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Inspection carried out on 11 September 2017

During a routine inspection

Willow Tree Lodge provides accommodation and personal care to a maximum of four people who live with a learning disability and/or associated health needs, who may experience behaviours that challenge staff. At the time of inspection four people were living at the home.

This inspection took place on 11 and 12 September 2017. The inspection was unannounced, this meant the staff and provider did not know we would be visiting.

At the last inspection in 22 October 2015 the service was rated 'Good'. At this inspection we found the service remained 'Good'.

The service did not have a manager who was registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC 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 and associated Regulations about how the service is run. The registered manager had recently left the home and had cancelled their registration with the CQC. The area manager and positive support coordinator were providing management cover to the home whilst a new registered manager was appointed.

People were kept safe from harm and staff knew what to do in order to maintain their safety. Risks to people were assessed and action was taken to minimise potential risks. Medicines were managed safely and administered as prescribed. The provider operated thorough recruitment procedures to ensure staff were safe to work with the people. There were always enough staff to provide care and support to meet people’s needs.

People were supported by staff who had the skills and training to meet their needs. The manager and staff understood their responsibilities in relation to the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. People were involved in making every day decisions and choices about how they wanted to live their lives and were supported by staff in the least restrictive way possible.

Arrangements were made for people to see their GP and other healthcare professionals when they needed to do so. People were supported to have a healthy balanced diet and had access to the food and drink of their choice, when they wanted it. The physical environment was personalised to meet people's individual needs.

People were supported by regular staff who were kind and caring. There was a warm and positive atmosphere within the service where people were relaxed and reassured by the presence of staff.

People's independence was promoted and support workers encouraged them to do as much for themselves as possible. Staff treated people with dignity and respect and were sensitive to their needs regarding equality, diversity and their human rights. People were encouraged and enabled to be involved as much as possible in making decisions about how their support needs were met.

The service was responsive and involved people in developing their support plans which were detailed and personalised to ensure their individual preferences were known. People were supported to take part in activities that they enjoyed. Arrangements were in place to obtain the views of people and their relatives and a complaints procedure was available for people and their relatives to use if they had the need.

The service was well led. There was a clear management structure in place and staff understood their roles and responsibilities. The vision, values and culture of the service were understood by all staff, which they demonstrated when supporting people. Staff consistently said they had received good support from the management team who were always available to give advice and guidance, especially whilst awaiting the appointment of a new registered manager. The safety and quality of support people received was effectively monitored and identified shortfalls were acted upon to drive continuous improvement of the service.

Further information is in the detai

Inspection carried out on 22 and 24 October 2015

During a routine inspection

This unannounced inspection of Willow Tree Lodge took place on 22 and 24 October 2015. The home provides accommodation and support for up to four people who have learning disabilities or autism. The primary aim at Willow Tree Lodge is to support people to lead a full and active life within their local communities and continue with life-long learning and personal development. The service is a detached bungalow, within a residential area, which has been furnished to meet individual needs.

At the time of the inspection there were four people living in the home. Three people had their own en-suite bedroom and one had a separate lounge, bathroom and bedroom, all of which had been specially adapted to meet their needs. The rear garden had been adapted to provide recreational areas to meet particular individual’s needs. A small garden at the front had been created to provide a peaceful haven for one of the people living at the home.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

People and relatives told us they trusted the staff completely as they provided reassurance when people worried and made them feel safe. Staff had completed safeguarding training and had access to current legislation and guidance. Staff had identified and responded appropriately to safeguarding incidents to protect people from harm. People were safeguarded from the risk of abuse as incidents were reported and acted upon.

Where risks to people had been identified in their care plans measures were implemented to manage these. Staff understood the risks to people’s health and welfare, and followed guidance to manage them safely. People were kept safe by staff who demonstrated their understanding of people’s risk assessments and management plans.

There were sufficient numbers of staff deployed with the necessary experience and skills to support people safely. The registered manager completed a weekly staffing needs analysis in order to ensure that any changes in people’s needs were met by enough suitable staff.

Staff had undergone required pre-employment checks, to ensure people were protected from the risk of being supported by unsuitable staff. Staff had received an induction into their role, required training and regular supervision which prepared them to carry out their roles and responsibilities.

People were cared for by sufficient numbers of well trained staff who were effectively supported by the registered manager and senior staff.

Medicines were administered safely in a way people preferred, by trained staff who had their competency regularly assessed by the provider. Medicines were stored and disposed of safely, in accordance with current legislation and guidance.

