This inspection was unannounced and took place on the 9 and 10 July 2018.

Willow Court Nursing Home is a ‘care home’ and is registered to accommodate up to 66 people. 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. At the time of the inspection, 63 people were accommodated at the home. Willow Court is situated in the grounds of Andover War Memorial Hospital.

There was 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 and associated Regulations about how the service is run.

At our last inspection on 27, 28 and 29 September 2016, we found one breach of regulations. The service did not have an effective system in place to monitor and assess the quality of the service provided, or to take action where necessary to address and rectify any shortfalls. During this inspection, we found action had been taken and improvements made.

People felt safe living at Willow Court Nursing Home and they were very much at the heart of the service. Staff enjoyed working at the home and understood the needs of people using the service and supported people in a personalised way. Staff knew people well and we saw that care was provided respectfully and sensitively, taking into account people’s different needs.

Relevant recruitment checks were conducted before staff started working in the home to make sure they were of good character and had the necessary skills. Staff had received training in safeguarding adults and knew how to identify, prevent and report abuse. There were enough staff to keep people safe.

The risks to people were minimized through risk assessments. There were plans in place for foreseeable emergencies and fire safety checks were carried out.

People received varied meals including a choice of fresh food and drinks. Staff were aware of people’s likes and dislikes and went out of their way to provide people with what they wanted.

Staff received regular support and one to one sessions or supervision to discuss areas of development. They completed a wide range of training and felt it supported them in their job role. New staff completed an induction programme before being permitted to work unsupervised.

Staff had an understanding of the Mental Capacity Act (MCA) and were clear that people had the right to make their own choices. Staff sought consent from people before providing care and support. The ability of people to make decisions was assessed in line with legal requirements to ensure their rights were protected and their liberty was not restricted unlawfully. People are supported to have maximum choice and control of their lives and staff supported them in the least restrictive way; policies and systems in the service support this practice.

People were cared for with kindness, compassion and sensitivity. Care plans provided comprehensive information about how people wished to receive care and support. This helped ensure people received personalised care in a way that met their individual needs.

People were supported and encouraged to make choices and had access to a range of activities.

The registered manager maintained a high level of communication with people through a range of newsletters and meetings. ‘Residents meetings’ and surveys allowed people and their families to provide feedback which was used to improve the service. People felt listened to and a complaints procedure was in place.

There were appropriate management arrangements in place. Regular audits of the service were carried out to assess and monitor the quality of the service.

This inspection was unannounced and took place on the 27, 28 and 29 September 2016.

Willow Court provides nursing, short term respite and residential care for up to 66 older people. The home accommodates people with a range of needs, including those living with dementia, epilepsy and diabetes. At the time of our inspection 63 people were living in the home.

Willow Court is a purpose built nursing home situated in the grounds of Andover War Memorial Hospital. The home comprises of single occupancy bedrooms with ensuite toilet and hand washing facilities. The home is over two storeys with the first floor accessible to those with mobility needs via a lift. Willow Court is divided into seven distinct living areas, Acacia, Juniper, Saffron, Rosemary, Jasmine, Primrose and Lavender with appropriate signage to make it easier for those with dementia to navigate independently. The building is situated around a secure garden which is accessible to people and visitors by double opening doors on the ground floor.

There was a registered manager at this location. 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 HSCA and associated Regulations about how the service is run.

We make recommendations to signpost providers to potential action they can consider to help them improve the quality of the service they provide to people who use it. We follow up recommendations at our next inspection. At our last inspection on 19 and 23 January 2015 we made two recommendations where the provider could take action. These concerned the documentation and practice regarding ‘as required’ medicines and pain assessments and ensuring that activities were offered which meet the needs and wishes of the people using the service.

During this inspection we saw that appropriate documentation was in place to provide guidance to staff in peoples care plans about the use of as required medicines. We saw that people were encouraged to participate in activities which better suited their needs. However we saw activities staff were also completing other functions within the home. We have made a recommendation that the role of the activities coordinator is reviewed to ensure they remain dedicated and able to complete the role they are employed to fulfil.

The provider did not always ensure that effective quality assurance and auditing systems were in place in order to drive improvements in the quality of the service people received. Action was not always taken to rectify where shortfalls in service provision were found.

There were sufficient numbers of staff deployed to meet people’s individual needs. Processes were in place to regularly review the required level of staff to ensure this remained appropriate.

The home provided both long term and short term care for people including those living with dementia and the environment was designed and decorated in a way to support people to move around the home safely enabling them to remain independent. Corridors were wide and well lit with contrasting different coloured handrails to aide people who were able to walk. Appropriate signage helped people to orientate themselves around the home.

Relatives of people using the service told us they felt their family members were cared for safely. Staff understood and followed the provider’s guidance to enable them to recognise and address any safeguarding concerns about people.

