Willow View Care Home

Willow View Care Home is a residential care home providing personal care to up to 77 people. The service provides support to older people, some of whom may be living with a dementia, physical disability or sensory impairment. The home is divided into 2 areas: Willow View and Willow Gardens. The 2 areas are joined by a covered walkway, and both areas comprise of 2 floors. At the time of our inspection there were 42 people living at the service.

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

Risks to people’s safety were assessed and recorded. However, risk assessments had not always been updated when changes occurred and some care plans contained contradictory information. Environmental risks had not always been identified and mitigated where possible. We found call bells that were inaccessible to people.

New recruitment processes were in place but they had not always been fully followed and gaps in recruitment records remained.

Improvements had been made to medicine management. However, records did not always reflect the prescriber instructions. Medicines prescribed to assist with bowel movements had not always been given in a timely manner.

Overall, some improvements had been made in relation to infection, prevention and control. However, Covid guidance was not being followed and dirty items were found in communal areas.

People had not always been provided with sufficient fluids and recommended modified diets had not always been followed.

Quality assurance processes were now in place. They failed to identify some of the shortfalls found during this inspection. Provider oversight had improved. Provider level audits were completed, but there was a lack of recorded evidence of action taken to address the shortfalls identified.

There was enough staff on duty to meet people’s needs. An effective dependency tool was now in place and used to help calculate safe staffing levels.

Staff had been provided with additional training following the last inspection. Staff told us they felt very well supported by the new manager.

People were supported to have maximum choice and control of their lives and staff supported /did them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. Appropriate signed consent was now in place.

Staff were now working effectively with other professionals. Where staff had concerns, referrals had been made in a timely manner. Professionals spoke positively of the improvements made to the service since the new manager was appointed in December 2023.

People and relatives told us staff were kind and caring and treat them like family. A new activities coordinator had been recruited and a variety of activities were on offer. People and relatives had been asked to provide feedback on the service and felt their views were listened to and acted upon.

A new process was in place to ensure complaints were recorded and acted upon appropriately. Accidents and incidents were now fully recorded and appropriate post falls checks were in place.

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 inadequate (report published 12 July 2023).

At this inspection we found the provider remained in breach of some regulations.

This service has been in Special Measures since 12 July 2023. During this inspection the provider demonstrated that some improvements have been made. However, further improvements are needed, and the service remains rated inadequate in the Safe domain.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 4, 9, 10 and 22 May 2023. 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 dignity and respect, consent, safe care and treatment, good governance and oversight and staffing levels and deployment.

We undertook this inspection to check they had followed their action plan and to confirm they now met legal requirements.

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

We have found evidence that the provider still needs to make improvements. Please see the Safe, Effective and Well-led sections of this full report.

Enforcement and Recommendations

We have identified breaches in relation to medicine management, infection prevention and control, assessing risk and good governance at this inspection.

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

The overall rating for this service is ‘requires improvement’. However, we are placing the service in 'special measures'. We do this when services have been rated as 'inadequate' in any Key Question over two consecutive comprehensive inspections. The ‘inadequate’ rating does not need to be in the same question at each of these inspections for us to place services 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.

Willow View Care Home is a residential care home providing personal to up to 77 people. The service provides support to older people, some of whom may be living with a dementia, physical disability or sensory impairment. The home is divided into 2 areas: Willow View and Willow Gardens. The 2 areas are joined by a covered walkway, and both areas comprise of 2 floors. At the time of our inspection there were 69 people living at the service.

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

The service was not safe. Risk assessments were either not in place or were not accurate. Checks to ensure the environment and equipment were safe had not been completed or were completed inconsistently. Fire exits were blocked throughout the service.

Medicines were not stored, recorded or administered safely. People were regularly not given their prescribed medicine due to poor stock management. Prescriber instructions had not always been followed which placed people at risk of harm.

