The Willows

The Willows is a residential care home providing accommodation and personal care to up to 66 people. The service provides support to older people and people living with dementia. At the time of our inspection there were 49 people using the service. The service is one adapted building over three floors. At the time of our inspection, the second floor was not in use.

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

Since our last inspection, there was now a registered manager in post. The registered manager and management team had systems to continuously assess and monitor the service provided. Where shortfalls were identified, actions were taken to address them. The registered manager was committed to provide a good quality service to people and discussions with the registered manager and records showed lessons were learned and used to drive improvement when things went wrong.

There were systems in place which reduced the risks of abuse and avoidable harm. Medicines were managed safely and regular monitoring reduced risks to people. There were enough staff to meet people’s needs and staff were recruited safely. The service was visibly clean. People were supported to have visits from their family and friends.

We received positive feedback from visitors to the service. A visiting professional told us, “I am very impressed, all the bathrooms are nice and clean, staff are extortionately friendly, the atmosphere is smashing.” A relative said, “We have been surprised how good it is here, [staff] are confident in what they are doing, and we are happy [family member] is here, it feels like a community.”

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.

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

Rating at last inspection

The last rating for this service was good (published 24 September 2022).

The overall rating was good and rated good in all key questions, with the exception of well-led which was rated requires improvement, because management had been inconsistent and there was not a registered manager at the time of our inspection.

At our last inspection we recommended that the provider continued to keep the staffing levels under review and amend them, for example, when people’s needs change or increased support was needed and to ensure staff were appropriately deployed to reduce risks to people in shared areas. At this inspection we found the provider had acted on our recommendation and had made improvements.

Why we inspected

The inspection was prompted in part due to concerns received about the safety of care provided and medicines. A decision was made for us to inspect and examine those risks. In addition, we raised part of the concerns with the local authority safeguarding team, who are responsible for investigating abuse.

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. Please see the safe and well-led sections of this full report. The overall rating for the service has remained good based on the findings of this inspection. We also found the key question well-led had improved to good.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Willows 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.

The Willows is a residential care home providing care and support to up to 66 people. The service provides support to adults in one adapted building, over three floors. At the time of our inspection only the ground floor and first floor were being used and there were 46 people using the service, some of these people were living with dementia.

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

Since our last inspection, there had been changes in the management of the service, a new manager started working in the service three days before our visit. We were concerned that the changes in management might affect the consistency of the service provided. However, despite the lack of a consistent manager, we noted improvements had been made in the service. There was an action plan in place with the majority of improvements implemented and some being in progress, we were assured enough improvement had been made to reflect an overall rating improvement. The new manager and nominated individual told us about further improvements planned.

Since our last inspection improvements had been made in the staffing levels in the service, which were ongoing. Staff were recruited safely. There were systems in place to learn lessons when things had gone wrong and actions to reduce future incidents happening. Risks to people were assessed and measures were in place to mitigate them which reduced the risks of avoidable harm and abuse. People had access to their medicines when needed and monitoring systems supported swift identification of shortfalls and actions were taken to address them.

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. People were supported to access social and health professionals where needed and referrals were made to the appropriate professionals where there were concerns with people’s wellbeing. People were provided with the support they required with their dietary needs.

People were supported by staff who were caring and compassionate. People’s privacy, dignity and independence was promoted and respected. Some staff told us that their colleagues could improve their approach when supporting people. We told the management team about this and were assured this was being addressed.

People’s care records included assessments of their needs and guidance for staff in how their needs were to be met. This included people’s preferences relating to their end of life care. People received support to access activities which reduced boredom and isolation. There were ongoing improvements planned in this area. People’s comments and complaints were addressed and used to drive improvement.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 21 June 2021). We had found a breach in relation relating to staffing. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We undertook this comprehensive inspection because the provider had been rated requires improvement at the last two inspections. We checked the provider was making improvements and had implemented the actions they had identified in their improvement plan. We had also received a concern about the care provided. During this inspection we reviewed the risks. We found no evidence during this inspection that people were at risk of harm from this concern.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

The overall rating for the service has changed from requires improvement to good based on the findings of this inspection.

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

Recommendations

We have recommend the provider continues to keep the staffing levels under review and amend them, for example, when people’s needs change or increased support is needed and to ensure that staff are appropriately deployed to reduce risks to people in shared areas.

Follow up

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

The Willows is a residential care home providing personal care to 42 older people at the time of the first day of our inspection on 10 May 2021. Some of the people were living with dementia. The service can support up to 66 people in one adapted building. The service had three floors, at the time of our inspection only the ground floor and first floor were being used.

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

There were not enough staff working in the service at the time of our inspection to ensure people’s needs were met at all times, including their emotional and social needs. During our inspection staff were being recruited to replace the staff who no longer worked in the service.

