The Willows

On this page

• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

People were not always treated with dignity and respect. Staff were task focused and did not consistently communicate with people when providing support. People were not supported to have appropriate care such as baths, showers and hair washes in line with their preferences. The provider failed to ensure that people were in receipt of person centred care that met their specific support needs. This was a breach of Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

This service scored 45 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We received mixed views from people about if the staff treated them with kindness,. We observed some caring interactions from staff, whilst others were undertaking their task-based roles and not communicating with people or asking for their consent when providing support. We also found people received poor standards of personal care and a lack of oral hygiene.

The provider and management team had failed to identify the concerns with people’s care and the promotion of their dignity that we found. We received feedback from leaders which stated people were provided with a caring service. The provider had failed to identify the shortfalls we had which demonstrated people were not always being provided with a compassionate service where their dignity was promoted and met.

We received feedback from social care and health care professionals, who also identified that people were not receiving their personal care needs as required. This was reflective of our findings from this assessment.

During our visits we saw that people’s dignity was not always respected. People did not always have access to baths, showers and support to wash their hair. Some people’s hair was visibly unclean. We reviewed the daily notes for 4 people and there was no indication they had been offered or supported to wash their hair. We saw people walking around the service with no socks, slippers or shoes on. This placed them at greater risk of falls. A relative told us their family member had several pairs of missing slippers, which they thought may be down to them being damaged in the laundry process. People’s privacy and dignity wasn’t always maintained. Personal care continence pads were on display in bedrooms, which was not dignified nor respected their privacy. Whilst some staff interacted with people in a caring way, others did not interact with people when providing care and support.

We did not look at Treating people as individuals during this assessment. The score for this quality statement is based on the previous rating for Caring.

We were not assured staff understood the needs of people living with dementia. For example, for people who walked with purpose, during lunch, they were being verbally and physically encouraged to sit in the dining room for their meal. We observed people were resistant to the staff’s interactions and continued to walk with purpose. There were no ‘finger foods’ or consideration to provide a meal in a smaller portion in a receptacle that the person could eat while they walked. We received feedback from relatives about missing items of their family members, including spectacles, dentures, clothing, shoes, slippers, and some telling us their family members often were wearing other people’s clothing. A relative told us, “At the end of the day, there are not enough staff to watch.” Another relative said, “[Family member] has a gate across [their] room door, but one particular resident knows how to unlock it and come into [their] room. We had two framed photographs go missing. They’ve never been found, and this did upset my [family member]. [Family member] doesn’t know anything about that now so the urgency to find them has gone away, though I would like them back.”

We discussed our concerns about people’s care with the registered manager and chief operating officer. There was a lack of oversight and the management team had failed to identify the shortfalls we had identified during our visits. We discussed our concerns about how people, who were living with dementia, and who walked with purpose were being supported during meal times. During our assessment feedback, the registered manager told us they had ordered some dining equipment to improve people’s experiences.

Our observations were that people did not have their independence and right to make choices respected. For example, although there were choices of meals available, we did not see support for people living with dementia to make decisions, for example, through the use of show plates to assist people. During lunch we saw a person say they did not want their meal, a staff member continued to put some food on a fork, wave it in front of the person’s mouth and say, “Come on try some.” Another staff member intervened and made alternative suggestions to the person, who made their choice and waited for their meal to be delivered. Although there were 2 choices of drink available during lunch, we observed a staff member take 1 jug of drink and pour this into people’s glasses without offering a choice.

There was a lack of oversight of the management team to independently monitor and identify where there were shortfalls in the care provision. There were gaps in staff training. Staff were not being provided with guidance in one-to-one supervision meetings to ensure they had the skills and knowledge to ensure people received a caring and compassionate service. People’s care records did not always identify how people could make choices and the areas of their care they could attend to independently.

Prior to our assessment we received concerns that people were not always being supported with their continence and personal care needs. Some people and their relatives raised concerns about the responsiveness of the staff in meeting their family member’s care needs. One relative told us staff were not always responsive in answering their call bells, when people needed assistance. This was also rose by some people using the service relating to call bell response times. Another relative said it was difficult to locate staff when they needed to speak with someone, they found this concerning due to if an emergency arose there were no staff available to identify the issue and act.

To enable us to assess the responsiveness of staff in meeting people’s needs we asked the registered manager to send us call bell audits. The registered manager provided us with an audit relating to call bell response times. The audit did not include the actual response times but had been rated as 75%. The registered manager told us the expected times for call bells to be answered and the response times were variable. The registered manager told us staff had been spoken with about any call bell responses which was longer than the acceptable time.

We found staff were not always responsive to people’s needs and to ensure they were safe. For example, there were not always staff available in the communal areas when there were people present. We saw a person had spilled a drink on the table and floor. They were trying to clean it up with a tissue and told us they had informed the staff. We found a staff member and told them a person had spilled their drink, instead of it being cleaned, they asked another member of staff to do it. It remained uncleaned and eventually we saw them asking a domestic staff member to clean it, at which point it was addressed. A person came out of the communal lounge, where there is a toilet, saying, “I need a pee now, I am going.” A staff member did ask them if they needed the toilet, and asked another staff member where the toilet was. They both walked the person along the corridor and down another corridor, into and then out of a bedroom and started walking back up the corridor, all the time the person was holding themselves saying they were going. We asked the staff where they were going and pointed out a toilet, they then turned with the person and entered another bedroom. This meant the persons were not met.

We did not look at Workforce wellbeing and enablement during this assessment. The score for this quality statement is based on the previous rating for Caring.