The Willows is a community house supporting four adults with learning disabilities and complex needs.One inspector carried out this inspection. The four people living at the home had complex needs and were not all able to tell us about their experiences. In order to get a better understanding we spoke with the relatives of three of the four people using the service, observed care practices and spoke with staff. The focus of the inspection was to answer five key questions; is the service safe, caring, effective, responsive and well-led?
Below is a summary of what we found. The summary describes what people using the service, their relatives and the 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.
Is the service safe?
Relatives we spoke with told us they believed that the service provided for their relatives was safe and they were confident that any concerns they raised with the staff or managers would be listened to and addressed. We saw that risks people might face had been assessed and were reviewed regularly. Up to date guidance was in place with actions for staff to take to minimize the risks while enabling people to do what they wanted safely.
There were policies and procedures in place in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards. While no one was subject to authorised deprivation of liberty at the time of this inspection we saw that the service communicated significant concerns to the Local Authority safeguarding team and notified the CQC of them. Involvement of the local safeguarding team meant that all concerns were investigated and people's safety was maintained.
Procedures for the safeguarding of vulnerable adults were robust. We saw that staff received annual training on the subject and those we spoke with told us that they would not hesitate to report suspected abuse or concerns of poor practice in order to protect people's safety.
Recruitment was carried out centrally by the provider and we saw that the processes were thorough and safe. While both staff and relatives of people using the service commented adversely on the recent rapid turnover of staff, the assistant manager informed us that this had now been addressed with the recruitment of additional permanent staff who were due to start work at the Willows very shortly.
There were quality assurance systems in place so that the managers and staff learnt from the outcome of service reviews and events such as incidents, comments and complaints.
Is the service effective?
Relatives told us that they were satisfied with the care provided and felt their relatives' needs were being met. One person using the service said 'It's good'. Evidence showed that staff received the appropriate support and training to provide effective care and treatment for people using the service who had complex needs and some of whom displayed challenging behaviours. It was clear from our observations and discussions with staff that they had a good understanding of peoples' needs, knew them well and were able to recognise early signs of change in behaviour or well-being and act appropriately.
We saw that people were enabled to make their own decisions and choices about their care and support where possible. However for people who lacked capacity to make specific decisions we saw that the service had effective consent procedures in place and meetings were held with the family and relevant professionals to decide what action was in the person's best interest.
One relative told us 'They understand and manage our relative's condition very well. They are as happy as they can be'. Another said 'They've worked hard with our relative. They now understand themselves'.
Is the service caring?
People were supported by caring and attentive staff. We saw support workers treated people with compassion, dignity and respect. They were friendly and patient in their interactions with them and gave suitable encouragement when providing support. They were understanding of people's needs and how these could be communicated and were aware of their preferences in the way they wished their care to be delivered.
Staff told us that they enjoyed caring for people, helping them to reach their potential and encouraging their independence.
Relatives' comments included 'the care is absolutely fantastic', 'caring is endemic in the management' and 'My relative's key worker is brilliant. They treat my relative normally and there is mutual respect'.
Is the service responsive?
Everyone living in the home had a person centred support plan which included information about how they wished to communicate, their needs and their preferences. We saw that the support plans were reviewed regularly with the involvement of relatives and other relevant professionals and staff responded positively to changes in people's needs and circumstances. Records confirmed that people received the care and support as described in their support plans.
We saw that people were given one to one support from staff in order to participate in a wide range of activities of their choice both in and outside the service and staff told us that these opportunities had increased after they obtained their own vehicle earlier in the year. People were also encouraged and supported to maintain close contact with their families through regular visits and telephone calls with the help of their key workers. Relatives we spoke with told us they had regular contact with the home and could also speak to staff or managers at any time. They said they were kept informed about any issues which affected their relative and one person said 'They keep us up to speed' and another 'We have so much communication all the time'.
Is the service well led?
The service had a quality assurance system and carried out monthly checks on a range of aspects of service provision. The provider organisation also carried out an external quality review of the standard of care on an annual basis and identified actions to be taken to improve the service. The records seen by us showed that not all these actions had been completed within the timescale agreed.
All stakeholders views were collected through the use of annual surveys. In addition meetings with minutes were held for staff and people using the service on a monthly basis. We looked at the feedback of the family questionnaire and the monthly meeting minutes and saw examples of where action had been taken to address the issues raised and improve the service provided.
Staff we spoke with told us they were clear about their roles and responsibilities and were well supported in their roles by the assistant manager and team senior. They described themselves as a good team of staff who worked well together.