The Willows

We found the following examples of good practice.

The provider had a robust system in place to ensure that all visitors entering the premises had their vaccination status and lateral flow tests (LFT) checked. The provider required visitors to have a negative LFT before entry, and staff were available and trained to support visitors to complete LFT where needed.

The service was very clean, tidy, and well maintained. A cleaning schedule was in place which included additional cleaning of frequently touched areas such as door handles. Windows were open where possible to support good ventilation.

Risk assessments were in place for staff, considering any healthcare needs. Each person using the service had a COVID-19 care plan and risk assessment in place. These outlined how to support the person according to their individual needs, and how to minimise risks to their safety and promote wellbeing.

Staff supported people in a person-centred manner to keep in touch with their families and friends, such as through video calls.

The Willows is a residential care home providing personal care to 29 people aged 65 and over at the time of the inspection. The service can support up to 40 people.

People’s experience of using this service and what we found

We received very positive views from people about the support provided to them. People said they felt safe and staff were kind and respectful.

Staff had positive links with health care professionals, which promoted people’s health and wellbeing. People’s received their medicines on time and safely.

Care and support were tailored to each person's needs and preferences. People and their relatives were involved in developing and updating their care plan. Staff had good knowledge of people and spent time chatting with them about their life history and family.

Staff had received training and support to enable them to carry out their role. We made a recommendation about training to ensure staff continued to receive up to date training to meet people’s needs. Recruitment checks were carried out to ensure staff were suitable to work in the service.

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

The registered manager led by example to ensure people received a good service. People and staff told us the registered manager was approachable and listened to them when they had any concerns. Feedback was used to make continuous improvements to the service.

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

Rating at last inspection

The last rating for this service was Good (published 24 January 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The home is registered to provide accommodation and care for up to 33 older people, including people who are living with dementia. On the day of the inspection there were 28 people living at the home, including one person who was having respite care. The home is situated in the village of Burton Fleming, close to the town in Bridlington, in the East Riding of Yorkshire and also close to the county of North Yorkshire. The premises has two floors and a passenger lift operates between both levels. The general care unit and the dementia unit are staffed separately.

The registered provider is required to have a registered manager in post and on the day of the inspection there was a manager who was registered with the Care Quality Commission (CQC). 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 were protected from the risk of harm or abuse because there were effective systems in place to manage any safeguarding concerns. Staff were trained in safeguarding adults from abuse and understood their responsibilities in respect of protecting people from the risk of harm.

There was evidence that the registered provider was working within the principles of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and the registered manager had informed the Commission when DoLS applications had been authorised.

There were recruitment and selection policies in place and these had been followed to ensure that only people considered suitable to work with vulnerable people had been employed. On the day of the inspection we saw that there were sufficient numbers of staff employed to meet people's individual needs.

Staff told us they received the training they needed to carry out their roles effectively and confirmed that they received induction training when they were new in post. Some staff told us that they were well supported by the registered manager, although other staff said they were happier with the support they received from the deputy manager.

Senior staff had received appropriate training on the administration of medication. We checked medication systems and saw that medicines were stored, recorded and administered safely.

People who lived at the home and relatives told us that staff were caring and that they respected people’s privacy and dignity. We saw that there were positive relationships between people who lived at the home, relatives and staff, and that staff had a good understanding of people’s individual care and support needs.

A variety of activities were provided to meet people’s individual needs, and people were encouraged to take part. People’s family and friends were made welcome at the home.

People told us that they were happy with the food provided and we observed that there was ample choice. We saw that people’s nutritional needs had been assessed and individual food and drink requirements were met.

The premises were clean and we did not detect any unpleasant odours. The registered manager was aware of how to use signage, decoration and prompts to assist people in finding their way around the home, and good progress had been made towards making these available.

There were systems in place to seek feedback from people who lived at the home, relatives and staff. People told us they were confident their complaints and concerns would be listened to. Any complaints made to the home had been investigated and appropriate action had been taken to make any required improvements.