There were insufficient domestic staff in the service to undertake cleaning, this is particularly important to ensure enhanced cleaning was undertaken throughout the pandemic. Whilst we found the service was generally clean, we found the hygiene standards in the kitchenette on the first floor needed improvement.

There had been some improvements in the systems to monitor and assess the service provided, such as falls analysis. However, the governance systems in place were not robust enough to identify the shortfalls we found during this inspection. There was inconsistent management in the service; over the four inspections of this service since registration, there had been a different manager each time. This had a destabilising effect on the staffing, morale and improvements being made and sustained.

The manager was in the process of making improvements following a recent staff survey. However, we were concerned that staff’s concerns relating to staffing levels had not been addressed.

We had received concerns relating to the lack of social interaction and activity provided to people. At the time of our inspection improvements were being made, but this was not yet fully implemented to ensure people received meaningful activity to reduce social isolation and boredom.

We identified positive caring and respectful interactions from staff and examples of good practice relating to improving people’s wellbeing. However, due to the staffing numbers we were not assured people were always receiving a caring service.

Systems in place reduced the risks of people not receiving their medicines safely and when they needed them. However, there had been a recent introduction of a new medicines system, for which staff had not received formal training.

Staff had been trained in keeping people safe from abuse. However, a recent incident had not been reported to the management and as a result to the appropriate professionals responsible for investigating safeguarding. Staff were recruited safely.

Staff wore personal protective equipment (PPE) during our inspection. The service was following guidance relating to visits, and testing during the pandemic.

Prior to moving into the service people’s needs were assessed. These were used to formulate care plans and risk assessments which guided staff how to meet people’s needs and mitigate risks, this included people’s end of life decisions. We found some shortfalls in the records maintained to show when people had received personal care.

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.

People were supported to maintain a healthy diet and where risks were identified actions were taken to reduce them. People had access to health care professionals where required.

There was a complaints procedure in place. People and their relatives were asked for their views of the service provided and these were being used to improve the service.

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

Rating at last inspection (and update)

At our last comprehensive inspection (published 21 February 2020) the rating for this service was inadequate and there were multiple breaches of regulation. The key questions Safe and Well-led were rated inadequate and the key questions Effective, Caring and Responsive were rated requires improvement. The provider completed an action plan after the last comprehensive inspection to show what they would do and by when to improve. The service had been in Special Measures since 21 February 2020.

We undertook a focused inspection (published 10 August 2020), we reviewed the key questions Safe and Well-led only. The ratings from the previous comprehensive inspection for those key questions not looked at were used in calculating the overall rating at this inspection. The overall rating for the service had changed from inadequate to requires improvement. We checked the provider had followed their action plan, to confirm they met legal requirements and we found the service was no longer in breach of regulations. The service was no longer rated as inadequate overall or in any of the key questions. Therefore, this service was no longer in Special Measures.

The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

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

Why we inspected

This was a planned comprehensive inspection based on the previous rating. The inspection was also prompted in part due to concerns received about staffing, staff morale, lack of social activity, safeguarding and leadership. A decision was made for us to inspect and examine those risks.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. Please see the safe, caring, responsive and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified a breach of regulation in relation to staffing at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The Willows is a residential care home providing personal care to up to 66 older people, in one adapted building. There were 31 people using the service during our inspection visit on 22 July 2020, some of these people were living with dementia.

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

Improvements had been made in the service since our last inspection, some not yet fully implemented and needed to be embedded in practice to ensure the improvements were sustained.

Since our last inspection, improvements had been made in the management of medicines, however, these were not yet fully implemented. Shortfalls were identified by the provider’s monitoring systems and actions were being taken to reduce risks to people.

Since our last inspection, improvements had been made in how the service assessed and mitigated risks to people, including in their daily living and their susceptibility to abuse. These needed to be sustained and embedded in practice.

Staffing levels continued to be assessed by the management team to help ensure people were provided with the care and support they needed. Since our last inspection, the service had introduced a shift allocation document to guide staff on their responsibilities during each day. Systems were in place to recruit staff safely.

The service was clean, and cleaning was undertaken regularly. Improvements were needed in how the staff wore their personal protective equipment, the management team assured us this would be addressed.

There were systems to learn lessons when things had gone wrong.

People’s care records had improved since our previous inspection, and there were now care plans and risk assessments in place which described the care people required and how risks were reduced. We found some discrepancies in the records, and these were addressed immediately.

The governance systems had improved since our last inspection. This needed to be embedded in practice to ensure the management team independently identified and addressed all shortfalls promptly.

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

Rating at last inspection and update:

We carried out an unannounced comprehensive inspection of this service on 13 and 14 January 2020 (published 21 February 2020). The rating for this service was inadequate overall. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve in safe care and treatment, safeguarding, staffing, governance and person centred care.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations. However, the improvements needed to be sustained and embedded in practice and some were not yet fully implemented.

