The Willows

About the service

The Willows is a residential care home providing personal care to nine people at the time of the inspection. The service can support up to nine people in three separate bungalows on the same site.

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

People were not always protected from risk of harm and abuse because safeguarding systems were ineffective. People were not receiving their commissioned one-to-one support, this and the high use of agency staff in the service had impacted on the support people received to engage in their local community and activities away from the service. Assessments of people’s needs and wishes, particularly in relation to visiting and activities in the context of COVID-19, had not been carried out collaboratively with people and other relevant parties.

People were not supported by effective governance systems and processes. This had resulted in regulatory requirements not being met. People were not supported to engage in meaningful feedback on the support they received.

Risks to people were assessed and responded to, this included in relation to the environment. People received their medicines safely and as prescribed. Staff worked well with other professionals to help identify and meet people’s needs.

Based on our review of safe and well-led the service was not able to demonstrate they were meeting some of the underpinning principles of Right support, right care right culture.

Right support

The model of care and setting did not maximise people's choice, control and independence. People were not receiving person-centred care due to the systems in place and staffing issues. Some people's specific support needs were not always clearly identified and met.

Right Care and Right culture

Some practice raised concerns regarding the culture in the service. Whilst some actions taken, such as restrictions around visiting and activities, were well meant they were not anchored in the values of empowerment, inclusivity and person-centred care. The provider's oversight of this issue was poor.

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 05 June 2018).

Why we inspected

We received information of concern about infection prevention and control measures and staffing levels at this service. We visited the service on 12 January 2022 to look at the infection prevention and control measures the provider has in place. We also asked the provider about any staffing pressures the service was experiencing and whether this was having an impact on the service. During the visit we identified further concerns about person centred care and governance. As a result, we returned to the service on 19 January and undertook a focused inspection to review the key questions of safe and well-led only.

Enforcement and Recommendations

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 and will take further action if needed.

We have identified breaches in relation to person-centered care, safeguarding, staffing, and 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 from 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.

At our last inspection on 6 November 2015, 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 on-going 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.

Why the service is rated good.

There was a Registered manager in post who was currently on maternity leave. 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. At the time of our inspection, an interim manager who was a senior member of staff at another of the provider’s registered locations, was responsible for running the service.

People received support to take their medicines safely. Staff knew how to keep people safe from the risk of harm. Actions had been taken to reduce risks to people’s safety. There was enough staff to keep people safe and meet their needs.

Peoples care and support needs had been assessed which was reflect in support plans. The care provided by staff was in line with this.

Staff were competent to carry out their roles effectively and had received training that supported them to do so. People were supported to eat freshly prepared meals, and their individual dietary needs were met. People were able to access and receive healthcare, with support, if needed.

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.

Staff were kind and compassionate in the way they delivered support to people. People were treated with dignity and respect and were able to lead their lives with high levels of independence. Staff ensured that people were able to have visitors, and enabled people to maintain relationships with relatives and friends who did not live nearby.

People and their relatives were confident that they could raise concerns if they needed to and that these would be addressed. People were able to access a range of activities of their choosing which they enjoyed.

The manager ensured that the home was well run. Staff were committed to the welfare of people living in the home. Staff were motivated and worked together with strong teamwork and high morale.

Further information is in the detailed findings below

The service is a care home providing support for up to nine people with a learning disability and need support with their mental health. On the day of the inspection there were nine people using the service.

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. We noted that management arrangements were changing and that a new manager had been appointed who intended to apply for registration. Although changes were in progress, the service was led by a stable and effective management team. There was a commitment to developing and improving the service that people received.

People received care and support that was focused on their individual needs. Their medicines were managed in a safe way. There were enough skilled staff who were able to ensure that support was delivered to meet people’s needs and minimise risks. Recruitment practices were robust and contributed to promoting people's safety.

People were encouraged to make decisions. Staff had been trained in the Mental Capacity Act 2005 and associated Deprivation of Liberty Safeguards and were aware of how people's rights should be promoted. Any restrictions necessary to promote the safety of individuals were considered carefully with other professionals as being in their best interests.

People were supported by staff who treated them warmly and with respect and their privacy and dignity was promoted. People were consulted about their care and involved in planning how their needs were to be met. They were supported to pursue meaningful activities within and outside the home.

Staff were knowledgeable about the support people required and worked well with other professionals; this contributed to ensuring placements at the service were successful and sustainable as far as practicable. Staff were able to identify and respond to signs that could indicate changes in individual needs or risks. Care plans were kept up to date when people's needs changed. People had opportunities to raise concerns or complaints.

We found that plans of care contained the information staff members needed to ensure that the health and safety of people was promoted and protected.

People we spoke who lived at the service told us that they were able to talk with staff at any time about any matters. One person told us that, “The staff are good here.”

At this inspection all areas of the service were clean and tidy. We found that the routines and systems in place supported the wellbeing of people, this was reflected in up to date records.

The provider ensured that safety checks such as Disclosure and Barring Service (DBS) and identity checks were completed for all staff prior to them commencing their employment with the home. This meant that the safety and wellbeing of people living in the home was supported.

Quality audits were being carried out to ensure the views of people were gathered on the quality of the service provided and that people were safe and happy.

One person told us how much they enjoyed swimming and their place of work. They said, "I used to go to college, but stopped as I wasn't enjoying it. I prefer to go to work." This told us that people were involved and listened to when planning their day to day lives.

People told us they were all involved in the meal planning. They said, "We meet weekly and decide what meals we would like." They told us that they were encouraged to eat healthily but would have the odd treat. People were provided with a choice of suitable and nutritious food and drink.

The medication supplied to the home was managed and administered by the staff, which was the choice of the individuals. The manager showed us records for training staff on medication management, discussed the safe management of controlled drugs and we saw safe storage for all medication.

On top of the mandatory training, the manager had obtained specialist training to ensure the staff team had the skills to offer the correct care and support to each person.

Concerns and complaints were listened to and acted upon.