Willowthorpe 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 inspection took place on 28 and 29 November 2018 and was unannounced. At our last inspection on 16 August 2017, the service was found not to be meeting all the required standards we looked at.

At this inspection we found that the provider had made the improvements required.

There was a manager in post who had registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the 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 and associated Regulations about how the service is run.

The service was safe. Recruitment practices ensured that suitable staff were employed. Staff received training in safeguarding and understood how to report concerns. Staffing levels were reviewed regularly to ensure people’s needs were met. Accidents and incidents were monitored to identify any trends or patterns to ensure appropriate actions could be taken. Medicines were managed safely by staff that received appropriate training. People were protected from the risk of infections by staff who followed correct infection control procedures.

The service was effective. Staff worked in line with the principles of the Mental Capacity Act. People’s nutritional needs were managed appropriately. Staff received appropriate training to meet people’s needs effectively. Staff received inductions and supervisions and felt supported to do their job. However, supervisions were still not where the registered manager wanted them and required improving. People could access other health services when needed.

The service was caring. Staff respected people’s privacy and dignity and supported people to maintain relationships. Staff knew people well and cared for them in a compassionate way. Support delivered by staff was supportive, kind and caring. People were involved in deciding how their care was provided and staff promoted their choice.

The service was responsive. People`s needs were assessed to ensure they received person-centred care and the support they required. People were involved with their care plan reviews. People were given the opportunity to think about what was important to them regarding end of life care. People knew how to raise concerns if required.

The service was not consistently well-led. Care records still needed further improvements. One person’s requirements when being supported with a hoist were contradictive and the audit trail to show why the changes were in place had not been documented appropriately. The registered manager was clear about their vision regarding the purpose of the home. Staff understood their roles and responsibilities and worked well as a team. Staff felt they could approach the management team at any time. There were effective systems to monitor the quality of the service, identified issues were actioned and lessons learned. People, relatives and staff were positive about how the home was run.

Further information is in the detailed findings below.

Willowthorpe is registered to provide residential accommodation and personal care for up 56 older people some of whom are living with dementia. At the time of our inspection 55 people were living at Willowthorpe.

We last carried out an inspection of Willowthorpe on 30 September 2016. This was a focused inspection and looked at the effective and well led domain and was rated as good. This inspection took place on 16 August 2017 and was unannounced. At this inspection we found improvements were required in relation to deployment of staff, completion of care records and overall governance of the service.

Willowthorpe had a registered manager in post. 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.

People told us they felt safe living at Willowthorpe. Staff were able to tell us how they kept people safe and how they positively managed risks to people's safety and well-being. There were not always sufficient numbers of staff deployed to support people; however the atmosphere in the home was calm and relaxed throughout our inspection. Staff were recruited following a robust recruitment process that ensured they were suitable to work with vulnerable adults. There were suitable arrangements for the safe management of people's medicines and people received their medicines as the prescriber intended.

Staff were supported to develop the required skills and knowledge to provide care effectively to people. Staff received regular support from management which helped them to feel supported and valued and they told us they felt able to seek assistance when they needed to. People’s permission was sought before staff assisted them with care and where people lacked capacity to make certain decisions themselves, the registered manager had completed the required assessments. People received appropriate support and encouragement to eat and drink sufficient quantities independently however records relating to nutritional needs and weight were not updated consistently. People had access to a range of healthcare professionals who they were referred to quickly when their needs changed.

People's privacy and dignity was promoted and they told us they were treated with kindness and compassion by staff who listened to them. Staff spoken with knew people's individual needs and were able to describe how to provide care to people that matched their current needs.

People were supported to lead active lives and pursue activities that were important to them. People told us they felt confident to raise anything that concerned them with staff or management. People’s relatives were able to visit freely at any time of day or night to maintain those relationships.

Peoples care records were not always regularly updated to provide a comprehensive account of their changing needs and care. However, all staff spoken with were aware about current care needs and how to provide support to people. Governance systems did not consistently and robustly identify areas of improvement although arrangements were in place to obtain feedback from people who used the service, their relatives and staff members about the services provided.

This inspection was carried out on 30 September 2016 and was unannounced. At the last inspection on 30 March 2016, the service was found to not be meeting all the standards we inspected. This was in relation to matters relating to consent; meeting people’s nutritional needs and ensuring accurate records were maintained. The provider sent us an action plan stating how they would make the necessary improvements. At this inspection we found that they had made the required improvements to meet the regulations.

This focused inspection took place on the 30 September 2016and was unannounced. At this inspection we reviewed whether the service provided effective care and whether it was well led. This report only covers our findings in relation to these areas. You can read the report from our comprehensive inspection carried out 30 March 2016 by selecting the ‘all reports’ link for Willowthorpe Care Home on our website at www.cqc.org.uk.

Willowthorpe provides accommodation and personal care for up to 56 older people some of who live with dementia. At the time of the inspection 52 people were living in the home.