Infection, prevention and control measures in place were insufficient. PPE was not being stored appropriately. Some elements of the environment were not suitable for people living with dementia. We have made a recommendation about this.

Safe staffing levels were not always in place. A dependency tool was used to calculate safe staffing levels, but the data used was not accurate.

People were not always treated with dignity and respect or involved in discussions about their care and support needs.

Records in all areas lacked up to date, person-centred information. Monitoring records had not been completed consistently and we could not be assured people were receiving appropriate care and support.

When complaints had been raised, thorough records had not been kept to evidence all areas of concern had been fully investigated.

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 policies and systems in the service did not support this practice.

People’s communication needs were not always met. Menus, picture menus and information in an easy read format were not available. We have made a recommendation about this.

Lessons had not been learnt when things went wrong. There was a significant lack of registered manager and provider oversight. The quality assurance processes in place were not effective and failed to identify and address shortfalls in a timely manner.

People did say they felt safe living at the service, and they enjoyed the activities on offer. People spoke highly of their regular staff for their caring approach.

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

Rating at last inspection and update

The last rating for this service was requires improvement (report published 29 April 2022) and there were breaches of regulations. 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 the provider remained in breach of regulations.

At our last inspection, we also recommended the provider made improvements to ensure a dementia friendly environment was in place and the Mental Capacity Act 2005 was followed. At this inspection we found the provider had not taken action in relation to the recommendations made and no improvements had been made.

Why we inspected

The inspection was prompted in part due to concerns received about medicines, staffing levels and systems used to monitor the quality and safety of the service. A decision was made for us to inspect and examine those risks.

We inspected and found there was a concern with capacity, consent and person-centred care so we widened the scope of the inspection to become a comprehensive inspection which included all key questions.

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 inadequate based on the findings of this inspection.

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

Enforcement and Recommendations

We have identified breaches in relation to dignity and respect, consent, assessing risk, medicine management, records and governance systems at this inspection. We have also made recommendations in relation to creating a dementia friendly environment and meeting people’s communication needs.

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

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.

Willow View Care Home provides accommodation and residential care for up to 77 people, some of whom have a dementia related condition. The home is divided into two areas: Willow View and Willow Gardens. The two areas are joined by a covered walkway, and both areas comprise of two floors. At the time of our inspection, 51 people were living at the service.

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

People’s medicines were not always safely managed which meant there was a risk that people did not always receive their medicines as prescribed. Information about risks to people was not always in place or was not always detailed enough. Staff had access to PPE but did not always wear their masks properly. People’s needs and choices were assessed but care plans were basic and lacked detail.

Quality assurance systems were not always effective. Audits had not identified the issues we found on inspection. Records did not always accurately reflect people’s needs. Sufficient improvements had not been made to the quality of the service since our previous inspection. However, there was a new registered manager in post and some action plans were in place at the time of our inspection.

The decoration of the service was not always dementia friendly. We have made a recommendation about the environment.

Information around people’s capacity, consent to care, and best interest decisions were in place in some care files but not others. We have made a recommendation about recording how staff are following the principles of the MCA.

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. However, records around this needed to be improved.

The service was clean and tidy. People told us they felt safe and staff knew what to do if they had any safeguarding concerns. Staff were recruited appropriately. We received mixed feedback about staffing levels, but the registered manager was actively recruiting.

People were supported to eat and drink and people were offered a nutritious diet. The registered manager had implemented new policies and procedures around referring people to healthcare professionals in a timely manner. These new procedures need to be maintained and become embedded within the service. Staff had suitable training and support.

Staff and relatives spoke positively about the registered manager. People were more engaged with the service than they had been at the previous inspection, and a residents’ committee had been set up. Staff had regular meetings, supervisions and appraisals, and told us they could give honest feedback. The registered manager was motivated to make the required improvements.

At our last inspection we recommended that all visitors were screened for COVID-19 prior to entering the home and that staff didn’t work across different floors during a COVID-19 outbreak. At this inspection we found the provider had acted on those recommendations and made improvements in those areas.

