This inspection took place on 06 and 07 June 2017 and was unannounced. Willett House is a home providing residential and nursing care for up to 37 people living with dementia. At the time of our inspection there were 36 residents living at the home. At our last inspection in June 2015 we found the service to be meeting regulatory requirements and was rated ‘good’.

There was no registered manager at the service at the time of our inspection. The previous registered manager had deregistered in January 2017 although they maintained a senior clinical role at 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. The provider’s nominated individual had taken on responsibility of manager of the home on a day to day basis, whilst recruiting for a new registered manager which we confirmed was in progress at the time of our inspection.

At this inspection we found improvement was required relating to the safe management of environmental risks and to ensure people consistently received their medicines as prescribed. The provider took prompt action to address the issues we identified in these areas to ensure people were protected.

People were protected from the risk of abuse because staff had received training in safeguarding adults. They were aware of the different potential types of abuse and the action to take if they suspected abuse had occurred. Risks to people had been assessed and measures put in place to manage identified areas of risk safely. There were sufficient staff deployed within the service to meet people’s needs and the provider followed safe recruitment practice when employing new staff.

Staff were supported in their roles through regular training, supervision and an annual appraisal of their performance. They were aware of the importance of seeking consent from people when offering them support and followed the requirements of the Mental Capacity Act 2005 (MCA) where people lacked capacity to make decisions for themselves to ensure decisions were made in their best interests. The provider worked within the requirements of the Deprivation of Liberty Safeguards (DoLS) to ensure any restrictions on people’s freedoms were minimised and lawful.

People were supported to maintain a balanced diet and told us they enjoyed the meals on offer at the service. Staff supported people to maintain good health and access a range of healthcare services when they needed them. People and relatives told us staff were caring and considerate and treated them with dignity and respect. Staff were aware of the steps to take to ensure people’s privacy was maintained.

People were involved in day to day decisions about their care and treatment and they, or their relatives where appropriate, had been involved in the planning and reviewing of their care. The provider offered a range of activities to people in order to promote social stimulation, and visitors were welcome at the service whenever they wished. The service had a complaints policy and procedure in place which was on display within the service for people to refer to. Records showed that any complaints received had been investigated and addressed.

Whilst people did not comment directly on the management of the service, relatives told us the service was well run, and this view was shared by staff, and health and social care professionals who visited the service. The service maintained a positive working culture and relatives spoke positively about the attitude of the staff. The provider undertook a range of checks and audits to monitor and improve the quality and safety of the service. They also sought feedback from people and relatives to help drive improvements at the service.

Most people using the service were not able to express their views regarding the quality of care they received due to the effects of dementia. However, relatives that we spoke with felt that staff were responsive to people’s needs and were very complimentary about the level of care provided for their relatives. Relatives comments included; “excellent care…second to none”, “always clean”, “staff couldn’t be more helpful and “more staff on primrose unit would be welcomed”. During our inspection, we observed most staff interacting with people respectfully, and in a manner appropriate to their individual care needs.

We found that relatives and professionals were involved in best interest decisions, where people lacked the mental capacity to make specific decisions about their care. Although staff had not received training of the Mental Capacity Act (2005), plans had been made by the provider to provide this training. We found that people’s needs were assessed, and care was regularly reviewed and delivered in line with an individual’s care needs. The provider had suitable arrangements in place to protect people against the risks associated with infections, and to ensure that suitable staffing levels were in place to meet the needs of the people. We found records were fit for purpose, securely stored and archived for an appropriate period of time.

The people at Willett House had difficulties in expressing their views to us due to having dementia. We spoke with four relatives who all made positive comments about the service, the care that was provided and the staff. They said that the home was ‘As good as it gets’, ‘All the carers are extremely kind’, ‘Care is very good’ and that their relative was ‘Being cared for very well’.

We found that people were treated respectfully, their needs were assessed and their care was planned and delivered in a way to meet people’s individual needs.

Staff members we spoke with told that they were well-supported by their senior workers and the manager and they liked working at Willett House.

This inspection took place on 9 and 23 April 2015 and was unannounced.

Willett House is a care home providing nursing care for up to 35 older people living with dementia.

We last inspected Willett House in October 2013. At that inspection we found the service was meeting all the regulations that we assessed.

There was not a registered manager in post at the time of our inspection. 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. The acting manager was in the process of applying for registration with CQC.

People and their visitors were positive about the care and support provided at Willett House. Staff knew people well and treated them in a kind and dignified manner. We observed positive relationships between staff and people at the service and their visitors throughout our visits.

Any risks to people were identified and they were supported to maintain their welfare and safety. Staff were knowledgeable about safeguarding adults procedures and said they would report any concerns they had to their manager and other senior staff.

People were supported to have their health needs met. Staff at Willett House worked well with other healthcare professionals and obtained specialist advice as appropriate to help make sure individual health needs were met. We saw that people’s prescribed medicines were being stored securely and managed safely.

Staff attended regular training which gave them the knowledge and skills to support people effectively. Staff had received training in the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS). Where people no longer had the capacity to consent to aspects of their care, staff worked in people’s best interests and looked to use the least restrictive option.

People and their visitors said they felt able to speak to the acting manager or other staff to raise any issues or concerns.

The acting manager supported staff to deliver appropriate care and support. There were effective systems to monitor the quality of the service and obtain feedback from people and their representatives.