About the service: Willow View Care Home provides accommodation and residential care for up to 64 people, some of whom have a dementia related condition. The home comprises of two areas; Willow View which was the original building and the new extension wing, Willow Gardens. The two buildings were connected by a covered walkway.

People’s experience of using this service: People and relatives were positive about the caring nature of staff. One person told us, “I’m living well here.” A relative said, “I know he’s well cared for, he’s in a nice place and they care about him.”

Staff spoke positively about the people they supported. They said they would be happy for their relatives to live at the home because of the standard of care provided.

Effective systems were in place to ensure people’s safety. There were no ongoing safeguarding investigations. Risks were assessed and monitored, sufficient staff were deployed and safe recruitment procedures were followed.

Health care professionals spoke positively about the service. One health care professional told us, “Staff are proactive, there is excellent team work here - staff are forward thinking.”

A range of activities were organised to help ensure people’s social needs were met.

There was a designated quiet area within Willow Gardens for end of life care. A multi-disciplinary approach was followed to help ensure consistent and responsive care was provided to meet people’s needs at this important time in their lives.

The was a clear management structure in place. Audits and checks were carried out to monitor the quality of the service. Action was taken if any shortfalls were identified.

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.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk.

Rating at last inspection: Requires improvement (report published 12 March 2018).

Why we inspected: At our previous inspection we identified four breaches of the regulations relating to safe care and treatment, safeguarding people from the risk of abuse and improper treatment, person-centred care and good governance. We carried out this inspection in line with our scheduling guidelines for adult social care services. We found that improvements had been made and all regulations were being met.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit. If any concerning information is received we may inspect sooner.

The inspection took place on 10 and 25 and 30 January 2018. The first day of the inspection was unannounced. This meant that the provider and staff did not know we were coming.

Willow View 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.

Willow View can accommodate up to 54 people across three separate areas each of which have separate adapted facilities. At the time of our inspection one of the areas specialised in providing care to people living with dementia. The Willow Gardens area is a newly built extension that is currently a stand-alone building but will be joined to the original building via the creation of a link corridor. Building work was still underway to construct the link at the time of our visit. There was a dining room on each unit and a number of communal living areas.

The service had 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 2008 and associated Regulations about how the service is run.

The provider had a safeguarding policy in place however we found that incidents were not always handled in line with this. Staff had received safeguarding training and knew the procedures for raising any concerns. Staff were also familiar with the provider’s whistleblowing policy.

People’s weight was not always monitored accurately.

Medicines were managed with support from an electronic system for recording medication administration. Medicines were stored safely and there was a robust system in place for ordering and disposal. Stock checks of one medicine identified two discrepancies over the period of one month. The discrepancies had not been handled in line with the provider’s policy. Medicine administration records (MAR) contained some errors that could not be accounted for.

People had personal emergency evacuation plans in place. However appropriate fire drills were not being conducted on a regular basis.

There were sufficient staff on duty to safely meet people’s care needs. Staff levels were calculated monthly using a dependency tool was. Safe recruitment procedures were in place and appropriate pre-employment checks were undertaken.

Accidents and incidents were recorded and monitored monthly to look for patterns or trends.

There were infection control procedures in place to minimise the risk of cross-infection. All areas of the service were clean and tidy and there were no unpleasant odours.

Capacity assessments were not being undertaken in line with guidance in the Mental Capacity Act 2005 code of practice. DoLS applications had not been submitted for every person who had restrictions placed on their movements.

Consent to care was not always correctly obtained or recorded. Details of relatives with Lasting Power of Attorney (LPA) were not clearly recorded on care files. We did not see any records of best interest decisions taking place. We have made a recommendation about this.

People were very happy with the food they were provided. The service supported people to maintain a balanced diet and kitchen staff were knowledgeable about people’s dietary needs. People and their relatives were involved in menu planning and the mealtime experience was a positive one.

Staff told us they received the right level of support and were happy the quality of the training. Records showed that training was up to date and staff had supervision meetings on a regular basis.

People’s health and wellbeing needs were met by regular visits from health care professionals. The provider had also recently begun to use a computerised system of monitoring people’s health. Posit

This inspection was unannounced and took place on 15 and 26 March 2016. The staff and provider did not know that we would be visiting.

Willow View Care Home is registered to provide accommodation for up to 35 older people who may or may not be living with a dementia. The home has two floors. All of the bedrooms had en suite facilities. There are a range of lounges, dining rooms, and a small room where people could sit and read. Willow View Care Home also had the benefit of an enclosed landscaped garden. At the time of our inspection there were 34 people living at the home.

There was a registered manager in post since the home opened two years ago and the new registered provider took over the operation of the home in April 2015. 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.

People were happy and felt safe. Visiting professionals commented that people’s level of functioning had dramatically improved since being admitted to the home. People had regained their confidence and ability to walk and be as independent as possible. Their risks were managed effectively and they felt confident that they would receive support of the staff when needed.

We found that a range of stimulating and engaging activities were provided at the home. There were enough staff to support people undertake activities in the community. Staff also volunteered to take people out for the day shopping and visiting local tourist attractions. People were supported to recognise the impact any memory loss had upon their ability to go out independently and they told us that they needed staff support.

People’s care plans were tailored for them as individuals and created with their, their family and social worker’s involvement. People were cared for by staff that knew them really well and understood how to support them. We observed that staff had developed very positive relationships with the people who used the service. The interactions between people and staff were jovial and supportive. Staff were kind and respectful; we saw that they were aware of how to respect people’s privacy and dignity. Staff also sensitively supported people to deal with their personal care needs.

Staff were very well supported and had the benefit of a programme of training that enabled them to ensure they could provide the best possible care and support. Staff lived the values of the registered provider and put people at the heart of everything they did. Staff were all clear that they worked as a team and for the benefit of the people living at Willow View Care Home. Their comments and feedback fed into the continuous improvement of the service.

The registered manager investigated even the smallest concern. We saw that they thoroughly looked at the concern and took prompt action to resolve them. They freely admitted where they had made mistakes and were very open and honest with people who raised issues.

The registered manager and staff had a clear understanding of safeguarding. They had recently identified and actively supported someone to deal with difficulties posed by someone visiting them. The registered manager also spoke with the safeguarding team at all stages and regularly checked that they were taking appropriate action to deal with any concerns.

People who used the service and the staff we spoke with told us that there were enough staff on duty to meet people’s needs. The registered provider and registered manager had closely considered people’s needs and for the 35 people using the service there was two senior carers and four care staff were on duty during the day and one senior carer and three care staff on duty overnight. The registered manager found that staff were team pla