Willow Green Care Home

Willow Green Care Home provides personal and nursing care for up to 63 younger and older adults living with a range of health conditions including dementia. At the time of inspection 53 people were using the service.

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

Care plans and risk assessments were person centred and reflective of people's current needs. Medicines were stored safely and were managed well. Quality audits clearly identified areas for improvement and ensured that people were safe and involved in their care and support. The culture of the service had significantly improved and feedback from staff, people and professionals echoed this.

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.

There were enough staff. Staff were recruited safely and received an induction to ensure they had the skills and knowledge to undertake their role. The staff team told us they were well supported and that they delivered person-centred care. We observed all the staff team working together well and interacting positively with everyone at the service.

Systems were in place to protect people from abuse. Staff demonstrated a good level of understanding in relation to safeguarding. Appropriate referrals to the local safeguarding team had been made. People and staff spoke positively about the registered manager and felt able to raise concerns and were confident that these would be addressed.

There were systems in place for communicating with people, their relatives, and staff to collect their views and feedback regarding people’s care and support.

Rating at last inspection and update

The last rating for this service was requires improvement (published 16 September 2022). 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.

At our last inspection we recommended that the provider made improvements in relation to assessing mental capacity. At this inspection we found the provider had made improvements.

Why we inspected

We carried out an unannounced inspection of this service in June 2022. 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 safe care and treatment, staffing, dignity and respect and governance arrangements.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions safe, effective, responsive and well-led which contain those requirements.

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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good. 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 Willow Green 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.

Willow Green Care Home provides personal and nursing care for up to 63 younger and older adults living with a range of conditions including dementia. At the time of inspection 54 people were using the service.

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

Auditing and oversight of the service were not robust. We found issues that the provider's systems had either not identified or not corrected. The provider did not meet all regulatory requirements. The management team had planned a range of improvements, but these did not address all the immediate concerns we found.

People did not always have their medicines as prescribed or at the correct times. Systems to manage and audit medicines were ineffective and did not identify all the issues found at inspection.

Record keeping was inconsistent. Support plans and risk assessments did not always give staff clear guidance about potential risks and some plans lacked essential details. The provider had not taken enough action to reduce potential fire and safety risks. Staff were responding to safeguarding concerns where these were identified but the outcomes were not always recorded. Staff were not all trained to recognise and report abuse. In some instances where concerns were identified, lessons were learnt and shared with staff. However, this was not done routinely for all incidents or accidents.

There were not enough trained, skilled and appropriately supervised staff on duty to provide person centred care. We received feedback that people sometimes had to wait for care or there were only enough staff on duty to provide care to meet people’s physical care needs. Staff rarely had time to spend with people on a one to one basis or engage in social activities of people’s choice. Most people and relatives gave positive feedback about the staff who supported them and told us they were caring and worked hard to compensate for the shortage of staff.

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. However, records did not always reflect discussions and decisions around this. We have recommended that the provider reviews how people’s capacity and consent are recorded.

There were limited systems for collecting feedback about the quality of the service and this was not always evaluated or used to drive improvements.

Management were reviewing practices in the service and had strengthened the management structure. The provider followed safe recruitment processes and had recruited staff recently to improve the level of permanent staff working in the home and reduce the reliance on agency staff. The service worked with partner agencies and was involved in some improvement work in medicines management and with the ambulance service to improve people’s transfer to and from hospital.

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 17 May 2021).

Why we inspected

This inspection was prompted by a review of the information we held about this service. Also, in part due to concerns received about infection control, people’s nutrition and the overall management of the service. 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 inspected and found a concern with responding to people’s social needs, so we widened the scope of the inspection to include the key question of responsive.

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

After the inspection the provider took immediate actions to address some of the concerns and further development work was planned. They continued to work with partner agencies for guidance and support. For example, in relation to fire safety and medicines management.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, responsive and well-led sections of this full report. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Willow Green Care Home on our website at www.cqc.org.uk.

Enforcement and Recommendations

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 monitor the service and will take further action if needed.

We have identified breaches in relation to; governance of the service, staffing, medicines management and responding to people’s social needs and preferences.

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

We have made a recommendation about improvements to the processes around capacity and consent.

Follow up

We will request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Willow Green Care Home provides personal and nursing care for up to 63 younger and older adults living with a range of conditions including dementia. At the time of inspection 40 people were using the service.

