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Inspection carried out on 4 April 2019

During a routine inspection

The Willows is a residential care home registered to accommodate up to eight people. At the time of this inspection the service was providing personal care to eight people who have a brain acquired injury.

People’s experience of using this service:

• The provider had taken action to make improvements and comply with the breaches of regulations identified at the last inspection visit. This ensured people received safe care.

• People felt safe living at the home and staff knew how to safeguard them from the risk of potential abuse.

• The potential risk to people was assessed and minimised to protect them from harm.

• People were cared for by sufficient numbers of staff who had been recruited safely.

• People were supported by trained staff to take their prescribed medicines.

• Appropriate systems and staff’s practices helped to reduce the risk of cross infection.

• Accidents were monitored and action taken to avoid a reoccurrence.

• People’s involvement in their assessments ensured they received a service the way they liked.

• People were cared for by skilled staff who received regular one to one support from the registered manager.

• People were supported by staff to eat and drink sufficient amounts to ensure their health was maintained.

• Access to relevant healthcare services promoted people’s physical and mental health.

• The environment was adapted to meet people’s needs.

• People were encouraged and supported by staff to make their own decisions.

• People were involved in planning their care, which was delivered by staff who were kind and respected their right to privacy and dignity.

• People received care and support specific to their needs and were supported by staff to engage in social activities of their choice.

• Complaints were listened to and acted on.

• At the time of the inspection no one was receiving end of life care.

•There was a clear management structure in place and people were encouraged to be involved in running the home.

•The provider’s governance was effective in monitoring the quality of the service and to drive improvements.

•The provider worked in partnership with other agencies to ensure people received appropriate care.

Rating at last inspection: The service was rated Requires Improvement at the last inspection in January 2018.

Why we inspected: This was a scheduled inspection based on the previous rating.

Follow up: We will continue to monitor intelligence we receive about the service until we return to

visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

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

Inspection carried out on 15 January 2018

During a routine inspection

This inspection was unannounced and took place on 15 and 16 January 2018.

The Willows is a ‘care home.’ People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The Willow accommodates eight people who have a brain acquired injury. On the days of our inspection the home was fully occupied. The home is situated on two floors, providing a passage lift to the first floor.

At the previous inspection in January 2015, the service was rated Good. At this inspection we found the provider was not meeting the regulations. The provider’s governance was ineffective in promoting quality standards to ensure people received a safe and effective service. Potential risk to people was not managed sufficiently to protect them from harm and people's liberty had been unlawfully deprived. You can see what action we told the provider to take at the back of the full version of the report.

The home had a registered manager who was present on the second day of our inspection visit. 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 home was not consistently well led; insufficient staffing levels meant people’s aspirations were not always supported. Although the registered manager was experienced they had not maintained their knowledge in relation areas relating to good practices.

People’s risk was not managed effectively to reduce the risk of potential harm. Inadequate staffing levels compromised the quality of care and support provided to people. However, the provider’s recruitment procedure ensured appropriate safety checks were carried out before people were employed.

People could not be confident that all the staff were skilled because systems and practices were ineffective in monitoring staff training and to ensure skills learnt were put into practice. Equality, diversity and human rights were not incorporated in the assessment and care planning to ensure people were not discriminated against. The principles of the mental capacity act and the deprivation of liberty safeguards were not adhered to and people’s liberty was unlawfully deprived.

People’s specific dietary needs were not known by all staff and this placed their health at risk. However, people told us they had access to a choice of meals and drinks were available at all times.

People’s right to privacy and dignity was not always respected. However, one staff member demonstrated their understanding of good practices to ensure people’s privacy and dignity were maintained. People may not always receive the necessary support because of staff’s lack of understanding of their care needs. People were involved in their care planning and were supported by staff who they described as kind and friendly.

Appropriate equipment was in place to support people’s mobility and where necessary referrals were made to review suitable aids and adaptations for the individual.

People were supported by staff who had received an induction into their role and who had received supervision. People’s care needs had been assessed by relevant professionals and they had access to healthcare services to promote their physical and mental health.

People’s interests were recognised by staff who supported them to do the things they liked where possible. People were supported by staff to maintain contact with people important to them. People could be confident their complaints would be listened to and acted on.

People felt safe living in the home and staff were aware of their responsibility of protecting them from the risk of

Inspection carried out on 14 September 2015

During a routine inspection

The inspection was unannounced and took place on 14 September 2015. At the last inspection in September 2013, the provider was meeting all of the requirements of the regulations we reviewed.

