This unannounced inspection took place over two days on the 27 and 28 July 2017.

Willow Brook House provides accommodation for people requiring personal care and is registered to accommodate up to 48 people. At the time of our inspection there were 48 people using the service many of whom were living with Dementia.

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.

People received care from sufficient numbers of experienced staff that were supported to carry out their roles to meet the assessed needs of people living at Willow Brook House. Recruitment procedures protected people from receiving unsafe care from care staff unsuited to the role. Staff received training in areas that enabled them to understand and meet the care needs of each person.

People’s care and support needs were continually monitored and reviewed to ensure that care was provided in the way that they needed. People had been involved in planning and reviewing their care and had detailed individualised plans of care in place to guide staff in delivering their care and support.

People’s health and well-being was monitored by staff and they were supported to access health professionals in a timely manner when they needed to. People were supported to have sufficient amounts to eat and drink to maintain a balanced diet.

Staff understood the importance of obtaining people’s consent when supporting them with their daily living needs. People experienced caring relationships with the staff that provided good interaction by taking the time to listen and understand what people needed.

People’s needs were met in line with their individual care plans and assessed needs. Staff took time to get to know people and ensured that people’s care was tailored to their individual needs.

People had the information they needed to make a complaint and the service had processes in place to respond to any complaints.

People were supported by a team of staff that had the managerial guidance and support they needed to carry out their roles. The quality of the service was monitored by the audits regularly carried out by the registered manager and provider. The registered manager was accessible and knew people well.

This unannounced inspection took place over two days on the 12 and 15 August 2016.

Willowbrook House provides accommodation for people requiring personal care and is registered to accommodate up to 48 people. At the time of our inspection there were 46 people using the service many of whom were living with Dementia.

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.

Staffing levels during the day were not always sufficient to provide safe, person centred and responsive care to people. People, staff and our observations consistently demonstrated that there were not sufficient numbers of staff deployed in order to meet people’s needs.

People’s individual plans of care lacked sufficient detail to ensure people were receiving person centred care and treatment appropriate to meet their needs and reflect their personal preferences.

There were not appropriate systems or processes to assess, monitor and improve the quality and safety of the service in a timely manner. Quality assurances processes implemented by the provider were effective at identifying shortfalls, however these were not addressed in a sufficiently timely manner to minimise the impact on people.

The food provided to people living in the home was of a variable quality. People were not involved in the planning of meals and people’s individual preferences were not always considered when providing meals.

Staff were not consistently caring in their interactions with people because they were rushed. Much of the interaction between staff and people in the home was task focussed because staff did not have time to have meaningful engagement with people.

People were supported by staff that had the skills and knowledge necessary to provide safe and effective care and support. People’s consent was sought prior to care and support being delivered by staff.

There were appropriate recruitment processes in place and people felt safe in the home. Staff understood their responsibilities to safeguard people and knew how to respond if they had any concerns.

There were a range of activities which people told us that they enjoyed. These included one to one activities as well as group activities and days out.

People knew how to make a complaint. Where complaints had been received, these were investigated and responded to appropriately.

The registered manager was visible and approachable within the home. The local community were encouraged to play an active part in the home and were utilised to provide activities and meaningful interaction with people living in the home.

We found three breaches of regulation during this inspection. You can see the action that we have asked the provider to take at the end of the report.

We considered all the evidence we had gathered under the outcomes we had inspected to answer questions we always ask; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well lead?

This is a summary of what we found-

Is the service safe?

People's needs had been assessed before they moved into the home and care plans described how any identified risks to people were minimised. Recent increases in staff meant that there were enough staff on duty to meet the fundamental needs of the people living there. A member of the management team was available on call in case of emergencies. People had been cared for in an environment that was safe, clean and hygienic.

Is the service effective?

It was clear from our observations and from speaking with staff that they had a good understanding of the needs of the people living in the home and that they knew them well. People living with dementia were able to express themselves and staff understood their needs. Where people moved into the service arrangements were made to ensure they settled in and had access to activities to maintain their sense of well being. Staff received training to meet people's needs.

Is the service caring?

People were supported by kind and attentive staff who understood them and engaged in conversation. We noted that care workers showed patience and gave encouragement when supporting people. People living with dementia were observed to move freely around the unit without unnecessary restrictions. We observed and people told us they were able to do things at their own pace and were not rushed. We observed that staff were very supportive of people to enable them to attend activities.

Is the service responsive to people’s needs?