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

The new management team and responsible person for the provider had continued to make significant improvements at the home.

Healthcare professionals we spoke with said the service was "responsive" and "positive" and they enjoyed a good working relationship with the staff team.

Care plans we viewed were person centred and we saw people's wishes were promoted. People told us they knew about their care plans and felt involved in their care. People were supported by staff who knew people well.

People told us the service promoted their well-being by ensuring their health needs were well monitored and records upheld this. The service has worked to decrease the level of falls in the home and reviewed mealtimes with people which led to an overall gain in people's weight.

We saw staff treat people with dignity and respect. People and a visiting relative said staff were kind and caring. People knew who to raise a concern or complaint with.

Infection control processes were embedded into the service and staff followed government guidance in relation to infection control and prevention practices, in particular, relating to COVID-19.

Quality monitoring systems had improved. Staff said the management team had made improvements and the culture had improved significantly. The service did not have a manager registered with the Care Quality Commission (CQC) at the time of this inspection, although an application had been submitted and accepted.

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 and update

The last rating for this service was requires improvement (published 19 February 2020) and there were three breaches of regulation. The provider completed an action plan after the last comprehensive inspection to show what they would do and by when to improve person-centred care, safe care and treatment and good governance.

Why we inspected

We undertook this focused inspection to check the provider had followed their action plan and to confirm they now met legal requirements regarding person-centred care, safe care and treatment and good governance. This report only covers our findings in relation to the key questions effective and caring which contained those requirements.

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 requires improvement to good. 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 Willow Green Care Home on our website at www.cqc.org.uk.

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 coronavirus and other infection outbreaks effectively.

Follow up

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

¿ Suitable arrangements were in place for visitors to the home. PPE and hand sanitizer were available, and visitors had their temperature taken.

¿ The provider and the manager had made changes to the environment so people who were discharged from hospital could enter the home separately. They had organised the home into zones to avoid cross-contamination.

¿ The provider was following national guidance for anyone moving into the home and admissions were carried out safely. Staff had been identified to work solely in the designated setting area of the home.

¿ Infection control policies and procedures were in place and being followed by staff. Supplies of personal protective equipment (PPE) were readily available in PPE stations throughout the home.

¿ Staff had received appropriate infection prevention and control training. The home had identified staff to be infection prevention and control champions. These staff were responsible for sharing best practice with other staff.

We were assured that this service met good infection prevention and control guidelines as a designated care setting.

Further information is in the detailed findings below.

Willow Green Care Home is a care home providing accommodation and nursing and personal care for up to 63 people. Care is provided over two floors. At the time of inspection, there were 34 people living at the home.

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

A wide range of new audits and systems for checking the quality of the service had been introduced since the previous inspection. These showed some shortfalls in the service which had been identified for development. We found some errors and omissions in records that audits had not identified. We have made a recommendation about consistent and effective quality checks. The provider gave assurances that the issues highlighted would be resolved as a priority following our inspection and supplied evidence these were being addressed.

The manager and staff had worked hard to improve the overall performance of the service, the culture and morale in the home. People, staff and professionals commented that the manager was approachable, responsive and driving improvements.

The service was clean, tidy and decorated to a good standard. People lived in a safe environment. Health and safety checks were made regularly. Individual and environmental risks had been identified and reduced. Fire safety records had improved, and people had personal emergency evacuation plans to support staff in the event of an emergency. The provider had systems which assisted them to learn from a range of information, including accidents and incidents, falls and safeguarding concerns. They analysed information for trends to enable them to reduce future occurrences.

There were improvements to the way the home planned personalised care for people, and their needs were regularly reviewed. We found some inconsistences in care records remained, although the provider was working to standardise and improve these. People were offered a range of activities. The provider had an effective complaints process. People and relatives were confident concerns raised would be dealt with appropriately.

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 and update

The last rating for this service was requires improvement (published 26 February 2020) and there were multiple breaches of regulation. These were breaches of regulation 9 (Person Centred Care), regulation 12 (Safe Care and Treatment), regulation 16 (Receiving and Acting on Complaints) and regulation 17 (Good Governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The provider completed an action plan after the last inspection to show what they would do and by when to improve. We also completed an inspection (published 23 October 2020) to follow up on a Warning Notice issued for a breach of regulation 17. We found the requirements of the Warning Notice had been met.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

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 coronavirus and other infection outbreaks effectively.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Responsive and Well-led which contain those requirements.

