This inspection site visit to place on 11 and 12 December 2018 and was unannounced.

Willow Lodge Care Home is a care home for 35 older 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. The home is purpose built over three floors. At the time of our visit there were 35 people living at the home, most of whom were living with dementia.

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.

At our last inspection, on 5 April 2016, we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At this inspection we found the service remained Good overall.

Why the service is rated Good.

We have made a recommendation about making the environment more dementia-friendly to promote people’s independence.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the systems in the service did not always reflect this practice. People were involved in day to day decisions about their care.

People were treated with kindness and compassion. Staff respected and upheld people’s privacy and dignity. People’s independence was promoted. Staff knew people well and understood their interests and hobbies. Visitors were welcomed.

There were sufficient staff available to meet people’s needs. Safe recruitment practices were used. Staff were supported with regular supervision and training. There was a positive and person-centred culture. Staff worked together as a team.

People needs were assessed before they moved into the home and as things changed. Care plans and risk assessments were person centred. Information was stored confidentially. People and their relatives understood how to raise a complaint and when these were made they were managed in a timely and effective way.

Risks to people due to the environment and their own needs were well managed. Plans were in place in the case of an emergency. Risks regarding the control of infection were well managed. Staff understood safeguarding and how to report any concerns. Action was taken to reduce the risk of incidents reoccurring. Quality assurance systems were used to reflect on practice and improve the service provided.

Prescribed medicines were managed safely. People had enough to eat and drink and were supported to eat, as required. People’s healthcare needs were met and staff worked in partnership with other agencies. Care at the end of people’s lives was planned for and people received personalised support at the end of their lives.

The inspection took place on 5 April 2016 and was an unannounced inspection.

Willow Lodge Care Home provides accommodation and care for up to 32 older people, most of whom have a diagnosis of dementia. The home is purpose built over three floors. At the time of our visit there were 29 people living at the home.

The service has 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.

People spoke positively about the care they received. They told us that staff were kind and friendly and that they were able to participate in a wide range of activities and outings. During our visit we heard lots of laughter and observed that people and staff enjoyed good relationships.

People felt safe at the home. Risks to people’s safety were assessed and reviewed. Any accidents or incidents were recorded and reviewed in order to minimise the risk in future. Staff understood local safeguarding procedures. They were able to speak about the action they would take if they were concerned that someone was at risk of abuse. People received their medicines safely. The home was clean and there were systems in place to protect people from the risk and spread of infection.

There were enough staff to meet people’s needs. Staff had received training and were supported by the management through regular supervision and appraisal. Staff were able to pursue additional training, such as in supporting people living with dementia which helped them to improve the care they provided to people. The provider was making improvements to the environment to make it more dementia friendly, such as by improving lighting.

People told us that staff treated them with respect. Staff understood how people’s capacity should be considered and had taken steps to ensure that people’s rights were protected in line with the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). We have made a recommendation about reviewing the use of locks on bedroom doors to ensure that people’s freedom of movement is not unnecessarily restricted.

People enjoyed the food and were offered a choice of meals. Staff were attentive to people’s needs and supported those who required assistance to eat or drink. People’s weight was monitored and prompt action taken if any concerns were identified.

People were involved in planning their care and were supported to be as independent as they were able. Where there were changes in people’s needs, prompt action was taken to ensure that they received appropriate support. This often included the involvement of healthcare professionals, such as the GP, district nurses or optician.

The registered manager had a system to monitor and review the quality of care delivered and was supported by the provider. People, their relatives and staff felt confident to raise issues or concerns with the registered manager. Where improvements had been identified prompt action had been taken.

One inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at. The home could accommodate 32 people and, when we visited, there were 29 people living in the home.

We spoke with five people living in the home and with four of their relatives who were visiting. We looked in detail at five care plans. We spoke with the registered manager, the head of care, the cook, two members of care staff and a member of the ancillary staff. We also spoke with a community psychiatric nurse who was visiting at the time of our inspection.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

Detailed assessments were undertaken to ensure the right level of care was available and staff were guided in their work by comprehensive care plans. Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. A dependency assessment was used to ensure that there were enough staff on duty. Staff were trained and competent to deliver a safe level of care. This meant that people were receiving a safe service.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place. Relevant staff have been trained to understand when an application should be made, and how to submit one.

