This focused inspection took place on 7 November 2018 and was unannounced.

We completed an unannounced comprehensive inspection of this service in February 2018. After that inspection we received concerns regarding the management and governance within the home and how people’s care, treatment and support needs were being delivered. Concerns were also raised as to whether staff had the skills, knowledge and experience to meet the needs of the service. Concerns that people were not receiving an appropriate level of nutrition and hydration. Lack of consent for care and support delivery and issues with the environment not being appropriate to meet people’s needs.

As a result, we undertook a focused inspection to look into those concerns. This report only covers our findings in relation to those topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for (St Martin’s Care Limited) on our website at “www.cqc.org.uk”

The team inspected the service against two of the five questions we ask about services: is the service effective and is the service well led? No additional risks, concerns or significant improvement were identified in the remaining Key Questions through our ongoing monitoring or during our inspection activity so we did not inspect them. The ratings from the previous comprehensive inspection for these Key Questions were included in calculating the overall rating in this inspection.

Willow Green 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 care home accommodates 63 people across two floors. At the time of the inspection 53 people were being supported in the home, 20 of which were receiving nursing care.

The service did not have a registered manager. A new manager was in post who had commenced the process to become the registered manager of Willow Green.

‘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.’

Some people felt the quality of the food needed improving. Plans were in place to address this with the development of new menus. A new chef had been employed.

People’s needs were assessed in line with best practice and current legislation to ensure they could be supported in Willow Green. People’s likes, dislikes and preferences were used in planning outcomes. Staff were aware on how to provide support and guidance to meet people’s outcomes.

Staff told they felt supported and received regular supervision and annual appraisals. Staff had received appropriate training to meet the needs of the service. The manager had planned in additional training for staff to completed to increase their skills and knowledge.

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

People had their nutritional needs assessed regularly and were supported to eat and drink safely. Where specialist diets and thickened fluids were required, these were provided. People’s health was monitored and when necessary staff ensured people had access to health care professionals when necessary.

The provider had commenced a programme of refurbishment with some rooms being redecorated. The reception carpet was due for renewal. Rooms were personalised to people’s taste. Communal areas were spacious and accessible. People had access to outside areas. The home was clean with no odours.

The provider’s senior management structure had been revised. Senior management wer

This inspection took place on 15 March and 5 April 2018 and was unannounced. This meant staff and the provider did not know that we would be visiting.

Willow Green Care Home is a ‘care home’. People in care homes receive accommodation and 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. Willow Green Care Home accommodates up to 63 people across four separate units, each of which have separate adapted facilities. Three of the units specialise in providing care to people living with dementia. At the time of this inspection 49 people were in receipt of care from the service.

At the last inspection in November 2015 we found the provider was meeting the fundamental standards of relevant regulations. At that time we rated Willow Green Care Home as ‘Good’ overall and ‘Good’ in four domains. We rated the service as ‘Outstanding’ in one domain, namely 'Responsive’.

The registered manager left their post since February 2018. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like 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. A new manager is in post and submitted their application to be the registered manager in March 2018.

At this inspection we found staff remained exceptionally responsive towards people and dedicated to ensuring people experienced high quality care. We saw that staff treated people very much as individuals and ensured people continued to follow their preferred routines. We found staff were passionate about providing a vibrant service that gave all equitable choices and experiences. We heard how the provider was currently reviewing the service to ensure guidance from Stonewall (which is an organisation that campaigns for equal rights for lesbian, gay, bisexual and trans people across Britain) is incorporated into all the practice. The aim was ensure the service supported people diversity and those from LGBT groups felt welcome to stay at the service.

We found that the activity coordinator had worked hard to create a sense of community within the service and developed links with local organisations. The activity coordinator was constantly looking at ways to engage people in activities. Following feedback from people the activity coordinator looked to find ways to support people to give back to the community and was currently organising a litter pick at a local cemetery. They had posted this activity on the service’s Facebook account and received a lot of positive feedback. The local council had donated equipment such as litter pickers and the local newspaper had written an article about this event.