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 not changed and is 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 Willow Green Care Home 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.

Willow Green Care Home is a care home providing accommodation and nursing and personal care for up to

63 people. Care is provided over two floors. At the time of inspection, there were 44 people living at the home.

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

The provider and the management team had taken steps to improve the service and ensure people received safer care. An action plan to address the warning notice carried out by CQC had been implemented. All the requirements of the warning notice had been met.

Quality assurance systems to measure the effectiveness of the service had improved and the management team had a better oversight of the service.

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 support this practice.

Infection prevention and control measures were in place. Hand sanitiser and masks were available in reception along with guidance on infection prevention and control procedures. The home had an automated system for checking visitor’s temperatures on arrival.

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 26 February 2020). Following our last inspection, we served a warning notice on the provider. We required them to be compliant with Regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 by 30 April 2020.

Why we inspected

We undertook this targeted inspection to check whether the Warning Notice we previously served in relation to Regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. The overall rating for the service has not changed following this targeted inspection and remains requires improvement.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

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 coronavirus and other infection outbreaks effectively.

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.

Willow Green Care Home is a care home providing accommodation and nursing and personal care for up to 63 people. At the time of inspection, there were 46 people living at the home.

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

During the inspection we found the registered provider was in breach of regulations in relation to person-centred care; consent; safe care and treatment; and good governance.

The service had a registered manager at the time of our inspection but they were on leave. They resigned from this role and the service shortly after our inspection visit.

Work was required to address issues identified within people’s individual risk assessments to ensure they included how staff should care for people to keep them safe.

Medicines were managed safely at the home however some areas required improvement. We could not be assured that incidents that should have been reported and recorded as safeguarding events had been.

Staff recruitment was not always safe but we saw the nominated individual took immediate action to ensure one staff member without a reference did not return to the home until this had been resolved. The nominated individual is responsible for supervising the management of the service on behalf of the provider.

We received mixed views about the levels of staffing within the home, however most people said their care needs were met. We made a recommendation about this.

Records relating to fire safety were incorrect and incomplete, immediately following our inspection this was addressed by the service. Governance arrangements in the service were poor. Audits carried out in the service did not identify the deficits we found.

Some people’s care plans included incomplete or incorrect mental capacity assessments. We could not verify from records who had deprivation of liberty safeguard (DoLS) authorisations in place.

Care plans did not guide staff on how to deliver person centred care. They were brief and task based. We did not see specific end of life plans for people.

Supervisions had been in place for staff but these were not well completed. Staff had received training to support them in their role.

People were provided with a range of food and drinks to help them to maintain a healthy balanced diet. Feedback from people about the quality of the food was mixed.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the systems in the service did not support this practice.

Most people told us they felt safe living at the service. Staff we spoke with knew people well.

People were supported where necessary, by staff to access the community. People were supported to take part in a range of activities within the home by a motivated and innovative activity co-ordinator.

Staff members had access to regular staff and handover meetings.

The nominated individual acknowledged work was required to address issues which had been identified prior to, and during the inspection. They had created an action plan for the home, the progress of which was monitored on a weekly basis. Additional management support had also been brought into the home following the resignation of the registered manager.

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 28 November 2018).

Why we inspected

We undertook this initially as a targeted inspection to check on multiple concerns raised by the local authority safeguarding team.

We widened the inspection to a comprehensive inspection after the first visit to assess whether there were any additional risks to people using the service.

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

Enforcement

We have identified breaches in relation to complaints, record keeping, good governance, person centred care and keeping people safe. Please see the action we have told the provider to take at the end of this report.

Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

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

We completed an unannounced comprehensive inspection of this service in February 2018. After that inspection we received concerns regarding the management and governance within the home and how people’s care, treatment and support needs were being delivered. Concerns were also raised as to whether staff had the skills, knowledge and experience to meet the needs of the service. Concerns that people were not receiving an appropriate level of nutrition and hydration. Lack of consent for care and support delivery and issues with the environment not being appropriate to meet people’s needs.

As a result, we undertook a focused inspection to look into those concerns. This report only covers our findings in relation to those topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for (St Martin’s Care Limited) on our website at “www.cqc.org.uk”

The team inspected the service against two of the five questions we ask about services: is the service effective and is the service well led? No additional risks, concerns or significant improvement were identified in the remaining Key Questions through our ongoing monitoring or during our inspection activity so we did not inspect them. The ratings from the previous comprehensive inspection for these Key Questions were included in calculating the overall rating in this inspection.