Is the service effective?

We found that staff had received appropriate training to meet the needs of the people living at the home. This included regular updates in areas such as manual handling, first aid and fire safety. In addition, there was additional training in areas such as dementia and end of life care.

Staff were using effective practices, for example, to treat pressure sores and to prevent falls. We also found care staff sought advice, where appropriate, from qualified nurses and other healthcare professionals. This meant that the service was effective.

Is the service caring?

We saw how the staff interacted with people living in the home and that they were caring and sensitive. We spoke with a community psychiatric nurse who was visiting and said, “I think they genuinely care for the residents in this home. What I like is that they ‘phone me in good time and do not wait for a crisis to occur. They are proactive and the care they offer is lovely to see.”

We spoke with people living in the home and they all were happy with the care. One relative we spoke with said, “They know what they are doing here and standards are high. I have no complaints and no worries about the care.”

Is the service responsive?

We saw that staff responded promptly to call bells and helped people with eating, drinking and moving about the home. We found evidence in the care plans that staff contacted appropriate healthcare professionals when required and informed relatives of any changes.

The provider invited and listened to feedback and made changes where they were reasonably practical. Recent changes had included investment in the building, changes to the layout and improvements in lighting. People we spoke with said they enjoyed the food, that it was suited to their individual needs and was well balanced and nutritious.

Is the service well-led?

The home was well managed with a qualified team of professional care staff. The staff we spoke with said that the managers were approachable and supportive.

The provider conducted an annual independent audit of the service and was working through an action plan to continually improve standards. There was also an annual survey to take feedback and suggestions from people who lived in the home and their relatives. Feedback from the relatives we spoke with was extremely positive and the people living in the home were happy with the care they received.

Due to the needs of people living at the home we were only able to speak to one person. We spoke to three relatives of people living at the home. We also observed people and staff in the communal areas of the home.

People told us the staff treated them well. One person said, “The staff are very good. They are very helpful and they are nice people.” Relatives also commented on the kindness and patience of the staff. One relative said, “The staff are delightful,” and, another said, “The staff are A1. Never a dull word. Always with a smile.”

Relatives also said the staff were skilled in working with people who have dementia.

People and their relatives said the home met people’s needs. A relative told us, “I am absolutely delighted with the place as is my relative.” A relative commented that staff were responsive to people’s requests for assistance.

Two relatives commented on how good the environment was. One relative said how light and airy the home was and a person told us the home was kept clean.

People and their relatives said people were able to make choices in how they spent their time and in the meals they had.

People and their relatives said they considered the home to be a safe place for people to live.

Relatives told us the home asked them to give their views on the home by a satisfaction survey. We were also told by relatives that they felt able to raise any issues with the home’s management team.

During our inspection of Willow Lodge Care Home, we spoke with four people who lived at the home and spoke with the four members of staff who were on duty. We found the home to be relaxed and members of staff were supportive of people’s needs. On the day of our inspection, the areas had seen record temperature and we found that people living at the home were well hydrated.

We spoke with four people who told us they were happy with the care and support they received from members of staff.

Due to the complex needs of some people, we also spent some time observing people and saw that they were engaged in activities of their choice and at a level that was appropriate for them. We also used the Short Observational Framework for Inspection (SOFI). 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 and whether they have a positive experience. This includes looking at the support that is given to them by the staff and also staff interactions with people. Although no formal activities were taking place during our visit, we observed members of staff interacting with people and supporting them to listen to music, read the newspaper or watch television.

We found members of staff were friendly in their approach to people and treated them with dignity and respect. They addressed them in a manner that was appropriate to them and which corresponded with their preferred method of address.

Throughout our inspection, we found people appeared content in the presence of members of staff and there was a friendly and calm atmosphere. People were at ease with the care staff and we saw positive interactions throughout our stay.

The care records we inspected showed that relatives were encouraged to participate in people’s care reviews and were kept updated with any changes in conditions. We spoke with three relatives who told us they were delighted by the service provided by the home.

Two relatives we spoke with told us that the home was clean and tidy. We found the rooms, bathrooms, toilets, lounge, dining and to be clean.

We reviewed the medication records and saw that people received prescribed medications on time and that the medication was stored safely.

We found that the provider had effective recruitment policies and procedures in place to ensure staff were both fit and able to meet people's needs.