The Willows Nursing Home is registered to provide accommodation for a maximum of seven people. The home specialises in providing care to adults who have a learning disability and complex support needs. At the time of our inspection seven people were living at the service.

At the last inspection, the service was rated Good.

At this inspection we found the service remained Good.

Why the service is rated good:

People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

Risks to people were assessed and where required a risk management plan was in place to support people manage an identified risk and keep the person safe.

Safe recruitment procedures ensured all pre-employment requirements were completed before new staff were appointed and commenced their employment. Staffing numbers were sufficient to meet people’s needs and this ensured people were supported safely.

The provider ensured that new staff completed an induction training programme which prepared them for their role. Training was completed in essential matters to ensure staff and people at the service were safe. Staff were supported through a supervision programme. Supervision is where staff meet one to one with their line manager to discuss their work and development.

People were supported to maintain good health and had access to external health care professionals when required.

Staff were caring towards people and there was a good relationship between people and staff. Staff demonstrated an understanding of the needs and preferences of the people they cared for.

Support provided to people met their needs. Supporting records highlighted information about what was important to people and how to support them. People were involved in activities of their choice.

There were systems in place to assess, monitor and improve the quality and safety of the service. Staff described the registered manager as supportive. Feedback from people and their representatives confirmed they were happy with the service and the support received.

Further information is in the detailed findings below.

This inspection took place on 23 October 2014 and was unannounced. The previous inspection of The Willows Nursing Home was on 30 October 2013. There were no concerns or breaches of the legal requirements at that time.

The Willows Nursing Home is a care home with nursing for up to seven people who have a learning disability and complex support needs. There was a registered manager in post. 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 service was safe for people. Staff had a good awareness of safety. They followed procedures which reduced the risk of people being harmed and which protected their rights. This included following the principles of the Mental Capacity Act 2005 to ensure any decisions were made in the person’s best interests when they lacked capacity.

Staff were knowledgeable about people’s needs and the support they required. They received training so that they were competent and did their jobs well. People had support plans which were kept under review. This helped to ensure people received care in a consistent way which reflected their current needs. Health professionals provided advice in areas such as diet and specialist seating for people so that staff provided the correct support.

People were supported by staff who made them feel valued. Staff understood how people communicated their feelings and emotions in non verbal ways. This meant staff could help people to make decisions, for example about what to eat and the clothes to wear. One staff member commented "We enable people as much as humanly possible."

Staff were responsive to people’s needs. For example, staff checked with people that they were comfortable and well positioned where they were sitting. Staff showed a caring approach towards people and helped people to maintain their family relationships.

Good information was available to staff about people’s likes and dislikes and staff supported people with their individual interests. One person attended a church regularly. Staff recognised that food preferences were important. We saw that one person’s had a particular liking for Chinese food and these meals had been provided.

There were some gaps however in the information that was available about people and the support they received. There was also a risk that some people’s views about the home were not being obtained and taken into account in the development of the service.

Systems were in place for monitoring the service people received. The registered manager had a clear vision for how the home was to develop, with the focus being on providing people with a more personalised service.

We visited The Willows to check if the service had implemented the action plan they had submitted to CQC to ensure they were compliant with the essential standards of quality and safety.

We looked at the cleanliness and infection control precautions of the premises and found that work had been completed and that the premises were safe for people who used the service.

During our visit we met four of the seven people who lived at the home and spoke with the manager and four members of staff. People appeared very comfortable in the presence of staff and it was evident that staff knew people well. They were skilled in recognising and responding to people's needs and the atmosphere in the home was relaxed. We observed people were offered assistance in a respectful and discreet manner. One staff member told us “I enjoy working here and taking people out to enjoy life and have fun.”

Each person had a plan which described the care and support they required and how staff should provide it. We looked at three care files for people who used the service we read that that people's health care needs were monitored to promote their well being.

We saw the provider monitored staff performance and that opportunities were given to staff for professional development.

We found that people were not protected from the risk of infection because appropriate guidance had not been followed. For example, we saw the sluice room was dirty and had an uncovered manual sluice which was not of an appropriate standard of cleanliness for the prevention and spread of infection. We judged that this had a moderate impact on people who used the service, and have told the provider to take action.

During the day of our inspection we were able to see everyone who lived at the home. No one was able to communicate their views verbally with us. We therefore spent time observing care, looking at records and speaking with staff who worked at the home.

Staff explained that they ascertained people’s preferences by interpreting body language and facial expressions.

We saw that people were well dressed and presented, demonstrating that staff took time to support people with personal care. When staff assisted people we noted that they explained everything that was happening to the person they were supporting and offered ongoing reassurance.

We observed that staff took people to their individual rooms to assist with personal care. This ensured that all personal care was carried out in private and maintained people’s dignity.

On the day of the visit there was a very relaxed atmosphere in the home and people appeared very comfortable with the staff who supported them. Staff interacted with people in a friendly and respectful manner.

There were adequate numbers of staff on duty to ensure that people received personalised care in line with their needs. The staff we observed, were patient and kind in their interactions and assisted people in an unhurried manner.

All staff spoken with demonstrated an excellent knowledge of the needs of the people who lived at the home.