The Willows is registered to provide accommodation and personal care for a maximum of eight adults who have an acquired brain injury. There were eight people living at home on the day of the inspection. One person was not at the home. There was a registered manager in place. 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.

People told us they felt safe living at the home. Staff knew and understood the procedures to follow to keep people safe. People’s risks were assessed in a way that kept them safe

and incidents were recorded and monitored to ensure that further occurrences were prevented. People had their medicines safely and as prescribed.

People’s capacity had been assessed and staff knew how to support people in a way that was in their best interests. Staff gained people’s consent before they provided any care and support. People had a choice of food and drink and were supported to manage their healthcare needs.

People received support from staff who were kind, caring and attentive and encouraged their independence. We saw that staff treated people with respect, gave people choices and listened to what people wanted. Staff promoted people’s privacy and dignity.

People told us they enjoyed partaking in their hobbies and interests and were encouraged to maintain friendships that were important to them. People were involved with the planning and reviewing of their care, which was provided in a way that met their preferences.

People were supported by staff who were properly supervised and supported in their work. Staff attended regular training in matters that were relevant to the needs of people living at the home.

People knew how to make their views known and had access to information to help them to make a complaint.

There was a registered manager in place. People told us the registered manager was approachable and was always available if they needed to see them. There were systems in place to gain people’s views about the service. The provider ensured that regular checks on the quality of care and service were undertaken to drive improvement.

Inspection carried out on 2 September 2013

During a routine inspection

When we visited The Willows we met six people who lived there. We spoke with four people who told us about themselves. One person told us where he lived before they came to The Willows. He said the home was comfortable and he liked to get up early. Another person told us about their previous work and a planned holiday to where they used to live and work. One person with the support of the registered manager told us about their hobby. We saw another person�s room where they spent time on their computer and listened to music. They said they had lived at The Willows for about five years and they were happy.

We observed the staff provide personal care and support. The people and the staff team were relaxed and the staff understood the people�s needs. We were told how the staff asked everyone what they wanted from the lunch menu. We observed lunch being prepared. Everyone sat together talking and enjoying their meal. We saw how the people were supported to undertake tasks related to lunch preparation and clearing up the kitchen area.

We were invited to go to people�s rooms and saw they were well furnished and people had thier own things. We were told everyone was encouraged to keep their rooms clean and tidy. We were shown around the rest of the building which was well kept and clean.

We were told by the staff and the registered manager how the staff team work with the people to promote independence as far as possible. We saw how they supported and encouraged people to undertake daily tasks. The daily tasks included house work, meal preparation, medication and money management.

We saw people going out on activities supported by staff. One person was able to go out alone but they telephoned the home when they arrived at their destination and when they were about to leave.

We spoke to staff on duty about their work and their training. They were able to tell us about how they supported the people. They also told us how they were supported by the management and their colleagues.

Inspection carried out on 23 July 2012

During a routine inspection

We spoke with five of the seven people currently living at The Willows to establish their views and experiences about the service that they received. We also spoke with all four staff working at the home on the day of our visit, the registered manager and the communities� manager. We looked at the care and support plans for two people and reviewed additional information as detailed within this report.

People told us that they were very satisfied with the support they received. We were told that staff met people�s care and support needs in ways that they preferred.

People said that they were involved and consulted in the development of their care and support plans. People�s likes, dislikes, preferences and goals were considered in relation to the care and support that they received. Everyone told us that they were treated with dignity and respect.

Two people told us that they were supported to be as independent as they were able. They detailed plans in place to enable them to do this in a structured and supported way. People said that they were involved in doing their own washing and cleaning although most people told us that they did not do cooking (apart from breakfast). Staff confirmed to us that they cooked main meals but said that people sometimes helped with the preparation.

We were told that people took part in a range of day time activities and records reflected this. One person told us that they would like more and we shared that information with the manager.

People were supported by a knowledgeable and well trained staff team who knew their care and support needs well. Staff were offered a range of training opportunities that were specifically designed to meet the needs of the people they supported.

People were protected because staff were confident to recognise and report abuse. The home had implemented changes in response to incidents to keep people safe.

The home effectively ensured that people's views were considered and listened to in relation to the running of the service. The organisation had a range of quality monitoring tools in place to ensure that they maintained good quality and safe care.