The Willows

The Willows is a residential care home providing personal care for up to six people. At the time of inspection, six people were living at the service. People living at the Willows had learning disabilities and some physical disabilities.

The Willows was an adapted building, in a bungalow style. The building was wheelchair accessible and had a large garden, that people liked to use.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

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

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 to gain new skills and become more independent.

People were not able to tell us that they felt safe, however we observed them to feel relaxed around staff that knew them, and their support needs well. Risks to people were well known and there were robust assessments to address concerns.

There were enough staff to ensure people’s needs and routines were met, and staff were recruited safely. The building was kept clean and safe through regular health and safety checks. People received their medicines safely from trained and competent staff.

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.

Staff had all received a variety of training to meet people’s needs, such as epilepsy and managing behaviours that challenged. Staff had also received more specialised training in advanced communication techniques.

People’s nutritional needs were consistently met, and guidance given by professionals followed by staff. People could choose what they wanted to eat and drink each day. People also received regular support from health and social care professionals to ensure their physical and emotional wellbeing.

Everyone we spoke to was consistent in their views that staff were kind, caring and attentive. One professional said, “Any interactions with residents I have seen during my visits have always been very supportive and caring.” We observed that strong relationships had been built between people and staff, based on mutual respect and trust. People’s dignity, privacy and independence was continually promoted.

People received personalised support centred around their support needs, preferences and choices. This was regularly reviewed with people, their relatives and professionals. People were engaged in a variety of activities of their choosing each day, based on their interests. This included building relationships with members of the community.

Staff, professionals and a relative spoke highly of the registered manager and felt the service was well-led. Audit processes were robust which meant that the registered manager had clear oversight of the service and people’s experiences. The registered manager valued continuous learning and had on-going plans to improve the skills and knowledge of staff. They also sought regular feedback from people, relatives, staff and professionals to improve the service provided.

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

Rating at last inspection

The last rating for this service was Good. (published August 2016)

Why we inspected

This was a planned inspection based on the previous rating.

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.

There was a registered 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.

The provider did not have a robust quality monitoring system in place. Areas for improvement such as cleanliness and maintenance were not always been identified. However, where other areas for improvement had been identified, action was taken.

Staff had the skills they needed to meet people’s needs effectively, and they were well supported with training, supervision and appraisal. Training was up to date and the provider used a computerised system to make sure any training needs were identified. There was always enough staff on duty to keep people safe and care workers were flexible about the hours they worked.

There was one minor gap in pre-employment checks, but disclosure and barring service checks were completed for all staff before they began work. People’s medicines were managed safely and staff understood when they needed to give people medicines on an ‘as and when basis’, and how some people communicated non-verbally this was what they needed.

Staff knew how to safeguard people from abuse and what they should do if they thought someone was at risk. Risks to individuals were well managed and people were able to stay safe without having their freedoms restricted. Managers and staff promoted peoples independence and encouraged positive risk taking. Incidents and accidents were well managed and staff understood the importance of learning from incidents, so they could make sure they did not re-occur.

The registered manager and staff had a good understanding of the Mental Capacity Act (2015) and gained consent from people in line with legislation. Deprivation of Liberty Safeguards referrals had been made to the appropriate authorities. Where best interest decisions had been made on behalf of a person, all of the relevant people were involved.

People were well supported to eat and drink enough. Food was homemade and nutritious and people were involved in making decisions about menus. People were supported with healthy eating and to maintain a healthy weight. Everyone was supported to maintain good health and all of the appropriate referrals were made to health care professionals when required.

People were treated with dignity and respect by kind and caring staff. Staff had a good understanding of the care and support needs of every person living in the home. People had developed positive relationships with staff and there was a friendly and relaxed atmosphere in the home. People were well supported to do the things that were important to them, such as going to college or church. People’s social and spiritual needs were met.

Person centred care was important to the service and staff made sure people were at the centre of their practice. Care plans focused on the whole person, and assessments and plans were regularly updated. Staff made sure that part of their practice was “nothing about me without me”. This helped staff to remember when an activity or conversation was about an individual, that individual should be involved at all times.

There was an open culture in the home, and staff felt confident to discuss any concerns they might have and said the registered manager would act on them. Staff said they were well supported and were well motivated to provide good care. The registered manager knew all of the people who lived in the home very well and ensured care was person centred.

There were processes in place to support people to make informed choices about the care and support they received.

Each person living in the home had a detailed plan of care in place that included individual needs and wishes and also recorded people's physical and emotional healthcare needs.

The home's staff worked with a variety of healthcare professionals including the local learning disability team, district nurses and dieticians. People had the specialist equipment they needed to support their independence.

There were systems and safeguards in place that ensured that people's medication was safely stored and administered and staff had received relevant training.

Staff told us that they were happy working in the home. They were well trained and well supported by the manager.

Records required for the running of the home were in place and regularly reviewed and updated.

Comments we received from two healthcare professionals included. 'Staff really know the people they support. All of the carers treat people with care, compassion and respect. The environment is lovely and there are lots of things for people to look at to stimulate them.'

In our discussions with staff they demonstrated a thorough knowledge of the people living at the service. This was confirmed by our observations and the record keeping.

Care records showed that people had been supported and involved to make decisions about their lives, including their care and support. When people's needs changed, we found that records had been updated to reflect this.

Staff spoken with demonstrated good understanding of how to safeguard people from harm. Training records showed that staff received regular training to update their knowledge on abuse and safeguarding. We found that the staff rota was consistent and that sufficient staff were employed.

Records showed the provider regularly assessed and monitored the quality of the service. We saw that people and their representatives were asked their views about the home and information from other professionals were sought.