We carried out this inspection on the 3 November 2016. It was unannounced.

Willows residential home is a service providing accommodation and support for up to ten older people who are frail and may be living with dementia. The building is set over two floors with stairs access only to the first floor. At the time of the inspection nine people lived at the service.

We last inspected the service on the 25 November 2015, when we made requirements for improvement in relation to administration of medicines, and implementing an effective system to assess, monitor and improve the quality and safety of the service being provided. At this inspection we found that the provider/registered manager had taken action and improvements had been made.

The provider/registered manager of the service had been in post since March 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.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Applications were being completed in relation to DoLS. The providers understood when an application should be made. The service needs to make further applications to meet the requirements of the Deprivation of Liberty Safeguards.

The provider/registered manager and staff had received training about the Mental Capacity Act 2005 and understood when and how to support peoples best interest if they lacked capacity to make certain decisions about their care.

People said they felt safe. People were protected against the risk of abuse. Staff received training about protecting people and recognised the signs of abuse or neglect and what to look out for. Management and staff understood their role and responsibilities to report any concerns and were confident in doing so. Staff told us they knew what to do if they needed to blow the whistle, and there was a whistleblowing policy available.

There were enough staff with the skills required to meet people’s needs. The service had a low turnover of staff and there had been no new staff since the last inspection. Current staff had been recruited safely. Staff were trained to meet people’s needs, and training was booked to ensure that staff were kept up to date and were supported through regular supervision and an annual appraisal so they were supported to carry out their roles.

People told us and demonstrated that they were happy at the service by showing open affection for example a smile, to the staff who were supporting them. Staff were available throughout the day, and responded quickly to people’s requests for care. Staff communicated well with people, and supported them when they needed it.

There were risk assessments in place for the environment, and for each person who received care. Assessments were kept updated and were individual for each person. Assessments identified people’s specific needs, and showed how risks could be minimised. There were systems in place to review accidents and incidents and make any relevant improvements as a result.

Individual person centred care planning documentation had changed and improved. People and their relatives were involved in planning their own care, and staff supported them in making arrangements to meet their health needs. Staff contacted other health and social care professionals for support and advice, such as doctors, speech and language therapist (SALT) and dieticians.

People were provided with food and drink that met their needs and wishes. Menus offered a choice. People said they liked the home cooked food. Staff made sure that people had plenty of drinks offered through the day. We observed lunch being served and people were happy with their choic

We carried out this inspection on the 25 November 2015. It was unannounced.

Willows residential home is a care home providing accommodation and support for up to 10 older people who are frail and may be living with dementia. It is over two floors and stairs access only to the first floor. At the time of the inspection nine people lived at the service.

The provider /registered manager of the service has been in post since March 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.

Medicines were not managed safely. People may not have received their medicines as prescribed. Audits of medicines had not picked up the errors to ensure people were getting the medicines they had been prescribed.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Applications were being completed in relation to DoLS. The providers understood when an application should be made. They were not however aware of the Supreme Court Judgement which widened and clarified the definition of a deprivation of liberty. The service needs to make further applications to meet the requirements of the Deprivation of Liberty Safeguards.

People were given individual support to take part in their preferred hobbies and interests. There had been an increased range of activities. However there were no planned trips out of the home, we have made a recommendation about this.

The provider was planning to extend the property, to give more space and include a lift for easy movement around the home.

People told us and demonstrated that they were happy at the service by showing open affection to the staff who were supporting them. Staff were available throughout the day, and responded quickly to people’s requests for care. Staff communicated well with people, and supported them when they needed it.

There were systems in place to obtain people’s views about the service. These included reviews and informal meetings with people and their families.

People were confident that the manager would deal with any complaints appropriately. People and relatives told us they had no concerns.

Staff had been trained in how to protect people, and they knew the action to take in the event of any suspicion of abuse towards people. Staff understood the whistle blowing policy. They were confident they could raise any concerns with the manager or outside agencies if this was needed.

People and their relatives were involved in planning their own care, and staff supported them in making arrangements to meet their health needs. The provider and staff contacted other health professionals for support and advice.

People were provided with diet that met their needs and wishes. Menus offered a choice. People said they liked the home cooked food. Staff made sure that people had plenty of drinks offered through the day. We observed lunch being served and people were happy with their choice. Staff gave appropriate support to people who needed assistance to eat their meal.

Staff in the past had been recruited safely. However the home has a very low turnover of staff and there have been no new staff recruited.

There were risk assessments in place for the environment, and for each person who received care. Assessments identified people’s specific needs, and showed how risks could be minimised. There were systems in place to review accidents and incidents and make any relevant changes to reduce further harm.