The Willows

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs.

At our last assessment, this key question was rated requires improvement. This key question has remained requires improvement. This meant people’s needs were not always met. These shortfalls are a repeat breach of legal regulation 9: Person centred care, people were not supported in a person-centred way.

This service scored 54 (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 were at the centre of their care and treatment choices and they did not always work in partnership with people, to decide how to respond to any relevant changes in people’s needs.

We reviewed the full care plans and risk assessments of 5 people and the sections of another 5 people. Although some improvements had been made in care plans, they were not always up to date and there were contradictions and omissions which could lead to inappropriate care. The care records lacked evidence that people were the centre of their care, including consultation with people and their representatives, where appropriate. The only evidence of consultation was when assessments were undertaken when the person first started using the service. Whilst care plans showed they were reviewed by staff, approximately monthly, there was no evidence that any changes were discussed with the person or their representatives. Where changes in the care plans had been made, all the relevant sections had not been updated to guide staff on the most up to date ways of meeting people’s needs. A staff member told us there were no people receiving their medicines covertly, such as hidden in food. However, a person’s records stated they received their medicines this way. This was changed as soon as we pointed it out, but we were concerned it had not been independently identified.

There were some shortfalls in how the provider understood the diverse health and care needs of people and their local communities, so care was not always joined-up, flexible or supportive of choice and continuity.

Because care plans were not always kept up date and did not reflect the dates of when guidance and/or treatment had been received, and who the guidance was from, we could not be assured people were receiving care which supported continuity of care and person-centred care.

Staff had received training in equality and diversity, and people’s specific needs such as dementia, although there were no people using the service with a learning disability or autistic people, training had been provided to staff. There was a lack of training and/ or sessions provided to staff who originated from overseas to ensure they understood the cultural and diverse needs of people who used the service. People's care plans did not always identify their specific cultural needs. This was important due to the diverse mix of staff working in the service.

There was detailed information in care plans for those who had diabetes. However, people’s care plans varied relating to other health conditions, and what information was available for staff to understand how their conditions affected them in their daily living. Care plans did not always include warning signs of them becoming unwell as a result of their condition. The management team told us this had been in place, but they had been advised, by external professionals, to remove them from the care plans as they held too much information. They agreed this would be included in future.

The provider supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

Since 2016 all organisations that provide publicly funded adult social care are legally required to follow the Accessible Information Standard. The Accessible Information Standard tells organisations what they have to do to help ensure people with a disability or sensory loss, and in some circumstances, their carers, get information in a way they can understand it. It also says that people should get the support they need in relation to communication.

Where people required information in alternative formats, such as larger print and other languages, this was available to be provided in accessible ways, such as the complaints procedure. People’s care records included information of people’s communication needs and guidance for staff in how to communicate effectively with them. We observed a staff member communicating with a person who had specific communication needs, they checked the person had understood them and checked they had understood the person.

The provider did not always make it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff did not always involve people in decisions about their care or tell them what had changed as a result.

There was a complaints procedure in place and people and relatives told us they would raise a complaint if required. Where relatives told us they had raised concerns, they told us these had been addressed. Records of complaints showed they were responded to and an apology made where required. However, the record of complaints did not always show if they were upheld or not and there were no lessons learned to show comments and concerns received had been used to drive improvement and reduce the risks of a reoccurrence.

There was a suggestion box in the entrance hall of the service, whilst this was positive where visitors could post their comments, there was no similar opportunity for people using the service. In the entrance hall to the service was a board which showed actions taken as a result of comments.

The provider did not always make sure that people could access the care, support and treatment they needed when they needed it.

People told us they had access to health professionals such as their GP when they needed to see them. The management team told us they had good working relationships with other professionals involved in people’s care, such as health care professionals. They told us referrals were made to health care professionals where required, such as if they were concerned about a person’s wellbeing relating to falls, or weight loss. We received feedback from a visiting professional who told us referrals were being made appropriately. We saw records in a handover book, where staff had made referrals and these were chased up where required. However, outcomes were not always documented throughout care plans to ensure they reflected the most up to date information about the person and their needs. This could lead to inappropriate care.

Staff and leaders did not always actively listen to information about people who are most likely to experience inequality in experience or outcomes. This meant people’s care was not always tailored in response to this.



People’s care plans were not always kept up to date and were sometimes contradictory. There was a lack of evidence to show that people, and their representatives, where appropriate, were included in their care plans, other than when they first started using the service. There was a lack of evidence to show that they were listened to about their experiences to ensure their care plans were tailored to their individual needs and preferences. There was a lack of analysis and lessons learned, for example in safeguarding and complaints, to learn from them, identify potential trends and reduce future risks. There was a risk that safeguarding and complaints could reoccur due to a lack of analysis and lessons learned. There was some analysis for accidents and incidents, however, again there were no lessons learned documented. In addition, we were not assured all of the incidents were documented. We found an incident of distressed reaction in a person’s daily notes, but this had not been included in the incident analysis. This did not support the management team to identify any triggers, identify trends and put measures in place to reduce the risks of distress.

People were not always supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

People’s care plans did not always include information about their end-of-life choices. For example, one person’s records stated the end-of-life outcome and goal was to ensure their end-of-life wishes were met in a “sensitive and dignified manner,” however, there was no information about their choices. The document stated it would be discussed at an appropriate time. There was information about if they wished to be resuscitated, however, there was no additional information, such as if choices had been sought regarding where the person preferred to be cared for should they become ill. Another person’s records, who was receiving end of life care, included their decisions relating to if they wished to be cremated or buried, but no information about their end-of-life care. This could lead to people not receiving the care they chose to at the end of their life.