The Willows Care Centre 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 service is a large converted property. Accommodation is arranged over three floors and a lift is available to assist people to get to the upper floors. The service provides care for up to 40 older people, people living with dementia or people with a mental health condition. There were 32 people living at the service at the time of our inspection.

At the last inspection we found continued breaches of regulations 12, 17 and 18 of the Health and Social Care Act 2008 and the service was rated Requires Improvement. Following the inspection, we asked the provider to complete an action plan to show what they would do and by when to address the breaches. At this inspection we found that the provider had completed their action plan and the service was no longer in breach of regulations.

Since our last inspection the provider had completed their plan to stop providing nursing care at The Willows Care Centre. People who required nursing care had been supported to move to alternative services and the provider no longer employed registered nurses.

At our last inspection in August 2017 we found people were at risk of harm because their medicines were not managed safely. At this inspection we found that significant improvements had been made to the management of people’s medicines and people were no longer at risk.

People were now protected from the risk of harm. Previously risks to people had not been assessed and action had not been taken to mitigate risks. Risks had now been identified and action had been taken to manage them.

Records about people and the care they received were now accurate and complete, held securely and easily accessible to staff when they needed them. The provider had addressed the shortfalls in the record keeping and storage found at our last inspection.

Previously effective systems to assess, monitor and improve the quality and safety of the service were not in operation. Since our last inspection the provider had improved the checks completed at the service and now had oversight of the service. The registered manager and the provider checked all areas of the service regularly to make sure it met the standards they required. Any shortfalls had been identified and action was planned and completed to address them. The views of people, their relatives, staff and community professionals were asked for and acted on to continually improve the service.

A registered manager was leading the service. 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.

Staff felt supported by the registered manager and were motivated. A member of the management team was always available to provide the support and guidance staff needed. Staff worked together to support people to be as independent as they wanted to be. All the staff we spoke with told us they would be happy for their relatives to live at The Willows Care Centre.

Staff were kind and caring and treated people with dignity and respect. They took time to get to know each person well and provide the care people wanted in the way they preferred. People received the care and support they wanted at the end of their life. Since our last inspection the provider had begun to implement the Gold Standards Framework (GSF) for end of life care. The GSF is a recognised approach to ensuring that everyone receives appropriate and individualised care which takes account of their wishes and preferences at the end of their life.

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The Willows Care Centre provides accommodation, personal and nursing care for up to 40 older people, people living with dementia or people with a mental health condition. The service is a large converted property. Accommodation is arranged over three floors and a lift is available to assist people to get to the upper floors. There were 35 people living at the service at the time of our inspection.

At the last inspection, the service was rated Inadequate. The provider took prompt action to reduce the risks at the service. We took enforcement action against the provider and applied a condition to their registration requiring them to send us an action plan twice each month informing us how they were improving the quality and safety of the service. We received these actions plans as required. At this inspection we looked to see if the action taken by the provider had been effective and found that improvements had been made. However, there were continued breaches of four regulations and further improvements were required in other areas.

Before our inspection the provider decided to stop providing nursing care to people. They were working with the people, their families, funding authorities and the local Clinical Commissioning Group to assess each person’s needs to make sure they could continue to be met at the service. Plans were in place to support people who required nursing care to find alternative services.

A manager was working at the service. They had applied to be the registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the care and has the legal responsibility for meeting the requirements of the law. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

The provider’s oversight of the service had improved since our last inspection. The support provided to staff had increased, however nurses had not always been held fully accountable for their responsibilities. A number of checks and audits had been completed; however, action had not always been taken to address any shortfalls found, including medicines errors.

Some staff continued not to follow the provider’s medicines procedures and people continued to be at risk from unsafe medicines management, including the safe storage and administration of medicines.

At our last inspection we found that risks to people had not been consistently identified, assessed and reviewed. At this inspection we found that some risks, including risks to people’s skin, continued not to be assessed and reviewed regularly. Care had not been planned to meet people’s changing needs, including the correct use of pressure relieving equipment. Other risks, such as the risk of people losing weight or falling had been assessed and action had been taken to keep people safe.

The provider’s recruitment procedures had still not been followed for all staff. The Disclosure and Barring Service (DBS) criminal records check for one staff member had not been fully completed and disclosures on another DBS had not be adequately assessed. The DBS helps employers make safer recruitment decisions and helps prevent unsuitable people from working with people who use care and support services.

People were not always treated with respect. People continued not to have enough to do during the day on occasions, despite care staff spending

The Willows Care Centre provides accommodation, personal and nursing care for up to 40 older people, people living with dementia or people with a mental health condition. The service is a large converted property. Accommodation is arranged over three floors and a lift is available to assist people to get to the upper floors. There were 37 people living at the service at the time of our inspection.

At the last inspection, the service was rated Good.

The inspection was prompted by a number of concerns raised by whistleblowers, people’s relatives and local authority commissioning and safeguarding staff. The concerns included a lack of leadership, people not receiving care to meet their needs, poor medicines management, people’s complaints not being acknowledged and acted on, reduced staffing levels, staff not having the skills to meet people’s needs, poor working relationships between staff and poor or inaccurate records.

