Willow Court

Willow Court is a residential care home providing personal and nursing care to people with a physical disability, a sensory impairment, a learning disability and autistic people. The service can accommodate up to 19 people. Nineteen people were using the service at the time of the inspection.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

People’s experience of using this service and what we found

The service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

Although people’s care and support was provided in a safe, clean, well equipped, well-furnished and well-maintained environment which met people's sensory and physical needs, the service was situated on a site which was separate to the local residential area so did not integrate well within the community.

People were not kept safe from avoidable harm because unexplained injuries such as bruising and scratches were not routinely followed up and investigated to establish potential causes.

The care provided was personalised despite shortfalls in the assessment and care review process. People were not always supported to identify and achieve goals and aspirations. Care plans were detailed and guided staff.

Activities were not part of people’s planned care and there were limited opportunities for people to engage in person centred activities. The service had started to organise activities to improve people’s quality of life.

People’s communication needs were met and information was shared in a way that people could understand.

Most staff knew people well, but people sometimes received support from inexperienced staff who did not have a good understanding of their needs. The service had carried out a recent recruitment drive, which would provide a more stable workforce.

The provider had their own therapy services such as speech and language therapists who helped people maximise skills and maintain independence.

People told us they felt safe and liked living at Willow Court. Family members told us people received kind and compassionate care.

The service understood staff required training and support, but this was not always provided consistently.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Medicines were managed safely and administered in a safe and caring way.

The service had systems for preventing and controlling infection. The service had only had a low level of COVID-19 infection with no deaths. The management team were proud of this achievement.

Governance systems did not ensure people were kept safe and received a high quality of care and support in line with their personal needs.

The management team were responsive to the inspection findings. They told us how they were improving their systems and processes to ensure people received safe, quality care.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Good (published 28 August 2019).

Why we inspected

We undertook this inspection as part of a random selection of services rated Good and Outstanding to test the reliability of our new monitoring approach.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, responsive and well-led sections of this full report.

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service.

We have identified breaches in relation to safeguarding people from avoidable harm and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The registered provider, Hollybank Trust, provides education and residential care for children, young people and adults living with complex and multiple physical disabilities and associated communication, sensory and learning difficulties. Willow Court is registered to provide nursing and personal care for people who require care and attention relating to their complex needs.

The single storey purpose built home is split into three smaller units, known as bungalows, each of which has separate adapted facilities. Access into and around the home is level providing equal access for people who mobilise using a wheelchair or other mobility aids.

The service was a large home, bigger than most domestic style properties. It was registered for the support of up to 19 people and 19 people were using the service at the time of our inspection. This is larger than current best practice guidance. However. the size of the service having a negative impact on people was mitigated by the service working hard to make sure outcomes for people reflected the principles and values of Registering the Right Support. There was a very strong focus on promoting people’s choice and control, independence and inclusion. People's support very clearly focused on them having as many opportunities as possible for them to gain new skills and become more independent.

People’s experience of using this service and what we found

People told us they were happy with the service provided at Willow Court

The service placed people at the heart of the service. There was a strong person centred, caring and responsive ethos. People told us how they were treated with kindness, compassion and respect. We saw there was a very positive atmosphere and engaging interaction during our visit. Comments from people and relatives were positive. People confirmed that staff were caring, friendly and made them laugh.

People were safeguarded from the risks of abuse. Risks associated with people’s care were assessed and monitored and people and relatives told us the service was safe. People’s medicines were safely managed.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible, and in their best interests. The policies and systems in the service supported this practice. There were enough staff to meet the needs of each person. Recruitment continued to be undertaken in a safe way. Staff were skilled, motivated and knowledgeable. They had received appropriate training and support and were encouraged to develop their individual skills and interests. People received a balanced diet which met their individual needs and took into consideration their preferences.

People were supported by staff who were very kind and caring and who maintained their dignity and privacy and treated them with respect. People received very good, personalised care and support that was specific to their needs and preferences. People’s needs were considered and reviewed, and changes made where needed. Staff knew people well and were passionate about promoting people’s independence. People were respected and valued as individuals; and empowered as partners in their care.

Staff were professional and motivated to achieve the best possible outcomes for people including choice, control and independence. People were fully involved in the service and had opportunities to give feedback. Systems of governance were in place to continually monitor the quality of the service provided. Feedback about the leadership and management was very positive and staff felt very well supported. Staff felt supported and spoke positively about the registered provider and registered manager.

Rating at last inspection:

The service was rated good at the last inspection in 2016 (published December 2016).

Why we inspected:

This was a planned inspection based on the previous rating. Although, the inspection was prompted in part by concerns received about of a specific incident, during which a person using the service sustained a serious injury. This incident is subject to further investigation. As a result, this inspection did not examine the circumstances of the incident. The information CQC received about the incident indicated concerns about the management of falls from moving and handling equipment overall. This inspection examined those risks. We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe section of this full report. During this inspection we found the provider had taken action to mitigate future risks.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

The registered provider, Hollybank Trust, provides education and residential care for children, young people and adults living with complex and multiple physical disabilities and associated communication, sensory and learning difficulties. Willow Court is registered to provide nursing and personal care for up to 19 people who require care and attention relating to their complex needs. The single storey purpose built premises provides 19 en-suite bedrooms, three assisted bathrooms, communal lounges and kitchen/ diners. The service is split into three smaller units, known as bungalows. Access into and around the home is level and therefore has good access for people who mobilise using a wheelchair or other walking aids. The home is on Hollybank’s main site and has good transport links to local shops and amenities.

