The Willows is registered to provide accommodation and support for six people with a learning disability or autistic spectrum disorder. There was a registered manager in post at the home. 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 (2008) Act and associated Regulations about how the service is run.

The inspection took place on 14 December 2017 and was unannounced. At our last inspection in November 2014 the service was rated Good.

At this inspection we found the service remained Good.

Why the service is rated Good.

People and their relatives told us they continued to receive care which protected them from avoidable harm and abuse. Risks to people's safety were identified and measures were in place to help reduce these risks. When people required support to take their medicines this only happened when staff had received the training to do so. Regular checks on staff practices were undertaken to support people's safety. People and their relatives thought there enough staff to provide support to people and meet their needs.

People are supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice.

Staff had received training to provide them the skills and knowledge they needed to provide the right care and support people as required. People were provided with care which continued to be effective in meeting their individual needs.

People enjoyed spending time with the staff that cared for them and were treated with dignity and respect. People were encouraged to maintain their own personal interests and take part in activities within the home or out in the local community.

People's care was planned in ways which reflected their preferences and wishes. Relatives' and health and social care professionals' views and suggestions were taken into account when people's care was planned.

People knew how to complain. The complaint procedure was available in Easy Read Format so was accessible for everyone. Although people and their relatives had not made any complaints about the service provided.

People living at the home and their relatives were encouraged to give regular feedback on the service provided. The registered manager regularly checked the quality of the care people received. Where actions were identified these were undertaken to improve people's care further.

The inspection took place on 20 November 2014 and was unannounced so no-one knew we would be inspecting that day. At the last inspection on the 17 December 2013 the regulations inspected were met.

The Willows is registered to provide accommodation and support for six people with a learning disability or autistic spectrum disorder. There was a registered manager in post at the home. 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 (2008) Act and associated Regulations about how the service is run.

Our observations showed that people were safe. The staff knew how to keep people safe and people who were able to share their views told us they were safe living in the home. People who were unable to communicate verbally expressed how they were feeling through the body gestures and smiling. Records showed that staff had received the appropriate safeguarding training in order to have the skills and knowledge to keep people safe from harm.

We saw enough staff to keep people safe and relatives we were able to speak with confirmed that there was always enough staff to meet people’s needs. The staff we spoke with told us there was always enough staff and if a number of people wanted to go out then extra staff would be brought in by the manager to ensure the correct levels of staff to meet people’s needs.

We found that there was a procedure in place to manage the administration of medicines and only staff who had been trained would administer medicines. Staff confirmed this and records showed that medicines were being recorded appropriately to show whether it was administered or not.

We saw people were able to make choices over the meals they had to eat. The menus were created through regular meetings with people where staff asked people what they wanted in the menu. The menus that was displayed in the kitchen was created using pictures to illustrate the meal choice on a particular day. People and relatives told us that the meals were good.

Most of the people who used the service were unable to verbally communicate decisions about the care they received. All the staff we spoke with understood the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). The manager confirmed due to the supreme court decision and impact upon DoLS, a DoLS application had been successfully applied for with the Supervisory Body for five people living in the home who were unable to leave the home without supervision.

We saw staff shutting doors while people used the toilet as part of ensuring their dignity and privacy was promoted. One person told us that their dignity, privacy and independence were always respected by staff and our observations of how staff interacted with people confirmed this.

People’s preferences and interests were being met. A number of people living within the home liked to listen to music. Staff we spoke with told us their interests were identified in their care plans. One person told us they were able to take part in things that interested them. Relatives we spoke with told us that people were able to take part in regular activities and on some occasions they would visit the home to find people had gone out on trips or a planned activity. We saw photographs displayed in the home of the many trips people had taken part in. The manager told us that whatever people wanted to do they would endeavour to make it happen.

Relatives we spoke with told us they had never had to complain, but would be happy to raise any concerns or complaint with the manager. Staff we spoke with were able to explain how a complaint would be managed and who would deal with any complaints. We found that there was a process in place to manage and action complaints, but there had not been any complaints for some time. Records showed that there were a number of compliments from relatives and other professionals.

We found that the manager who was also the provider was regularly carrying out audits to ensure the quality of the service was being maintained. All the staff we spoke with told us that the manager was always available to support them or monitoring the support they gave people.

