had ensured improvements were made in these areas and these had led the home to meeting the above regulations.

Willowdene Care Home is a purpose built, two storey, care home located just north of Sedgefield, County Durham. The home provides care and accommodation for up to 47 people and includes a small, separate 12 bed unit for older people living with dementia type illness. It also provides nursing care. On the day of our inspection there were 44 people using the service. The home comprised of 47 bedrooms, most of which were en-suite. The home was set in its own grounds and facilities included several lounges, dining rooms, communal bathrooms and toilets, a therapy room and a hairdressing room.

People who used the service and their relatives were complimentary about the standard of care at Willowdene Care Home. Everyone we spoke with told us they were happy with the care they were receiving and described staff as very kind, respectful and caring.

There were sufficient numbers of staff on duty in order to meet the needs of people using the service. The provider had an effective recruitment and selection procedure in place and carried out relevant checks when they employed staff. Training records were up to date and staff received supervisions and appraisals were planned.

There were appropriate security measures in place to ensure the safety of the people who used the service and the provider had procedures in place for managing the maintenance of the premises.

The layout of the building provided adequate space for people with walking aids or wheelchairs to mobilise safely around the home and some areas of the home were designed for people with dementia type conditions.

The service was working within the principles of the Mental Capacity Act 2005 and any conditions on authorisations to deprive a person of their liberty were being met. We saw mental capacity assessments had been completed for people and best interest decisions made for their care and treatment. Care records contained evidence of consent.

People were protected against the risks associated with the unsafe use and management of medicines.

People had access to food and drink throughout the day and we saw staff supporting people at meal times when required.

The home had a programme of activities in place for people who used the service.

All the care records we looked at showed people’s needs were assessed and reviewed. Care plans and risk assessments were in place when required and daily records were up to date. Care plans could be written in a more person centred way.

We saw staff used a range of assessment tools and kept clear records about how care was to be delivered. People who used the service had access to healthcare services and received ongoing healthcare support.

The registered provider had a complaints policy and procedure in place and complaints were fully investigated. The registered provider had a quality assurance system in place and gathered information about the quality of their service from a variety of sources.

As part of this scheduled inspection we followed up on a compliance action set at the previous inspection in August 2012. We found improvements had been made in this area.

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. One person said “The staff do ask my permission (before providing care or treatment).”

People’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan.

People told us they were happy with the care and support they received. One person told us "I like it here, I get looked after” and another person said “I think it’s alright, but they could do with more staff.” Other comments included “It’s like a home from home”, “Anything you need, you’ve only got to ask for it” and “It’s absolutely marvellous, the way we are looked after, there’s everything you need.”

People were cared for in a clean, hygienic environment. People told us their rooms were kept clean and they were happy with the standard of cleanliness throughout the home. Comments included “They (cleaning staff) come in (to my room) every morning”, “The cleanliness is excellent”, “It’s spotless – perfect” and “My room is always kept beautiful.”

There were effective recruitment and selection processes in place. We also saw the professional registrations of nurses were checked to ensure they were up to date.

People were protected from the risks of unsafe or inappropriate care and treatment. This was because people’s personal records, including medical records, were accurate and fit for purpose.

People we spoke with said they were happy at Willowdene Care Home. One person said "You get a bit confused when you come in, but they (the staff) help you bit by bit."

People told us they were happy with the care and treatment they were receiving. One person said "I'm definitely well looked after." People also said they were involved in their care, with their preferences being sought and taken into consideration.

People said they were happy with the staff employed by the service and the care they provided. One person said "The staff are worth their weight in gold" and another person said "They (the staff) are a great help." Other comments made by people who used the services included "They'll do anything for you", "Very good staff" and "They (the staff) are very good, the whole lot of them."

Everybody we spoke with told us they felt safe at Willowdene Care Home and with the care staff employed by the service. One person said "If I had any concerns, I would go straight to the manager." Another person said "Nothing's too much bother for them (the staff)."

People said they knew they could ask the staff at any time if they wanted something. They also said the staff knew them well and how best to help and support them in their everyday life.

People told us they were happy with the service and knew how to raise issues, should they have any. Everyone we spoke with said they didn't have any complaints or concerns.

This inspection took place on 31 October 2014 and 03 November 2014 and was unannounced. This meant the staff and provider did not know we would be visiting.

Willowdene Care Home provides care and accommodation for up to 48 people and includes a small, separate 12 bed unit for older people living with dementia. It also provides nursing care. On the day of our inspection there were 43 people using the service.

The home had a registered manager in place. 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.

Willowdene Care Home was last inspected by CQC on 29 May 2013 and was meeting all the regulations inspected.

During our inspection visit we found there were insufficient numbers of staff on duty in order to meet the needs of people using the service. There was only one member of staff in the residential part of the home for the 12 residents, one of whom had nursing needs and required 2:1 care.

The provider had an effective recruitment and selection procedure in place and carried out relevant checks when they employed staff.

We saw evidence that thorough investigations had been carried out in response to safeguarding incidents or allegations and comprehensive medication audits were carried out regularly by the manager.

Training records were up to date and staff received regular supervisions and appraisals, which meant that staff were properly supported to provide care to people who used the service.

People had access to food and drink throughout the day and we saw staff supporting people in the dining room at lunch time when required.

We saw in the care records consent was obtained for photographs and the sharing of information, as well as end of life wishes. However, not all of these records were signed by the person using the service or a family member. This meant we could not be sure if the information contained in the record was a true reflection of people’s wishes.

The layout of the building provided adequate space for people with walking aids or wheelchairs to mobilise safely around the home, and the Maple Suite was suitably designed for people with dementia.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The Deprivation of Liberty Safeguards (DoLS) are part of the Mental Capacity Act 2005. They aim to make sure that people in care homes, hospitals and supported living are looked after in a way that does not inappropriately restrict their freedom. We discussed DoLS with the registered manager and looked at records. We found the provider was following the requirements in the DoLS.

People who used the service, and family members, were complimentary about the standard of care at Willowdene Care Home. They told us, “The care here is brilliant”, “she loves it here, it’s the healthiest she’s been for years”, “everything about the care home, I can’t fault” and “happy with the care”.

We saw staff supporting and helping to maintain people’s independence. We saw staff treated people with dignity and respect and people were encouraged to care for themselves where possible.

On the first day of our inspection visit we saw that people’s care records were left outside each room, tucked behind the hand rails. As care records contain personal information, we discussed this with the registered manager who told us that it was not normal practice and should not be happening. The registered manager rectified it straight away and care records were placed back in people’s rooms. On the second day of our inspection visit, we did not see any care records in the corridors.

We saw that the home had a full programme of activities in place for people who used the service.

All the care records we looked at showed people’s needs were assessed before they moved into Willowdene Care Home and we saw care plans were written in a person centred way.

Some care plans we looked at did not contain sufficient detail about people’s needs and preferences and some risk assessments were missing important information. We also saw that risk assessments were not always up to date and some care plan reviews were overdue. This meant that care records were inconsistent.

We saw a copy of the provider’s compliments, concerns and complaints procedure, and saw that complaints were fully investigated.

The provider had a robust quality assurance system in place and gathered information about the quality of their service from a variety of sources.

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