People were actively involved in making decisions about their care and were always asked for their consent before any support was provided. Staff supported people to identify their individual wishes and needs by using their individual and unique methods of communication. People were encouraged to be as independent as they were able to be, as safely as possible.

Staff had completed training on the Mental Capacity Act (MCA) 2005 and understood their responsibilities. The MCA 2005 legislation provides a legal framework that sets out how to support people who do not have capacity to make a specific decision. Where people lacked the capacity to consent to their care, legal requirements had been followed by staff when decisions were made on their behalf. People were supported by staff to make day to day decisions.

The CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLS provide a lawful way to deprive someone of their liberty, where it is in their best interests or is necessary to protect them from harm. The registered manager had completed the required training and was aware of relevant case law. Since the last inspection the provider had made four DoLS applications, two of which had been authorised and appropriately notified to the CQC. The provider was awaiting the decision in relation to two further applications. The registered manager had taken the necessary action to ensure people’s human rights were recognised and protected.

People were provided with nutritious food and drink, which met their dietary preferences and requirements. People were supported to eat a healthy diet of their choice.

People’s dignity and privacy were respected at all times and supported by staff. Where people’s needs changed these were identified by staff and reported to relevant healthcare services promptly where required.

The provider had deployed sufficient staff to provide stimulating activities for people. The activities programme ensured people were supported to pursue social activities which protected them from social isolation.

Relatives told us they knew how to complain and that the provider encouraged them to raise concerns. No complaints had been made since the last inspection. When minor concerns were raised records showed they were investigated and action was taken by the provider to make improvements where required.

Staff had received training in the values of the provider, which we observed being demonstrated in practice. Relatives and staff told us the service was well managed, with an open and positive culture. People, relatives and staff told us the registered manager was very approachable, willing to listen and make any necessary changes to improve things for people. Staff told us the strength of their home compared to others was their commitment to people and that they did their very best to make sure people were happy and had fulfilling and rewarding lives. The senior staff provided clear and direct leadership and effectively operated systems to assure the quality of the home and drive improvements.

Records accurately reflected people’s needs and were up to date. Detailed care plans and risk assessments were fully completed and provided necessary guidance for staff to provide the required support to meet people’s needs. Other records relating to the running of the home such as audit records and health and safety maintenance records were accurate and up-to-date. People’s and staff records were stored securely, protecting their confidential information from unauthorised persons, whilst remaining accessible to authorised staff.

Inspection carried out on 23 December 2013

During a routine inspection

At the time of the visit there were four people living in the home. We spent time with two people and observed support being given to one other person. We met with five members of staff including two of the managers. The two people indicated that staff were kind, friendly and helpful.

Staff appeared motivated and one said they "loved" their job. That enthusiasm was evident during their interactions with people and people appeared to benefit from the energy and motivation of staff. Staff said they felt valued and would be able to raise any concerns or ideas they had, confident they would get a response from managers.

We saw the home was clean and in a good state of repair. There was adequate storage space for people's belongings as well as space for equipment necessary for the running of the home.

Staff demonstrated a good understanding of their responsibilities in relation to safeguarding, and staff felt safe working in the home.

People were encouraged to make choices and staff made efforts to support them in this. We saw people were treated as individuals and there were opportunities for people to pursue leisure and social activities.

Staff were observed to interact with people in a friendly and respectful way and people largely, appeared calm and relaxed.

Inspection carried out on 7 November 2012

During a routine inspection

We spoke with two people who lived in the home and three staff. We examined records, minutes of meetings and surveys. We saw that staff were familiar with people's needs and gave them opportunities to make choices.

We found that people living at Willow Tree Lodge and their representatives had been involved in planning their care and staff were familiar with people's needs. The care plans we saw provided individual details of people's needs, wishes and preferences. The home sought advice from external healthcare professionals where necessary and this was recorded in people's care files. A range of activities were provided and people could choose whether they wished to take part.

Staff had received appropriate induction and training and their manager provided them with regular supervision. Staff were also supported through a system of appraisals.

The provider had effective systems in place to ensure the CQC were notified of safeguarding incidents. Safeguarding and complaints information was available on request for the staff and residents to refer to.

The provider had effective quality assurance systems in place to monitor the performance of the home. The views of people living there and their representatives were taken into consideration.

Reports under our old system of regulation (including those from before CQC was created)