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Inspection carried out on 8 November 2018

During a routine inspection

We completed a comprehensive inspection of this service on the 08 and 09 November 2018. The first day was unannounced; the second day was announced as we needed to be able to access various records at the headquarters of the provider.

At our last inspection in November 2015 the service was rated outstanding. In June 2017 CQC published Registering the Right Support. This along with associated good practice guidance sets out the values and standards of support expected for services supporting people with a learning disability.

At this inspection we assessed the service in line with this guidance and therefore after this inspection of The Willows we rated the service as good. This was because The Willows did not meet the values and principles of Registering the Right Support and associated guidance. Current good practice guidance encompasses the values of choice, independence, inclusion and living as ordinary a life as any citizen. The size, layout, staffing arrangements at The Willows meant that it does not feel or operate as the people's home. Certain physical aspects to the building and staff practices felt institutional and detracted from a homely atmosphere. As an example, we saw that the office was a hub within the home with staff and people living there spending a significant part of their time in or near to it. The building is on a campus and does not lie within the heart of the ordinary community which is difficult to access other than by a vehicle.

The Willows 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.

The Willows is registered to accommodate eight people in one specially designed and purpose-built building. At the time of our inspection there were eight people living there. These people were unable to give us verbal feedback about their views on the service but we observed them and their interactions with staff, during our inspection. We ensured that we had as many opinions from their relatives and health and social care professionals to support our own observations.

The home requires 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. There was a registered manager in place who had been in post for several years.

We found that the home was a safe environment for people, who were supported by properly recruited staff who administered their medication correctly and who followed the policies and procedures of the provider. There were appropriate staffing levels and people were treated without discrimination and their human rights were protected and promoted. Staff knew how to safeguard people from abuse and how to report any concerns about this or any other accident or incident.

The building had been purpose-built specifically for people who were on the autism spectrum. We saw that it was well maintained.

Staff were well-trained and supervised and had the skills and knowledge to deliver effective support to people living in the home. Staff were encouraged to develop their skills by attending local and nationally organised specialist events. They had an understanding of the Mental Capacity Act 2005 and worked with other agencies to ensure that people had the right support. The service was also effective by supporting people in their everyday lives, by using many technological methods, such as electronic tablets which helped people to communicate.

Staff treated everybody with kindness and compassion and involved them in decision-making. They actively promoted people’s equality and diversity, gave explanations an

Inspection carried out on 26 and 30 November 2015

During a routine inspection

This inspection took place on 26 and 30 November 2015. We announced this inspection because the people using the service were young adults who were often out, with their support staff, during the day. We wanted to be sure that they would be at home.

The Willows had been recently registered and was a purpose built building which had been completed early in 2015. The home was registered to provide accommodation and support for up to eight people with autism. There were eight people living in The Willows at the time of our inspection.

We found that there were outstanding elements about this service.

The home required 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. There was a registered manager who had been in place since the home had opened and who was experienced through managing other homes for the provider.

The registered manager was supported by a home manager and a suitably recruited and trained staff team of support workers and senior support staff. There were sufficient staff on duty to support the people living at The Willows, throughout each day and night.

We found that effective measures were in place to ensure that people were cared for in a safe way and in a safe environment. The premises were designed specifically for people with autism. Much research and planning had been done in preparation and a specialist architect had been commissioned to design the building. We saw that this building had improved people’s lives. The building had been designed to promote people’s safety as they moved about it and used the facilities. People were able to access areas and tasks they had not experienced previously and they had benefitted from both the design of the building, its management and the support of staff. We found that the service demonstrated it was very effective and rated this domain as outstanding.

Staff had received safeguarding adults training and were able to tell us about abuse and knew what it was and how to report it.

Staff were able to demonstrate to us that they had been trained to meet the needs of the people they were supporting and had received specialist training to promote peoples’ independence. They had worked closely with other professionals to deliver care and support to the people living in the home. Staff had received specialist training in order to support individuals’ with the move to a different environment and more general training to promote people’s independence and skills. The requirements of the Mental Capacity Act 2005 and the associated Deprivation of Liberty Safeguards were known and were adhered to by the service and staff were familiar with their responsibilities. We found that the service demonstrated  it was very effective and rated this domain as outstanding.

We saw that people were cared for by the staff, who demonstrated an empathetic and a friendly approach whilst remaining professional. Staff were heard giving explanations and information and were seen to respect people’s privacy and dignity. We saw that they promoted and encouraged people’s independence and used the facilities to full advantage for the people living in the home. We found that the service demonstrated it was very caring and rated this domain as outstanding

People’s care was planned and delivered in a person-centred way. Their care was reviewed regularly and any concerns they had were dealt with quickly and appropriately. We saw that they were treated as individuals, with individual needs and wants. People who lived in the home were encouraged to maintain family links.

We saw that the transition between services had been smooth and well planned. An innovative scheme was being piloted at the home with staff from NHS and the service working co-operatively and collaboratively together, in enable people to live in the community. The staff in the home had shown that they were keen to contribute and to receive training in order to make the scheme work. They told us they happily invested a great deal of emotion and time to ensure that the scheme was a success.

Individual people benefitted from this way of working and had shown skills and improvements in their behaviour. The joint working between staff in The Willows and staff in the NHS had benefitted not only the people in the home, but had also helped their relatives.

There was an open and transparent management of the service, with checks and audits to maintain the quality of it. The service maintained good and clear records. We noted that there was good partnership working.