About the service: Willows Court is a residential care home providing personal care and accommodation for up to 29 younger and older people. There were 26 people using the service at the time of the inspection.

People’s experience of using this service:

• We found issues relating to the premises which posed significant risks of accidents and harm to people.

• We found issues relating to the cleanliness of the home and staff’s inconsistent use of personal protective equipment.

• The programme of improvement of the premises failed to consider the needs and safety of the people that used the service.

• People told us that they felt safe living at Willows Court.

• Staff were supported to manage risks in a way that did not restrict people’s freedom or choice.

• People’s needs were met by staff who had the training, skills and experience required to meet their needs.

• People were supported to have timely access to health care services.

• Staff were kind and compassionate to people that used the service.

• People were supported to be involved in the decisions about their care. The registered manager dealt satisfactorily with any concerns that they may have.

• The service did not meet characteristics of Good in most areas; more information is in the full report.

Rating at last inspection: Requires improvement, published 13 March 2018

Why we inspected: Planned inspection based on previous rating.

At our last inspection, we found issues which showed that the provider was in breach of Regulation 11, 15 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection, we found that the provider had made some improvements. However, they we found issues which showed they remained in breach of Regulation 15 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, Premises and equipment. More information is in the full report.

Enforcement: Action we told provider to take (refer to end of full report)

Follow up: Ongoing monitoring; we will continue to monitor this service and respond accordingly. We plan to inspect in line with our re-inspection schedule for those services rated Requires Improvement.

We inspected Willows Court on 30 January 2018. The visit was unannounced. This meant the staff and the provider did not know we would be visiting.

Willows Court provides accommodation and support for up to 29 younger and older people. The service specialises in caring for people with dementia, learning disabilities and/or physical disabilities. The home comprises of 15 single bedrooms, 14 of which have en-suite facilities and seven double bedrooms with en-suite facilities for people who prefer to share. There is an enclosed garden for people to use. On the day of our inspection there were 25 people living at the service. At the last inspection in December 2015, the service was rated Good. At this inspection we found the service Required Improvement.

The service had a 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.

We found concerns with regard to the environment in which people’s care and support was provided and with some of the equipment used. We noted windows in some of the upstairs rooms and corridor did not have functional window restrictors and a trip hazard was noted at the entrance of the conservatory. Not all areas of the service were clean and hygienic. This included communal areas, bathrooms and toilets. Some of the equipment used including wheelchairs and the stair lift were soiled and stained.

People using the service told us they felt safe living at Willows Court. Relatives and friends we spoke with agreed they were safe living there.

The staff team were aware of their responsibilities for keeping people safe from avoidable harm and knew to report any concerns to the management team.

Risks associated with people's care and support had been assessed to enable the staff team to provide the safest possible support. Where risks had been identified these had, wherever possible, been minimised to better protect people's health and welfare.

Appropriate pre-employment checks had been carried out on new members of staff to make sure they were safe and suitable to work there. Suitable numbers of staff were deployed in order to meet people’s needs.

New staff members had received an induction into the service and ongoing training was being delivered. This enabled the staff team to gain the skills and knowledge they needed to meet people's needs. The staff team felt supported by the registered manager and were provided with the opportunity to share their views of the service through, supervision, appraisals and team meetings.

People were supported with their medicines in a safe way. Though, ointments prescribed by people’s doctor’s had not always been dated when opened to make sure it was not used longer than the manufacturer’s guidelines.

The staff team had received training in the prevention and control of infection and the necessary protective personal equipment was available.

The registered manager had assessed people’s care and support needs prior to them moving into the service to make sure they could be met by the staff team.

The staff team supported people to make decisions about their day to day care and support. They were aware of the Mental Capacity Act (MCA) 2005 and Liberty Protection Safeguards (LPS) ensuring people's human rights were protected.

Where people lacked the capacity to make their own decisions, documentation to show decisions had been made for them in their best interest was not always completed. Where people required additional support to make decisions, advocacy support was available to them.

People's food and drink requirements had been assessed and a balanced diet was being provided. Records kept for people assessed as being at risk of not getting the food and drinks the

We inspected the service on 27 November and 1 December 2015; the first visit was unannounced.

The service was previously inspected on 1 May 2014 where we asked the provider to take action to make improvements. We asked them to make changes to the environment and premises to make them safe and suitable for people living at the service. We found that the home had made some of the required improvements but there were still some risks to people using the service.

Willows Court is a residential home offering accommodation for up to 29 people. The service supports older people, people with a learning disability, people with dementia, younger adults and people with mental health difficulties. At the time of our inspection, 25 people were living at the service. Accommodation is on two floors with lifts for people to access the property. All bedrooms had en-suite facilities and there are communal areas for people to use and socialise with others.

It is a condition of registration that the home has a 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. At the time of our inspection there was a new manager in place who was applying to be registered with CQC.

People’s safety was being monitored and staff understood their responsibilities in relation to safeguarding and abuse.

Risks to people using the service had largely been considered. However, some equipment was not adequate to protect people from harm and medicines were not always stored correctly.

The home was being upgraded and people and visitors spoke positively about this. Health and safety at the service was being audited and the correct checks were in place.

There were robust recruitment processes in place and there were enough staff to meet the needs of people.

People received their medicines as prescribed by their doctor and the administration of this was completed safely by staff.

Staff received training and support to enable them to care for people effectively. Staff knew how and why to offer choices to people. The service was effective in undertaking mental capacity assessments and staff understood their responsibilities in relation to choice and control.

People’s nutritional needs were being met and mealtimes were relaxed. Where people required additional support this was available. Access to healthcare services were available and people had the right support to stay healthy.

