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Inspection carried out on 19 May 2017

During a routine inspection

The Oaks and Willows provide supported living and personal care to younger adults who have a learning disability or autistic spectrum disorder. The ethos of the service is to enable people to gain and maintain skills to achieve independent living. Tenants who use the service live in two supported living houses and an independent bedsit on the same site. They hold a tenancy agreement for their bedroom and/or flat.There were seven tenants living there at the time of our inspection, one of whom lived with dementia. The organisation’s office is located in one of the houses. The Care Quality Commission inspects the care and support the service provides to younger adults but does not inspect the accommodation they live in.

At the last inspection, the service was rated Good. At this inspection we found the service remained Good and met all relevant fundamental standards.

The service was outstandingly caring. The registered manager and the staff’ approach promoted an environment where people could affirm themselves and excel. They promoted people’s independence, encouraged them to do as much as possible for themselves and make their own decisions. Comments from relatives included, “Exceptional staff, they care so much, they often go the extra mile”, “The staff are truly fabulous, always friendly, always caring” and, “I cannot think of one negative thing to say about them.” A local authority case manager who oversaw the wellbeing of some of the tenants in the service told us, “I hope in the future they [the provider] will have more supported living properties like this or an outreach service. They continue to provide a brilliant caring friendly service (…) Individuals are encouraged to live their lives socially, families are encouraged to continue to be part of service users’ lives.”

Staff knew how to recognise signs of abuse and how to raise an alert if they had any concerns. Risk assessments were centred on the needs of the individual. Each risk assessment included clear measures to reduce identified risks and guidance for staff to follow or make sure people were protected from harm.

Accidents and incidents were recorded and monitored to identify how the risks of recurrence could be reduced. Appropriate steps had been taken to minimise risks for people while their independence was actively promoted.

There was a sufficient number of staff deployed to meet people’s needs. Thorough recruitment procedures were in place to ensure staff were of suitable character to carry out their role. Staff received essential training, additional training relevant to people’s individual needs, and regular one to one supervision sessions.

People were appropriately supported with taking their medicines, attending appointments and were promptly referred to health care professionals when needed.

Staff knew each person well and understood how to meet their support and communication needs. Staff communicated effectively with people and treated them with kindness and respect.

Personal records included people's individual plans of care, likes and dislikes and preferred activities. These records helped staff deliver support that met people’s individual needs. Staff knew about and people’s dietary preferences and restrictions, and helped them prepare their menus.

The provider and the management team were open and transparent in their approach. They placed emphasis on continuous improvement of the service. There was an effective system of monitoring checks and audits to identify any improvements that needed to be made. The registered manager acted on the results of these checks to improve the quality of the service and support.

Further information is in the detailed findings below.

Inspection carried out on 12 and 13 May 2015

During a routine inspection

This inspection was carried out on 12 and 13 May 2015 by one inspector and an expert by experience. It was an announced inspection. Fourty-eight hours’ notice of the inspection was given to ensure that the people we needed to speak to were available. People living at the service were able to express themselves verbally.

The Oaks and Willows is registered to provide personal care and supported living to younger adults who have a learning disability or autistic spectrum disorder. The ethos of the service is to enable people to gain and maintain skills to achieve independent living. People who use the service live in two supported living houses and an independent bedsit on the same site. There were nine people living there at the time of our inspection. The organisation's office is located in one of the houses. The Care Quality Commission inspects the care and support the service provides to younger adults but does not inspect the accommodation they live in.

There was a 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.

Staff were trained in how to protect people from abuse and harm. They were aware of the procedures to follow in case of abuse or suspicion of abuse, whistle blowing and bullying.

Risk assessments were centred on the needs of the individual. They included clear measures to reduce identified risks and guidance for staff to follow to make sure people were protected from harm. Accidents and incidents were recorded and monitored to identify how risks of re-occurrence could be reduced.

There were enough qualified, skilled and experienced staff to meet people's needs. Staffing levels were calculated according to people’s changing needs and ensured continuity of one to one support. Thorough recruitment practice was followed to ensure staff were suitable for their role.

Staff were trained in the safe administration of medicines. Records relevant to the administration of medicines or the supervision of medicines were monitored. This ensured they were accurately kept and medicines were administered to people and taken by people safely according to their individual needs.

Staff knew each person well and understood how to meet their support needs. Each person’s needs and personal preferences had been assessed before care was provided and were continually reviewed. This ensured that the staff could provide care in a way that met people’s particular needs and wishes.

Staff had completed the training they needed to support people in a safe way. They had the opportunity to receive further training specific to the needs of the people they supported. All members of care staff received regular one to one supervision sessions to ensure they were supported while they carried out their role. They received an annual appraisal of their performance and training needs.

All care staff and management were trained in the principles of the Mental Capacity Act 2005 (MCA) and were knowledgeable about the requirements of the legislation. People’s mental capacity was assessed and meetings were held in their best interest when appropriate.

Staff sought and obtained people’s consent before they provided support. When people declined or changed their mind, their wishes were respected.

Staff supported people when they planned their individual menus and ensured people made informed choices that promoted their health. Staff knew about people’s dietary preferences and restrictions.

The staff used creative ways to make sure that people had inclusive methods of communication. People told us that staff communicated effectively with them, responded to their needs promptly and treated them with kindness and respect. People were satisfied with how their support was delivered. Clear information about the service, the management, the facilities, and how to complain was provided to people. Information was available in a format that met people’s needs.

People were referred to health care professionals when needed and in a timely way. Personal records included people’s individual plans of care, likes and dislikes and preferred activities.

The registered manager and the staff’s approach promoted an environment where people could affirm themselves and excel. They promoted people’s independence, encouraged them to do as much as possible for themselves and to make their own decisions. Comments from relatives included, “The staff are exceptional; they go the extra mile and go beyond the call of duty”, “The staff are amazing, their approach is exceptional”.

People’s privacy was respected and people were assisted in a way that respected their dignity and individuality. Staff took account of people’s psychological wellbeing.

People’s individual assessments and care plans were reviewed regularly with their participation or their representatives’ involvement. A relative told us, “We are invited to attend and we are involved.” People’s care plans were updated when their needs changed to make sure they received the support they needed.

The provider took account of people’s complaints, comments and suggestions. People’s views were sought and acted upon. The provider sent questionnaires regularly to people, their legal representatives and stakeholders. The results were analysed and action was taken in response to people’s views.

Staff told us they felt valued and supported under the manager’s leadership. There was honesty and transparency from staff and management when mistakes occurred. The manager notified the Care Quality Commission of any significant events that affected people or the service. Comprehensive quality assurance audits were carried out to identify how the service could improve and action was taken to implement improvements.

Inspection carried out on 17 April 2013

During a routine inspection

Nine people were using the service at the time of the inspection. Four people lived in each of the houses, one person lived in an independent bedsit adjoining one house. This was the first inspection of the service since it became registered with The Care Quality Commission in August 2012.

We spoke with five people who used the service. People told us they were happy with the support they received and made choices and decisions about their daily lives. One person said “I chose how I wanted my room decorated” and “I do food shopping on line, I use the computer or laptop”. Another person said “I have done my food shopping, got my own money out and have my own PIN number”. People said they chose what they wanted to eat and where and when they ate meals. They chose what to do, this included educational, work, social and leisure activities.

People told us they kept their care plans in their rooms and were involved in planning and reviewing their support. They said if changes were needed they took place.

People told us they felt safe and knew who tell if they had any concerns. They could discuss any issues at house meetings and individually with staff. They said they liked the staff. A person said “I like the staff and I like them helping me”.