The Willows Care Home

The Willows Care Home accommodates up to 130 people across 3 floors, including a separate unit called Lavender Unit, which is based on the same site. At the time of our inspection 114 people were using the service.

People’s experience of using this service and what we found

The manager promoted a positive person-centred culture. We received positive feedback from people using the service that demonstrated staff treated them with kindness and compassion.

Systems and processes were in place to support people's safety. People's needs, including their safety in relation to care were assessed and monitored. Timely referrals were made to health care professionals when required to promote people's safety and well-being.

Protocols and procedures were in place to ensure medicines were safely managed and administered by staff that received medicines administration training and had their competency to administer medicines assessed.

People were supported by staff that had full recruitment checks. There was sufficient staff deployed throughout the service to meet people’s needs.

Staff worked consistently within the providers policy and procedure for infection prevention and control and followed current government guidance related to COVID-19.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Quality monitoring was undertaken on all aspects of the service and kept under review to continually drive improvement. Opportunities were available for people and family members to share their views. Feedback received from people using the service, relatives and staff was used to drive improvement at the service.

Rating at last inspection

The last rating for the service was Good, published on 18 June 2019.

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

Why we inspected

We received concerns in relation to staffing. As a result, we undertook a focused inspection to review the key questions of Safe and Well-Led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. We found no evidence during this inspection that people were at risk of harm from this concern and the overall rating remains Good.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Willows Care Home on our website at www.cqc.org.uk

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

People’s experience of using this service and what we found

¿ Safe arrangements were in place for professionals visiting the service. This included a confirmed negative lateral flow test, vaccination against COVID-19, requirement to show a COVID-19 pass, hand sanitisation and wearing personal protective equipment (PPE).

¿ There were plentiful supplies of personal protective equipment (PPE) throughout the designated setting which included gloves, masks and aprons for people if required.

¿ There were PPE stations located around the setting and outside bedrooms where people would isolate.

¿ Staff participated in a daily and weekly testing regime prior to commencing work.

¿ There was a dedicated staff group who would only work in the designated setting for the duration it remained open.

¿ Staff had a designated area to change their clothes before, and on completion of, their shift.

¿ Isolation, co-horting and zoning were used to manage any potential spread of infection. This meant people were admitted knowing they were required to isolate in their bedroom throughout their stay.

¿ We saw various cleaning and disinfection records which included regular high touch point cleaning to ensure the potential for cross infection was reduced.

¿ Policies, procedures and risk assessments related to COVID-19 were up to date which supported staff to keep people safe.

¿ All staff had completed training in relation to infection control, and recently received training about the correct use of PPE including putting on and taking off safely. There were further training refreshers planned to ensure staff knowledge was kept up to date. Spot checks were planned to ensure staff adhered to the training provided.

People’s experience of using this service.

People received safe care. Staff understood safeguarding procedures.

Risk assessments were in place to manage risks within people’s lives.

Staff recruitment procedures ensured that appropriate pre-employment checks were carried out.

Medicines were stored and administered safely.

Staffing support matched the level of assessed needs within the service during our inspection, however, some people felt that staffing levels could be improved upon to enable more person centred care.

Staff were trained to support people effectively.

Staff were supervised well and felt confident in their roles.

People were supported to have a varied diet, and food and fluid intake was monitored as required.

Healthcare needs were met, and people had access to health professionals as required.

People's consent was gained before any care was provided, and they were supported to have maximum choice and control of their lives.

Staff treated people with kindness, dignity and respect and spent time getting to know them.

People were supported in the least restrictive way possible.

Care plans reflected people likes dislikes and preferences.

A range of activities was on offer. Some people felt that staff did not always have the time to engage them in conversation or with activities.

People and their family were involved in their own care planning as much as was possible.

A complaints system was in place and was used effectively.

The manager was open and honest, and worked in partnership with outside agencies to improve people’s support when required

Audits of the service were detailed and any issues found were addressed promptly.

The service had a registered manager in place, and staff felt well supported by them.

Rating at last inspection: Good (report published 11/05/2017)

Why we inspected: This was a planned inspection based on the rating at the last inspection. The service remained rated Good overall.

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.

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

At the last inspection, the service was rated Good.

At this inspection we found the service remained Good.

People using the service felt safe. Staff had received training to enable them to recognise signs and symptoms of abuse and felt confident in how to report them.

People had risk assessments in place to support them to be as independent as they could be in a safe manner. Staff knew how to manage risks to promote people’s safety, and balanced these against people’s rights to take risks and remain independent.

There were sufficient staff, with the correct skill mix, on duty to support people with their needs. Effective recruitment processes were in place and followed by the service. Staff were not offered employment until satisfactory checks had been completed. Staff received an induction process and on-going training. They had attended a variety of training to ensure they were able to provide care based on current practice when supporting people. They were supported with regular supervisions.

Medicines were managed safely. The processes in place ensured that the administration and handling of medicines was suitable for the people who used the service.

People were supported to make decisions about all aspects of their life; this was underpinned by the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. Staff were knowledgeable of this guidance and correct processes were in place to protect people. Staff gained consent before supporting people.

People were enabled 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 able to make choices about the food and drink they had, and staff gave support when required to enable people to access a balanced diet. Drinks and snacks were available throughout the day.

People were supported to access a variety of health professional when required, including opticians and doctors, to make sure they received continuing healthcare to meet their needs.

Staff provided care and support in a caring and meaningful way. They knew the people who used the service well. People and relatives, where appropriate, were involved in the planning of their care and support.

People’s privacy and dignity was maintained at all times.

People were supported to follow their interests and join in activities.

People knew how to complain. There was a complaints procedure in place which was accessible to all. Complaints had been responded to appropriately.

Quality monitoring systems were in place. A variety of audits were carried out and used to drive improvement.

Further information is in the detailed findings below

Since our inspection in September 2013 a new manager had been appointed. The manager informed us they were in the process of submitting their 'registered manager' application to register with the Care Quality Commission.

We looked at the care records for 11 people residing on the dementia unit. We also spent time directly observing the care people received. We spoke with four people using the service and one relative. All the people we spoke with confirmed the staff were, caring, 'friendly', 'helpful' and 'welcoming'. We observed that people were treated with respect and dignity and their individuality was upheld.

We used a number of different methods to help us understand the experiences of people using the dementia care service, because the people using the service had complex needs which meant they were not able to tell us their experiences. We spoke to the relatives of five people, who told us that they were unhappy with the care their relative received. One person told us 'there are not enough staff to look after everyone', another person told us 'does not receive all the personal care on the days that I do not visit'. Two families sighted examples when they had recently visited and had to ask the staff to call the doctor as their relative needed medical attention.

We found that the residential and nursing floors were well managed and people received care that met their needs.

We found concerns about the dementia care service at Willows Care Centre as there were not sufficient staff to observe and assist people. We also found there were inaccurate risk assessments, poor record keeping practices, poor nutrition and staff not always recognising when people were becoming unwell.

We observed the care for people who were unable to communicate verbally; we saw that they were cared for with consideration and where possible other non-verbal methods of communication were used effectively. We found that the staff were kind and were understanding of people's frailty.

We found that care plans reflected the needs of people who used the service and the staff delivered people's care in accordance with their care plans.