People’s needs were being met by staff who cared and showed respect and dignity.

Where possible, people were involved in the planning of their care and decisions. Where this was not possible, relatives had been asked for information. People had care plans that focused on their needs and support they required.

There were opportunities for people to undertake activities that were important to them.

There were ways for people, staff and visitors to offer feedback to the service. When this was received, information was acted upon. The management of the home was open and were able to make suggestions to improve the service.

The manager knew their responsibilities and was carrying these out.

The service carried out audits to make sure the care offered was to a high quality.

We set out to answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people using the service, their relatives, the staff supporting them and looking at records.

If you wish to see the evidence supporting our summary please read the full report.

We spoke with 10 people who lived in the home. They all told us that staff were very friendly and always helped them.

We spoke with two relatives who stated they had been satisfied with the service.

We observed life in the home to see if people were treated properly and their needs were met. We found that staff were friendly, helpful and caring.

This was largely a positive mixed inspection. People living in the home we spoke with told us said that the care that staff supplied was very good. We observed a number of positive staff practices. However, we also found that the premises had not been maintained to create a homely environment and to always keep people safe.

There were a number of suggestions made to us during the inspection by people and staff: to have proper staff cover at all times, and to have attractive decor throughout the home. The manager later sent us information stating that staff cover would be increased and the directors had approved plans to improve the decor.

Is the service safe?

People told us they felt safe. Two relatives we spoke with also said they thought their relatives were safe in the service.

The service was clean, however lighting levels in some areas were dim. This meant that people may not be protected from the risk of accidents. Fire systems had not been fully evidenced as being serviced .There was therefore a greater chance of risks to peoples’ safety.

We looked at the recruitment of new staff. This showed that required recruitment checks to protect people from unsuitable staff were being followed.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to providing a homely and safe environment.

Is the service effective?

People or their families had not always been involved in writing their care plans. Some people told us that they were not aware of what was in their care plans.

Specialist dietary needs had been included within care plans and care staff told us that they had read these. Care plans were therefore able to support staff consistently to meet people’s needs.

People’s mobility and other needs were taken into account in relation to building adaptation, enabling people to move around freely.

Relatives we spoke with confirmed that they were able to see people in private and that visiting times were flexible. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to people’s needs and involving people in planning their care.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. People commented, “Staff are always gentle when they help me.” A relative told us; “staff are really nice and always welcome you when you visit.”

People’s preferences, interests, and needs had been recorded. Because of this there was a greater chance that care and support could be provided in accordance with people’s wishes.

Is the service responsive?

Records showed that people's preferences, interests and needs had been included in care plans. This meant that the service was informed about people’s needs.

There was no evidence that people using the service and relatives were involved in the completion of an annual satisfaction survey. However, staff and relevant professionals were provided with this opportunity. People were therefore at some risk of not having their concerns and needs properly taken into account.

We found that the manager was in the process of promoting more dementia friendly facilities with regard to providing appropriate activities and the design and layout of the premises, taking account of expert bodies such as the Alzheimer’s society.

Is the service well-led?

Staff said that if they witnessed poor practice they would report their concerns.

The service had a quality assurance system to assess and monitor the quality of service provision. However, the system did not fully ensure that staff were able to provide feedback to their managers, so their knowledge and experience was not being properly taken into account.

There was evidence that the service worked in partnership with key organisations, including specialist medical personnel to support care provision and service development.

We have asked the provider to tell us what they are going to do to strengthen quality assurance systems.

We spoke with six people who used the service. One person told us, "I like it here. The staff look after me. They help me with everything I need." That comment was representative of what other people told us. People thought highly of the staff. One person told us, I like the cheerful atmosphere. The staff are always willing to help." Another person told us, "The manager and staff ask me for my opinion." People knew about the activities that were available to them and chose whether to participate. A person told us, "I know about the activities. I move from room to room because they are all different." People told us they had a choice of meals that they enjoyed.

What people told us was confirmed by what we saw and the documents we reviewed. People were involved in decisions about their care and had been treated with respect. People's care plans were person centred and people's needs had been assessed, planned and delivered.

The home was undergoing refurbishment that was expected to be completed by 31 December 2013.

The provider had not surveyed people or their representatives for their views about their experience of living at the home. That meant that an opportunity had been missed to find out what improvements people wanted to see.

The provider was registered to provide regulated activity treatment of disease, disorder or injury but did not in fact carry out that activity. The provider may wish to remove that activity from their registration.

We spoke with four people who used the service and a relative of a person who used the service. A relative told us that they had been involved in reviews of their mother's care plan and that the home had kept them informed about her mother's care. That relative told us that the home had organised many activities for people who lived at the home. They added that, "The care is good, my mother is safe at the home. I know that I could raise any concerns with the manager." People who used the service had a positive experience of the home. All of the people we spoke with were complimentary about the food the home provided. One person told us, "It's a marvellous home. I like everything about it. I'm kept active and there is enough for me to do. The carers look after me properly. They're polite." Another person described the care as "extremely good" and added, "I wouldn't want to be anywhere else." Another person told us, "The staff are excellent. You couldn't wish for better people." People told us that they felt that enough staff were always on duty.

We found that people had been involved in their care plans. The home had offered people a variety of meaningful activities that kept people active in the home and in the community. The registered manager had ensured that staff had received appropriate training and had regularly monitored the quality of care provided to people. The home was meeting the standards that we inspected.

People using this service told us that they were happy living at the home. The service users we spoke to were very complimentary about the staff who worked at the home. Service users told us that they enjoyed the facilities that were available to them.