This service has been in Special Measures since 21 February 2020. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

When services are in special measures and rated inadequate we plan to re-inspect these services within 6 months of the publication date. However, we are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what regulatory action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We undertook this focused inspection to check the provider had followed their action plan and to confirm they now met legal requirements. The inspection was also prompted in part due to concerns received from the local authority regarding the care provided to people. A decision was made for us to undertake a focussed inspection of the key questions Safe and Well-led and examine those risks and check improvements had been made following our last inspection. This report only covers our findings in relation to the key questions Safe and Well-led.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from inadequate to requires improvement. This is based on the findings at this inspection.

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

Follow up

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

The Willows is a residential care home providing personal care for up to 66 older people. At the time of our inspection there were 52 people using the service, the majority were living with dementia. The service has three floors and people were living on each of these floors.

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

Since our last inspection there had been a significant deterioration in the quality of care provided to people. This had not been promptly identified by the governance systems in place and improvements implemented, which resulted in people receiving unsafe care. We have identified a breach of regulation in this area. The operations manager and the director were open with us about the failings in the service and were committed to making improvements. The local authority were so concerned about the service, they had replaced the provider’s voluntary agreement on not admitting new people to the service with their own suspension due to concerns of quality and safeguarding.

People were not being provided with a safe service. This included, people were not being protected from abuse, current risks were not promptly assessed and mitigated, and medicines were not being managed safely. We have identified breaches of regulation in relation to safeguarding people from abuse, safe care and treatment and staffing. There were shortfalls in staffing levels, which had been addressed by the provider following the first of our inspection visits. They had increased the staffing levels by 50%.

Staff were provided with training to meet people’s needs. However, this training was not always effective because staff were not skilled and competent to meet people’s specific needs relating to people’s behaviours which may be challenging. We have identified a breach of regulation relating to staff training and competence. People’s health and dietary needs were assessed; however, care records did not always reflect people’s current needs and they were not always being provided with health care treatment in a timely way. People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests.

The quality of interactions between staff and people varied. Whilst we observed some caring interactions, we also observed some which were not so caring. People’s rights to privacy were not always being respected.

Improvements were needed in how people’s care needs were assessed, planned for and met. The operations manager was in the process of reviewing and updating people’s care records. However, this was not yet fully implemented to ensure people received the person centred care they required to meet their needs. There was a varied programme of activities people could participate in. However, there was limited provision for people who chose not to participate in group activities. We have identified a breach of regulation relating to the provision of person centred care. There was a complaints procedure in place. We had received concerns prior to our inspection these were not always being acted on. The operations manager was making improvements in this area.

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

Rating at last inspection

The last rating for this service was good (published 21 November 2018).

Why we inspected

The inspection was prompted in part due to concerns received about the management of medicines, people’s safety and the care they were provided with. A decision was made for us to inspect and examine those risks. We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, responsive and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

The provider has taken action to mitigate the risks, this includes increasing staffing levels and planning training for staff. In addition, the local authority are working with the service to encourage improvement. The overall rating for the service has changed from good to inadequate. This is based on the findings at this inspection.

Enforcement

We have identified breaches in relation to safe care and treatment including medicines management, safeguarding people from abuse, person centred care, staffing including training and support provided to staff and how the service is managed at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures:

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

On the day of our comprehensive unannounced inspection on 24 October 2018, there were 33 people living in the service. The Willows was registered with the Care Quality Commission in November 2017, this was their first inspection.

There was a registered manager in place. The registered manager was working as the operations manager. There was a new manager in place, their registered manager application was being processed. 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.

People received a safe service. The risks to people were assessed and staff were guided how to reduce these risks. Staff were trained in safeguarding people from abuse and where incidents had happened the service learned from these to drive improvement. There were systems in place to assess the numbers of staff required to meet the needs of the people using the service. Staff recruitment processes reduced the risks of staff being employed in the service who were not suitable. There were systems in place to manage people’s medicines safely. Good infection control practices were in place to reduce the risk of cross contamination.

People received an effective service. People were supported by staff who were trained and supported to meet their needs. People had access to health care professionals when needed. Staff worked with other professionals involved in people’s care. People’s nutritional needs were assessed and met. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The environment was well maintained and suitable for the people using the service.

People received a caring service. People shared positive relationships with staff and their privacy, independence and dignity was respected. People were listened to in relation to their choices, and they and their relatives, where appropriate, were involved in their care planning.

People received a responsive service. People’s individual needs were assessed, planned for and met. People had access to social activities to reduce the risks of isolation and boredom. People’s choices were documented about how they wanted to be cared for at the end of their life. There was a complaints procedure in place and people’s complaints were addressed.

The service was well-led. There was a programme of audits in place which demonstrated that they assessed and monitored the service provided. Where shortfalls were identified actions were taken to improve. People were asked for their views about the service and these were valued and listened to. As a result, the service continued to improve.