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 20 December 2021) and there were breaches of regulation.

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 the provider remained in breach of regulations.

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

Why we inspected

The inspection was prompted in part by notification of a specific incident, following which a person using the service died. This incident was subject to a criminal investigation and therefore the inspection did not examine the circumstances of the incident. Following the inspection, the police confirmed they were taking no further action.

The information CQC received about the incident indicated concerns about the management of medicines and policies and procedures. This inspection examined those risks.

The inspection was also prompted in part due to concerns received about the management and prevention of falls, nutrition, daily records and staff training. A decision was made for us to inspect and examine those risks. The inspection also looked at the breaches identified at the previous inspection.

We undertook a focused inspection to review the key questions of safe, effective and well-led only.

For those key questions not inspected, we used the ratings awarded at the last comprehensive inspection to calculate the overall 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 COVID-19 and other infection outbreaks effectively.

We found evidence that the provider needs to make improvements. You can see what action we have asked the provider to take at the end of this full report.

The new registered manager has been responsive to our inspection feedback and has devised and implemented action plans to address the concerns identified and mitigate the risks to people using the service.

You can read the report from our last inspection, by selecting the ‘all reports’ link for Willow View 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 safe care and treatment and good governance 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 and 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Willow View Care Home provides accommodation and residential care for up to 77 people, some of whom have a dementia related condition. The home comprises of two areas; Willow View which was the original building and the new extension wing, Willow Gardens. The two buildings were connected by a covered walkway. At the time of our inspection 58 people were living at the service.

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

From 11 November 2021 anyone who enters a location which provides the regulated activity ‘accommodation for persons who require nursing or personal care’ must be double vaccinated against COVID-19 infection, unless they meet the exemption criteria set out by the Department of Health and Social Care. At this inspection we found three staff members who had not received any vaccinations. One staff member did meet the exemption criteria but had not self-certified or been asked to do so prior to 11 November by the registered manager. The other two staff were not medically exempt and had been allowed to work a number of shifts after the deadline. Although the provider addressed this following our feedback, they had been aware of the new legislation prior to our visit and had failed to act in a timely manner.

Medicines were not well managed, and unsafe medicine practices put people at risk.

Risks to people’s health and wellbeing were not well managed. Risk assessments did not always accurately reflect people's current needs. Some risk assessments were not completed and others were not detailed enough to guide staff on how to safely support people.

Safe recruitment procedures were followed. Although records showed the home was staffed to a safe level, staff members, people living in the home and their relatives felt more staff were needed. Following our feedback, the registered manager was going to review the way staffing levels were calculated.

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 were not fully assured the service was following safe infection control guidelines in relation to COVID-19 and we have made a recommendation about this.

Records were not always fully completed or up to date. Audits that took place did not highlight all the concerns found on the inspection day.

Accidents and incidents were reviewed monthly for any learning outcomes.

Staff understood safeguarding procedures and how to report concerns.

Most of the staff we spoke with felt well supported by the management team. Further work was needed to improve communication with relatives and to involve them and people using the service, more.

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

The last rating for this service was Good (published 29 May 2019)

Why we inspected

The inspection was prompted in part due to concerns received about staff working without a vaccination. A decision was made for us to inspect and examine those risks. We carried out a focused inspection of this service on 22 November 2021. This report covers our findings in relation to the key questions safe and well led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection. We have found evidence the provider needs to make improvement. Please see the safe 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 View Care Home on our website at www.cqc.org.uk.

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 breaches in relation to unvaccinated staff, risk management, medicines, and governance 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 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Due to the current nationwide lockdown there had been some restrictions placed on visiting. People had been keeping in touch with their families via Zoom meetings, Skype and window visits. Relatives were able to visit loved ones who were receiving end of life care. Plans were in place for visiting to start again in line with government guidance.

