CQC report explained · a nursing home
What the CQC found at Willow Tree House
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- Inspectors found that risks were assessed and monitored, medicines were managed safely, staffing levels were sufficient and infection control measures were robust.
- Effective?
- Good
- People's health and social needs were assessed, staff were trained, and people were supported with nutrition, hydration and access to healthcare.
- Caring?
- Good
- Staff treated people with kindness, compassion, dignity and respect. People were involved in decisions about their care and daily routines.
- Responsive?
- Good
- Care plans were personalised and reflected people's needs, preferences and communication methods. People could choose whether to join activities and were supported to maintain relationships.
- Well-led?
- Good
- Management oversight, quality monitoring and learning from incidents had improved. People, relatives and staff said management listened and acted on concerns.
What inspectors found, January 2022
Rated Good; inspectors found safe, kind and personalised care, with major improvements since the previous inspection and no longer in Special Measures.
This was an unannounced comprehensive inspection on 9 November 2021. Inspectors visited at night because of concerns about continence care, personal choice and safety overnight. They spoke with people, relatives, staff and a health professional, and reviewed care, medicines, staff and management records.
The home was rated Good in all five areas: Safe, Effective, Caring, Responsive and Well-led. Inspectors found that risks were assessed, medicines were managed safely, staffing was sufficient, and infection control measures were in place.
People were involved in their care and were treated with kindness, dignity and respect. Care plans reflected individual needs and preferences. People were supported with food, activities, relationships and healthcare.
The previous rating was Requires Improvement, with several regulatory breaches, and the home had been in Special Measures. Inspectors found enough improvement had been made, so the home was no longer in breach, no longer rated Inadequate and no longer in Special Measures.
Risk management
Care plans and risk assessments had been updated. Staff had clear guidance about how to support people safely, including with pressure area care.
“Risks were assessed, managed and monitored.” from the report
Safe staffing and medicines
The home used a dependency tool to plan staffing and had trained staff on duty. Medicines records and as-needed medicine instructions were detailed.
“Medicines were managed safely.” from the report
Kind and respectful care
Inspectors observed patient, compassionate care. People were supported to make choices and their privacy, dignity and independence were respected.
“Staff delivered care in a kind and compassionate manner to all people.” from the report
Personalised support
Care plans described individual needs, preferences and communication methods. Staff supported people's routines, food choices and activities.
“People received personalised care and support tailored to their needs and preferences.” from the report
Improved leadership
The management team had strengthened quality checks, reviewed safety records and analysed incidents to reduce the chance of problems happening again.
“The registered manager and supporting senior manager had implemented and embedded a robust system in order to monitor and improve the quality of care.” from the report
Inspectors raised no specific concerns in this report.
- 01How do you make sure staffing levels remain safe, especially overnight?
- 02How are continence needs recorded, reviewed and communicated to staff?
- 03How do you check that care plans still reflect a person's current needs and preferences?
- 04What quality checks and incident reviews are now carried out, and what happens when a problem is found?
- 05How will you support my relative to make choices about routines, food, activities and visits?
This was an unannounced comprehensive inspection, including a night visit, covering all five key questions and following up on concerns and breaches identified at the previous inspection. This explanation was written from the published report of 5 January 2022 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, August 2021
Rated Requires Improvement; Safe was Inadequate, with ongoing risks around staffing, care plans and medicines, and the home remained in special measures.
This was an unannounced follow-up inspection on 18 June 2021. Inspectors spoke with people, relatives, staff and visiting professionals. They reviewed care records, medicines records, staff recruitment files and management records.
The home had improved since its previous inspection, including safeguarding, skin checks, cleaning, staff training and involvement of people and relatives. However, risk assessments were not always accurate or up to date. Inspectors found risks linked to choking and falls, too few staff to meet people's needs, unsafe medicines practices and incomplete infection control measures.
The overall rating improved from Inadequate to Requires Improvement. Safe remained Inadequate and Well-led improved from Inadequate to Requires Improvement. The home was still breaching Regulations 12, 18 and 17, and remained in special measures.
Safeguarding improved
People were kept safe from abuse and avoidable harm. Staff understood safeguarding and the home was no longer in breach of the safeguarding regulation.
“People were kept safe from abuse and avoidable harm.” from the report
Skin care checks
Management had improved pressure care monitoring and was carrying out regular checks on people's skin.
“We found that management of pressure care had improved, and regular checks were being carried out on people's skin integrity.” from the report
Staff training
Staff training had increased and improved since the previous inspection. It included safeguarding, infection control and tissue viability.
“Staff training had improved, and staff told us that they had a lot of training” from the report
Safe recruitment
The staff files checked showed that appropriate recruitment checks were completed before staff started work.
“We saw evidence of safe recruitment taking place.” from the report
Better involvement
People and relatives were being asked for their views through meetings and feedback forms. Communication with health professionals had also improved.
“Improvements had been made and meetings were now taking place and people had also been requested to complete a feedback form.” from the report
Risk assessments
seriousSome risk assessments were not accurate or up to date. Staff did not always know or follow guidance, creating risks around choking and falls.
“The failure to mitigate risk and keep people safe is an ongoing breach of Regulation12 (Safe care and treatment)” from the report
Too few staff
seriousStaffing levels were not based on an accurate, up-to-date assessment of people's needs. Inspectors found that there were fewer night staff than planned, despite many people needing two staff for hoisting.
“The lack of staffing to support people safely was a continuing breach of Regulation 18 (Staffing)” from the report
Medicines not always safe
seriousSome medicines to be taken when needed did not have clear instructions. Inspectors also saw poor hand hygiene and a person being given medicine when not fully awake.
“Medicine was not managed safely.” from the report
Infection control practice
needs fixingCleaning had improved, but some staff did not wear or change PPE correctly and did not always clean their hands between tasks. The infection control policy also lacked COVID-19 information.
“there was a failure to monitor staff wearing and changing personal protective equipment as per government guidance” from the report
Management oversight
seriousAudits and checks had been introduced, but they had not operated long enough to identify and fix all the problems. Care plans, staffing and medicines still needed stronger oversight.
“This was an ongoing breach of Regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities).” from the report
- 01How many staff are working on each shift now, especially at night, and how are these numbers matched to people's current needs?
- 02How do you make sure choking, falls and moving-and-handling risk assessments are accurate, current and understood by every staff member?
- 03What checks now confirm that medicines given when needed have clear instructions and are administered safely?
- 04How do you monitor PPE use, handwashing and changing PPE between supporting different people?
- 05What evidence can you show that the new audits and management checks have fixed the breaches in Regulations 12, 17 and 18?
This was an unannounced follow-up inspection that rated Safe and Well-led; the report did not give separate ratings for Effective, Caring or Responsive. This explanation was written from the published report of 26 August 2021 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Willow Tree House
5 rated inspections over 5 years: the service has held its Good rating throughout.
- January 2022Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- August 2021Requires improvementup from InadequateSafe: InadequateWell-led: Requires improvement
- July 2021Inadequatedown from Requires improvementSafe: InadequateWell-led: Inadequate
- January 2020Requires improvementdown from GoodSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- November 2016GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- August 2016
Registered with the Care Quality Commission on 23 August 2016.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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