We found the staff had developed excellent links with external healthcare professionals and worked collaboratively with these teams, for example, the REACT team, hospital occupational therapists and physiotherapists. The staff also worked closely with the local palliative care team and people told us this assisted staff to plan end of life care plans, which met individual’s need. The team worked collaboratively with people and their relatives to ensure the care provided met each person's needs.

The community nursing team regularly visited and told us they were very impressed with the service and the way staff supported people. One of the visiting professionals found this to be one of the best services in the area and they had recommended it to a relative, as a place to reside.

The provider had recently introduced new assessments and care records, which staff told us were more informative and easier to use. They were currently evaluating the tools to ensure they were effective and see where improvements could be made.

People’s care needs were risk assessed with risk managem

Our inspection team was made up of one inspector. We gathered evidence against the outcomes we inspected to help answer the five key questions: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

In this report the name of a registered manager appears who was not managing the location at the time of the inspection. Their name appears because they were still a registered manager on our register at the time of inspection. The service had a manager in post that at present is going through the registration process.

We looked at a range of records; spoke with the deputy manager, nursing unit manager, activity co-ordinator, eight members of staff, 15 people who used the service and two friends of a person using the service. We also observed the interactions between staff and people living at Willow Green Care Home.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records.

Is the service safe?

Everyone we spoke with told us they felt safe and secure living at Willow Green Care Home. Procedures were in place to guide staff on the actions they needed to take if they suspected abuse. The staff we spoke with had received safeguarding training and were aware of their reporting responsibilities and understood the procedures they needed to follow to ensure people were safe.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care home. The home had proper policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards. At the time of our inspection they had no DoLs safeguarding's in place. The majority of staff had received training in relation to these topics along with the safeguarding of vulnerable adults and had an understanding of the actions to take.

Willow Green Care Home was clean, hygienic and well maintained. There were good processes in place that ensured infection prevention and control of the home.

People were aware of the complaints procedure and there were systems in place for monitoring complaints.

There were effective systems in place for the ongoing maintenance and servicing of equipment. There were also good systems in place in respect of fire safety and fire training.

Is it effective?

People all had their needs assessed and had individual care records which set out their care needs. People told us that they received the care and support they needed. We saw evidence of how the information from people's care records were transferred into practice. For example, staff were seen to use the moving and handling equipment identified in a person's care record and how one person was supported with gentle hand exercises in bed.

It was clear from our observations and from speaking with staff that they had a good understanding of the people's care and support needs and that they knew them well.

Staff knew how and when to involve other health and social care professionals. We saw lots of evidence contained within people's care records.

Is it caring?

People were supported by kind and attentive staff. We saw that staff engaged with people in a positive way and showed respect, kindness and gave people gentle encouragement. Some people who used the service liked to have a joke with the staff and there was a lot of laughter.

People's needs had been assessed and care plans put in place which detailed people's needs and preferences. These records provided a good level of information to staff on what care and support people who lived at Willow Green Care home needed. Care and support had been provided in accordance with people's wishes.

There was also a lot of information in the care files about peoples past called ‘my life my memories.’ This included information on a person’s childhood, young adulthood, middle age and later years.

The activity co-ordinator showed us some work she had being doing on memory boxes; these boxes were covered with photographs of the person who used the service and their families, friends and pets. For people who they could not find out information on their past lives, the activity co-ordinator was starting a memory book from the day they entered Willow Green Care Home.

Is it responsive?

There was clear evidence contained within people's care plans to show how they worked with other health and social care professionals. Records were kept of all interactions with doctors, dentists, opticians, physiotherapists etc.

People told us that they knew how to make a complaint if they needed to. When asked about the complaints process, they all said they would go to the manager with any problem which had not been resolved with care staff.

It is well led?