Staff now worked in only one area of the home to minimise the risk of cross infection. Communal areas such as lounges and dining rooms had enough space for people to be two metres apart. Numbers around dining tables was limited to maintain a safe distance between people.

Staff who needed to shield were supported to do so. Special provision and changes to working patterns had been made to accommodate staff who were more vulnerable due to underlying health conditions. The registered manager did regular daily walkarounds of the home and told us checking in on staff wellbeing was an important part of this. They also visited the home outside usual office hours to ensure night staff felt supported. The registered manager and deputy praised how well the staff team had coped and supported one another. Staff we spoke with felt well supported.

People were admitted to the home safely. A negative test result was needed prior to admission and following admission people isolated in line with current government guidelines. Notices were placed on bedroom doors to remind staff which people were still in their isolation period and when this was due to end.

Staff changed into their uniform before the start of their shift and changed again before going home. We observed staff wearing PPE correctly throughout the home. There was a plentiful supply of PPE and a number of PPE stations around the home. Clinical waste bins were in place for the safe disposal of used PPE. Staff had received support and training on PPE use and minimising infection control risk from a specialist infection prevention and control (IPC) nurse. No anxiety about the wearing of PPE was witnessed in people with dementia. People seemed calm and settled with the staff supporting them.

The home was very clean and tidy. Cleaning of high use areas and touch points such as handrails and door handles had been increased. Suitable arrangements were also in place to manage contaminated laundry. The deputy manager was infection control champion and supported staff with safe working practices. Regular awareness sessions were held on topics such as good hand hygiene.

There was a detailed infection prevention and control policy in place and regular checks were complete.

People’s experience of using this service: People and relatives were positive about the caring nature of staff. One person told us, “I’m living well here.” A relative said, “I know he’s well cared for, he’s in a nice place and they care about him.”

Staff spoke positively about the people they supported. They said they would be happy for their relatives to live at the home because of the standard of care provided.

Effective systems were in place to ensure people’s safety. There were no ongoing safeguarding investigations. Risks were assessed and monitored, sufficient staff were deployed and safe recruitment procedures were followed.

Health care professionals spoke positively about the service. One health care professional told us, “Staff are proactive, there is excellent team work here - staff are forward thinking.”

A range of activities were organised to help ensure people’s social needs were met.

There was a designated quiet area within Willow Gardens for end of life care. A multi-disciplinary approach was followed to help ensure consistent and responsive care was provided to meet people’s needs at this important time in their lives.

The was a clear management structure in place. Audits and checks were carried out to monitor the quality of the service. Action was taken if any shortfalls were identified.

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.

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

Rating at last inspection: Requires improvement (report published 12 March 2018).

Why we inspected: At our previous inspection we identified four breaches of the regulations relating to safe care and treatment, safeguarding people from the risk of abuse and improper treatment, person-centred care and good governance. We carried out this inspection in line with our scheduling guidelines for adult social care services. We found that improvements had been made and all regulations were being met.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit. If any concerning information is received we may inspect sooner.

Willow View 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.

Willow View can accommodate up to 54 people across three separate areas each of which have separate adapted facilities. At the time of our inspection one of the areas specialised in providing care to people living with dementia. The Willow Gardens area is a newly built extension that is currently a stand-alone building but will be joined to the original building via the creation of a link corridor. Building work was still underway to construct the link at the time of our visit. There was a dining room on each unit and a number of communal living areas.

The service had a registered manager in place. 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.

The provider had a safeguarding policy in place however we found that incidents were not always handled in line with this. Staff had received safeguarding training and knew the procedures for raising any concerns. Staff were also familiar with the provider’s whistleblowing policy.

People’s weight was not always monitored accurately.

Medicines were managed with support from an electronic system for recording medication administration. Medicines were stored safely and there was a robust system in place for ordering and disposal. Stock checks of one medicine identified two discrepancies over the period of one month. The discrepancies had not been handled in line with the provider’s policy. Medicine administration records (MAR) contained some errors that could not be accounted for.