We saw that care plans had been updated when people’s needs had changed and that referrals had been made to health and social care professionals when needed. We noted that when people needed assistance then staff were responsive to their needs. One relative told us they were very pleased with the care their mother received. The service was very busy and on the dementia unit there were times when people did not always have access to staff to respond to their immediate needs. This meant there was a breach of the Health and Social Care Act regulations. A compliance action has been set and the provider must tell us how they plan to improve.

Is the service well-led?

There was a registered manager in post who managed the service on a day to day basis. There were systems in place to audit how people were cared for, if medication was administered safely and to ensure staff were competent to carry out their job role. People were encouraged to attend meetings to shared their views on the care at the home along with meetings for their relatives and staff. The manager had made changes to the premises, the staff team and the rota to ensure people were cared for safely.

We spoke with seven people who used the service and four visitors. One person said, ''Staff treat me with respect and observe my dignity, they help us where they can.’’ A visitor told us that they were very happy with the care their relative received and said, ‘’I do know that the care is much better here than where she was before.’’

We found that the home provided a programme of organised activities which helped people pass the time and kept them stimulated. These activities took account of people's needs, capabilities and their ability to concentrate.

People told us they felt safe living at the home and we found that people were able to express themselves freely and openly.

We found that the provider needed to make improvements to the way they agreed and communicated people’s care needs and to their quality assurance systems so the people and their relatives experienced a good service.

We carried out this inspection to check that improvements had been made. We spoke with several people during our inspection visit whose feedback confirmed that improvements had been made. Two people who use the service told us that there were more staff available and they didn’t have to wait as long for help as they used to do.

Two relatives told us that they had always been happy with the care of their family member. They described staff as “very caring” and said they always made sure that the person’s needs were met. Another relative commented “things are much better, improvements are being made”.

We also watched how staff responded to the needs of people with dementia who were not able to tell us about their experiences. We saw that there were sufficient staff to respond to people’s needs and that people were relaxed in the presence of staff.

We carried out this compliance review to check that improvements had been made since our last review.

We spoke with four people who used the service and their comments were summarised by one person who said “All the staff are kind and do what they can for me”. Three of the people we spoke with told us that there was not enough staff. This was supported by our findings and comments from three relatives of people using the service who all said there had not been enough staff.

Some people who used the service had complex needs which meant they were not all able to tell us their experiences. We watched how staff attended to the needs of people and the level of care they provided. We saw that staff worked hard to respond to people’s needs and to deliver the care that they needed.

Some of the residents at Willow Brook House have dementia and therefore not everyone was able to tell us about their experiences. To help us to understand the experiences of residents with dementia we used our SOFI (Short Observational Framework for Inspection) tool. The SOFI tool allows us to spend time watching 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 residents were able to tell us about their experiences and we also spoke with visitors to the service.

Residents made positive comments about the care that they received and the staff that provide their care. These included: “I get the help that I need”, “very good”, “caring”.

Six residents spoken with confirmed that they are treated with respect and feel safe at Willow Brook House.

Our observations during the inspection confirmed that residents are usually treated with respect by staff. We also saw residents enjoying conversation and laughing with staff.

This inspection took place on the 29 and 30 September 2015 and was unannounced.

The service is registered to provide accommodation and personal care for up to 48 older people, some with physical disabilities and others living with dementia.

At the time of the inspection there was no registered manager. 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. There was a manager in post who was in the process of applying to become the registered manager.

Staff were not having regular supervision at the time of the inspection and there were differences in the level of induction staff had experienced. The manager was aware of this and had plans in place to address this. All staff had undertaken mandatory training such as manual handling, health and safety and safeguarding. Some staff were very confident and competent at meeting the needs of the people living in the home whilst others needed more guidance and direction.

People expressed mixed opinions about the care and attention they received from staff. Some people told us how friendly and helpful the staff were whilst others felt the staff did not show enough interest in them. People were treated with respect but their dignity was not always maintained. Visitors to the home were welcomed at any time and encouraged to take part in activities. There was a weekly activities programme and everyone praised the involvement of the activities coordinator.

People were involved in decisions about the way in which their care and support was provided. Staff understood the need to undertake specific assessments where people lacked capacity to consent to their care and / or their day to day routines. People’s health care and nutritional needs were carefully considered and relevant health care professionals were appropriately involved in people’s care.

There were appropriate recruitment processes in place and people felt safe in the home. Staff understood their responsibilities to safeguard people and knew how to respond if they had any concerns.

There were a variety of audits in place and action was taken to address any shortfalls. Management were visible and were actively looking at ways to improve and develop the service.