The service had a manager who was registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the 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 and associated Regulations about how the service is run.

People were supported in accordance with the Mental Capacity Act 2005 and their consent sought before care was offered. Independent advocacy services were available when people needed these services. People`s nutritional needs were met and where people were at risk of poor nutrition or hydration, their needs were regularly reviewed and managed appropriately. Staff supported people with nutrition and hydration in accordance with their individual needs. People had access to health and social care professionals regularly.

The registered manager was knowledgeable and worked well with the staff team. There were systems in place to monitor the quality of the service. The registered manager sent us statutory notifications appropriately. People’s personal care records were accurately maintained and reviewed as and when their needs changed.

Willowthorpe is registered to provide residential accommodation and personal care for up 56 older people some of whom are living with dementia. At the time of our inspection 52 people were living at Willowthorpe.

The inspection took place on 05 and 10 February 2016 and was unannounced.

Willowthorpe had a registered manager in post. 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.

People told us they felt safe living at Willowthorpe. Staff were able to tell us how to keep people safe and how they positively managed risks to people’s safety and well-being. There were sufficient numbers of staff deployed to support people, and the home was calm and relaxed throughout our inspection. Staff were recruited following a robust vetting process that ensured they were suitable to work with vulnerable adults. There were suitable arrangements for the safe administration of people’s medicines; however people’s medicines were not always managed safely and records were not consistently completed.

People were asked for their permission before staff assisted them with care or support. Staff were supported to develop the required skills and knowledge to provide care effectively to people. Staff received regular support from management which helped them to feel supported and valued and they told us they felt able to seek assistance when they needed to. Where people lacked capacity to make certain decisions the manager had not completed the required assessments accurately. People received appropriate support and encouragement to eat and drink sufficient quantities however people’s nutritional needs were not regularly assessed and monitored effectively. People had access to a range of healthcare professionals when they needed them.

People’s privacy and dignity was promoted they told us they were treated with kindness and compassion by staff who listened to them. Staff spoken with knew people’s individual needs and were able to describe how to provide care to people that matched their current needs. People were able to freely visit family and were supported to engage in a wide range of activities and follow their own interests.

People and staff told us the culture in the home was open and inclusive. People’s care records were not always regularly updated to provide a comprehensive account of their changing needs and care. However, all staff spoken with were aware about current care needs and how to provide support to people. Arrangements were in place to obtain feedback from people who used the service, their relatives, and staff members about the services provided. People told us they felt confident to raise anything that concerned them with staff or management.

We inspected Willowthorpe because we had received concerns that there were insufficient numbers of staff available to meet people’s needs, and keep people safe at night.

We carried out an inspection during the evening of 03 March 2014 and found that there was sufficient numbers of staff to meet the needs of people at night and keep them safe.

During our inspection on 09 October 2013 we spoke with six people who used the service, two people’s relatives, four members of staff and a visiting health professional.

People understood the care, treatment and support choices available to them and felt they were treated with dignity. One person told us, “They look to privacy being very important. I have never felt exposed in any way.”

People felt the provider acted in accordance with their wishes and sought their consent before providing support. Where people lacked capacity to make decisions, the home acted in accordance with legal requirements. One person who used the service told us, "They [staff] explain everything to me and ask me before they help me, so I have no concerns.”

We found that people’s needs were individually assessed and care and support was delivered in a planned manner. People felt involved with their care and were complimentary about the home and service they received. One person told us, “I liken this place to a four star hotel, but they also care about us here. We have everything that we could possibly need.”

People’s health, safety and welfare was protected when more than one provider was involved in their care and treatment, and when they moved between different services.

People who used the service told us they felt there were sufficient numbers of staff available to support them. One person told us, “When I pull my call bell the staff quite literally come running. It is rare that I ever have to wait.”

People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. One person we spoke with told us, "The staff are always training in one area or another, but it’s good they take it so seriously as it makes us feel safe."

We spoke with eight people who told us that they were respected and treated with dignity. One person explained: “Staff are excellent. There is no wait when we call them. They are always gentle and kind.” Another person stated that, “Staff know their job, they are well trained and always kind.”

A person depending on two staff to help them walk stated: “They always come when I call them and tell them that I want to go for a walk.”

We checked four care plans and saw that people’s consent to care was sought from them or their relatives.

We checked medication processes and saw that all guidance and procedures were followed and that people were protected.

We saw that staff worked in an organised and effective way and that they had enough time to stop and chat to people which was much appreciated by all the people we saw.

Complaints were treated appropriately, investigated and used to improve the service and care for people.

The people we spoke with during our visit to Willowthorpe Care Home on 13 January 2012, told us that they were happy with the care and support they received. They also said that their privacy and dignity were respected, they and their relatives had been involved in deciding how their care and support should be provided and felt that their needs were met by a caring and competent staff team.