The service had a registered manager. 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.

We spoke to five relatives in person and by telephone. They told us that their relative was safe at Willow Court and that they had no concerns about the quality of care being provided. We found that the staff had an in depth knowledge of how to keep people safe from harm and they spoke confidently about their roles. Staff knew the correct procedures to follow if they considered someone was at risk of harm or abuse. They had received appropriate safeguarding training and there were policies and procedures to support them in their role. Risk assessments were in place to identify risks due to people’s medical, physical and mental health conditions and to make sure these were minimised.

The service recruited staff in a safe way, making sure all necessary background checks had been carried out and that only suitable people were employed. Processes were in place to assess the staffing levels that were needed, based on people’s dependency and the lay out of the building. Relatives told us staff were always available, during the day and night when required. Our observations during the inspection showed there was appropriate deployment of staff, including staff providing care, catering and housekeeping tasks.

Records showed staff received the training they needed to keep people safe. The manager had taken action to ensure that training was kept up to date and future training was planned.

Medicines management was well organised and administered in a safe way. This meant that people received their medicines in accordance with the prescriber’s instructions.

Staff told us the manager, and other senior staff employed by the service, were supportive and approachable. They also confirmed to us that the on call arrangements were well organised, and that they could seek advice and help out of hours if necessary. This meant there was good oversight of the service, and staff were confident about the management structures.

Staff had a good understanding of the Mental Capacity Act and we observed consent being sought routinely before any support or care was given. People had been supported to make their own decisions wherever possible, and staff had taken steps to support people to do this. Where people were unable to make a decision there was a best interest decision recorded within their care plan and we saw the person and relevant people had been involved in making this. This meant people were given the opportunity to be involved in decision making and decisions were made in the person’s best interests. The service had effectively implemented the Deprivation of Liberty Safeguards (DoLS) as required.

Relatives spoke highly of individual staff and told us that staff treated people with the utmost respect and kindness. We saw good practice throughout our visit, including the support of people to move around the home and the encouragement of people to eat and drink. Staff approaches were professional, friendly, appropriate and discreet.

Staff told us they felt supported by the management team and the organisation. Staff told us they had ample opportunities to reflect on the service they provided through supervision and regular contact with each other. Staff told us they were passionate about developing and improving the service for people. People were cared for and supported by qualified and competent staff.

The premises were well maintained, clean, fresh smelling and comfortable. The adaptations and equipment provided, including assistive technology, meant that people could maintain their independence.

People were provided with a varied menu at each meal time. People also had continual access to drinks and snacks in between meals. If people were at risk of losing weight or choking, we saw plans in place to manage this. People had excellent access to health care services, including on site physiotherapists, occupational therapists and speech and language therapy. The service was also committed to working in partnership with other healthcare and social care professionals.

People had their care needs assessed and planned, and regular reviews took place to make sure people received the right care and support. Information in people’s care plans was person centred and contained sufficient detail to guide staff.

A wide range of activities took place both on site and in the wider community. People were supported to attend regular activities. Relatives were encouraged to become involved if they wished.

A complaints procedure was in place and records were available to show how complaints and concerns would be responded to. People who used the service and their representatives were encouraged to give feedback, through meetings and reviews. There was evidence that feedback had been listened to, with improvements made or planned as a result.

The manager submitted timely notifications to both CQC and other agencies. This helped to ensure that important information was shared as required. We found audits were taking place consistently and were effective in highlighting any issues before they arose and when improvements were needed, the manager was proactive.

On the day of the visit we observed good interactions between people who lived in the service and staff. People’s wellbeing, privacy, dignity and independence were monitored and respected and staff worked to maintain these wherever possible. This ensured people felt satisfied and were enabled to take control of their lives.

not able to verbally tell us their experiences. We therefore used a number of different methods to help us understand the experiences of people who used the service, including observing the care being delivered, talking with staff and looking at records in the home.

As part of our inspection we spoke with the deputy manager and staff at the home. We also observed people receiving care and looked at care records.

Below is a summary of what we found.

Is the service safe?

People were treated with respect and dignity by the staff. Systems were in place to make sure that managers and staff learned from events such as accidents and incidents, complaints, concerns and investigations. This reduced the risks to people and helped the service to continually improve. The home had a safeguarding adults' procedure that complied with all of the relevant legislation and good practice guidelines. Staff understood their responsibilities to protect people from harm.

Is the service effective?

People's health and care needs were assessed with them. We looked at the care records for two people who lived at Willow Court. We found that people's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. We saw evidence that demonstrated staff were provided with regular formal supervision. Staff told us that they were supported by management who enabled and encouraged them to access appropriate training on a regular basis.

Is the service caring?

Staff communicated well with people and were attentive when they needed support. We saw evidence that people were involved with the planning of their care.

Is the service responsive?

We saw staff caring for the needs of people in a professional manner. They ensured the people they cared for were supported in taking part in activities in the local community.

Is the service well-led?

The service had a quality assurance system, records seen by us showed that identified shortfalls were addressed promptly. As a result the quality of the service was continuingly improving. This helped to ensure that people received a good quality service at all times.

We reviewed people's care records and spoke with commissioners involved in funding the care for these people. The care records we looked at were person centred and provided an accurate and up to date picture of the person's needs. The commissioning staff we spoke with were happy with the quality of care the people they funded received.

We saw there were systems and processes in place to protect people from unsafe equipment.