Willow Court

Willow Court is a care home providing accommodation and personal care to up to 11 people. The service provides support to people who have a learning disability or autism in one adapted building. On the day of the inspection 11 people were living at the service.

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support:

People were supported to have maximum 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. The service provided support in a safe and clean environment suitable for people's needs. People could make choices and personalise their living space. When necessary, significant adaptations were made to ensure the environment was safe and suitable for people.

Right Care:

Staff understood how to protect people from poor care and abuse. Staff had training on how to recognise and report abuse and they knew how to apply it.

People’s medicines were managed safely.

The service had enough appropriately skilled staff to meet people's needs and keep them safe. Care and support plans were tailored to people's individual needs.

People were protected by the provider's recruitment processes as appropriate checks were completed; ensuring staff were suitable to work with people who used the service.

Risks to people's safety and wellbeing were well managed by staff and clearly recorded in people's support plans. We have made a recommendation about fire drills for night staff.

Right Culture:

Whilst there was not a registered manager in place the provider had put an interim manager in place until a new manager was due to start. The staff were positive about working at the service.

People were supported by staff to pursue their interests. People were encouraged to share their views and develop and improve the service. The quality of support provided was evaluated regularly.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 03 July 2021) and there were breaches of regulation. The provider completed an action plan following the last inspection, to show what they would do and by when to improve safe care and treatment. At this inspection improvements had been made and the provider was no longer in breach of regulations. The overall rating for the service has changed from requires improvement to good based on the findings of this inspection.

Why we inspected

We 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.

We received concerns in relation to fire safety. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe and well led sections of this full report.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Willow Court is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. The service can support up to 11 people who have a learning disability or autism in one adapted building. On the day of the inspection 10 people were living at the service

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 guidance CQC follows to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture. Staff did not always treat people with dignity and respect or speak to them in a way that promoted this.

People were not always communicated with in their preferred way.

Risks to people were not always fully assessed. Guidance and direction to staff on how to minimise risk was not always clear and detailed.

Infection control guidance had not always implemented or followed correctly.

Oversight of the service was not always effective and had not identified the issues we found at this inspection.

People received their medicines safely and as prescribed.

Staff had ad good understanding of safeguarding and knew how to recognise and report abuse. Staff told us they received training and supervision

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection (and update)

The last rating for this service was good (published 30 October 2018).

Why we inspected

The inspection was prompted in part due to concerns received about safeguarding. A decision was made for us to inspect and examine those risks. We undertook a focused inspection to review the key questions of safe and well-led.

We reviewed the information we held about the service. No areas of concern were identified in the other key question. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We 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 coronavirus and other infection outbreaks effectively.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection. We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe and well-led sections of this full report.

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

Enforcement

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to dignity and respect and good 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The service is registered to provide accommodation, care and support for up to 11 people who live with a learning disability and autism. 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. The service was in the centre of the community with the town centre being only a short walk away. The service specialised in working with people with complex behaviours where previous placements may have broken down.

At our last inspection in February 2016 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 ongoing 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. This inspection took place on 30 October 2018

Systems and processes were in place to keep people safe and risks associated with people's care needs had been assessed. There were sufficient staff to meet people's needs and recruitment processes and procedures were robust. Medicines were managed safely.

Staff received appropriate induction, training and supervision to provide safe and effective care. The registered manager worked in partnership with other organisations to support people's needs. People's nutritional and healthcare needs were met. 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 knew people well and care plans were detailed and provided staff with guidance on how to meets people's needs. Staff respected people privacy and dignity and encouraged people to remain independent. People and relatives could express their views about the running of the service.

Complaints and concerns were managed appropriately and outcomes were actioned. People and relatives knew how to make a complaint. A range of activities were available for people to take part in.

Staff said the registered manager was approachable and listened. Staff said the service was well-run and the registered manager was supportive. There was evidence of effective checks being carried out to assess and monitor the quality of the service provided.

Further information is in the detailed findings below.

Willow Court provides accommodation and personal care for 11 people requiring specialist learning disability, autism and mental health support. At the time of our inspection there were 11 people using the service.

A registered manager was in post at the service. 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.

The Care Quality Commission (CQC) monitors the operation of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) which apply to care homes. We found the provider had followed the MCA code of practice in relation to DoLS.

People were safe because staff understood their responsibilities in managing risk and identifying abuse. People received safe care that met their assessed needs.

There were sufficient staff to provide people with the support they needed to live as full life as possible. Staff had been recruited safely and had the skills and knowledge to provide care and support in ways that people preferred.

The provider had systems in place to manage medicines and people were supported to take their prescribed medicines safely.

Staff had developed positive, respectful relationships with people and were kind and caring in their approach. People were given choices in their daily routines and their privacy and dignity was respected.

Staff knew people well, they were able to recognise and avoid triggers which could have provoked behaviours which were difficult to manage.

People`s physical and mental health was monitored and reviewed and people had sufficient food and drink that met their individual needs.

Staff were trained, skilled and competent in meeting people’s needs. Staff were supported and supervised in their roles. People, who were able, were involved in the planning and reviewing of their care and support.

The provider had systems in place to check the quality of the service and take the views and concerns of people and their relatives into account to make improvements to the service.

Staff we spoke with said they had been properly recruited and trained. Staff told us that they received very good support in their roles.

People had the opportunity to enjoy a range of activities and, mostly with staff support, were able to get out and about in the local community.

We saw that people's care and support was planned and reviewed regularly. Risks to the health, welfare and safety of the person were identified and managed.

Some of the people we met at our inspection could not, because of their disabilities, tell us verbally about their experiences and so we used observation to help us understand their experience of the service. We also looked at care records and gained feedback from staff about people's care and support needs. People we were able to speak with told us that they were satisfied with how they were treated, with the level of support provided and with the facilities and activities available. One person told us, "The staff support me well, they take me out to do the things I like to do.' Another person told us that, 'The food is lovely, I get plenty to eat and the staff cook the meals that I choose, they also keep my room clean and ask me about what I want to do and where I want to go.'

People received care and treatment which supported their wellbeing and independence. They had access to a range of specialist professionals and therapists to meet their health needs. Risks were assessed and eliminated or reduced with appropriate strategies. Medicines were safely stored, handled and administered at the home. People received their medicines at the right time and in the right dosage.

Flexible arrangements were made so that people could take social leave. People felt safe at the home and staff ensured that they were protected from abuse. People were written about in a respectful way. Records were comprehensive, clearly completed and securely stored. They could be accessed promptly by staff.

Staff were well trained for their roles and supported to develop their knowledge and skills. They received regular supervision and support from senior staff.