Willow Green 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 care home accommodates 63 people across two floors. At the time of the inspection 53 people were being supported in the home, 20 of which were receiving nursing care.

The service did not have a registered manager. A new manager was in post who had commenced the process to become the registered manager of Willow Green.

‘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.’

Some people felt the quality of the food needed improving. Plans were in place to address this with the development of new menus. A new chef had been employed.

People’s needs were assessed in line with best practice and current legislation to ensure they could be supported in Willow Green. People’s likes, dislikes and preferences were used in planning outcomes. Staff were aware on how to provide support and guidance to meet people’s outcomes.

Staff told they felt supported and received regular supervision and annual appraisals. Staff had received appropriate training to meet the needs of the service. The manager had planned in additional training for staff to completed to increase their skills and knowledge.

People were supported 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 had their nutritional needs assessed regularly and were supported to eat and drink safely. Where specialist diets and thickened fluids were required, these were provided. People’s health was monitored and when necessary staff ensured people had access to health care professionals when necessary.

The provider had commenced a programme of refurbishment with some rooms being redecorated. The reception carpet was due for renewal. Rooms were personalised to people’s taste. Communal areas were spacious and accessible. People had access to outside areas. The home was clean with no odours.

The provider’s senior management structure had been revised. Senior management were improving systems and processes within the service and increasing their presence to support staff and the home’s management. Audits were in place which were used as part of service improvement.

The new manager had only been in post for a few weeks. Staff were already positive about the changes they had made. They confirmed they felt supported and could raise concerns. Staff all commented on how they felt so happy when the manager returned and the mood in the home has lightened and everyone is a team again. One staff member told us “There is an open and honest culture here now which makes for a good feeling in the home both for residents and staff”.

We observed the manager was visible in the service and found people interacted with them in an open manner. People and relatives felt the management approach in the home was positive.

Links with the local community were in place. Partnership working with other agencies, commissioning and local health and social care teams was in place.

Willow Green Care Home is a ‘care home’. People in care homes receive accommodation and 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. Willow Green Care Home accommodates up to 63 people across four separate units, each of which have separate adapted facilities. Three of the units specialise in providing care to people living with dementia. At the time of this inspection 49 people were in receipt of care from the service.

At the last inspection in November 2015 we found the provider was meeting the fundamental standards of relevant regulations. At that time we rated Willow Green Care Home as ‘Good’ overall and ‘Good’ in four domains. We rated the service as ‘Outstanding’ in one domain, namely 'Responsive’.

The registered manager left their post since February 2018. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like 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. A new manager is in post and submitted their application to be the registered manager in March 2018.

At this inspection we found staff remained exceptionally responsive towards people and dedicated to ensuring people experienced high quality care. We saw that staff treated people very much as individuals and ensured people continued to follow their preferred routines. We found staff were passionate about providing a vibrant service that gave all equitable choices and experiences. We heard how the provider was currently reviewing the service to ensure guidance from Stonewall (which is an organisation that campaigns for equal rights for lesbian, gay, bisexual and trans people across Britain) is incorporated into all the practice. The aim was ensure the service supported people diversity and those from LGBT groups felt welcome to stay at the service.

We found that the activity coordinator had worked hard to create a sense of community within the service and developed links with local organisations. The activity coordinator was constantly looking at ways to engage people in activities. Following feedback from people the activity coordinator looked to find ways to support people to give back to the community and was currently organising a litter pick at a local cemetery. They had posted this activity on the service’s Facebook account and received a lot of positive feedback. The local council had donated equipment such as litter pickers and the local newspaper had written an article about this event.

We found the staff had developed excellent links with external healthcare professionals and worked collaboratively with these teams, for example, the REACT team, hospital occupational therapists and physiotherapists. The staff also worked closely with the local palliative care team and people told us this assisted staff to plan end of life care plans, which met individual’s need. The team worked collaboratively with people and their relatives to ensure the care provided met each person's needs.

The community nursing team regularly visited and told us they were very impressed with the service and the way staff supported people. One of the visiting professionals found this to be one of the best services in the area and they had recommended it to a relative, as a place to reside.

