Willow Brook

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We identified 1 continued breach of the legal requirements in relation to people’s consent to care and treatment. Where restrictions had been placed on people the principles of the Mental Capacity Act 2005 (MCA) had not always been followed. Records did not always show how decisions had been made in people’s best interest. Some improvement was needed to people’s care records to ensure staff would have all the information needed to monitor and support people to achieve positive outcomes. The provider assessed people's needs. Staff liaised with other external professionals to help make sure people's needs were monitored and met. People had access to external healthcare professionals. When concerns were identified, the staff made timely referrals to other professionals.

This service scored 63 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People were not able to give us any detailed feedback about assessing needs.

The manager was involved in carrying out assessments and the deputy manager supported them in writing people’s care plans. They explained they liaised with other professionals to gather information about people's needs. Staff told us they conducted hourly checks on people throughout the night. Staff we spoke with all had different reasons for checking on people and ways of checking on people. The manager did not know why these checks were taking place and how it had been assessed as being required.

Most assessments and care plans were more detailed and included more personalised information following our previous inspection. The manager kept a tracker which recorded monthly care plan reviews noting that care plans had been updated after receiving feedback from professionals. There was no detail in the tracker record to understand what changes had been made to ensure the provider could monitor people’s changing needs and support. The provider had not always assessed all of people's needs or made plans in respect of these. This included assessments about restrictions placed on people.

People were not able to give us any feedback about delivering evidence-based care and treatment.

Staff we spoke with told us their training helped them understand and deliver best practice. The manager told us the Care Director was very good at sharing new and updated information with them. They also said, “[Managers name] is on several different social media platforms and updates the team.”

Improvement as needed to ensure national best practice would be followed when assessing and planning the care of people who could not consent to their care and support arrangements. The manager worked closely with the local authority and followed advice and guidance provided by them. The staff had received training in identifying when people became unwell and the manager was working at ensuring staff were assessed as competent in using the assessment tool. The provider had improved care plans with the help of the local authority. Care plans detailed when medical advice should be sought. The provider used a recognised pain communication tool to support people to express any pain or discomfort. They monitored people’s weight due to health conditions and sought medical advice when required.

People were not able to give us any feedback about how staff, teams and services worked together.

Staff told us they were provided with adequate training and competency checks from healthcare professionals if they were performing certain health related tasks such as taking temperatures and blood pressure readings. The manager told us health care professionals were involved in drafting care plans and risk assessments. They worked with other professionals to investigates concerns. They told us they have been working with the local authority safeguarding team and had built up good relationships with the GP.

Health and social care professionals found the service was working closer with the GP surgery and staff were getting more skilled in identifying when people had become unwell, or their needs had changed.

The provider had policies in place to support staff to work with other stakeholders when planning and delivering people’s care. Most support plans which were in place identified areas of support required and detailed achievable goals and what support people needed to achieve their goals. Health reviews took place annually with the local GP surgery.

People were not able to give us any feedback about how people were supported to live healthier lives.

Staff we spoke with told us if people became unwell, they would seek support quickly from the appropriate medical professionals. Their comments included, “If it happens on my own shift I will contact emergency to make sure the person gets the best help,” “You quickly phone 999,” “If a district nurse is needed, they will attend and offer what is needed.” Staff felt suitably skilled to recognise and respond to changes in a person’s mood or mental wellbeing. The manager told us they shared information about people’s changing healthcare needs with other professionals. They gave an example of when they had shared information with the social worker, advocate and the Complex Care team at the GP surgery. They told us they had a weekly call with the Complex Care team to ensure people received the appropriate non urgent medical care when required. The manager told us they had received access to training videos by the NHS to support staff to understand how to identify when people were unwell. They told us better information was now contained in support plans and risk assessments.

People did not have a health action plan in place to ensure staff had all the information needed to support people effectively with their health needs. The manager told us the team leader had just created a template. Support plans detailed when and how staff should seek medical attention for people. Daily notes demonstrated staff sought medical attention for people who were unwell. Records of health visits were recorded in people’s daily notes and not easily accessible to ensure staff could easily understand any changes in people’s health needs and support. Following the inspection the manager set up a document for recording healthcare visits. Hospital passports were in place and contained detailed relevant information to enable the hospital staff to know how to support people.

People were not able to give us any feedback about how people were monitored, and outcomes improved.

Staff told us how they monitored people’s care. For example, monitoring if people ate and drank enough when required. Staff told us how people’s quality of life had improved since they moved into the service. For example, 1 staff member told us, about a person who had lost weight but has now started gaining weight and is now healthier and happier in themselves.

Processes in place were not always effective at achieving positive outcomes for people. For example, both people declined having their teeth brushed. Plans were not put in place to improve the outcome for people regarding teeth brushing. Most support plans which were in place identified areas of support required and detailed achievable goals and what support people needed to achieve their goals. They listed the person responsible which was generally all staff and a date to be achieved however, some of the dates recorded in some care plans was “ongoing”. Records did not note what progress people had made in achieving their goals or what additional support might be required to achieve agreed outcomes. This meant there were not always effective processes for monitoring whether planned care was meeting people's individual needs.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The MCA requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to make decisions, any made on their behalf must be in their best interests and as least restrictive as possible. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the Mental Capacity Act (MCA). In care homes, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS). People were not able to give us any feedback about how they consented to care and treatment.

Staff told us they had received training in the Mental Capacity Act (MCA), and they always asked for consent before providing care. One staff member told us, “I ask for consent if not given you don’t go ahead with the care. Don’t’ force it on the person.” However, we were not assured that all staff had a full understanding of how the MCA applied to their role. The manager did not always understand their responsibility under the principles of the Mental Capacity Act. We asked the manager, the deputy manager and team leader if anyone had conditions associated with their DoLS. All 3 did not understand the question and when explained they said no one had conditions associated with their DoLS. One person did have a condition associated with their DoLS, this was around medicines reviews. We asked the manager how people were supported to make decisions about their care. The manager told us, “We complete MCA paperwork we make sure we complete every aspect of that documentation.” We found this not to be the case for both people during our onsite visit.

At the last inspection the provider failed to ensure consent was sought in line with the Mental Capacity Act (MCA) and their Consent to Care and Treatment policy. At this assessment we found the same concerns, meaning there was a continued risk people’s legal rights would not be upheld in line with the principles of the MCA. People did not have mental capacity assessments and best interest decisions in place for all areas required. Some restrictions were placed on people such as the kitchen was locked preventing people from accessing this area. One person was checked every 30 minutes throughout the day and both people being checked hourly throughout the night. Care records provided no clear rationale as to why these restrictions were in place and how decisions had been made that these were in people’s best interest. This meant people's freedom, choices and rights were being restricted without always following recognised processes. The provider was not always effectively monitoring whether these systems were being followed. There was evidence in people’s care plans that their choices and wishes were being considered.