About the service:

Willows Care Home is a residential care home registered to provide

accommodation and personal care to 72 people. At the time of the inspection, 54 people were living in the home.

People’s experience of using this service:

•People were safe in the home and there were procedures to protect them from abuse.

•Risks associated with people’s needs were assessed to mitigate them and keep people safe.

•People were provided their medicines as prescribed.

•People were supported with their nutritional needs and had choices with meals. People had access to health care professionals such as GPs when required.

•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 received care from staff who were kind and compassionate. Staff treated people with dignity and respected their privacy. People’s independence was promoted.

•Staff had developed positive relationships with the people they supported. They understood people’s needs, preferences, and what was important to them.

•Care plans were person centred and detailed people’s support needs.

•People and relatives were supported with complaints they wished to make.

•Staff were recruited safely and were supported with the necessary training and development to increase their skills.

•Staff felt supported by the management team and told us there was a positive culture.

•There was a system in place to monitor the home and ensure consistent and good quality care was provided to people.

•The registered manager was committed to make continual improvements to the home.

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

Rating at last inspection:

At the last inspection on 15 February 2018 (report published 6 April 2018), the service was rated ‘Requires Improvement’ because the service was not always caring, responsive or well-led. At this inspection, we found these issues were addressed and the rating for the service has now improved to ‘Good’.

Why we inspected:

This was a planned inspection based on the rating of the last inspection.

Follow up:

We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care.

This unannounced inspection took place took place on 15 February 2018. At our last comprehensive inspection on 26 April 2016, we rated the service ‘Good’. After that inspection we received concerns in relation to the safety and the overall management of the service.

We looked into these concerns at this inspection and we have rated the service ‘Requires Improvement’.

Willows 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.

Willows Care Home accommodates up to 72 people across three separate units, each of which have separate adapted facilities. The units specialises in providing nursing care to people living with dementia.

One the day of our inspection, 52 people were living in the home.

The home had 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.

Each unit in the home was managed by a registered nurse who was supported by the registered manager and a deputy manager. The deputy manager was unavailable on the day of our inspection.

Risks to people were identified to ensure they remained safe. However, we noted that any risks relating to people's personal equipment which helped them remain comfortable was not always assessed by the provider. This was addressed by the registered manager during the inspection.

Medicines were stored, managed and administered by staff who were trained. We noted that staff had not appropriately followed procedures following a change to a person's medicine prescription.

People were involved in the planning of their care and received care and support to ensure their individual needs were met. Care plans were person centred and contained information on people’s backgrounds and preferences, including for end of life care.

Staff ensured people had access to appropriate healthcare when needed and their nutritional needs were met. People were provided with a choice of meals, although some people told us they were not always happy with the variety and the presentation of their meals. We have made a recommendation for the provider to look into maintaining good quality catering standards.

Feedback was received from people and relatives in the form of questionnaires and surveys to help drive quality improvements. People and relatives were able to make complaints and have them investigated by the registered manager. However, we have made a recommendation about ensuring all types of complaint are responded to and followed up because some people did not feel they were always listened to or shown enough respect.

The registered manager was committed to developing the service, although further improvements were required to ensure people continued to receive a caring and responsive service.

The premises were clean and regularly maintained. The environment was suitable for people who had specific needs such as dementia.

Infection control procedures were followed after a recent outbreak, which affected people in the home.

Records of accidents and serious incidents showed that the provider learned from mistakes to prevent reoccurrence.

Staff had received training on how to keep people safe. They were able to describe the actions they would take if they had any concerns about people’s safety. The provider also had a whistleblowing policy, which staff were aware of and they knew how to report concerns both internally and to external organisations.

The provider had safe recruitment procedures in place and carried out checks on new employees. There were enough staff on duty to en

This inspection was unannounced and took place on 25 and 26 April 2016. Willows Care Home is a care home with nursing for up to 70 older people that registered with the Care Quality Commission (CQC) in September 2014. At the time of our inspection thirty one people were living there. Willows is a purpose built care home. There are two separate units, one for people with higher needs and each floor has a dining room and communal lounge area people can use. The service is provided by Churchgate Healthcare (Willows) Limited, an organisation run by Canford Healthcare.

At our previous inspection on 7 August 2015 we found that the provider was not meeting legal requirements. This was because medicines were not always administered safely, infection control guidelines were not always followed and people were not always cared for by staff who had the skills and competence to care for people on oxygen or to follow guidelines already in place. People's dignity was not always respected as there were instances where staff had walked in on people without knocking. People's records such as observation charts, fluid and food records and daily records were not always completed correctly. The inconsistent leadership found at our last inspection meant that some aspects of the systems in place for monitoring the quality of care were not effective.

The service did not have a registered manager in place in August 2015, however, a new manager had been in post since September 2015 and had applied to CQC to manage the service. A registered manager is a person who has registered with 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. Additionally a new deputy manager was appointed in December 2015.

During this visit we found that a more stable and consistent staff team were in place and reliance on agency staff had decreased. The registered manager had a system in place to ensure there were enough staff to meet people's needs safely and in a timely manner. People's health care needs were met and the provider had recently contracted with a new GP surgery who was also undertaking a medicines review for each person.

People told us they felt safe and cared for. Staff told us what steps they would take to keep people safe and how they offer people choices. Staff explained that people could make decisions about some things even when they might lack capacity to make more complex decisions. Where people lacked capacity to make some decisions, best interests decisions were made in line with legislation. Applications had been made for authorisations where necessary to deprive people of their liberty for their own safety.

Safer recruitment practices were followed and a training and quality lead had been appointed with responsibility for ensuring all new staff completed a mandatory induction, including agency staff.

People's needs were assessed and risks relating to their support were also assessed. We saw evidence that these assessments and care plans were regularly reviewed.