Quality audits undertaken by the registered manager and senior managers were designed to identify that systems at the home were protecting people’s safety and well-being.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach. We undertook a focused inspection on the 29 June 2016 to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to these topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for The Willows on our website at www.cqc.org.uk.

The home is registered to provide accommodation for up to 33 older people who require assistance with personal care, some of whom may be living with dementia. On the day of the inspection there were 27 people living at the home, including two people who were having respite care. The home is situated in the centre of the village of Burton Fleming, close to the town of Bridlington, in the East Riding of Yorkshire. It is also close to the county of North Yorkshire. The general care unit and the dementia care unit are staffed separately.

The registered provider is required to have a registered manager in post and on the day of the inspection the manager who was employed at the home was registered with the Care Quality Commission (CQC). 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 focused inspection on 29 June 2016 we found that the registered provider had followed their plan in respect of the safety of the premises. We toured the premises and saw that the flooring identified as a trip hazard had been replaced. We did not see any other flooring that created a trip hazard. The bed we saw that had a loose headboard had been replaced. A chain across one person’s bedroom door had been replaced with a gate; this was easy to open in the event of an emergency but provided a safe way of deterring people from entering the person's bedroom. This reduced the risk of an accident occurring.

We saw that robust systems had been introduced to monitor the safety of the premises and equipment, and that any concerns identified had been promptly dealt with. This included checks on the safety of beds and flooring. We saw these changes resulted in the registered provider meeting the breach of Regulation in respect of the safety of the premises.

At the inspection on 29 June 2016 we found that the registered manager had followed their plan in respect of the submission of some notifications. Since the previous inspection in January 2016 we had received notifications from the registered manager in respect of deaths, serious injuries, safeguarding and events that stopped the service. However, there was also a legal requirement to submit notifications when DoLS applications had been authorised by the local authority. The registered manager was not aware of this and, although some DoLS applications had been authorised, no notifications had been submitted to CQC.

This was a continued breach of Regulation 18 (Registration Regulations 2009) Notifications of other incidents. We are addressing this breach with the registered provider.

We undertook this inspection to check that they had followed their plan and to confirm that they now met legal requirements, to look at the overall quality of the service, and to provide a new rating for the service under the Care Act 2014.

The home is registered to provide accommodation for up to 33 people who require assistance with personal care, some of whom may be living with dementia. On the day of the inspection there were 28 people living at the home, including three people who were having respite care. The home is situated in the centre of the village of Burton Fleming, close to the town of Bridlington, in the East Riding of Yorkshire. The general care unit and the dementia care unit are staffed separately.

The registered provider is required to have a registered manager in post and on the day of the inspection there was a manager who was not registered with the Care Quality Commission (CQC). However, they had submitted an application for registration and it was being progressed by the Commission. 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.

During this inspection we identified two breaches of regulation; this related to the risks associated with the submission of notifications to the CQC and safe care and treatment. You can see what action we told registered the provider to take at the back of the full version of the report.

On the day of the inspection we saw that there were sufficient numbers of staff employed to meet people’s individual needs. New staff had been employed following the home’s recruitment and selection policies and this ensured that only people considered suitable to work with vulnerable people were working at the home.

Some improvements had been made to the environment. On the first floor of the premises [the dementia unit] an additional seating area had been created so there was space for people to sit quietly if they chose to do so, or to meet with family and friends in private. However, we identified some concerns with the environment such as loose bath sides and a damaged bed and these had not been identified in audits undertaken by the service.

People told us that they felt safe whilst they were living at The Willows. People were protected from the risks of harm or abuse because the registered provider had effective systems in place to manage any safeguarding concerns. Staff were trained in safeguarding adults from abuse and understood their responsibilities in respect of protecting people from the risk of harm. Staff also told us that they would not hesitate to use the home’s whistle blowing procedure if needed. Although safeguarding alerts had been submitted to the local authority when required, the CQC had not received notifications from the registered provider.

Staff confirmed that they received induction training when they were new in post and told us that they were happy with the training provided for them. Staff had received training on the administration of medication and people told us they were happy with how they received their medicines.

People told us that staff were caring and that their privacy and dignity was respected. People told us that they received the support they required from staff and that their care plans were reviewed and updated as required.