The provider had recently introduced new assessments and care records, which staff told us were more informative and easier to use. They were currently evaluating the tools to ensure they were effective and see where improvements could be made.

People’s care needs were risk assessed with risk management plans in place and support for staff when they needed it. The staff team were aware of risks within the service and undertook regular analyse of risks. The service had emergency plans in place and took action when they became aware someone was at risk. The staff critically reviewed all incidents to determine if lessons could be learnt. We found staff had an understanding of safeguarding and how to raised concerns.

Staff were respected within the organisation and were provided with comprehensive training including specialist training. The provider had employed a dedicated trainer and we found they had developed a wide training programme, which meant all staff could keep up to date. We observed one of their training sessions on understanding dementia and found it was very interactive and engaging. The nursing team had ensured they accessed a full range of clinical updates and the provider supported them to achieve the requirements to maintain their registration. All the staff enthusiastically discussed the wide range of training they had been able to complete. Staff received supervision on a monthly basis and they received annual appraisals.

We found the director of care and manager’s leadership style had led to people and staff feeling that they were integral partners in the operation and enhancement of the service. Staff supported people to make decisions and spoke with people about their wishes and preferences. The manager, staff and activity coordinator regularly sought people's views and acted upon their comments.

Robust recruitment checks were carried out and people who used the service were involved in interviewing prospective employees. We found that there were sufficient staff to meet the needs of people and saw that two nurses were always available during the day.

Staff safely managed medications. A large proportion of the staff had worked at the service for many years, which provided consistency for people using the service.

People, relatives and staff described the director of care and manager as being effective leaders who ensured the service consistently delivered a good service. Staff told us they could contribute their ideas about how to make improvements at the service and they were listened to. The registered manager and provider carried out a number of quality assurance checks to monitor and improve standards at the service.

The manager had informed CQC of significant events in a timely way by submitting the required notifications. This meant we could check that appropriate action had been taken.

In this report the name of a registered manager appears who was not managing the location at the time of the inspection. Their name appears because they were still a registered manager on our register at the time of inspection. The service had a manager in post that at present is going through the registration process.

We looked at a range of records; spoke with the deputy manager, nursing unit manager, activity co-ordinator, eight members of staff, 15 people who used the service and two friends of a person using the service. We also observed the interactions between staff and people living at Willow Green Care Home.

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

Is the service safe?

Everyone we spoke with told us they felt safe and secure living at Willow Green Care Home. Procedures were in place to guide staff on the actions they needed to take if they suspected abuse. The staff we spoke with had received safeguarding training and were aware of their reporting responsibilities and understood the procedures they needed to follow to ensure people were safe.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care home. The home had proper policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards. At the time of our inspection they had no DoLs safeguarding's in place. The majority of staff had received training in relation to these topics along with the safeguarding of vulnerable adults and had an understanding of the actions to take.

Willow Green Care Home was clean, hygienic and well maintained. There were good processes in place that ensured infection prevention and control of the home.

People were aware of the complaints procedure and there were systems in place for monitoring complaints.

There were effective systems in place for the ongoing maintenance and servicing of equipment. There were also good systems in place in respect of fire safety and fire training.

Is it effective?

People all had their needs assessed and had individual care records which set out their care needs. People told us that they received the care and support they needed. We saw evidence of how the information from people's care records were transferred into practice. For example, staff were seen to use the moving and handling equipment identified in a person's care record and how one person was supported with gentle hand exercises in bed.

It was clear from our observations and from speaking with staff that they had a good understanding of the people's care and support needs and that they knew them well.

Staff knew how and when to involve other health and social care professionals. We saw lots of evidence contained within people's care records.

Is it caring?

People were supported by kind and attentive staff. We saw that staff engaged with people in a positive way and showed respect, kindness and gave people gentle encouragement. Some people who used the service liked to have a joke with the staff and there was a lot of laughter.

People's needs had been assessed and care plans put in place which detailed people's needs and preferences. These records provided a good level of information to staff on what care and support people who lived at Willow Green Care home needed. Care and support had been provided in accordance with people's wishes.

There was also a lot of information in the care files about peoples past called 'my life my memories.' This included information on a person's childhood, young adulthood, middle age and later years.

The activity co-ordinator showed us some work she had being doing on memory boxes; these boxes were covered with photographs of the person who used the service and their families, friends and pets. For people who they could not find out information on their past lives, the activity co-ordinator was starting a memory book from the day they entered Willow Green Care Home.