People’s safety was promoted because risks that may cause them harm had been identified and guidance provided to manage these appropriately. People were assisted by staff who encouraged them to remain independent. Appropriate risk assessments were in place and regularly reviewed to keep people safe.

Thorough recruitment procedures were completed to ensure people were protected from the employ

During this inspection we met some of the people who used the service and spoke with the registered manager, a deputy manager, a nurse and five care staff. We looked at care and support records for six people who used the service. We saw that improvements had been made to ensure that peoples’ needs were assessed and care and treatment was planned and delivered in line with their individual needs. The care records we saw had been audited thoroughly and reflected a person-centred and responsive approach to the review of records. This was to ensure that all documents were fit for purpose, understood by staff and fully completed.

People were being supported to be able to eat and drink sufficient amounts to meet their needs. During the lunch time meal, we observed that staff provided people with assistance to eat and drink, where required, in a patient, calm and friendly manner. A person who had just finished their meal told us: “The food is good”. The provider had also taken steps to ensure there were enough qualified, skilled and experienced staff to meet people’s needs. Additional staff were on duty and further recruitment was taking place. Throughout the inspection we observed staff meeting people’s needs in a timely and responsive manner. All of the above improvements will need to be embedded in practice and sustained.

We spoke with the manager, four nurses, four care assistants, an activities coordinator, four people who used the service and a relative.

Staff worked in ways that respected people’s privacy and dignity and took their views and experiences into account. A person who used the service said that the meals were very good and they could choose what they would like to eat. However, we found that people were not always protected from the risks of inadequate nutrition and dehydration. Staff received appropriate professional development, supervision and training and staff we spoke with demonstrated their knowledge of people’s needs. Records showed that external health professionals were appropriately consulted about changes in people’s health and well-being.

One person told us “the care is wonderful”. Another person said that they felt “well looked after”. They said that staff came quickly if they pressed the call bell. They told us that that they got on well with staff and looked forward to seeing them. However, other evidence showed that there was not an effective system in place to ensure that people’s needs were assessed and care and treatment was planned and delivered in line with their individual needs. There were not always enough qualified, skilled and experienced staff to meet people’s needs. We found that people were not protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were not being maintained.

People using the service told us staff checked with them whether they were happy to receive care and confirmed that staff respected their wishes.

People told us staff provided the care and support that they needed. Comments from people included “Staff provide all the care I need” and “Staff come quickly when I use the call bell and provide good care”. People said they had been involved in developing and reviewing their care plan and that staff provided the care detailed in their plan.

People told us the home was always kept clean. Comments included, “The place is always very clean, smells very fresh” and that the home is “Cleaned everyday”.

People we spoke with said they were able to raise concerns with the staff or manager and were confident that action would be taken to address the issue. One person said they could raise issues at residents’ meetings and staff would “Do something about it”. Another person said they had not had to make any complaints, but were confident that any concerns would be taken seriously and resolved.

People we spoke with said they felt they were well treated by staff and that staff had the right skills to meet their needs. People said staff provided care in the way they wanted it and did things differently if requested.

People said they felt safe in the home and were confident that staff would respond appropriately to any concerns they raised.

Most people we spoke with said they thought there were sufficient staff available when they needed them. People gave examples of staff responding promptly when they used their call bell. Some people said staff were rushed at times, but they were able to meet their needs.

This inspection took place on 19 and 23 January 2015 and was unannounced.

Willow Court is a purpose built nursing home, in the grounds of Andover War Memorial Hospital. The home provides care for up to 66 people, some of who are living with dementia. There were 60 people using the service at the time of this inspection.

The service had a 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.

The majority of people were complimentary about the service they received. However, our own observations and the records we looked at did not always match the positive descriptions people and relatives had given us.

Although people told us they felt safe and they received their medicines on time, we found good practice was not always followed for the recording of medicines or the assessment and administration of as required medicines, particularly around pain relief.

There were enough staff to meet people’s needs and a system was in place to monitor and vary staffing levels if people’s needs changed. The service carried out appropriate recruitment checks to help ensure that staff were suitable to work with people at risk.

Staff were aware of their responsibilities in regards to safeguarding and reporting any issues of concern. They were confident to use the relevant policies and procedures and had received training to support them in keeping people safe.

Staff were knowledgeable about the wishes and needs of the people they supported. We found care planning required improvement as there were some gaps within the care records which did not always include specific guidance for particular needs.

People were treated with dignity and respect. Privacy was maintained and staff offered choices and involved people in their care.

People were supported to have sufficient to eat and drink. Snacks and drinks were available during the day. Specialist needs were responded to. Family and friends were able to visit and told us they were kept informed about their relative.

Staff had mixed views about the effectiveness of communication with the management. Relatives and people were not always fully involved in the running of the service.

Staff involved relevant health professionals and responded quickly to people’s changing health needs. Staff were supported by the registered manager and received relevant training and supervision to support them in their roles.