People’s nutritional needs had been assessed and they told us they were very happy with the food provided.

There was a complaints policy and procedure in place and we saw that any complaints or concerns raised had been dealt with following the home’s policies and procedures. However, we noted complaints were stored in both the quality assurance folder and in the ‘significant events’ folder and this could have made it difficult to monitor complaint received.

There were systems in place to seek feedback from people who received a service, and feedback had been analysed to identify any improvements that needed to be made.

The quality audits undertaken by the registered provider were designed to identify any areas that needed to improve in respect of people’s care and welfare. Staff told us that, on occasions, incidents that had occurred had been used as a learning opportunity for staff. However, we found some areas that required improvement that had not been identified through the home’s own quality audits. We have made a recommendation about the effectiveness of quality audits in this report.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with staff and from looking at records.

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

Is the service safe?

On the day of the inspection we found that the manager's role had not been covered during her absence and this left care staff with insufficient time to provide safe care to the people who lived at the home.

Is the service effective?

We saw that people had care plans in place that recorded their dependency levels and that care staff were aware of people's individual needs.

Is the service caring?

We saw that staff were kind and compassionate when they supported the people who lived at the home. We observed a member of staff assisting someone to eat their lunch and that this was carried out with dignity and respect.

Is the service responsive?

We saw that staff were unable to meet the needs of people who lived in the residential unit promptly because they also had responsibility for answering the telephone, the administration of medication, preparation of the evening meal and laundry duties.

Is the service well-led?

The manager was absent of the day of the inspection as they had been working overnight elsewhere. We noted that some tasks could not be carried out in the manager's absence, for example, service users did not have access to their money.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to staffing levels.

We checked the care records for three people who lived at the home and saw that they had been reviewed and updated consistently so that staff had up to date information about the people they cared for. People who we spoke with were positive about the care they received and described staff as "Pleasant" and "Patient".

People received nutritious meals that could be adapted to meet their specific dietary requirements and they were consulted about the menu in resident meetings. Drinks were provided regularly throughout the day.

Staff had received training on safeguarding adults from abuse and the people who lived at the home told us that they felt safe living there.

Satisfactory recruitment and selection procedures had been followed to employ staff to ensure that people employed were considered suitable to work with vulnerable people. Most of the time there were sufficient numbers of staff on duty.

People told us that they were consulted about the care and support they received. They told us about the resident meetings and one person said, 'You can say anything you like at the meetings'. Quality audits had been carried out to monitor that systems in the home were being followed consistently to ensure that people received safe and appropriate care.

We found that action had been taken to improve hygiene standards. One bathroom had been refurbished and the flooring in the upstairs area of the home where we had previously identified unpleasant odours had been replaced. We did not detect any unpleasant odours during this inspection.

Toilets and bathrooms had been fitted with soap dispensers and paper towel holders to promote good hand hygiene.

Staff had undertaken appropriate training and an infection control lead had been appointed.

The infection control lead and the manager had devised new cleaning rotas that were designed to ensure all areas of the home would be cleaned on a regular basis.

We discussed some areas for improvement with the manager, such as colour coding cleaning equipment and segregating areas of the laundry room. We also reminded the manager about the need to inform CQC of any outbreaks of infectious diseases.

We saw that staff tried to obtain a person's consent prior to assisting them with personal care or eating/drinking.

We saw that assessments, care plans and risk assessments were an up to date record of a person's care needs. People told us that they were happy at the home. One person said, 'I have lived her for a long time and the staff look after me well. They are pleasant and always try to help me if they can'. People said that staff responded quickly if they rang the call bell. We saw that there were sufficient numbers of staff on duty to care for the people who lived at the home.

We observed the administration, storage and recording of medication and found that staff followed the home's policies and procedures.

We were concerned about certain aspects of cleanliness and infection control at the home. Some areas needed to be refurbished to provide accommodation that could be maintained in a clean and hygienic condition and the infection control policy did not adhere to current guidelines.

We saw that people who lived at the home or their representatives were told about the complaints procedure and records evidenced that complaints were dealt with appropriately.