The service worked well with other agencies and services to make sure people received their care in a joined up way. People who used the service could be seen by the chiropodist, dentist, hairdresser and optician who regularly visited the home.

The home had a manager who was currently going through the registration process. The manager was on holiday at the time of inspection. The manager was supported by a deputy manager. There were systems in place to assure the quality of the service they provided. The way the service was run was regularly reviewed. Actions were put in place when needed and we were able to see that these actions had been addressed.

People who used the service, their relatives and friends had opportunities to attend regular meetings.

Staff we spoke with were clear about their roles and responsibilities. These staff had a good understanding of the ethos of the home and were knowledgeable about people's needs. This helped to ensure that people received a good quality service at all times.

People who used the service choose when to go to bed and get up in the morning. The activity co-ordinator arranged for a local clothes shop to bring in clothes and jewellery for the people who used the service to buy, we observed this and it was received very well. People also attended a tea dance in the local town on the afternoon and told us how much they enjoyed this. The activity co-ordinator told us she is always trying to think of new activities and recently hired a music studio where the people who used the service made a CD and sang ‘with a little help from my friends, this was recorded in the local newspaper.

What people told us

We spoke with 15 people who used the service and they said “It is comfortable here, it is like a home from home,” and “Staff are good, I have never been refused anything,” “It is very clean here, staff hoover every day.”

One person who used the service said “I was very reluctant to come in, there were lots of tears, but now I realise it was the right thing for me, I feel safe and I can go to bed and sleep without worrying, as the staff always check on me to make sure I am okay.”

Staff we spoke with said “We are like a little family and it’s all about the residents,” “I am really, really happy here, I am developing as a nurse,” and “They are all unique in their own way, I treat them all as individuals.”

The activity co-ordinator said “I like to help and encourage them to do new things, things that they would think were impossible such as the recording of the CD.”

We spoke with seven people living at the home. Some people were not able to tell us directly what they thought about the service. However, during our visit we spent time observing how care staff supported people and this was positive and respectful.We spoke with one person who chose to self administer one of their medicines and was supported to do so.

People were positive in their views about the home. They told us; “I have a lovely sunny room” and “It’s alright here, I’ve got no complaints”,

We saw that the activities co-ordinator had carried out some sensitive work with people around advanced care planning. She told us “It’s good to talk with people about their end of life wishes if it is appropriate to do so”.

The home had a quality assurance system in place that showed regular checks were carried out on equipment and the environment.

A complaints procedure was in place which was clearly displayed in easy to read format. A record was in place which showed the provider had systems in place to deal with comments and complaints. Staff received relevant training, supervision and appraisal which meant they were supported to deliver care safely and to an appropriate standard.

We carried out this visit in response to concerns that had been raised around the use of equipment in the home particularly around hoists that were not fit for purpose.

We spoke with four people who used the service and one visitor. They were very positive in their views of the home. One lady told us it was her birthday and the chef had specially prepared her favourite lunch. We saw staff interacting sensitively with people and we saw staff assisting someone who had fallen by using role modelling to show the person how they should safely get into a position whereby staff could use equipment to help them get back up.

We looked at records and spoke with managers from the home and the provider. We saw that new hoists had been purchased and that three previous hoists that had faults had been de-commissioned. We saw that the provider had arranged appropriate servicing and checks on new hoists and daily checklists were in place for all staff to complete to ensure equipment was safe and ready for use.

Records showed that checks were being regularly undertaken on fire equipment and we saw servicing records for other safety requirements such as electrical safety and water temperatures. We also looked at two care files, one for someone recently admitted to the service. These showed assessment and involvement of the person and their family and were personalised.

We spoke with seven people living at the home. Some people were not able to tell us directly what they thought about the service. However, during our visit we spent time observing how care staff supported people and this was positive and respectful.

People were positive in their views about the home. They told us; “It’s very good here”,

“I’m well looked after”, and “I’d have no life if I wasn’t here."

