Archived: Willow Community Care

Willow Community Care is a service providing personal care and support to people in supported living accommodation. The service is run by Willow Care Homes Ltd who also operate a care home nearby. At the time of this inspection Willow Community Care was providing care and support to three people who lived together in supported accommodation.

The last inspection of the service was on 28 November 2016 where we found four breaches of legal requirements. The provider had not ensured suitable training for staff to carry out their roles. They did not have sufficient oversight and good governance of the service. They had not ensured all risks to people's health were addressed in risk assessments and they also failed to notify the Care Quality Commission of events that they were required to notify by law.

At this inspection we found that the manager was aware of required notifications and there had not been any incidents that were required to be reported since our last inspection. Risk assessments had improved and we found the manager was managing risks to people's health and safety. Staff had adequate knowledge about safeguarding people from abuse.

Most of the time there was one member of staff working to provide support to people but the manager and other members of staff worked as a second staff member on duty when needed to ensure people could attend appointments and go out when they wanted to.

There was no registered manager at the time of the inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The deputy manager had been promoted to manager of the service a few months previously but had not yet applied to be registered with the Care Quality Commission. The director informed us that the manager would be applying for registration shortly after the inspection.

Staff training was by online learning. First aid training was not face to face training which meant that staff were not all properly trained in first aid. Training was highlighted at the last inspection but the provider had not made sufficient improvements in ensuring that they had an oversight of staff training needs.

People enjoyed their lives and were happy with the support provided to them. They had support to go out and follow their own interests, both individually and together. They had good social lives. Staff enjoyed working with people and felt supported in their roles.

People had good support with their diet and maintaining their health.

The provider had not supported the new manager with training, supervision or by providing the guidance that was needed in order to ensure compliance with the fundamental standards. They had not ensured records were regularly reviewed and up to date.

The manager carried out internal audits regularly and had made improvements in medicines management and personcentred care since the last inspection.

There was one breach of regulation in relation to governance of the service. You can see what action we required the provider to take at the end of the full report.

Prior to this inspection this service was inspected on 16 January 2014 where all standards inspected were met.

Willows Community Care is registered to provide personal care to six people. The client group consist of people with learning disabilities, sensory impairment and autism. At the time of our inspection there were four people using the service living in supported accommodation based at Brookside Road.

There is a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Staffing levels were allocated based on people’s level of need. Senior staff were hands on and involved in the provision of care. People’s needs were assessed and support plans created for each person using the service. We observed good interactions between staff and people using the service and people were treated with respect.

Safeguarding procedures were in place. However, we found incidents of unexplained bruising which had not been reported to the local safeguarding authority. Staff were able to tell us what would constitute abuse, but some staff felt they were not able to approach senior managers with their concerns as they were not confident that this would be addressed.

Assessments were undertaken to assess any risks to the people using the service and the staff supporting them. The risk assessments we viewed included information about action to be taken to minimise these risks. However, we noted gaps in risks for one person at risk of falls. Following our inspection the registered manager submitted a mobility risk assessment.

Although we noted some learning from incidents, the service did not always manage incidents well and provider did not have a policy in place. This put people at risk of receiving care that was inappropriate or unsafe.

The service carried out disclosure and barring criminal checks to ensure that people employed were safe to work with vulnerable people. However, we found some gaps in records relating to references.

Care staff received supervision and some had received an appraisal. These processes gave staff an opportunity to discuss their performance and identify any further training they required.

People’s independence was encouraged and their likes and dislikes taken in to account. . Staff supported people to take their medicines when required and attend healthcare appointments and liaised with their GP and other healthcare professionals as required to meet people’s needs. However, we found some gaps in medicine administration charts (MAR). Protocols were not in place for medicine taken ‘as required.’

The service had a complaints policy. This included timeframes for dealing with complaints and provided external contact details. Relatives told us that they knew how to make a complaint and felt comfortable approaching the registered manager and staff with any concerns.

We found that the service was not meeting the Regulations of Health and Social Care Act 2008 in relation to medicine and risk management, staff training and governance and Registration Regulations 2009 in relation to notifications of incidents.

You can see what action we have asked the provider to take at the end of this report.

Relatives told us that they were happy with the quality of care provided by the service. We received mixed feedback from stakeholders whilst one describe the service as, 'very organised and caring,' another felt that staff did not have the in depth knowledge to support someone with autism and who challenged the service.

People were supported to access other health and social care services they needed, including involvement from healthcare professionals, such as, speech and language therapist for people with special dietary requirements and involvement of neurologist for someone recently diagnosed with Parkinson's disease (a degenerative disorder of the central nervous system).This showed that the service worked in co-operation with other healthcare professionals to ensure that people's individual needs were met.

Staff personnel records showed that staff had been subject to appropriate and necessary checks when they were employed by the agency. Recruitment checks including an enhanced Criminal Record Bureau checks.

Systems were in place for monitoring the quality of the service, including protocols for dealing with complaints.

Staff had access to care records and confirmed that they had discussed record keeping at their last team meeting in May 2013. They were all aware of the confidentiality policy and gave examples of what this constituted in relation to their work with the people they supported. Staff understood the importance of keeping personal information about people safe and secure.

Although the service operates from their registered location in Barnet, records relating to people who use the service were kept at the supported living scheme where personal care is currently provided. At this inspection we visited the supported living scheme to review records and speak with staff.

Staff were able to give us examples of how they treated people with dignity and respect such as ensuring the door was closed when assisting with personal care and respecting people's preferences and likes and dislikes.

There were systems in place to ensure that people were protected from abuse and that they received the care they needed. Systems were in place to monitor and to make improvements to the quality of care and support provided by the agency.

Staff felt supported by the manager, however we were concerned that some supervision records and records for people using the service were not up to date.