There were six people who lived there on the day of our inspection. We met with all the people that lived there. Some people were unable to verbally communicate their views of the service provided at the home. Therefore, we spent time observing how staff interacted with and supported people. We also spoke with two relatives of people who lived there, two members of staff and the provider.

Staff had the information they needed to know how to support people to meet their individual needs. One person said, “Since I’ve lived here, I’ve come on in leaps and bounds.” We observed that staff knew how to support people in the way they preferred and to meet their individual needs. We saw that people’s healthcare needs had been monitored and met.

We saw that appropriate systems were in place to safeguard people who lived there from abuse and harm.

People lived in a clean, homely and safe environment that met their individual needs.

There were sufficient staff who had the appropriate skills and knowledge to ensure that the needs of people who lived there were met.

People and their relatives were asked for their views about the service provided and these were listened to. A relative said, “It’s excellent here, it couldn’t be better, we don’t know what we did without the staff here, it’s a family atmosphere.”

The willows is a well run family service that provides support to adults diagnosed with a learning disability or autistic spectrum disorder. The service operates in a person centred approach and ensures that frequent feedback is sought from the people who use the service to ensure that service provision is personalised and appropriate. The provider works in close partnership with Sandwell Local Authority. This close partnership ensures that the people using the service have regular opportunities to give feedback about the care they receive.

We spoke to people who told us that they are involved in planning their care. We heard from people that they are “Involved in as much as I can”.

We looked at people’s individual care plans and where possible checked out the accuracy of these with people. We also spoke to a number of staff about their understanding of how people wanted to be supported, as detailed in their plans.

Based on these discussions and observations during the time we visited, we found these plans to reflect people’s preferences and support needs. One person told us that staff had sat and talked through their plan with them. They said that support was provided in a way that acknowledged their likes and dislikes.

We saw that the care plans were available in an easy to read format with supporting pictures. These pictures related to the information that was in the care plan making it easier to read for everyone.

The understanding of the staff matched to what was written in people’s individual care plans. We spoke to staff and they were able to tell us what people’s likes and dislikes were.

We looked at the visitors’ book for the service which had positive comments from other professionals who had visited.

We saw that people gave feedback on the service every week which was positive. This was also signed by the people and could put forward ideas for the next resident meeting.

We also saw that the weekly feedback had supporting pictures and gave an opportunity for everyone to have their say. Overall this was positive and provided a good way to identify any issues.

We saw that the minutes of the resident’s meeting had pictures and was made easy to read. It showed by using pictures, who had spoken in the meeting or shared ideas.

We saw that people were well presented, clean and looked content at the time of our visit.

People said that they “like living here” and that staff were “kind and friendly”. People also told us that the staff “has changed my life, I love it here”.

People told us about the things that they like and said that they have choices open to them. We saw that people’s independency was being encouraged through helping prepare lunch and making hot drinks.

People told us that there are different activities available to them at the home and told us that they “go out constantly every day” and “twenty four seven stuff to do”.

We heard that the people had enjoyed playing the touch screen quiz machine in the pubs and a quiz machine had been purchased for the home. People told us that they enjoyed playing the “Touch screen”.

We heard that people had gone to Blackpool Pleasure Beach and were currently in the middle of their ‘Around the world in 80 days with food’. People had put countries forward and would have something cooked from that country everyday. We heard that people were involved in making the menus.

We heard from people that after being at the home for under a year they had already had three holidays.

We saw that people were stimulated by staff by playing people’s favourite music and singing along to the song. We also saw staff playing the keyboard and singing with people in a group.

People told us that they that would speak to any of the staff, if they had any problems and that staff have “all the time in the world” when talking people.

People also told us that if they felt uncomfortable with anything then they would speak to any of the staff. People told us that even if they had made mistakes, staff will take them through what happened and not just tell them that it was wrong to do.

People told us about how they are involved in the running of the home to reflect their choices. They told us how redecoration of their rooms was chosen by them and the room was laid out how they wanted.

We saw that positive feedback was given from people during the quarterly satisfaction survey in response to “Do the staff treat you with care and respect”.

People told us that they “feel safe” and that they “like living here”.