The Willows

We carried out this assessment on 22 July 2026. This service was previously rated as good. We carried out this assessment to confirm whether the rating of good remains accurate. This report does not provide detailed information on areas where we found practice continues to meet a good standard. Instead, our findings focus on any areas where the service needs to improve or where we found exceptional practice.

The care and support people received was exceptional. People received kind, compassionate, and respectful care from all members of the staff team. Staff knew people extremely well and could describe how they supported people to meet their needs, their individual preferences and wishes. The provider fostered a culture where people were at the heart of their care and supported to achieve positive outcomes through staff providing exceptionally personalised care. We saw outcomes included significantly improving people’s health and well being and maintaining and developing their independence. Staff told us, “Personalised care is about the individual person – their care and medicine. The actual person. For example, if someone wants to stay up at midnight it’s their choice. It’s not a factory, it’s a home.”

People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. In care homes, this can be done through a procedure called the Deprivation of Liberty Safeguards (DoLS), which is part of the Mental Capacity Act 2005 (MCA). We checked whether the service was working within the principles of the MCA and how they managed DoLS within the service. We found that staff and management understood and worked within the MCA. Staff told us, “You have to ask the person what they want, I ask them can I do this for you.? Each and every step has to be consented to. You have to create a bond with the person. If the person is unable to give consent, you have to do things in their best interest. Assess what you can do for them and in the best way possible." DoLS authorisations were appropriately applied for and overseen. People were not subject to unlawful or excessive restrictions they had choice, control and freedom over their lives.

Systems were in place to review all incidents and learn lessons when things went wrong. Staff understood how to recognise abuse and could describe the actions they would take to report any concerns. Staff had received training to support their practice and there was a whistleblowing policy in place. Where incidents had happened, the registered manager had reported these to the appropriate body, and we saw all incidents were monitored to track the outcomes and internal reviews were undertaken to identify any wider themes or learning. The registered manager explained how handovers and staff meetings were used to discuss any concerns and updates and ensured lessons were learnt to mitigate future risks. A staff member told us, “It is all on the (electronic care plan). You can gain access to all of a person's information, risk assessments etc. For example, a person is at risk of falls. They sometimes forget they walk with a walking aid. We have to monitor and remind them to keep them safe.”

People received their medicines as prescribed. Medicines administration records were also in place and accurately completed. Guidance was in place for where people needed as required medicines and medicines were stored safely. Staff were observed seeking consent from people to accept their medicines and administering these safely. People had an initial assessment which identified their needs and outcomes. Staff told us they received information about people’s needs through the electronic care plans and information handovers. We saw the system identified people’s individual needs and preferences and documented the outcomes they wanted to achieve. The electronic record also ensured people had regular reviews of their needs and outcomes, and evidence-based tools were included in the system. A staff member told us, “We normally learn about new admissions from the registered manager in a meeting. They will give a short de-brief then we look at the new admission information on the system.”

Systems to ensure there were sufficient staff deployed to meet people’s needs were in place. Where people were assigned 1 to 1 care to keep them safe, this was in place and used effectively. For example, we saw staff provided timely support and intervention when people became distressed and required reassurance or redirection. Staff told us they had completed an induction when they first started. They were introduced to each resident and had time to go through each care plan before providing care and support. Staff were positive about the training and supervision they received. They told us, “We are trained all the time. There are 2 training sessions every Wednesday. Everyone is treated the same. Everyone does the same training.” The registered manager told us they had identified most staff preferred face to face training and found this had had a positive impact on embedding good working practices. A staff member told us, “We do some on-line training and some face to face. I like the face-to-face training as it gives me confidence.”

Systems to check people received their care were operating effectively and audits were in place to check medicines administration was done safely. The registered manager had systems in place which supported learning and there was a clear understanding of the providers vision for the service. Staff were unanimously positive about the leadership and management of the service and felt supported in their roles and as individuals. Staff told us, “We are supported by management. They are very flexible and you can talk about anything work related or personal. We work as a team and management help you to be the best way they can” and “Management are amazing, very approachable. They are also supportive in personal aspects of your life.”