This inspection took place on 19 and 27 May 2015 and was unannounced. The Willows provides care and support for up to six people with a learning disability and/or other complex needs. There were five people living in the home at the time of our inspection.

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 six people living in the home at the time of our visit. We spent time with people and they indicated to us that they were happy in their surroundings. We determined this by our observation of their body language and interaction with the staff supporting them.

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.”

We used a number of different methods to help us understand the experiences of people using the service, because the people using the service had complex needs which meant they were not able to tell us their experiences. We observed staff interacting courteously and communicating effectively with people. We saw people undertaking activities and displaying pleasure when doing them. We saw that people appeared happy and at ease around the staff.

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.