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

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question requires improvement. At this assessment the rating remained requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

At our last assessment, we identified a breach of regulation 11 relating to consent, at this assessment the provider was no longer in breach of this regulation, but improvements were still needed.

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not always make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.

People’s needs were assessed prior to them moving into the service, with their input and their representatives, where appropriate. Some people’s care records held their life history, however, there was little to show how their past, such as trauma, had affected them and the support they required. For example, a person’s records referred to a prescribed medicine for depression, however, their care plan failed to identify potential triggers, signs and indicators and how to support the person. Another person’s records referred to them liking to talk about their spouse, who was deceased, there was no guidance for staff in how to respond to ensure their interactions did not trigger distress.

Care plans were reviewed by staff, but where changes were made, these were not always included in all areas of the care plan leading to inconsistencies. There was not always evidence of ongoing consultation with the person or their representatives, where appropriate, to show any changes were needed following discussions.

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

We received concerns from people about the quality of the food provided. A new chef had started working in the service during the week of our visits. Records were kept about how much people had to eat and drink to support the service to monitor and reduce risks of malnutrition and dehydration. However, the records maintained were confusing and we were concerned that an accurate record was not always maintained. For example, fluids were sometimes recorded twice at the same time by different staff. Food was recorded as a percentage of a standard portion. This placed people at risk of not receiving appropriate levels of food and fluid. Prior to our assessment, we received concerns from external professionals about the small portion sizes, during our visits, we noted the portions service were large. However, there was no change in the daily notes to show a change in portion size. We asked the manager how they were sure staff understood percentages when estimating how much people had eaten, they said this was a good point and would check this with staff. Staff were receiving training in portion sizes; a staff member told us this would help when documenting how much people had to eat. A record of people’s weights showed 13 people had lost weight in January 2025, 10 of these, included 3 consecutive months of weight loss or weight loss of 3 kilograms or more from the current weight and the weight measured 3 months previous. The last audit on file for weights was November 2024, this gave an inaccurate report of the numbers of people who had lost weight. The management team told us how appropriate referrals were made relating to people’s weight loss and they were able to tell us how some people’s weight loss was due to their current health condition.

The provider did not always work well across teams and services to support people. They did not always share their assessment of people’s needs when people moved between different services.

Where there were concerns about a person’s wellbeing, the service made referrals to the appropriate professionals, including the GP, district nurses, falls team and dieticians. However, where guidance was received by the service to improve outcomes for people, when it was incorporated into care plans, it did not always indicate the date the guidance was received, and where from. The guidance was not always being entered into all relevant parts of the care plans and risk assessments. This was a risk that people could receive inappropriate care which did not meet their current care needs. There was little information to show how the guidance being followed by staff would be monitored and measured going forward, to check people were improving. A person’s care plan stated there was a plan to have a medical procedure, a member of the management team told us this had already taken place. The care plan had not been updated to evidence this and any actions required by staff. This did not support consistent care which reduced risks to people receiving inappropriate care.

The provider did not always support people to manage their health and wellbeing, so people could not always maximise their independence, choice and control. Staff did not always support people to live healthier lives, or where possible, reduce their future needs for care and support.

People told us they could see their GP when they wanted to and records showed when there were concerns about a person’s wellbeing referrals were being made. Daily notes evidenced where people had chosen to accept or decline treatment this was respected. A person’s care plan showed they were supported to choose healthy options for food to maintain a healthy weight. However, changes in health and wellbeing were not always being documented to ensure continuity of care and reduce risks of people receiving inappropriate care and support. For example, a person’s records showed they used a catheter and also no longer used a catheter. A staff member told us at feedback this care plan had been updated, the care plan was sent to us and documented the person no longer used a catheter, but there was still reference to the catheter being in place. This could lead to inappropriate care.

People had access to fluids in their bedrooms, however, their daily notes did not indicate they were provided with fresh drinks in their bedrooms. For example, a person’s daily notes over 8 days showed the jug was cleaned and replenished between 1:17am to 3:47am. There was no further documentation to show this happening at other times in the day. For 1 day their jug was cleaned and refilled with water at 1:17am, the person had taken a drink prior to this at 0:56am. It was not clear from the records if the person had been drinking fluids which had been stored in their bedroom for almost 23 hours, therefore no access to fresh drinking water.

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

The systems in place to monitor people’s care and support were not robust. Care plans were not always kept up to date to show people’s current needs and records relating to the care people received needed improvement. People were not always supported in line with guidance in the care plan to reduce the risks of pressure injury, including the administration of creams and support with repositioning. Records relating to when people had been supported with their personal care needs were contradictory and therefore inaccurate. For example, a person’s daily notes stated at the same time they had a wash, a shower and were seen by a chiropodist. A member of the management team told us they had recently identified that some staff were recording chiropodist when they were checking their feet and were in the process of addressing this with staff. This demonstrated the care notes were not accurate, and did not give a clear timeline of the actual care people received, either by the staff or external professionals. This had not been addressed by the management team at the time of our assessment.

The provider did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The MCA requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the Mental Capacity Act (MCA). In care homes, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS).

Since our last assessment, some improvements had been made in how people’s capacity to make decisions about their care was assessed and documented. However, these were not always person centred, for example, a person’s capacity assessment referred to another person’s relative. Where best interest decisions were made, the date and detail of the discussions leading to the decision were not always recorded. There was a lack of consent recorded in people’s electronic records, however, the manager told us these were kept in paper copies and they were planning to add these to the electronic care records.

Where required, DoLS referrals were made and kept under review to reduce the risks of unlawful deprivations. Staff had received training in MCA and DoLS.