Willow Brook

Willow Brook is a domiciliary service that provides care and support for people with mental health needs, a learning difficulty and physical care needs. The service provides personal care to people living in five 'supported living' houses. Staff provided support to people in each of the houses on a 24/7 basis. At the time of our inspection the service was supporting seven people with personal care needs.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.

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

‘As required’ medicine (PRN) protocols were not always detailed and PRN protocols were not completed for one person. Care plans and risk assessments did not always contain enough information to guide staff.

Best interest decisions had not always been recorded following a mental capacity assessment.

People were not always supported effectively with their communication needs. We made a recommendation about this.

The provider and the manager had taken steps to improve the service and ensured people received safer care. An action plan to address the warning notices issued by CQC had been implemented. All the requirements of the warning notices had been met.

Arrangements were in place for obtaining, storing, administering and disposing of medicines in accordance with best practice guidance. Staff knowledge had improved, and people received their medicines as required.

People were safeguarded from abuse and significant events were being reported to CQC as required.

An effective system had been developed and put in place to record and respond to complaints. Lessons learnt were shared throughout the staff team.

Recruitment was managed in line with the provider’s policy to ensure suitable staff were employed.

We observed people were treated with dignity and respect throughout the inspection.

End of life care plans were in place and managed in line with best practice guidance.

Systems and processes were in place for quality assurance and monitoring, these were being improved further. These needed to be embedded into practice.

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 applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

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

Rating at last inspection and update

The last rating for this service was inadequate (published 19 December 2019) when there were six breaches of regulation.

Following our last inspection, we served a warning notice on the provider. We required them to be compliant with Regulation 13 (Safeguarding service users from abuse and improper treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and, Regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 by 8 February 2020. The provider sent us a monthly action plan detailing how they are going to progress and improve. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection started as a targeted inspection based on the warning notices, we served on the provider following our last inspection. CQC are conducting trials of targeted inspections to measure their effectiveness in services where we served a warning notice. However, due to the significant improvements that had been made we moved to a comprehensive inspection which meant we looked at all five key questions.

We undertook this inspection to check the provider now met legal requirements.

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

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information, we may inspect sooner.

Willow Brook is a domiciliary service that provides care and support for people who may have mental health needs, a learning difficulty and physical care needs. The service provides personal care to people living in five 'supported living' houses where facilities are shared with people who do not have personal care needs. Staff provided support to people in each of the houses on a 24/7 basis. At the time of our inspection the service was supporting 11 people with personal care needs.

The service didn't consistently apply the principles and values of Registering the Right Support (RRS). Whilst the ethos of the service was in line with the principles to promote people's control, choice and independence, some processes were not consistently implemented to support this.

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

The provider’s quality assurance systems had not been effective in ensuring the delivery of safe, high quality care and support. We received conflicting views about the management of the service, which had been inconsistent following the departure of six senior managers in recent months.

We identified significant failings in the way people were safeguarded from the risk of abuse. Allegations of abuse were not always managed in accordance with established protocols.

We also identified significant failings in the way people’s rights and freedom were protected. Current legislation and guidance was not being followed in relation to the use of restraint.

We received conflicting feedback about the way staff treated people. However, we observed positive interactions between people and staff during the inspection and staff protected people’s privacy.

Arrangements were in place for obtaining, storing, administering and disposing of medicines in accordance with best practice guidance. However, we found this guidance was not always followed.

There was not an effective system in place to record and respond to complaints. Significant events had not been reported to CQC as required.

Enough staff were employed and there were clear recruitment procedures in place. However, full employment histories were not always obtained from applicants to check their suitability to work with the people they supported.

Staff supported people to achieve positive outcomes and enabled them to lead as full a life as possible. This reflected the principles and values of Registering the Right Support by promoting choice and independence. However, we received mixed views as to whether people’s needs were met when they became distressed and agitated.

Risks to people's safety were assessed and monitored appropriately, including infection control risks.

People were supported to maintain a healthy, balanced diet and to access healthcare services when needed.

Staff expressed a commitment to delivering compassionate, dignified end of life care.

Staff had a good understanding of people’s communication needs. They supported people to develop and maintain important relationships.

There was a duty of candour policy in place and the provider’s previous rating was displayed on the premises and on their website.

Rating at last

The last rating for this service was good (published 19 April 2017).

Why we inspected

The inspection was prompted in part due to concerns received about safeguarding arrangements, medicines management and staff training. A decision was made for us to inspect and examine those risks as part of a comprehensive inspection.

We have found evidence that the provider needs to make improvements. Please see the key questions sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement

At this inspection, we identified breaches of regulations in relation to safeguarding, the protection of people’s rights and freedoms, the management of complaints, notifications of incidents to CQC and quality assurance systems.