Care plans were written in a clear and easy to understand way and people’s personal preferences were clearly recorded.

There were sufficient staff on duty to support people for their care needs. We looked at how the service recruited staff by checking six staff files. These showed proper checks and procedures were being followed.

We spoke to two people who used the service about their medicines at this visit. One said he was very happy for staff to look after his tablets but he wanted to keep his own eye drops so that he could use them when he needed to. The other person who looked after his inhalers would have also liked to administer his own tablets but also said that he probably would find them too confusing and would be unable to manage them correctly.

The people we spoke to were positive about the care they or their relative received at Willow Green.

• Overall, we found that Willow Green Care Home was meeting this essential standard.

The inspection took place on 4 and 5 November 2015. The inspection was unannounced. We previously inspected this service on 13 August 2014 and found the service to be complient.

Willow Green is a residential and nursing care home based in Darlington, County Durham. The home provides care to older people and people living with dementia. It is situated close to the town centre, close to local amenities and transport links. On the day of our inspection there were 52 people using the service.

The home 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.

We spoke with a range of different team members; care, nursing, senior and kitchen staff who told us they felt well supported and that the registered manager was passionate about his job and his staff team and always available and approachable. Throughout the day we saw that people who used the service and staff were comfortable, relaxed and had a positive rapport with the registered manager and with each other. The atmosphere was exceptionally welcoming, homely and relaxed. We saw that staff interacted with each other and the people who used the service in a friendly, supportive, positive and respectful manner.

From looking at people’s detailed care plans we saw they were written in plain English and in a person centred way and they also included a ‘one page profile’ that made good use of pictures, personal history and described individuals care, treatment and support needs. These were regularly reviewed and updated by the care staff and the registered manager.

Individual care plans contained risk assessments. These identified risks and described the measures and interventions to be taken to ensure people were protected from the risk of harm. The care records we viewed also showed us that people’s health was monitored and referrals were made to other health care professionals where necessary for example: their GP, community nurse or Chiropodist.

Our observations during the inspection showed us that people who used the service were supported by sufficient numbers of staff to meet their individual needs and wishes.

When we looked at the staff training records they showed us staff were supported and able to maintain and develop their skills through training and development opportunities. The staff we spoke with confirmed they attended a range of learning opportunities. They told us they had regular supervisions and appraisals with the registered manager, where they had the opportunity to discuss their care practice and identify further mandatory and vocational training needs. We also viewed records that showed us there were robust recruitment processes in place.

We observed how the service had made improvements to how they administered medicines and how they did this safely. We looked at how records were kept and spoke with the registered manager about how staff were trained to administer medication and we found that the medication administering process was safe.

During the inspection we witnessed the staff rapport with the people who used the service and the positive interactions that took place. The staff were extremely passionate, caring, positive, encouraging and attentive when communicating and supporting people and nothing was too much to ask of them.

People were consistently actively encouraged to participate in numerous activities that were well thought out, organised, personalised and meaningful to them including a community choir, animal therapy and sensory activities. We saw staff spending their time positively engaging with people as a group and on a one to one basis in fun and meaningful activities. We saw evidence that people were not only being supported to go out and be active in their local community but were also valued members of the local community. People were members of the working mens club and regularly supported the local drama group and the service was active on social media

We saw people were encouraged to eat and drink sufficient amounts to meet their needs. We observed people being offered a varied selection of drinks and snacks. The daily menu that we saw offered choices and it was not an issue if people wanted something different.

We saw a complaints and compliments procedure that was in place and this provided information on the action to take if someone wished to make a complaint and what they should expect to happen next. The compliments that we looked at were overwhelmingly complimentary to the care staff, management and the service as a whole. People also had access to advocacy services if they needed it.

We found an effective quality assurance survey took place regularly and we looked at the results. The service had been regularly reviewed through a range of internal and external audits. We saw that action had been taken to improve the service or put right any issues found. We found people who used the service; their representatives were regularly asked for their views at meetings.