Willow House

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

This is the first time we have inspected the service since the provider changed. This key question has been rated good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

This service scored 67 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

The registered manager assessed people’s needs before they started using the service to ensure their needs could be met. Staff told us they received good information about people’s needs. There were detailed care plans and staff developed risk assessments in partnership with people, so they could take positive risks.

People’s changing needs were shown as a task on the provider’s care planning system. There were regularly updated and reviewed care planning documents which changed in line with people’s needs. This meant people were receiving up to date care which changed with their needs.

One person became unwell and staff knew that they would need to increase the level of care and support they were providing. Hourly checks were put in place. This ensured actions were taken to keep people safe.

The provider told us about some recent referrals for new people to move into the service. The registered manager told us they could not offer a placement to some of these people due to their needs clashing within people already living within the home. This demonstrated the provider was aware of the service’s capabilities and they considered the impact on people already living at the home.

The provider planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards such as right support, right care and right culture.

People told us staff provided good support for them to undertake their daily living tasks. One person signed ‘food’, ‘staff’ and ‘help’ and gave a thumbs up which indicated they were happy with their care delivery. Staff completed regular training in nutrition, food safety and positive behaviour support to ensure their knowledge was up to date.

Where possible, the provider planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards such as right support, right care, right culture. Care records contained details of people’s needs and preferences and how to support them.

Staff communicated well with people and there was a relaxed relationship between people and staff supporting them. Staff knew people’s needs and preferences. People were relaxed with their support and engaged in the activities they had chosen. One person told us they were supported to leave their house to access various groups within the community.

The provider worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people joined the service.

We saw evidence of the provider working closely with relatives. Calls from relatives were followed up by the provider, with actions and outcomes listed. Care notes were detailed. The provider informed us they were moving over to a digital based platform to document care. The registered manager was in the process of transferring all documentation across to the new platform.

When additional support from external agencies was required, we saw evidence of good communication and partnership working. Speech and language therapists (SALT) and the hearing and vision team had engaged with the service to ensure people’s changing needs were assessed.

People told us staff worked well with other services, such as community nurses, GPs and hospitals to ensure they received the care they needed.

The provider supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support.

Staff escalated any changes to people’s health to the registered manager who took immediate action. For example, staff recorded any new concerns via their daily notes and the manager viewed these and decided whether delivery of care needed to be adjusted or if a referral to healthcare professionals was needed. This meant there was a multi-disciplinary approach to support people with their health needs.

People had health reviews and care records contained details of how to support people and what people could do for themselves. For example, where people were recommended to maintain a healthy lifestyle, they were supported to access the community with staff, go for walks and make healthier food choices.

The provider did not always monitor people’s care and treatment to continuously improve it. They did ensure outcomes for people were positive and consistent and met the expectations of people themselves but did not always meet clinical expectations.

Leaders had not approached clinicians for a delegated nursing task. A delegated nursing task means the transfer of responsibility for performing a specific nursing task from a registered nurse to a competent individual, such as a care team. This meant a person was at risk of not receiving the most up to date professional care and treatment in relation to the care of a specific condition. Furthermore, this meant that staff were at risk of not providing support in line with national guidance. The provider sourced clinical training and took immediate action to book this as soon as was possible.

Staff maintained records of the care provided, including whether people’s needs were changing. Records demonstrated changes were shared with healthcare professionals where needed.

The provider maintained records of team meetings and meetings with people. These detailed actions to ensure people were receiving effective support. This included staff discussing the importance of maintaining an activity routine for one person who had been unwell. Records demonstrated staff had supported the person but temporarily adjusted the activity, based on their reduced ability. This ensured that outcomes were positively managed, even when care needs had changed.

The registered manager told us they regularly checked care records and completed observations to make sure support was provided in a person-centred way.

The provider did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment.

The provider was not always able to evidence appropriate records were completed for gaining people’s consent. For example, the provider could not demonstrate they had attempted to gain consent from an individual, nor when a person lacked capacity did they ensure a best interest decision was made. This meant the provider could not evidence that people and their representatives were involved in decisions around their care and treatment or that least restrictive practices were followed.

Further, the provider had applied for a deprivation of liberty safeguard (DoLS) authorisation in relation to restrictions for another individual however they could not evidence they had considered the least restrictive options for that person before applying for the DoLS. This meant the person could have been at risk of a lack of privacy leading to living restrictions.

We spoke to the provider about this who took immediate steps to organise a best interest meeting.