People had personal emergency evacuation plans in place. However appropriate fire drills were not being conducted on a regular basis.

There were sufficient staff on duty to safely meet people’s care needs. Staff levels were calculated monthly using a dependency tool was. Safe recruitment procedures were in place and appropriate pre-employment checks were undertaken.

Accidents and incidents were recorded and monitored monthly to look for patterns or trends.

There were infection control procedures in place to minimise the risk of cross-infection. All areas of the service were clean and tidy and there were no unpleasant odours.

Capacity assessments were not being undertaken in line with guidance in the Mental Capacity Act 2005 code of practice. DoLS applications had not been submitted for every person who had restrictions placed on their movements.

Consent to care was not always correctly obtained or recorded. Details of relatives with Lasting Power of Attorney (LPA) were not clearly recorded on care files. We did not see any records of best interest decisions taking place. We have made a recommendation about this.

People were very happy with the food they were provided. The service supported people to maintain a balanced diet and kitchen staff were knowledgeable about people’s dietary needs. People and their relatives were involved in menu planning and the mealtime experience was a positive one.

Staff told us they received the right level of support and were happy the quality of the training. Records showed that training was up to date and staff had supervision meetings on a regular basis.

People’s health and wellbeing needs were met by regular visits from health care professionals. The provider had also recently begun to use a computerised system of monitoring people’s health. Positive feedback was received from a visiting health professional.

The environment was bright and well decorated with clear signage to help people find their way around independently. People had access to outdoor areas and spent time in the garden when the weather was good.

People and their relatives were very happy with the way care was being delivered and spoke positively about the staff approach. The atmosphere within the care home was relaxed. Staff promoted privacy, dignity and independence. There was a good rapport between staff and people using the service. Relatives and friends were able to visit at any time and were made to feel welcome.

People were supported to follow their religion without being discriminated against unfairly on these or any other grounds. People were also supported to vote to ensure their rights were upheld. Information on an advocacy service was made available to people.

People felt there were not enough activities on a day to day basis to prevent boredom. There were no staff members employed specifically to deliver activities. As a result people were at risk of social isolation.

People were treated as individuals and were able to make choices for themselves. Relatives were involved with the planning of care for their family members and invited to review meetings.

Complaints were handled in line with the provider’s complaints policy. People received information on the complaints procedure when the moved in to the service and this was also displayed in communal areas.

People had end of life care plans in place to ensure their wishes were observed at this important time.

A programme of audits was undertaken but this was not always effective and had not picked up all of the issues we found. Records relating to the care and treatment of people were not always complete, up to date or accurate.

Feedback was sought from people using the service and their relatives but action had not always been taken to address issues highlighted.

The registered manager had an open door policy and people, relatives and staff all told us the registered manager was approachable and supportive. Staff meetings were held every three months.

The service has developed links with the local community and was also working in partnership with other agencies such as the police and local NHS trust.

During the inspection we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

This is the first time the service has been rated Requires Improvement.

Willow View Care Home is registered to provide accommodation for up to 35 older people who may or may not be living with a dementia. The home has two floors. All of the bedrooms had en suite facilities. There are a range of lounges, dining rooms, and a small room where people could sit and read. Willow View Care Home also had the benefit of an enclosed landscaped garden. At the time of our inspection there were 34 people living at the home.

There was a registered manager in post since the home opened two years ago and the new registered provider took over the operation of the home in April 2015. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People were happy and felt safe. Visiting professionals commented that people’s level of functioning had dramatically improved since being admitted to the home. People had regained their confidence and ability to walk and be as independent as possible. Their risks were managed effectively and they felt confident that they would receive support of the staff when needed.

We found that a range of stimulating and engaging activities were provided at the home. There were enough staff to support people undertake activities in the community. Staff also volunteered to take people out for the day shopping and visiting local tourist attractions. People were supported to recognise the impact any memory loss had upon their ability to go out independently and they told us that they needed staff support.