People told us that they enjoyed the activities that took place, joining in when they wanted. There was use of a minibus to take people outside of the care home environment. There was an activities room and activities also took place in the communal lounges and in people's rooms.

People told us they liked the food, were given choices and could make requests for foods they liked. Visitors told us they felt welcomed and that they felt improvements had been made by the new manager and staff.

This inspection was unannounced and took place on 7 August 2015. Willows Care Home is a care home with nursing for up to 70 older people that registered with the Care Quality Commission in September 2014. At the time of our inspection, there were 16 people living there.

At our previous inspection on 9 January 2015 we found that the provider was not meeting legal requirements. This was because medicines were not always managed appropriately especially for people who self-administered their medicine. Care was not always delivered in such a way as to ensure the welfare and safety of people. Although staffing levels were monitored according to the dependency level of people, the skill mix and the layout of the building did not promote people’s safety. Records about people’s care were not always accurate and did not always reflect people’s current health needs. People who used the service were not always given a choice of food that met their individual needs or preferences.

At the time of this inspection improvements had been made, however the service was still not meeting legal requirements. Medicines were not always administered safely. Infection control guidelines were not always followed and people were not always cared for by staff that had the skills and competence to care for people on oxygen or to follow guidelines that were already in place. People’s dignity was not always respected as there were instances where staff had walked in on people without knocking. People’s records such as observation charts, fluid and food records and daily records were not always completed correctly. Although risks assessments were in place for most people, we found that for a person on oxygen these were not in place and could put the person at risk of receiving inappropriate amounts of oxygen which may in turn impact on their health negatively.

The inconsistent leadership since our last inspection meant that some aspects of the systems in place to monitor the quality of care delivered, such as medicine management, recruitment and monitoring of skills and competence of temporary staff, were not yet effective. There was no registered manager in place. A regional manager was on site until a newly recruited manager was due to start on 1 September 2015. 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 told us they felt safe with the exception of one person who expressed concerns about night time staff and some of the agency staff. Staff were aware of the procedures to follow in order to safeguard people from harm and how to deal with foreseeable emergencies such as fires and other medical emergencies.

We reviewed staff rotas and dependency scores for July 2015 and found that staffing was decided upon based on people’s needs. The provider followed safe recruitment practices, however there were still vacancies that needed to be filled in order to ensure that, on every shift, there was a mix of both permanent and agency staff with the right skills and competence to enable them to deliver care in a safe way.

Where people lacked the mental capacity to make decisions, the manager made best interest decisions in line with legislation. This included making applications where necessary to deprive people of their liberty for their own safety. Staff were aware of the Mental Capacity Act 2005 and understood that a person could have capacity to make some decisions but could lack capacity to make more complex decisions.

People’s needs were assessed on admission and reviewed regularly. People told us that they enjoyed the activities that took place and that they could go out when they wanted. Regular days out to local places of interest had already taken place with more planned in the future. People told us and we observed that they were given a choice of food that met their dietary requirements and personal preference. People were supported to access healthcare professionals when they needed in order to maintain their health.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of the full version of this report.

The inspection was unannounced and took place on 9 January 2015 in response to anonymous concerns we received about the care delivered at the service. There had not been any previous inspections since the provider registered with the Care Quality Commission in September 2014.

Willows Care Home is registered to provide accommodation for up to 70 people who require nursing or personal care. It is a modern and purpose built nursing and residential home situated in Romford. On the day of our visit, there were 20 people using the service.

At the time of inspection a registered manager was 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.

We found that the provider was not meeting some of the legal requirements in relation to medicines management, care and welfare of people, records, staffing levels and nutrition. You can see what action we told the provider to take at the back of the full version of the report.

Medicines were not always managed appropriately, especially for people who self-administered their medicines. There were no risk assessments in place to ensure that the person stored their medicines safely and took their medicines as prescribed.

People were not protected against the risks associated with receiving care that was inappropriate or unsafe. Risk assessments were not always completed or updated.

People’s care records were not always accurate and did not always reflect people’s current needs. Other records such as food temperature probe checks and daily medicine room temperature checks were not always completed.

People were not always given a choice of food that met their individual needs or preferences. Although individual food preferences were documented these were not always followed.

Staffing levels were monitored according to people’s needs. However, there were staff vacancies at the time of our inspection and a lot of agency staff were used to cover shifts. This meant that people were not always supported by staff who knew them and their needs. On the day of our visit three staff working on one floor with six people were all agency staff.

The service followed safer recruitment practices and ensured that there were arrangements in place to deal with foreseeable emergencies. Staff received training and supervision.

Where people lacked the mental capacity to make decisions, the registered manager and nursing staff made best interest decisions in line with the Mental Capacity Act 2005 (MCA). This included making applications for Deprivation of Liberty Safeguarding authorisations (DoLS) where it was felt necessary to impose restrictions on people in their best interests. DoLS are part of the Mental Capacity Act 2005. They aim to make sure that people in care homes, hospitals and supported living are looked after in a way that does not inappropriately restrict their freedom. The safeguards should ensure that a person is deprived of their liberty in a safe and correct way, and that this is only done when it is in the best interests of the person and there is no other way to look after them. Staff understood that a person could have capacity to make some decisions but could lack capacity to make more complex decisions.

People’s needs were assessed on admission but were not always reviewed or updated in line with policy or when people’s needs changed.

Although activities were provided by the home these were not frequent. This left people bored and just sitting in communal areas or in their bedrooms. People told us that they did not always have information about what was happening.

Staff and relatives told us that although they could approach the manager at any time they felt that issues were not always resolved. There were clear leadership structures in place. There was a procedure to monitor the quality of care delivered but it was difficult to monitor effectiveness because the home had only been operating for four months.