There was a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the care and has the legal responsibility for meeting the requirements of the law. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The registered persons did not have oversight of the service. They had not supported staff to provide a good level of care or held them accountable for their responsibilities. A care consultant’s audit in October 2016 had identified a number of shortfalls in the service that we found at the inspection. Action had not been taken to improve the service following this audit.

People were not always treated in a kind and caring way and were not always treated with respect. For example, one person was given their medicine in some yoghurt while they were eating a savoury meal.

Some staff did not know the signs of possible abuse. Safeguarding risks had not been identified and referred to the Kent local authority safeguarding team for their consideration or investigation. Some staff had contacted the Kent local authority safeguarding team and CQC about concerns they had about the care people received.

Risks to people had not been consistently identified, assessed and reviewed. Action was not always taken to reduce risks. Detailed guidance was not available to staff about how to keep people safe.

Staff did not have the skills and guidance they required to keep people safe in an emergency. Following our inspection we informed the local Fire and Rescue Service about the risks we found.

Care had not been provided to keep people as healthy as possible. For example, care had not been planned for one person following an injury and treatment at the local hospital. Nurses did not follow the provider’s medicines procedures to protect people from the risk of unsafe medicines management, including the safe storage and administration of medicines.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Applications had been made to the supervisory body for a DoLS authorisation when people were restricted.

Staff did not follow the principles of the Mental Capacity Act 2005 (MCA). Assessments had not been completed of people’s capacity to make specific decisions. People were not consistently supported to make day to day decisions.

People did not have enough to do during the day. Their interests and preferences had not been considered when staff planned activities. One person told us they were lonely in their bedroom and had nothing to do or listen to.

People told us they liked the food at the service and portions sizes had increased following their complaints. People were not always offered food to help keep them as healthy as possible. Meal times were not planned to make sure tha

One inspector undertook the inspection. We spoke with management, care staff and reviewed documentation relating to the service.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking staff and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

We were made aware of concerns that people’s needs may not be being met. Our inspection found the service was safe.

Care plans were regularly updated and included guidance for staff about how to support a person’s needs and preferences. The service had a pre-admission procedure which included an initial assessment of people's needs. Potential risks to people were identified, assessed and managed. People's care plans and risk assessments were reviewed regularly to check they were still up to date. Spot checks were carried out that ensured that changes of needs were re-assessed and care plans were adjusted to reflect any changes.

The service acted in people’s best interests and had consulted with relatives / friends or advocates where people lacked capacity or had partial capacity. Deprivation of Liberty Safeguards (DoLS) assessments had been completed, when needed to protect people’s human rights.

People were supported to attend health appointments, such as, doctors or dentists. We saw records to show that the service worked closely with health and social care professionals to maintain and improve people's health and well-being.

We were made aware of concerns relating to staff shortages and that people’s needs may not be being met at all times. We therefore carried out a responsive inspection. We reviewed all the information we hold about this provider, then carried out a visit. We observed how people were being cared for, talked with staff, checked the provider’s records and looked at records of people who used the service.

The outcome of our inspection based on existing evidence, our visit and discussions with relatives at the time did not raise any concerns about the quality of care at The Willows.

The people that used the service had dementia and therefore not everyone was able to tell us about their experiences. To help us to understand the experiences people hade we used our SOFI (Short Observational Framework for Inspection) tool. The SOFI tool allows us to spend time observing what is going on in a service and helps us to record how people spend their time, the type of support they get and whether they have positive experiences. Some people using the service were able to tell us about their experiences and we also spoke with visiting relatives to the service.

We observed people expressing their opinions in a way that staff understood despite their communication difficulties. Staff had a good understanding of people’s methods of communication and picked up on an individual's body language in order to support people in a way they preferred. We were unable to directly talk to all of the people who used the service due to their communication difficulties but observed that they were happy with the care and support being offered and that their independence was encouraged.

Relatives spoken with told us that the service responded to their relatives health needs quickly and that staff talked to them regularly about their plan of care and any changes that may be needed. People said staff were caring and treated them with respect. Relatives spoken with and observations made did not raise any concerns with regard to the quality of care received. All staff spoken with demonstrated experience and knowledge to enable them to support people who lived at the service with their needs.

People were cared for, or supported by, suitably qualified, skilled and experienced staff. There was a clear recruitment procedure. Appropriate checks were undertaken before staff began work.

Staff demonstrated, through discussion, that they had the skills to carry out their role. Records we viewed showed that staff had received training in core courses. Training updates had been carried out in line with current guidance as recommended by Skills for Care, a government training agency. Staff said they felt supported by the training to carry out their role.

We reviewed all the information we hold about this provider, then carried out a visit on 17th June 2013. We observed how people were being cared for, talked with staff, checked the provider’s records and looked at records of people who used the service.

We used a number of different methods to help us understand the experiences of people who used the service, because some of the people using the service had complex needs which meant they were not able to tell us their experiences. These included observing the care and interactions between the people and staff.

