About the service:

Willowmead Care Home is a care home in a rural location near Hatfield Peveril which provides accommodation with personal care for up to 60 older people, some of whom may be living with dementia. There were 50 people living at the service on the day of our inspection. The service is made up of two units called Hatfield and Wickham which are based in separate houses attached by shared communal gardens. The main offices are based in the larger Hatfield Unit.

People’s experience of using this service:

Historically, Willowmead Care Home had been unable to maintain improvements over time and the quality of care and accommodation people received had not been consistently good. At this inspection, we found the management team was committed to ensuring people received good quality care and improvements were sustained.

Every aspect of the service had improved since our last inspection. Feedback from people and their families about the changes was overwhelmingly positive.

The service was managed in a more structured and efficient way. The management team knew what was happening at the service and used learning from audits, mistakes and complaints to make things better. The provider had shown their commitment by investing in the property and in the resources required to implement the changes.

The management of risk had improved, with clearer advice provided to staff in care plans and guidance. Staff considered people’s needs in a more holistic manner and worked well with outside professionals to maintain their health and wellbeing.

Staff were recruited safely. Better organisation meant agency staffing had decreased so people were increasingly supported by a consistent staff group who knew them well. Feedback from staff was mixed. They told us it had been a challenging year, with an increase in paperwork and the fast pace of change. However, staff also consistently said the service had improved for the people they supported.

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 promoted this practice.

Retention of dedicated activity staff had been an ongoing issue which the provider was addressing. Despite this concern, staff worked well as a team to ensure people received personalised care which met their needs.

Support was provided in a dignified manner. The management team promoted a culture which was focused on people’s needs.

Rating at last inspection:

Requires improvement. The last report was published on 20 April 2018.

Why we inspected:

This was a planned inspection based on the previous rating.

Follow up: We will continue to monitor Willowmead to ensure people receive care which meets their needs. We plan our inspections based on existing ratings and on any new information which we receive about each service.

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

Willowmead Care Home provides residential care for up to 60 people. People in care homes receive accommodation and personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and we looked at both of these during this inspection. At the time of our inspection there were 47 people living in the service. The service was located in large grounds in a rural location.

This unannounced inspection took place on 15 and 18 January 2018.

The service did not have 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. We met the new manager during our visit and they told us were applying to become the registered manager of the service.

There had been a great deal of disruption at the service over the last year, with the departure of the registered manager and other key staff. The provider had not managed change well over this period. There had been a number of area managers responsible for the service over this time which resulted in an unsettled time for people, families and staff.

The provider had started to address the concerns and had increased investment in all areas of the service, including the fabric of the building and additional staffing. There was a new management team in place and increased support from the wider organisation to help drive the improvements. However, there had not been enough time for us to measure whether these changes were sustainable.

The provider had not ensured there were clear plans in place to manage risk to people’s safety. Where staff knew people well, they provided them with safe support. However, lack of clear guidance to staff meant people could not be confident they would receive consistent support when they were at risk.

The provider had invested in improving the maintenance and cleanliness of the property, and had dealt robustly with concerns regarding infection control. Staff supported people to take their medicines safely. The provider and manager reviewed mistakes in the administration of medicine and used this information positively to make improvements.

Care plans were not always person-centred. People’s support was not reviewed in a consistent manner. An additional member of staff had been recruited to improve the activities and stimulation provided to people at the service. There were more resources available to provide activities for people with dementia, however not all staff were offering these to people. The provider had implemented effective systems in place to investigate complaints, however they had not been well managed for a period in 2017. Care staff continued to communicate well with families.

Staff supported people when they were at risk of abuse and worked well with outside professionals to investigate concerns about people’s safety. There were enough safely recruited staff to meet people’s needs.

Staff were effective in meeting people’s needs. The manager and provider had made changes to provide more support to staff and to improve the training on offer. We made recommendations about improving training for people with dementia.

Staff worked well with outside professionals to meet people’s health care needs. People had enough to drink and eat in line with their preferences. Communication between the kitchen staff and the manager was improving. We made recommendations around increasing involvement and consultation with people when redecoration and improvements were planned to the property.

The manager met their responsibility under the Mental Capacity Act 2005 (MCA). Where people did not have capacity to make decisions, the manager consulted families and professionals to ensure decisions we