CQC report explained · a nursing home
What the CQC found at Willows Care Home
Rated Inadequate: inspectors found the home performing badly and the CQC has taken enforcement action.
- Safe?
- Requires improvement
- People at high risk of falls were left unsupported in communal areas. Parts of the building and kitchen were dirty or unsafe, and infection control systems were not effective enough.
- Effective?
- Requires improvement
- People could access healthcare and had ongoing assessments, and mealtimes had improved. However, care plans did not always guide staff clearly, and the provider could not assure inspectors that staff had the practical training needed for some care.
- Caring?
- Requires improvement
- People generally spoke positively about staff, who were respectful and protected privacy. However, meaningful engagement was limited, care was often task-led, and relatives gave mixed feedback about involvement and whether concerns were acted on.
- Responsive?
- Inadequate
- People were not shown to be involved in care planning, and personal hygiene needs were not always met. There was little evidence of suitable activities or stimulation, including for people in bed or in their rooms.
- Well-led?
- Inadequate
- Audits and checks were inconsistent, and identified actions were not always completed. There had been repeated management changes, no registered manager had been in post for 12 months, and oversight of training and care quality was not robust.
What inspectors found, February 2024
Willows Care Home is rated Inadequate and in special measures; inspectors found serious shortfalls in personalised care, activities, infection control and leadership.
Inspectors visited unannounced on 17 and 19 October 2023. They spoke with people, relatives and staff, observed care, and checked care records, staff files and management records.
The overall rating was Inadequate. Safe, Effective and Caring were rated Requires Improvement. Responsive and Well-led were rated Inadequate. People were often positive about staff, but inspectors found people left without prompt support, limited activities, poor parts of the building and weak oversight of risks and care quality.
The home remained in breach of regulations 9 and 17 from the previous inspection and was also found in breach of regulation 12. The CQC issued warning notices and will monitor the home with the provider and local authority.
People felt safe
People and relatives generally said their loved ones were safe. Staff understood how to report abuse and felt management would respond.
“Overall feedback from people and relatives told us they felt their loved ones were safe living at the Willows.” from the report
Medicines administration
Medication administration records were accurate and complete, and medicines were stored safely. The home still needed to manage surplus stock more effectively.
“Records of the administration of people's medicines were accurate and complete.” from the report
Respectful care
Inspectors saw staff treating people sensitively and respecting their privacy and dignity.
“We observed staff knocking on doors and asking for permission prior to providing care.” from the report
Healthcare support
People were supported to access healthcare when needed, with appointments and actions recorded in care plans.
“People were supported to access appropriate healthcare services when required.” from the report
People left without prompt support
seriousCommunal areas were sometimes left without enough staff. This included people at high risk of falls and left them at risk of injury.
“During the inspection people who were identified as high risk of falls were left unsupported by staff in communal areas.” from the report
Poor environment and infection control
seriousSome areas were dirty, poorly maintained and difficult to clean. Inspectors found poor repairs, dirty kitchen items, unpleasant smells and flies.
“Systems were either not in place or effective enough to demonstrate that risks associated with infection control and the environment were safely managed and effectively actioned.” from the report
Too few activities
seriousPeople had limited stimulation and some were bored or disengaged, including people who stayed in bed or their rooms. This was a continuing problem from the previous inspection.
“One person told us, "I stay in bed, I am bored. All I can do is watch TV and read.” from the report
Personal care not always met
seriousInspectors found concerns about dirty fingernails, toenails and other hygiene needs. People were not consistently involved in planning their care.
“We also raised concerns in relation to some people's hygiene needs which were not being met by staff.” from the report
Weak management checks
seriousAudits were irregular and actions were not always completed. The provider could not give assurance about some practical staff training, including manual handling and wound care.
“The provider had failed to address and make Improvements required since the last inspection.” from the report
Complaints not always resolved promptly
needs fixingA complaints process was available, but relatives said problems were not always dealt with quickly after they complained.
“However, we received feedback from relatives that following raising complaints that issues were not promptly resolved, we shared this feedback with the manager.” from the report
- 01What immediate changes have been made to ensure communal areas are staffed and people at risk of falls receive prompt support?
- 02What activities are now available for people in communal areas, in bed or in their rooms, and how do you check that activities match their interests?
- 03What repairs, cleaning and infection control work has been completed since the inspection, including the communal bathrooms, bedrooms and kitchen?
- 04How are care plans now updated to give staff clear instructions and to involve each person in decisions about their care?
- 05How do you check staff have completed and can demonstrate practical training in manual handling, wound care, creams and blood glucose support?
This was an unannounced inspection prompted partly by concerns about care quality and it assessed all five key questions, including infection prevention and control. This explanation was written from the published report of 10 February 2024 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, March 2023
Requires Improvement; inspectors found kind care and improved care plans, but risks, activities and management oversight were not consistently handled well.
Inspectors visited the home without notice on 10 and 18 January 2023. They spoke with people living there, family members and staff. They observed care and reviewed care plans, medicine records, staff files and management records.
The home was rated Requires Improvement overall. Safe, Effective, Responsive and Well-led were all rated Requires Improvement. Inspectors found gaps in risk monitoring, infection control, staff training, mealtimes and meaningful activities. Routine audits had not been completed for more than six months.
