The Willows

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

People and their representatives were involved in assessing and planning the care people required. Assessments of people’s care were thorough and captured important aspects of people’s lives and history. However, we could not be assured staff always followed people’s care plans, due to the concerns we identified during our inspection. The service worked with other health and social care professionals to ensure people received care which met their needs. We found the service was working within the principles of the Mental Capacity Act 2005 and if needed, appropriate legal authorisations were in place to deprive a person of their liberty.

This service scored 71 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Peoples care needs were assessed before they moved into the service. Relatives told us they were invited to be involved with all care assessments and ongoing reviews, including those with external health professionals.

Service managers and the registered manager were responsible for updating and reviewing peoples care records. All staff spoken with were confident that when records were updated, they could access new information easily. Staff and leaders were clear on when records and assessments needed to be updated.

Historic incidents were not always taken into account when completing care needs assessments. For example, one person had a past incident of ingesting a balloon, however the risks associated with disposable gloves, which are very similar in look and texture, had not been considered within their assessment. Electronic care records were used at the service, and these contained detailed information relating to people’s needs. When changes were made, the system flagged these automatically to ensure staff were aware. Peoples care records were person centred, and included important information such as life history, likes and dislikes.

Where people required the input from specialist services, this was in place. For example, we saw people had been referred to Speech and Language teams and Physiotherapy services. Relatives we spoke with had no concerns around the services ability to follow the guidance from healthcare professionals. One relative told us their loved one recently needed medical attention and the registered manager kept them up to date “I had a phone call from [registered manager]. I’m happy they do the right things when required”.

The registered manager told us they work in successful partnership with healthcare professionals, and ask for advice where needed to ensure care is delivered in line with best practice. One staff member told us they understood the process for seeking medical attention for people, and would consult with the service manager or registered manager to arrange this.

Processes for ensuring care is delivered in line with best practice was supported by policies. Care records used recognised tools to assess and monitor people’s health and well-being. The registered manager undertook meetings both within the service, and with the senior leadership team, to review and monitor how care was delivered to people.

Peoples relatives told us The Willows worked well with other services supporting people, such as Speech and Language Therapy teams and GP’s. However, some relatives felt communication between the staff team internally could be improved, as sometimes information they shared regarding their loved ones was not passed on between staff teams.

Staff and leaders spoke positively about their working relationship with external services. However, staff and leaders told us there was some unrest between the internal staff team currently. Some staff also felt the management team were not responsive to issues they raised. Whilst this did not appear to impact the care people received, it did impact staff morale and communication between staff and management teams. The management team at the service were aware that some members of the staff team were appearing disgruntled, and assured us they would take action to resolve this.

We did not receive feedback in relation to this quality statement from partners. However, we observed staff to be helpful and knowledgeable about people’s needs when supporting visiting healthcare professionals.

The registered manager told us they sought feedback from healthcare professionals to drive improvements where needed. Processes were in place to ensure information and advice received from external services was recorded and acted upon. People's care records were easy to access, and the electronic system in place enabled records to be updated quickly as required.

People were supported to access health appointments such as chiropody, dental care and opticians. Care plans detailed how staff could support the person to access these services in the way which suited them best. For example, for one person who was frightened of blood tests, their care plan gave staff clear information on how to make the appointment as comfortable as possible for them. Relative’s told us they felt their loved ones health was held in high regard, and had confidence in the service to take appropriate action as needed.

Staff and leaders were knowledgeable around how to support people to live healthier lives. Where people had specific healthcare needs, staff had received training to ensure they had sufficient knowledge of their condition. Staff told us they felt confident in managing people’s healthcare needs.

Processes were in place to support people to live healthier lives. This included planning and cooking healthy meals and encouraging regular physical exercise. People’s health conditions were monitored and reviewed by the leadership team, and referrals made to external professionals appropriately. Consideration had been given to how appointments with healthcare professionals could be made more accessible for people.

Relative’s told us they were kept up to date with their loved one’s progress and felt involved in decisions relating to the care they received. All relative’s we spoke with were aware of their loved one’s care plan and felt able to make suggestions and additions to its content.

Staff and leaders knew people very well, and care plans in place were detailed and thorough. Staff were able to speak about goals people had, and demonstrated dedication in helping people achieve them. For example, one staff member told us about how they were supporting a person to go on holiday as it gave them something to look forward to.

Processes for monitoring and improving outcomes for people were robust. People and their relative’s were given ample opportunities to give feedback, and were consistently involved in care reviews. This meant outcomes for people were monitored, and changes could be made as necessary to improve people’s experience.

Most people living at the service had limited decision making capability. Therefore, care was agreed in their best interests with the involvement of specialist teams and the person’s family or advocates. Where people were able to make decisions in relation to their care needs, these were respected and reflected within care records appropriately. Relative’s told us they felt the service gave their loved one’s choice “Yes, I’ve seen what choices they offer - where he goes, what he buys, who he sees. Plenty of option to make choices.”

Staff gave mixed feedback on whether they felt care was restrictive at all. Whilst some told us they found the service to respect people’s wishes and work in a person centred way, others told us some elements of the care people received were unnecessarily restrictive. We raised this with the leadership team at the service, who provided evidence that care was being delivered in line with the Mental Capacity Act 2005 (MCA). However, further work was required to ensure staff were aware of why some restrictions were in place for people.

Assessments of people’s mental capacity and best interest meetings had taken place however there was no evidence these decisions were regularly reviewed to ensure they remained relevant and proportionate. For example, where peoples doors were locked overnight, this restriction had not been reviewed in between annual Deprivation of Liberty (DOLS) applications. Some staff were also unsure why doors were locked for some people, and thought this was a blanket rule rather than for specific reasons.