The Willows

The accommodation was based in a bungalow and a main house with communal facilities such as a shared kitchen and activities area. People had individual flats some of which had kitchenettes and individual gardens.

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

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.

The Willows is larger than the current best practice guidance, but people lived in their own flats, some of which had their own kitchens and gardens. There were some shared communal facilities, such as activity spaces. Most activities were conducted on site, but we were assured by staff that they were enabled to support people to access local leisure amenities in line with COVID-19 guidelines.

The service was located some way out of the nearest town and had some additional security features such as high gates and a large car park which meant that it looked different to nearby properties.

Risk assessments were personalised, and we observed people being supported to access the local community both on foot and using one of a number of vehicles which were available

There was enough staff on duty at any one time and this reflected the commissioned hours and the high needs of the people resident. The service was dependent on agency staff and staff and relatives expressed some concerns about the impact of this. The provider told us that they had put mitigation in place such as using consistent agency staff and were actively recruiting.

Positive behaviour support plans were in place and regularly reviewed. Records were maintained of incidents including where people’s behaviour could challenge and where restrictive interventions were used. Incidents were monitored by the providers in-house behavioural support team and analysed to identify learning to prevent a reoccurrence. Not all staff were confident in some of the approaches used and the provider told us that further training was planned.

People were supported to take their medicines by staff who had received training and had their competency checked.

The environment was reasonably well maintained and clean. The provider told us that they were planning to refurbishment parts of the service.

Staff were clear about the procedures to follow in an emergency. There was an alarm system in place for staff to use to request assistance, but this did not always work effectively. We were assured by the provider that they had already identified this and were purchasing new equipment to address the concerns.

Infection prevention and control systems were in place and staff confirmed that they had received training and were clear about the actions that they had to take to keep themselves and the people they support safe. Staff told us that there had been an impact with COVID-19 on people’s ability to access the community, but they had tried to reduce this by initiatives such as the on-site shop staffed by people living in the service.

The service had developed good relationships with extended families who were positive about the care provided. They told us they had been kept up to date about their relative’s needs and enabled to keep in touch with their relative during the pandemic, in line with the government advice.

The registered manager was enthusiastic about the service they were delivering and told us about some of the changes they had introduced. Relatives and staff expressed confidence in the management team and how the service was developing. Regular audits were completed on quality including areas such as medicines, the environment and care planning. The provider collated data on a wide range of areas as part of their governance systems and had an action plan in place which set out priorities with timescales for improvement.

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 requires improvement (published 26 September 2019).

Why we inspected

At the last inspection we found inconsistencies in the quality of care. We undertook this targeted inspection to check how risks were being managed at the service. Concerns had been identified at another nearby service which is owned by the same provider which the registered manager also has oversight. A decision was made for us to inspect to check to see if the managerial oversight had impacted on the risks we already knew about.

We reviewed incidents and how they were being managed to ensure people were not being unnecessarily restricted, particularly in light of the national restrictions during the pandemic.

We also 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.

The overall rating for the service has not changed following this targeted inspection and remains Requires Improvement. We have not reviewed the rating because we only looked at parts of the key questions we had specific concerns about.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Willows on our website at www.cqc.org.uk.

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.

The Willows is a residential care home providing personal and nursing care to 19 people aged 18 to 65. At the time of our inspection there were 19 people using the service.

The Willows accommodates 19 people who have a learning disability and, or a diagnosis of autism. People live in their own flats but share some communal facilities. Living accommodation included a bungalow and a main house. There was also an activity room.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

The Willows was registered to support of up to 19 people. This is larger than current best practice guidance. However, the size of the service having a negative impact on people was mitigated by having two separate accommodation types, a bungalow and a house. The properties were appropriate in design and within a residential area. There were no obvious signs to identify this as a care home. There was some additional security and external cameras to give people using the service and staff some additional protection.

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

The service had not consistently delivered good outcomes of care for people over the last twelve months. Some people had not been sufficiently supported with their health care needs, behaviours or been able to access social activities when they wanted to. This could be attributed to turn over and change of staff and management which has created inconsistent levels of service provision.

There is a new registered manager in post who has been in post for four months. They were supported by a management consultancy group who had introduced a robust governance process to measure and improve the quality of the service provided. An area manager started about the same time as the registered manager and was supporting the changes being made. They had begun to stabilise the service and had an improvement plan in place. Improvements were noted but there were still areas to address including establishing a regular staff team, filling vacancies and reducing agency usage to help ensure people have continuity of support. Staff were not yet working effectively because staff performance and competencies had not been adequately reviewed over a period and not all staff had completed all training considered necessary.