There were also positive findings. Care plans had been updated to reflect people's current needs. People were supported to make choices and access healthcare. The new management team had started new monitoring systems, but these had not been used long enough to show lasting improvement. The home had also been rated Requires Improvement at the previous inspection, so this was the second consecutive inspection with that rating.
Updated care plans
Inspectors found significant work had been done to make care plans reflect people's current needs.
“Significant work had been done to ensure care plans were reflective of people's current needs.” from the report
Choice and consent
People were supported to make choices and staff generally used the least restrictive approach and acted in people's best interests.
“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 interests.” from the report
Access to healthcare
Staff worked with other agencies and supported people to obtain medical help when needed.
“Records confirmed people were supported to access their GP and other health services when required.” from the report
Safe recruitment
The required recruitment checks were completed before staff were offered employment.
“Appropriate checks had been made before being offered employment.” from the report
Positive views of care
People living in the home and family members gave positive feedback about the care.
“People who lived at Willows Care Home and family members spoke positively about the care people received.” from the report
Risk monitoring
seriousAccidents and incidents had not been analysed for six months, and there were not enough recorded management meetings to review risks such as falls, weight loss and infections. This was linked to a breach of Regulation 17.
“Systems had not been established to assess, monitor and mitigate risks to the health, safety and welfare of people using the service.” from the report
Lack of activities
seriousStaff shortages meant there were few planned activities, including none planned for people cared for in bed. This was linked to a breach of Regulation 9.
“Due to staff shortages there was a lack of planned activities throughout the week.” from the report
Weak management oversight
seriousRoutine audits and analysis had not been completed for more than six months. The new systems were not yet embedded in everyday practice, and this was linked to a breach of Regulation 17.
“Routine audits and analysis of events had not been completed for more than 6 months.” from the report
Infection control and environment
needs fixingThere were occasions when there were not enough cleaning staff. Some carpets needed replacing and a shower room needed upgrading.
“Improvements were needed to ensure people were fully protected from the risk of infection.” from the report
Mealtimes and training
needs fixingPeople were sometimes waiting for meals, had not recently been consulted about menus, and some staff training was incomplete or not detailed enough. CQC recommended that the provider review both areas.
“There were some gaps in training records and a number of staff needed to complete refresher training.” from the report
- 01What regular checks now show that falls, weight loss, infections and accidents are being reviewed and acted on?
- 02What activities are planned each week for people who are cared for in bed?
- 03How are you improving mealtimes, including choice of food, waiting times, condiments and consultation with residents?
- 04Which staff training and refresher courses are still outstanding, and how are they recorded?
- 05What cleaning, carpet replacement and bathroom improvement work has been completed since the inspection?
This was an unannounced inspection that assessed Safe, Effective, Responsive and Well-led, including infection prevention and control; no separate Caring rating is shown in the report. This explanation was written from the published report of 7 March 2023 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 Willows Care Home
12 rated inspections over 9 years: the service has held its Inadequate rating throughout.
- February 2024Inadequatecurrent ratingdown from Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: InadequateWell-led: Inadequate
- March 2023Requires improvementstayed Requires improvementSafe: Requires improvementEffective: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- December 2021Requires improvementup from InadequateSafe: Requires improvementWell-led: Requires improvement
- May 2021InadequateSafe: InadequateWell-led: Inadequate
- December 2020Inspected but not ratedSafe: Inspected but not ratedEffective: Inspected but not ratedWell-led: Inspected but not rated
- July 2020Inadequatedown from GoodSafe: InadequateWell-led: Inadequate
- January 2020Goodup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- December 2018Requires improvementup from InadequateSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- May 2018Inadequatedown from Requires improvementSafe: InadequateEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Inadequate
- October 2016Requires improvementstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: GoodWell-led: Requires improvement
- September 2015Requires improvementup from InadequateSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- June 2015Inadequatestayed InadequateSafe: InadequateEffective: InadequateResponsive: Requires improvementWell-led: Inadequate
- December 2014InadequateSafe: InadequateEffective: InadequateCaring: GoodResponsive: Requires improvementWell-led: Inadequate
- July 2013
Report published without a new overall rating.
- February 2013
Report published without a new overall rating.
- December 2012
Report published without a new overall rating.
- May 2011
Report published without a new overall rating.
- January 2011
Registered with the Care Quality Commission on 18 January 2011.
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.
Weigh the report against the rest
Fees, photos and reviews from families
How to read CQC ratings and reports
What to check when you visit
84 live-in carers within about an hour of Cheshire West and Chester
These are self-employed carers on PrimeCarers, the introductory agency that runs this directory. Each has a profile with their own rates and reviews from families, and you choose who to talk to.
Most charge £980 to £1,260 a week. 76 can care for a couple. 10 years' experience on average.
“She is an exemplary carer, she is knowledgable empathetic and very respectful in the home.”
“It was clear that she genuinely cared and her warm approach really helped put our minds at ease.”
Every carer has had an enhanced DBS check in the last 18 months, ID and right-to-work checks and an online interview. Their skills and training are for you to check with them. Carers set their own rates, and who is free changes week to week.