People told us that the service responded to their health needs quickly and that staff talked to them regularly about their plan of care and any changes that may be needed. People spoken with and observations made did not raise any concerns with regard to the quality of care received. All staff spoken with demonstrated experience and knowledge to enable them to support people who lived at the service with their needs..

We saw that the people who used the service were making choices about their lives and were part of the decision process. People had their own individual routines which were respected. One person who used the service said "staff are very good. I have no concerns". Another person said “Food is great, lovely choices and plenty of it”. One other person who lived in the service said " If I was unhappy I would talk to the manager. My wife lives here. Staff look after her well. I have no concerns".

We did not speak with people at the care home, but we used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

We observed 4 people in the dining room and also observed other people in other parts of the home. We noted that staff were polite and respectful in their interactions with people. There was an activity co-ordinator who asked if people wanted to go on a walk along the sea front that morning, and 2 of the people joined in the activity.

We spoke with 2 visitors, who told us that their relative was happy at the home, and “settled well from the first day”. The visitors also told us that they were satisfied with the care received, and would not want to move their relative to another home.

We did not speak with people at the care home, but we used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

We observed 9 people in the dining room and also observed other people in other parts of the home. We noted that staff were busy and people initially did not have structured activities to occupy themselves, but an activity coordinator arrived after half an hour of observation, and started some group activities, including a game of dominoes.

This was an unannounced inspection that took place on 22 and 23 October 2014.

The Willows Care Centre is a large building set over three floors near to the seafront. There are 32 single bedrooms and four shared bedrooms. Communal areas include three lounge areas and a large lounge / dining area. The service provides nursing care and accommodation for up to 40 older people who also have dementia. At the time of our visit there were 39 people using the service.

The service has a registered manager who was present on both days of the inspection. 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 Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Whilst no-one living at the service was currently subject to a DoLS, the manager understood the implications of restricting people’s freedom and was aware of a recent Supreme Court Judgement which widened and clarified the definition of a deprivation of liberty. Policies and procedures were in place relating to the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). When people did not have the capacity to make more complex decisions appropriate advice was sought. Where people lacked the mental capacity to make decisions the home was guided by the principles of the Mental Capacity Act 2005 to ensure any decisions were made in the person’s best interests.

People’s needs were assessed and care plans detailed the support people needed. Care plans gave staff guidance and detailed people’s preferences, likes and dislikes. Some people using the service could become anxious. Care plans contained information about the most effective ways to manage people’s anxiety.

Staff were kind, attentive and patient when supporting people and treated them with respect. Staff spent time with people and were present in communal areas. Staff were quick to intervene when they noticed people needed support.

Staff understood how to protect people from risk of abuse and had been trained in safeguarding people. Relatives told us they were happy with the care and support provided at The Willows Care Centre and felt that people were kept safe. They said that the staff were caring and kind and knew people well. One visitor said, “‘I’m confident he’s safe and well cared for when I’m not here”.

The registered manager made sure there were enough staff on duty at all times to meet people’s needs. Appropriate checks were carried out before new staff started working at the service. Any gaps in employment were recorded, although only ten years of employment history was requested rather than a full employment history. Staff received appropriate training relevant to their role that was on-going and so kept up to date. Nursing staff were supported with training in specific nursing interventions such as wound care management and use of specialist equipment to help people maintain their independence.

Medicines were managed safely and people received their medicines when they needed them. Any risks associated with medicines were assessed and managed in people’s best interests.

There had been an accident in the home which had resulted in a serious injury. An investigation by the appropriate authorities had found that the service was not at fault. The premises were safe and well maintained. There was a clean, spacious environment which allowed people to move around freely without the risk of harm.

People’s health care needs were monitored and staff sought support and advice from appropriate health care professionals. Visitors told us they had no concerns about how staff supported people and said they were made aware of any changes and always knew when the GP was involved. One visitor told us, “The staff seem to look after every person individually and they do not regard them as ‘one’ but as people”.

People were provided with choices at meal times and relatives thought the meals always looked and smelled nice. One relative said, “There is always something different to choose from”. Another said, “Since the home has had this outside catering system, the variability of meal quality has been resolved. I am more than happy with it.”

People were given opportunities to take part in a range of activities. Staff worked with relatives to build up life histories for people and they used this information to spend time reminiscing with people and talking to them about different things that had happened during their lives. Visitors told us how they had been involved in bringing in information about their relative’s lives. Regular church services were held for people of different denominations and people were able to take Communion in private.

There was a complaints procedure and people were able to leave comments in a suggestion book. All the relatives we spoke with told us they had no complaints and were confident any concerns were acted upon. The manager gave relatives the opportunity to give their opinions on the quality of the service and listened to what people had to say. Relatives attended regular meetings and suggestions and requests were acted upon. Relatives and staff were confident in the management of the service. They told us that the manager was available to give support.

Systems were in place to make sure that the manager and staff learned from events such as accidents, incidents, and concerns.