Is it responsive?

There was clear evidence contained within people's care plans to show how they worked with other health and social care professionals. Records were kept of all interactions with doctors, dentists, opticians, physiotherapists etc.

People told us that they knew how to make a complaint if they needed to. When asked about the complaints process, they all said they would go to the manager with any problem which had not been resolved with care staff.

It is well led?

The service worked well with other agencies and services to make sure people received their care in a joined up way. People who used the service could be seen by the chiropodist, dentist, hairdresser and optician who regularly visited the home.

The home had a manager who was currently going through the registration process. The manager was on holiday at the time of inspection. The manager was supported by a deputy manager. There were systems in place to assure the quality of the service they provided. The way the service was run was regularly reviewed. Actions were put in place when needed and we were able to see that these actions had been addressed.

People who used the service, their relatives and friends had opportunities to attend regular meetings.

Staff we spoke with were clear about their roles and responsibilities. These staff had a good understanding of the ethos of the home and were knowledgeable about people's needs. This helped to ensure that people received a good quality service at all times.

People who used the service choose when to go to bed and get up in the morning. The activity co-ordinator arranged for a local clothes shop to bring in clothes and jewellery for the people who used the service to buy, we observed this and it was received very well. People also attended a tea dance in the local town on the afternoon and told us how much they enjoyed this. The activity co-ordinator told us she is always trying to think of new activities and recently hired a music studio where the people who used the service made a CD and sang 'with a little help from my friends, this was recorded in the local newspaper.

What people told us

We spoke with 15 people who used the service and they said 'It is comfortable here, it is like a home from home,' and 'Staff are good, I have never been refused anything,' 'It is very clean here, staff hoover every day.'

One person who used the service said 'I was very reluctant to come in, there were lots of tears, but now I realise it was the right thing for me, I feel safe and I can go to bed and sleep without worrying, as the staff always check on me to make sure I am okay.'

Staff we spoke with said 'We are like a little family and it's all about the residents,' 'I am really, really happy here, I am developing as a nurse,' and 'They are all unique in their own way, I treat them all as individuals.'

The activity co-ordinator said 'I like to help and encourage them to do new things, things that they would think were impossible such as the recording of the CD.'

People were positive in their views about the home. They told us; 'I have a lovely sunny room' and 'It's alright here, I've got no complaints',

We saw that the activities co-ordinator had carried out some sensitive work with people around advanced care planning. She told us 'It's good to talk with people about their end of life wishes if it is appropriate to do so'.

The home had a quality assurance system in place that showed regular checks were carried out on equipment and the environment.

A complaints procedure was in place which was clearly displayed in easy to read format. A record was in place which showed the provider had systems in place to deal with comments and complaints. Staff received relevant training, supervision and appraisal which meant they were supported to deliver care safely and to an appropriate standard.

We spoke with four people who used the service and one visitor. They were very positive in their views of the home. One lady told us it was her birthday and the chef had specially prepared her favourite lunch. We saw staff interacting sensitively with people and we saw staff assisting someone who had fallen by using role modelling to show the person how they should safely get into a position whereby staff could use equipment to help them get back up.

We looked at records and spoke with managers from the home and the provider. We saw that new hoists had been purchased and that three previous hoists that had faults had been de-commissioned. We saw that the provider had arranged appropriate servicing and checks on new hoists and daily checklists were in place for all staff to complete to ensure equipment was safe and ready for use.

Records showed that checks were being regularly undertaken on fire equipment and we saw servicing records for other safety requirements such as electrical safety and water temperatures. We also looked at two care files, one for someone recently admitted to the service. These showed assessment and involvement of the person and their family and were personalised.

People were positive in their views about the home. They told us; 'It's very good here',

'I'm well looked after', and 'I'd have no life if I wasn't here."

Care plans were written in a clear and easy to understand way and people's personal preferences were clearly recorded.

There were sufficient staff on duty to support people for their care needs. We looked at how the service recruited staff by checking six staff files. These showed proper checks and procedures were being followed.

We spoke to two people who used the service about their medicines at this visit. One said he was very happy for staff to look after his tablets but he wanted to keep his own eye drops so that he could use them when he needed to. The other person who looked after his inhalers would have also liked to administer his own tablets but also said that he probably would find them too confusing and would be unable to manage them correctly.