There needed to be clearer management oversight on shift as not all staff were working to the required standard particularly as agency staff did not have the same level of training as regular care staff which meant they could not always provide the most appropriate support to people using the service. Neither was their initial onsite induction recorded. We have made a recommendation about this.

Communication was not yet effective. We found arrangements for staff handover were poor which meant information was not effectively handed over or known by all staff. Record keeping was not of a consistently high standard particularly daily notes and incident recording did not always give enough detail making analysis more difficult. We have made a recommendation about this

The environment was mostly appropriate to people’s needs but some redecoration and refurbishment was necessary to bring the properties up to standard. Some people had behaviours which challenged, and this included the destruction of property. This was being addressed by the registered manager.

People’s care and support plans were being updated and had improved. There were enough staff on duty at any one time who had a good understanding of people’s needs and able to provide some stability and oversight. The service was not yet able to consistently manage people’s needs but core teams were being established and helping to reduce people’s anxieties.

Staffing levels were being maintained and people had the support the Local Authority commissioned. Staffing numbers were high due to the nature of support people required. Staff recruitment and retention were being effectively managed with robust recruitment processes in place. Staff were being supported to develop the necessary skills and competencies through training and observation of practice. Induction was robust and being strengthened by the introduction of the Care Certificate a nationally recognised induction course.

Medicines were being effectively managed and there were audits in place to determine if medicines were being given as intended.

Most people needed constant supervision for their and others’ safety, but this was provided in a sensitive way and where possible took into account people’s needs and preferences. People were supported to have 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.

People accessed services in the community and staff supported people to attend health care appointments. When necessary staff accessed more specialist services and took advice about how best to support people in line with best practice.

Rating at last inspection and update

The last rating for this service was good (Report published February 2017)

Why we inspected

This was a planned inspection based on the previous rating.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for on our website at www.cqc.org.uk.

We previously carried out a comprehensive inspection at Westward Farm on 23 and 26 October 2015. At this inspection, we found the provider was in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and the Care Quality Commission (Registration) Regulations 2009. This was because we identified concerns in respect to the training of staff, notifications of allegations of abuse, people’s privacy and dignity, and quality monitoring. The service received an overall rating of 'requires improvement' from that comprehensive inspection.

After our inspection in October 2015, the provider wrote to us to tell us what action they were taking to meet the legal requirements in relation to the breaches.

We undertook this unannounced comprehensive inspection in December 2016 to look at all aspects of the service and to check that the provider had followed their action plan, and confirm that the service now met legal requirements. At this inspection, we found improvements had been made in the required areas and the provider was no longer in breach of the regulations.

Westward Farm is registered to accommodate up to 19 people with a learning disability. People living at the service have their own flats. At the time of our inspection there were 19 people living in the service.

There were two registered managers in post at the time of our inspection. 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. One of these registered managers had recently registered and was responsible for the day to day running of the service. The other registered manager was in the process of cancelling their registration following changes to the provider’s organisational structure.

Staff were aware of their role in safeguarding people from the risk of abuse and had received appropriate training. Risk assessments had been devised to help minimise and monitor risk, while encouraging people to be as independent as possible. Staff were very aware of the particular risks associated with each person's individual needs and behaviour.

When staff were recruited, their employment history was checked and references obtained to ensure new staff were safe to work within the service. There was enough staff on duty to ensure people were safe.

Accidents and incidents were recorded appropriately and steps taken to minimise the risk of similar events happening in the future. Risks associated with the environment and equipment had been identified and managed. Emergency procedures were in place in the event of fire and people knew what to do, as did the staff.

Medicines were managed safely and in accordance with current regulations and guidance. There were systems in place to ensure that medicines had been stored, administered, audited and reviewed appropriately.

People's needs had been identified, and from our observations saw that these were met by. Staff used touch as well as words and tone to communicate with people in a positive way. There was positive interaction between people and the staff supporting them. Staff spoke to people with understanding, warmth and respect and gave people opportunities to make choices. Staff knew each person's needs and preferences in detail, and used this knowledge to provide tailored support to people.

We found the service to be meeting the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Staff received specific training in this area and were able to explain to us how they used this in their work.

People were supported to eat and drink sufficiently to maintain a balanced diet and encouraged to be as independent in the preparation of food.

