The Willows

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• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Care was not person-centred, and people's needs and preferences were not always met. People did not have up to date care plans that set out their preferences about their care and what was important to them. People didn’t always have access to activities and opportunities to engage in their hobbies and interests.

This service scored 54 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We received mixed views about if staff were responsive to people’s needs. One person raised concerns about the use of agency staff and newly employed staff who didn’t always know how they liked to be supported and cared for. A relative told us, “Some staff are very good and give their all,” but they also told us some staff did not appear to know what they were doing. Another relative told us, “They are meant to bath or shower [family member]. [Their] hair was looking greasy. [Family member] always liked to look good. I wasn’t sure if I or they were meant to be washing it. I’ve booked [family member] into the hairdresser every two weeks now.” Another relative said, “I complained as one carer refused to [support with personal preference of clothing].” Some people told us they were bored and had no one to talk with. We saw people in their bedrooms and communal areas receiving no engagement or social interactions. One person told us, “They try to coax me out of the room I go down (to activities on the ground floor) sometimes we go out, I decided not to sit and rot.” Another person told us the activities staff member took arts and crafts items to their bedroom for them to do, which they liked. Whilst some relatives told us they would recommend the service to others, we were made aware by 3 relatives, they were working with the commissioners to find an alternative placement.

The management team had failed to independently recognise that people were not receiving their personal care needs as required. We asked the registered manager if they reviewed people’s daily notes to monitor where people had been provided with personal care support. They told us they did not. We were concerned that despite us and other professionals identifying people’s appearance showed they were not being supported with their personal care needs, the management team had not independently identified this and taken any action.

We expressed concerns to the registered manager and management team because we saw people whose appearance did not indicate their person-centred personal care and hygiene needs were being met. People were not always being supported with their personal care needs, including the provision of baths and showers and having their oral care needs met. We reviewed the daily notes of 5 people and, for example, for 1 person their records from 6 to 21 March 2024 showed they had 1 bath and 1 shower and no support with oral care. Another person’s records from 7 to 21 March 2024 showed they had not been supported with a bath or shower and had support with their oral care twice. Another person from 7 to 21 March 2024 had no bath, no shower and had support with their oral care twice, this was despite their care plan stating their oral health support level was high. People’s care plans were not up to date and did not reflect the care and support people required and contained inconsistencies and inaccuracies about their actual care and support needs. For example, a person’s care plan did not indicate the distressed behaviours they demonstrated, and which may be challenging to others, which was identified in their daily notes, the support they required was not included in their care plan. We arrived in a communal area at The Willows at 8:25am where there were 3 people, one wearing undergarment clothing and another asleep in a chair, there were no staff present, and no evidence of drinks or food available for people to access. There was a lack of activities and social opportunities for people to participate in. The management team told us there used to be 2 activities staff members however 1 had left employment, and they were actively recruiting to the vacant post. However, we found the provider had not addressed the shortfall, for example increasing the care staffing levels to fill the gap and to provide people with engagement activities and social interaction.

We did not look at Care provision, Integration and continuity during this assessment. The score for this quality statement is based on the previous rating for Responsive.

We did not look at Providing Information during this assessment. The score for this quality statement is based on the previous rating for Responsive.

We received mixed views about if concerns and complaints were acted on. A relative told us they had been reimbursed when their family member’s new outfit had been damaged when laundered, despite them asking staff not to wash their family member’s clothing. Another relative said, “I’ve complained about the stress it [people going into their bedroom] causes to [family member] at least three or four times but nothing changes.”

The management team told us they would act on any concerns and complaints received. However, the feedback that we received from people and their relatives and the records we viewed evidenced complaints were not consistently responded to.

There was a complaints procedure in place for the registered manager and staff team to work to and follow. We received a copy of the log of complaints and concerns received at The Willows; however, we had been told by people using the service and relatives about complaints/concerns they had already raised, and we found these were not on the log. Therefore, we were not assured all concerns and complaints were being recorded and resolved appropriately and used to aid learning. We also received feedback from relatives that they were not updated with actions taken when concerns were raised. This meant relatives could not be assured the service were taking appropriate action in response to their concerns.

We did not look at Equity in access during this assessment. The score for this quality statement is based on the previous rating for Responsive.

People’s views about the quality of service they were provided with varied, as did their views about if they felt listened to. We did not see any minutes from meetings with people using the service to enable them to discuss the care and support they received. A staff member told us the last ‘resident meeting’ had been held the latter part of 2023. Care records provided little or no information to show how people had been consulted about the carer they were provided with. We were concerned that there were gaps in staff training to ensure they were provided with guidance they required to meet people’s needs, including those with diverse needs, such as dementia. We observed that staff did not appear to be skilled in supporting people living with dementia when they may not always be able to express their views and preferences. This included not always communicating with people at eye level and asking people for their choices of meal in a way they understood.

The provider told us in the provider information return that documentation, such as the service user guide, could be provided in different formats, so they were accessible to people using the service. They also told us they had introduced learning disability and autism training, and a diversity and equality champion was in place. We found, however, that staff training was not up to date and new staff had not all undertaken training necessary for their job role.

We received concerns from social care professionals regarding the care and support provided to people using the service. This included the lack of person centred support and personal care.

We did not look at Planning for the future during this assessment. The score for this quality statement is based on the previous rating for Responsive.