Please see the action we have told the provider to take at the end of this report. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within six months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

We conducted our inspection on 16, 17 and 26 October 2018. At the time of our inspection there were eight people using the service.

A registered manager was 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 and associated Regulations about how the service is run.

We previously inspected Willow Brook on 23 August 2017 and found the provider had not ensured staff were always appropriate trained. We identified governance systems were not robust in recognising areas for improvement. We rated the service ‘Requires Improvement’. At this inspection we found improvements had been made so we rated the provider as ‘Good’.

Medicines were managed safely and in accordance with current regulations and guidance. There were systems in place to ensure that medicines had been stored, administered, audited and reviewed appropriately.

People were happy and relaxed with staff. They said they felt safe and there were sufficient staff to support them. When staff were recruited, their employment history was checked and references obtained. Checks were also undertaken to ensure new staff were safe to work within the care sector.

Staff were knowledgeable and trained in safeguarding adults and what action they should take if they suspected abuse was taking place. Staff had a good understanding of equality, diversity and human rights.

People were being supported to make decisions in their best interests. The registered manager and staff had received training in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS).

Accidents and incidents were recorded appropriately and steps taken to minimise the risk of similar events happening in the future.

Staff had received essential training and there were opportunities for additional training specific to the needs of the service, including challenging behaviour and epilepsy.

Staff received supervision and annual appraisal to support development.

People felt well looked after and supported. We observed friendly relationships had developed between people and staff. Care plans described people's preferences and needs in relevant areas, including communication, and they were encouraged to be as independent as possible.

People said they felt listened to and any concerns or issues they raised were addressed.

Staff were asked for their opinions on the service and whether they were happy in their work. They felt supported within their roles, describing an 'open door' management approach, where managers were always available to discuss suggestions and address problems or concerns.

The provider undertook quality assurance reviews to measure and monitor the standard of the service and drive improvement.

Willow Brook is a supported living service where people reside in self-contained flats on the first floor of a purpose built building and have designated key workers to support them with activities of daily living and personal care. The service operates from an office within the building. At the time of our inspection one person was being supported at Willow Brook.

There was a registered manager in place. 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 provider supported staff with mandatory training which enabled them to care for people effectively. However, not all staff had completed training to assist them in managing behaviours that challenge which could impact on their skills in being able to deal with these behaviours in every day practice and audits had not identified this lack of training. However, there were other quality auditing and management systems in place to ensure that areas of improvement were identified and acted upon and to maintain best practice throughout the service.

Staff knew about the risks of abuse and avoidable harm and there were suitable processes

in place if they needed to report concerns. The provider had procedures in place to identify, assess, manage and reduce other risks to people's health and wellbeing which were tailored to their individual needs.

There were enough staff employed by the service to keep people safe and in accordance with their needs. Safe recruitment practices were followed to ensure that those employed were suitable to work in a care setting.

Medicines were stored securely in individual people's flats and administered by appropriately trained staff. Medicine administration records (MAR) were kept up to date and medicines that were no longer required were disposed of appropriately.

Staff demonstrated a good understanding of the Mental Capacity Act 2005 and provided good

examples of seeking consent when providing personal care and support. Deprivation of Liberty Safeguards (DoLS) applications were all completed thoroughly with a robust system in place to renew applications when required. There were good examples of best interest decisions having been made for a person when they lacked capacity to make decisions for themselves.

Staff were supported by regular supervision, well-being checks, group work and annual appraisal.

Staff were able to develop caring and warm relationships with people. They respected their independence, privacy and dignity when supporting people with their personal care and other activities of daily living. People were encouraged and supported to engage in meaningful activities according to their individual preferences.

People were supported and encouraged to maintain a healthy balanced diet and access health and social care professionals when required.

The provider's assessment, care planning and reporting systems were designed to make sure people received care and support that met their needs and was delivered according to their preferences and wishes. People were actively encouraged to contribute to decisions regarding their care and support. Support plans were personalised and holistic.

People knew how to make a complaint if they had concerns and complaints were logged, investigated and followed up in accordance with the provider policy. The complaints procedure was available in an easy read format.

The registered manager sought feedback from people, staff and external professionals to ensure the continual improvement of service provision. Feedback was very positive. However, the registered manager did not always ensure that mandatory staff training was undertaken by all staff in a timely manner.

The culture of the service was very caring and supportive which was cultivated by the registered manager. Staff spoke positively of the management team. The registered manager promoted staff well-being by introducing a number of processes to ensure staff felt valued. Meetings were held to encourage people and staff to discuss any issues they may have and for the management team to share best practice and learning from incidents.