People’s care plans were tailored for them as individuals and created with their, their family and social worker’s involvement. People were cared for by staff that knew them really well and understood how to support them. We observed that staff had developed very positive relationships with the people who used the service. The interactions between people and staff were jovial and supportive. Staff were kind and respectful; we saw that they were aware of how to respect people’s privacy and dignity. Staff also sensitively supported people to deal with their personal care needs.

Staff were very well supported and had the benefit of a programme of training that enabled them to ensure they could provide the best possible care and support. Staff lived the values of the registered provider and put people at the heart of everything they did. Staff were all clear that they worked as a team and for the benefit of the people living at Willow View Care Home. Their comments and feedback fed into the continuous improvement of the service.

The registered manager investigated even the smallest concern. We saw that they thoroughly looked at the concern and took prompt action to resolve them. They freely admitted where they had made mistakes and were very open and honest with people who raised issues.

The registered manager and staff had a clear understanding of safeguarding. They had recently identified and actively supported someone to deal with difficulties posed by someone visiting them. The registered manager also spoke with the safeguarding team at all stages and regularly checked that they were taking appropriate action to deal with any concerns.

People who used the service and the staff we spoke with told us that there were enough staff on duty to meet people’s needs. The registered provider and registered manager had closely considered people’s needs and for the 35 people using the service there was two senior carers and four care staff were on duty during the day and one senior carer and three care staff on duty overnight. The registered manager found that staff were team players and if there was ever a shortage staff provided the cover. This had meant that they had never needed to use agency staff.

Staff received a wide range of training, which covered mandatory courses such as fire safety as well as condition specific training such as dementia care.

Where people had difficulty making decisions we saw that staff gently worked with them to work out what they felt was best. Staff understood the requirements of the Mental Capacity Act 2005 and had appropriately requested Deprivation of Liberty Safeguard (DoLS) authorisations.

We reviewed the systems for the management of medicines and found that people received their medicines safely. Medicines were closely managed and this ensured people received their medication exactly as prescribed.

People told us they were offered plenty to eat and we observed staff to assist individuals to have sufficient healthy food and drinks to ensure that their nutritional needs were met. A generous catering budget was provided and the cook told us this was because the registered provider expected that people ate restaurant quality food. The cook also provided a range of fortified meals for people who needed extra calories to ensure they maintained their weight.

People were supported to manage their weight and nutritional needs. The home had been selected to be part of a pilot being run by local dieticians. The staff had regular contact with the dieticians and sent them weekly weights so that prompt action could be taken when needed, which had led to people’s regaining weight. The staff also took prompt action to support people manage excess weight gain.

People were supported to maintain good health and the local GP practice visited each week to complete a ‘ward round’ style review of people. If people were well and did not need GP input when they visited the doctors would review the individual’s medication. The staff also had close links with the speech and language therapists, community nurses, the falls team, physiotherapists and occupational therapists. These clinicians spoke highly of the staff and the effective working relationship they had with the team.

Effective recruitment and selection procedures were in place and we saw that appropriate checks had been undertaken before staff began work. The checks included obtaining references from previous employers to show staff employed were safe to work with vulnerable people.

The registered manager had nominated their two apprentices for awards and both had won in their category. One of the apprentices had won the apprentice of the year award and had this presented to them by the local Mayor. The registered manager also encouraged excellence within the home and valued the team by celebrating staff achievements.

The service had a strong leadership presence with a registered manager who had a clear vision about the direction of the service. They were committed and passionate about the people they supported and were constantly looking for ways to improve. Thorough and frequent quality assurance processes and audits ensured that all care and support was delivered in the safest and most effective way possible. The registered manager actively sought review from external agencies. The pharmacists, infection control nurses, environmental health officers, fire authority and commissioners had completed audits that showed a high compliance rate and a number of these scored 100% in all areas checked.