Willow House

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At this inspection we found the service remained Good.

People told us they trusted the staff team and felt safe at the service. The provider had systems and processes in place to safeguard people against harm and abuse. Staff knew how to report and act on concerns of poor care and abuse.

People’s medicines were managed safely. There were enough suitable staff to meet people’s needs safely. Staff followed safe infection control practices. Accidents and incidents were recorded and lessons learnt to improve when things went wrong.

Staff were well trained and received regular supervision to meet people’s needs effectively. Staff worked well together as a team.

People’s needs were assessed before they moved to the service. People’s dietary needs were met and they were supported to access healthcare services.

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

People told us staff were caring and treated them with dignity and respect. Staff encouraged and assisted people to remain as independent as possible.

People’s cultural and spiritual needs were identified, recorded and met.

Staff knew people’s personalised needs and these were recorded in their care plans. People and their relatives were involved in the care planning process and their care was reviewed regularly.

Staff were trained in equality and inclusion and told us they treated people equally. People were asked about their sexuality but this was not recorded in their care plans. We have made a recommendation in relation to recording people’s sexuality.

People and their relatives were encouraged to raise concerns and told us they felt comfortable to make a complaint.

People were encouraged to discuss their end of life wishes and where disclosed these were recorded in their care plans.

The provider had effective monitoring, auditing and evaluating systems and processes in place to ensure the quality and safety of the service.

People, their relatives and staff spoke positively about the registered manager and they told us the service was well-led.

The registered manager worked with several services to improve the care delivery and people's experiences.

Further information is in the detailed findings below.

Willow House is a care home which has been registered to accommodate a maximum of six people with mental health issues and learning disabilities. On the day of our inspection there were five people using the service.

The home 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.

Procedures and policies relating to safeguarding people from harm were in place and accessible to staff. All staff had completed training in safeguarding adults and demonstrated an understanding of types of abuse to look out for and how to raise safeguarding concerns.

Detailed current risk assessments were in place for all people using the service. Risk assessments explained the signs to look for when assessing the situation and the least restrictive ways of mitigating the risk based on the individual needs of the person.

Medicines were managed safely and effectively and there were regular medicine audits in place. Staff had completed medication training and the home had a clear medicines policy in place which was accessible to staff.

The home maintained adequate staffing levels to support people both in the home and the community.

We saw friendly, caring and supportive interactions between staff and people and staff knew the needs and preferences of the people using the service. Care plans were person centred and there were regular key working sessions.

We saw evidence of a comprehensive staff induction and ongoing training programme. Staff had regular monthly supervisions and annual appraisals. Staff were safely recruited with necessary pre-employment checks carried out.

All staff had received training on the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards (DoLS) and staff understood what to do if they had concerns as regards people’s mental capacity. These safeguards are there to make sure that people are receiving support are looked after in a way that does not inappropriately restrict their freedom. Services should only deprive someone of their liberty when it is in the best interests of the person and there is no other way to look after them, and it should be done in a safe and correct way.

People are supported to eat and drink. People were consulted about weekly menu choices and supported to prepare their own meals.

People are supported to maintain good health and have access to healthcare services. Referrals are made quickly when concerns are noted as regards people’s health.

A complaints procedure in place which was displayed for people and relatives. There was an incident and accident procedure in place which staff knew and understood.

There was evidence of audits as regards medication and overall compliance. Issues identified were actioned promptly. The registered manager and team leader were accessible to people and staff who spoke positively about them and felt confident about raising concerns.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

There were risk assessments in place to ensure that people's safety and well-being were maintained when receiving care and support. This meant that people's needs were identified and met in a manner that promoted their independence and safety.

One person said, "I am happy, they treat me very well." Staff knew how to respond to safeguarding concerns to keep people safe and promote their rights. They were able to explain how they would recognise the signs of abuse and report their concerns.

People's needs were assessed when they joined the service and reviewed regularly. There were enough staff available to meet people's needs, and staffing levels were regularly reviewed to ensure this was maintained.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place. Relevant staff have been trained to understand when an application should be made, and how to submit one.

Is the service effective?

People's needs were assessed and support was delivered to meet their individual needs. Care plans highlighted the signs that showed when people's mental health was deteriorating, such as social isolation, auditory or visual hallucinations and changes in the person's dietary habits.

Care plans provided guidance as to how these symptoms should be responded to in order to maintain people's well-being. The two staff spoken with understood people's support needs.

Is the service caring?

People's views and experiences were taking into account and this informed how their care was delivered. People told us that they were involved and consulted about decisions affecting their care and treatment. One person said, "staff are interested in what you have to say." People explained that they had been involved in decisions regarding their medication and their future care needs. Care records showed that people had been involved and consulted about their care.

We observed that people were treated well by staff. We saw that staff understood their needs. People were spoken to in an appropriate manner. The two people we spoke with told us that they received the care and support they needed. One person said, 'staff are nice, it's good here.'

Is the service responsive?

People's needs were assessed and support was delivered to meet their individual needs. We looked at three care plans. These provided information about people's needs. Care plans gave guidance for staff about how they should meet people's needs. Care plans clearly identified people's needs resulting from their diverse cultural backgrounds. Daily notes showed that people were taking part in activities and were being supported to access their local community. For example, people were supported to go to the park and to do their shopping. Records confirmed that people were helped to practice their religion.

The provider worked in co-operation with other provider to respond to people's needs. One person said, 'I see the doctor and staff arrange my appointments when I ask them to." Care records showed that people had been able to attend their Care Plan Approach (CPA) reviews to discuss the mental health needs with the professional involved in their care and treatment. Where people had specific needs these had been addressed through working with the appropriate professional. For example, people had regular checks on their health to make sure that the medication they were taking was not adversely affecting them.

Is the service well-led?

Staff told us they were able to make suggestions to improve the home. Staff told us that the manager was supportive. Staff felt that staff meetings provided them with a way to raise issues. Staff meeting minutes showed that staff had a regular opportunity to discuss improvements to the home. Staff played an active role in improving the care of people.

An annual quality survey had carried out. The manager explained that a report had been produced, and any suggestions to improve the service were addressed. We saw that the service had a suggestion box, and people told us they had used it. Peoples' suggestions were used as the basis to improve the care provided by the home.

We observed staff administering medication and saw that they checked the medication administration record before giving people their medicines. Staff told us and records confirmed that they had completed training on the safe administration of medicines. Medicines were handled appropriately.

There were effective recruitment and selection processes in place. Staff told us that they had been through a detailed recruitment process that included completing an application form, interviews and references being taken up from their former employers. People's personal records including their care plans were accurate, and had been reviewed and updated at regular intervals. Care records gave an explanation of how people's needs were to be met.

Staff understood people's support needs. A person said the staff were, 'nice and friendly'. People knew how to raise concerns about issues that affected their well-being. A person said, 'I can talk to the staff if I need too.' People said that staff knew how to meet their needs. A person said, 'Staff know how to help me.'