People were supported to maintain good health and to have access to healthcare services. We looked at people's records and found they had received support from healthcare professionals when required.

People's individual care plans included information about who was important to them, such as their family and friends and we saw that people took part in lots of activities in the service and in the community.

There was a complaints procedure, and evidence that people were consulted about the service provided.

Staff liked working at the service and felt there was a good team spirit. Staff meetings took place regularly, staff felt confident to discuss ideas and raise issues with managers at any time.

People were asked about the quality of the service and feedback was included in plans for future improvements. There were effective systems in place for monitoring the quality and safety of the service. Where improvements were needed, these were addressed and followed up to ensure continuous improvement.

A single inspector carried out this follow-up inspection. The focus of the inspection was to check that improvements had been made and to answer the five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what people using the service, relatives and staff told us, what we observed and the records we looked at.

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

This is a summary of what we found:

Is the service safe?

People told us that they liked living at Westward Farm. Improvements had been made to ensure that people were consulted and involved in planning their care. The care and support needs of people had been reassessed and reviewed and staffing levels had been increased to ensure people were safe and provided with the care and support they needed.

Staff training had increased to ensure the staff knew how to care and support people living with complex communication, care and behavioural management needs. This meant that the staff members employed had the qualifications and skills needed to support people living at the service.

There was a process in place in relation to the Mental Capacity Act (2005) and Deprivation of Liberty Safeguarding (DoLS) to ensure that people who could not make decisions for themselves were protected. Policies and procedures were held. DoLS applications had been submitted for each person living at the service. Staff had been trained and knew when a DoLS application was needed. The service manager and deputy manager knew how to submit a DoLS application.

Is the service effective?

People's health and care needs were assessed with them or their family member. Specialist dietary, mobility and equipment needs had been identified in care plans when required. Relatives told us their family member received the care and attention they required in a way that met their needs. Through our observations and speaking with staff we noted that the staff understood the care and support needs of each person. One person living at the service told us. 'It is nice here and my core staff team are lovely.' Staff had received suitable training to meet the needs of people living at the home.

Is the service caring?

People were supported by staff who used a kind and attentive approach. We saw that the staff were patient and encouraged people to be as independent as possible. People told us that they had their own core staff team who worked with them. Our observations confirmed this. A relative told us. 'I am happy with the care given to my family member. The members of staff are polite and respectful.'

Is the service responsive?

Improvements had been made and care and risk assessments had been rewritten and regularly reviewed. The care and support provided was adjusted to meet the needs of each person. Changes in a person's care and support had also been recorded in their plans of care. A record was held of people's preferences, interests and diverse needs so that these could be respected by staff. Relatives told us that staff members consulted their family member and encouraged them to make their own decisions. People received the individual support they needed and had access to a range of planned activities

Is the service well led?

Staff spoken with had an understanding of the ethos of the home. An improved complaints' system was in place and people were provided with information in a written and pictorial format that met their needs. Relatives and staff told us that improvements had been made. They said that they now felt listened to when they made a suggestion or raised their concerns. They told us that the new manager, service manager, deputy manager and team leaders were approachable and that the service was now better organised. The records we looked at and our observations confirmed this.

People had complex needs and were not all able to let us know their views. One person living at the service indicated that they were happy living at Westward Farm.

No evidence was seen that people were involved in planning their care but relatives told us that staff consulted them and included them in discussions and decisions about their family member.

We found that the plans of care did not all contain complete and up to date information.

Relatives told us that their family member was well cared for. We saw that people received the care, attention and support they needed and that staff used a friendly, calm approach.

We found that people were provided with the food and drink they required.

We found that people were not provided with a way to raise their concerns or report abuse.

We saw that the people's individual medication was available, administered safely and recorded accurately.

We saw that the environment met the needs of the people living there.

We found that there were times when inadequate staffing levels were provided.

We found that not all staff had completed all of their training and that staff work practise had not been regularly monitored.

Relatives told us that their complaints were listened to and resolved but people living at the service were not assisted to raise their concerns.

Our observations showed us that people were consulted and given choice and received the individual support and attention they needed. We saw that people had a positive experience of being included in conversations, decision making and activities.

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

Relatives told us that people received the care and support they needed and that staff were excellent.

We saw that the people's individual medication was available and found that it was administered, recorded and stored accurately and safely.

Staffing levels had been increased to ensure people received the personal, one to one or two to one care and support they needed.

Relatives told us their complaints were listened to and resolved. We found that there was a complaints system in place that met the needs of people living in and visiting the home.