Willow View

Willow View 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. Willow View is a small residential home for two people with learning disabilities. At the time of our inspection, one person was living at the service. There were no plans for any other person to move into the service at this time. The home is detached with a private garden and situated in a quiet side street in the town of Warminster. The provider also had another service nearby. Both services shared the same manager.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

There was not a registered manager in post. 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. There was a manager in post who had applied to become registered for the service.

Activity provision was not as varied as it could be. Staff and the manager recognised this and had plans to improve and widen the provision. Key activities that were important to the person had stopped, the manager told us they would be resuming in the near future.

There was a complaints procedure in place however it was only available in one format, which the person would struggle to use.

At our last inspection we found that risk assessments were not always detailed enough to minimise the levels of risk and care plans lacked detail on the person’s preferences. At this inspection, we found these areas had improved. There were a range of risk assessments in place that identified environmental risks and risks to the person such as nutrition and development of pressure ulcers. All risk assessments were completed in full and reviewed regularly. There were behavioural care and support plans in place that identified triggers and clear strategies for staff to deploy to keep people safe.

Staff were well supported. There were systems and processes in place to support lone working, and staff had regular opportunity to have formal supervision with their line manager. This meant they could discuss any concerns or training needs they might have.

Appropriate recruitment checks were undertaken before staff commenced employment. Staff were well trained and could ask for additional training if they wished.

The provider had systems and processes in place to safeguard people from the risk of abuse. Staff we spoke with were aware of safeguarding procedures and knew how to use the provider’s policies to report any concerns.

Medicines were managed safely. All staff had received medicines training and were observed administrating medicines by the provider so that their competence could be checked.

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 support this practice. Where people had their liberty restricted, the service had completed the related assessments and decisions had been properly taken. Staff had been trained and understood the general requirements of the Mental Capacity Act (2005).

The premises were clean and in good repair and the risks of cross infection were minimised. Records demonstrated that staff received infection prevention and control training and food hygiene training.

A visiting director completed quality monitoring regularly and action plans produced if needed. Feedback from the person was sought regularly and the service had access to a local advocacy service if needed.

This inspection took place on the 5 January 2017 and we gave the registered manager short notice of our visit. This service was dormant for a short period of time and is registered to provide a service for up to two people with learning disabilities. One person was living at the service at the time of our inspection.

A registered manager was in post. ‘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.’

Our time at the service was limited as the person was not able to tolerate unfamiliar visitors. We reviewed records and spoke to staff. We saw staff engaged well with the person and they were knowledgeable about the triggers and the actions they must take to maintain a calm environment with low sensory stimulation.

Some risks were assessed and risk assessments developed. Where risk assessments were in place they lacked detail on how to minimise the level of risk. Risk assessments were not in place for some behaviours and for travelling within the community. Fire risk assessment and evacuation procedures were in place. However, the recommendations as a result of the fire risk assessments made were not actioned. The registered manager had agreed to take action on one recommendation. We acknowledge there were difficulties in undertaking remedial action when the person was present. However, the potential risk to people and staff increased as remedial action remained outstanding. This meant the staff were not provided with the actions they must take to ensure the safety of people.

Where care plans were in place they lacked detail on the person’s preferences. While social worker’s care plans were out of date, the areas of need identified were not used to assess the person’s current need. Strategies on managing challenging behaviour were in place but they were not reviewed following incidents. These strategies were inconsistent with positive behaviour management (PBM) plans and with the analysis of antecedents, behaviours and consequences (ABC) charts. This meant staff were not provided with updated guidance on consistently meeting people’s current needs and to manage behaviours exhibited.

Quality assurance systems were not fully effective. Areas identified for improvement were not consistent with the inspection findings. Internal audits were in place and there were routine visits from the provider to ensure standards were maintained, people’s rights were promoted and their welfare needs met.

The member of staff we spoke with said they had attended the safeguarding of vulnerable adults from abuse training. This member of staff was aware of the types of abuse and the expectation placed on them to report alleged abuse. Members of staff were aware of the importance of developing trusting relationships with people. They knew people’s likes and dislikes and promoted their rights.

Members of staff were supported to develop their skills and deliver the roles and responsibilities of employment. New staff received an induction to prepare them for the role they were to perform. Staff attended mandatory training set by the provider and other specific training to ensure they were able to meet people’s changing needs. One to one meetings were taking place to ensure staff had an opportunity to discuss performance and their personal development.

The person living at the service had one to one support from staff at all times and two to one in the community. The rotas were in picture format and confirmed the staffing levels. Members of staff said the team worked well together and the registered manager was approachable.

Recruitment procedures ensured the staff employed were suitable to work with vulnerable adults. The completed application forms in place included an employment history, the names of referees and declarations of previous conviction where applicable. Checks were conducted before new staff started work to establish their suitability and included references from the previous employer and a Disclosure and Barring Service (DBS) check. The DBS helps employers to make safer recruitment decisions by providing information about a person’s criminal record and whether they are barred from working with vulnerable adults.

The safe handling of medicine systems were in place. Profiles gave staff information about the medicines to be administered which included guidance on the person’s preferences on how their medicines were to be administered. Medication Administration Records (MAR) were signed to indicate the medicines administered.

People were subject to continuous supervision and authorisation was granted for care and treatment at the service. Staff were aware of the principles of the Mental Capacity Act (MCA) and best interest decisions taken for people unable to make specific decisions. The member of staff we asked described the day to day decisions the person living at the service made.

People were supported to maintain a healthy lifestyle. Staff assisted the person to develop menus and they were supported to purchase daily food provisions to prepare meals. Whilst we were at the service we saw the person living at the service having snacks between meals.

You can see what action we told the provider to take at the back of the full version of the report.

People who use the service were protected from the risk of abuse because the provider had taken all reasonable steps to identify the possibility of abuse and prevent abuse from happening.

Consent was addressed in a positive way in this service. There were best interest meetings that demonstrated how the process was correctly applied, with all significant people involved.

Staffing was of sufficient numbers and experience to provide good support to anyone who lives at this service.